Mona Johnson 🦓 💙

1/11 My good deed for the week. A 🧵 Halfway through my endo list yesterday the DSU nurse came in. “The last patient's arrived with his mother. He’s autistic and says he gets seizures when he is overstimulated.” She handed me his file. “There’s a letter from the neurologist”.

TW: ENDING OF LIFE Have my #ActuallyAutistic comrades ever been bullied and harassed so much that this is something they’ve considered? We are 11x more likely to according to the latest study. We need more support. More awareness. YOU’RE NOT ALONE #AskingAutistics

@drjanaway I’m reading the most fantastic book about this. Would recommend: routledge.com/Imposter-Syndr…

@ClareNews2 Hoping your beautiful tribute helps raise funds for research. Condolences.

There is no cure or treatment for Motor Neurone Disease. Most of Harriet’s working life was spent researching diabetes. She believed passionately in the power of medical research. If you are able, please help by donating to mndassociation.org

This is cousin Harriet and me, aged about 7. She died earlier this month. She was 51 and had Motor Neurone disease. Her husband Pete died from cancer earlier this year, in May. They are survived by two wonderful girls aged 14 and 16. We are bereft…. 🧵1/8

@gji1964 It can make you question everything when it feels like the system you work in has let down folks you love the most. Hope things improve.

6/52 my wonderful wife had a large stroke. This has significantly affected her physically & mentally. She lacks insight and cannot understand each night why I am not taking her home. This journey started with errors both in hospital and general practice. Don't know why I post😢

@DocEd @doctorcaldwell @TimBonnici Imagine if you added an ML to it to make sure it’s the true abnormals/trend of change for that pt (not just everything out of lab ref range)

I die a little in reposting my own stuff, but I think this is fascinating stuff. The NHS desperately needs to improve productivity, and there's an answer to that staring us right in the face. Training clinicians properly on EPRs can deliver massively increased efficiencies.

@DigitalNurseMel @DHCNIO Spot on. And I reckon we can do both. The safety work helps work out what to monitor and how to weave into quality management systems. Nuanced Agile methodology helps too.

Moving quickly on to question 2! How can we, as clinicians and other digital health professionals, balance innovation with clinical safety? Don't forget to use the hashtags #CNIO #DHNetworks

Clinical decision-making is a complex process involving patient characteristics, medical history, evidence, and clinician and patient values. It's crucial to consider risks, benefits, resources, and ethical and legal aspects. It's much more challenging than many people realise.

The consultation on the regulations around PAs was in 2017 (Published 2019) Less than 70 PAs were working in GP at the time & very few GPs responded It is important to get this right for PAs, making it safe for them & patients, giving clear future guidance for all concerned

@hasyourregtried I did a vasc surgery job as a ho. When I was relieved from retractor holding, I sat with the anaesthetist and we talked physiology. Those weekly 1:2:1 discussions nearly made me choose anaesthetics. & def helped in every exam I did after that. You make a good point.

@DrLindaDykes Same question re psychics.

Q for psychiatry colleagues I’ve been pondering for the past 3 years, since doing home visits to patients whose houses are 500+ years old… if someone believes in ghosts (I.e. culturally normal for them) does that figure in m differential for visual or auditory hallucinations? 🤔

@sanilrege Seems especially important now that adhd services/diagnostic pathways are becoming increasingly isolated from a more holistic view.

“Initial documents have revealed doctors wrote 3.1 million prescriptions for the disorder in 2022, a 134% increase from just five years earlier.” A glimpse into the world as an inpatient psychiatrist - 10 consecutive patients ( severe end of spectrum) 9/10 on stimulants with a Dx of ADHD 1. Do they have an ADHD phenotype? - very likely / YES ✅ 2. Do they have ADHD only? - A big NO ❌ So why did they become unwell? 🚨 1. ADHD is highly comorbid - up to 80% comorbidity 2. ADHD # Stimulants POINT 2 is a very important point as a diagnostic process of ADHD consists of 1. Diagnostic Hierarchy 2. Diagnostic Formulation 3. Diagnostic label (e.g ADHD) Doing only number 3 can lead to a narrow approach missing the factors that need modification over the long term. Even though the recognition of ADHD with increased access & diagnosis is helpful a narrow approach to this life span condition could lead to harm in some. #ADHD #ASD

@jraph97 Being a supervisor of a dr in training is different than being the supervisor for other HCPs. JDs present cases so they can hone Hx & exam skills in a relatively safe way, so they will spot when things don’t fit the textbook. Protocols, algorithms and lesser experience ≠

@jraph97 It also depends how the case was presented. Which will have been verbal. If you don’t know to put the Sx together in the right way then, unless the reviewer sees and hears from the pt themselves, it will continue to be missed.

Very sad story. I find it difficult to understand how this PA was able to discharge a patient without any further review; as an F2, I rightly cannot discharge anyone without at least a registrar seeing them.

I'm genuinely upset that non-MBBS graduates can now join FY1. Yes, its a trial scheme, but this is a real erosion of the NHS doctor. There is no equivalency, a medical degree is accredited, registered, audited and rigorous. Its 110% from day one for 5-6yrs.

Welcome to the 21st century…🙄

@TheEMboardround @DrLindaDykes Not being funny, but did you read the constellation of symptoms? We need to look at how skills are being matched in settings and to symptoms to make sure pts are the someone with the right skill-mix to see them. And ppl whose knee jerk isn’t “you’re fine, go home”

While this case is a tragedy, a D-Dimer is 95% sensitive for aortic dissection (possibly higher), and this patient had a low pre-test probability. Potentially Increasing sensitivity further. Anyone who thinks they would’ve made the diagnosis…

@drkeithsiau PS for anyone who gets them, when you feel them start, stop what you’re doing, press hard/squeeze and put your hand above your head. Usually stops them from being super painful.

@drkeithsiau Loving how many people got this right. Mine happen with really super minimal trauma. Eg last time was when I was changing a bed sheet.

Patient with recurrent pain and bruising in the right middle finger without history of trauma. What’s the diagnosis?