Charlotte

London is always being lost and re-found. Every generation harms the city that came before. The Edwardians replaced much of central London with cliffs of classically ornate Portland stone. Few complained. Shock, for example, was muted when this turned into...

@DrAndrewHuang And shoulders square to everything else!

Revelation I had while supervising a registrar performing an in-plane block - it's much easier to achieve needle visualisation when your needle, your probe, AND your vision are all in the same plane.

@ceebee6ax @hippocampophile (We would love to both be able to give you the time you need and remain within your appointment to keep the clinic on time. When the problems people bring to clinic aren’t predictable that can only be done with some “wiggle room”… which in efficiency terms is waste)

@ceebee6ax @hippocampophile The problem is - “more flexibility” or longer appointments = fewer patients seen = longer waiting lists. Third option is more clinics (=recruitment/higher costs). Current balance lies at lower cost + shorter waiting list. Not within individual clinicians’ power to change.

There we have it, entitled Amazon generation who demand everything right now with little to no understanding of what goes on in clinics as to why they're running late. 🤡

@mancunianmedic She agreed for the ongoing physiotherapy (which never really materialised), but did less in the hospital than she would have been doing at home, ate less well, and had her diabetes mismanaged in a way she wouldn’t have had she been allowed to do it herself.

@mancunianmedic I hear this - but also the other side of the equation was my (increasingly frail, but determined) granny being moved to a second hospital for “rehabilitation” after acute illness rather than being allowed to return home, and really receiving very little rehab. Let her go home!

@Robert_Palgrave I wonder if someone could model this for doctors - higher starting loan value, period of orange zone accumulation where repayments not=interest, then eventually reaching the green zone at inflated total loan value so possibly never clearing the loan despite higher earnings?

What not many people realise about UK student loans is that earners in the middle of the salary range end up paying back far more than either lower or higher earners, as they earn enough to pay the loan and interest back before the 30 year cut off, but not enough to pay it off early before the interest balloons. Someone earning £70k ends up paying almost double someone on £150k.

@StefanFSchubert What’s the y axis?

By contrast, earnings for people who didn't finish school have grown faster in Britain than in its peer countries. ->

Whereas the graduate premium has increased in most rich countries, it has plummeted in Britain since 1997. Earnings for British graduates have shrunk (next pic). ->

@MSharifpourMD This is standard in the UK - all elective patients screened by nurses in POA with high risk patients/ops then referred to anaesthetists for decisions or risk discussion. (Referred onwards for optimisation if needed.)

Anesthesiologists should be able to clear/not clear patients for surgery. They might ask a cardiologist for risk stratification or medical optimization but they should be able to decide whether a patient is optimized enough to undergo surgery or not

Mr Beast lined up one person from each age 1-100 and had them race to a finish line, and the overhead camera is an oddly beautiful data visualization of speed by age.

Yes but what do we then do for airway management….? We know the incidence of a non-empty stomach in all elective patients is around 5-6% (much higher in some series) But the incidence of aspiration is around 1 in 10,000 That’s 600-fold lower If we start doing RSIs or even intubating all these patients then there is a significant risk we’ll cause more harm. So I think identifying who has a full stomach is the easy bit. Working out who is actually at high risk or deciding what to do about it is the complex one! @kariem

@UPS I ordered some blinds from Turkey. An attempt was made to deliver whilst I was away but I can’t find any way on your website to rearrange delivery, or any way to get through to a human customer service person. Help, please!

Cardiac arrest isn’t a diagnosis in the same way as headache isn’t a diagnosis, jaundice isn’t a diagnosis, chest pain isn’t a diagnosis, abdo pain isn’t a diagnosis. If we keep trying to find magic bullets that treat the presenting complaint, we’re relying on luck to innovate.

@DrLKVaughan Where does the law stand on using non-GMC radiologists to report scans as part of NHS care? I’ve wondered this before

The New Plan is riddled with inconsistencies, if not outright contradictions. Wes has basically said no to IMGs. But wants to employ lots of people based OUTSIDE the UK to support 'remote services'. Using firms in different times for things like real time radiology 1/

@AdamBoulton17 @doctimcook @Anaes_Journal @adk300 @jas_soar @drrichstrong @emirakur @RCoANews Is there evidence that if we put an art line that there’s then less haemodynamic variation or better management?

@AdamBoulton17 @doctimcook @Anaes_Journal @adk300 @jas_soar @drrichstrong @emirakur @RCoANews Agree - the high risk ortho patient may be so because of multimorbidity having a fairly non-dynamic surgery 😅whereas the specialties with high use may be expecting intraoperative physiological and haemodynamic changes where the art line form or gas may change the management

Great to see this Science letter from #NAP7 published The graphic shows frequency of IABP use by specialty and patient risk category You decide, is current use of arterial lines is logical.....& equitable? @Anaes_Journal @adk300 @jas_soar @drrichstrong @emirakur @RCoANews @RCoA_CRI @AgeAnaesthesia …-publications.onlinelibrary.wiley.com/doi/epdf/10.11…

If you have time this Sunday- and would like to read one thing regards the #NHS and it's future? Read this from @sallygainsbury in @bmj_latest "The notion that the health service has emerged as a “winner” from the chancellor’s spending review is a bit like congratulating someone who has just won back the face value of a scratch card"- Chefs Kiss opener. I would encourage @NHSEngland @DHSCgovuk to be much more honest about what's coming. bmj.com/content/389/bm…

It is beyond question that we now have a two-tier healthcare system. The govt need to start having very serious discussions with the public about how we move forward. The current private medical insurance market is not geared up to provide a proper replacement for the NHS.