Mark Tehan

@TJCoats @jabberwock951 Do medical directors usually get involved this sort of policy? IME, usually left to individual specialities to manage their 'criteria'.

@jabberwock951 You should not be upset at the paediatrician (lots of variation). BUT - You should be VERY upset at your Trust Medical Director for not having a clear policy in place.

Has anyone come across paediatrics refusing to accept a 16 year old patient (who wants to go to paeds) and insisting they come under adult medicine? Happened to me today and I'm unsure how upset to be.

@brionytheliony I think what's not often made clear is the difference between signing an ECG to say it's not an immediate life threat and actually interpreting it. We know know the doc who signs it does the former and the doc who sees the patient assumes they did the later.

@telocker @TJCoats ED won't be emptied. The hossie will delay and doubt and see how little they can get away with.

@TJCoats None of the current major incident plans will work in the current situation. If all the ambulances are stuck outside EDs you should get a good few hours from declaring an incident until the patients arrive, it might even take long enough that the ED could be emptied.

Anyone solved the problem of major incident call out at night? In the olden days land lines and pagers worked 24/7. Now most people have only mobiles - and have them silenced at night? How does your HMIP approach this? (And has anyone done a 2am rest?)

@EM_Dr_Jacklin I prefer the reduction of working hours, feels much more sustainable.

@Nat_O_Byrne @TheRealRead Srsly tho, I cannot think of a single case where a GCS hasn't required a more specific explanation of *how* it is abn. A GCS of 10 in an aphasic 18 year-old girl is very different to a 3 in a collapse outside a pub is very different to a 13 in an agitated head injury.

@Nat_O_Byrne @TheRealRead What's the evidence base for it being important in improving the outcome of medical patients? 😉

@Nat_O_Byrne @TheRealRead GCS exists to prognosticate traumatic brain injury. Not to debate whether Doris' longstanding cognitive impairment loses her 1 for voice.

@TheRealRead Not to sound like a knob, but why is GCS not important? Guessing this is in the context of a pre-alert?

@MaxMarsden83 @rachelgemma90 In my mind, we need to educate, train & empower clinicians at every level to use their brains and think about why someone is in arrest. But, I think we need to be mindful that the basic (and advanced) life support drills need to keep your options open.

@MaxMarsden83 @rachelgemma90 It's difficult cos the label gets applied early; who hasn't been dispatched to an "RTC, traumatic arrest" when a car has rolled to a gentle stop against the central reservation?

(External) Chest compressions in traumatic cardiac arrest?

@MaxMarsden83 @rachelgemma90 Do we count positional asphyxia or impact brain apnoea as 'traumatic' arrests?

@rachelgemma90 Which aetiology would get you doing compressions?

@Roseberrykate @mancunianmedic @DrNeenaJha But 111, the ambulance service, an EM clinician and a medical one have all decided not to discharge... I don't think it will be a huge percentage.

Wow NHSE, what a solution 👏 Fellow GPs, All we need to do to help hospitals is to avoid hospital admissions for our sick patients during winter?! Who knew?! Lightbulb moment indeed! (Btw NHSE - we ONLY admit patients to hospital who actually NEED hospital admission!)

@Shanghai_Rose @mancunianmedic @DrNeenaJha In order to get to post-take, they've been through a triage and at probably two clinicians. If all of those people thought they needed to be in...

@mancunianmedic @DrNeenaJha Just curiosity how many of those didn't actually need hospital treatment.....apologies if this has been considered further in the replies.

@KadeF96 Switchboard even screen some *internal* calls all the time!

@mark_tehan This would be ideal, but I don't think switchboard would tolerate being asked to screen who is asking and to say no to patients. Sometimes patients questions regarding sample collection criteria we can help with, it's the clinical advice Qs we can't though 💔

I'm experiencing an increasing number of patients calling the lab directly for blood results advice who get angry when I say that I can't give it as I am not their doctor. Does anybody have any advice regarding how to diffuse this? I'm usually met with "I can't reach my GP".

@Dr_JSA Yer, and your rationale is perfectly reasonable, but in what other specialities would that behaviour be appropriate?

@mark_tehan I already gave a perfectly reasonable rationale for my view. If you don't accept it, I really don't mind. The issue here is you realising that I will not yield to your viewpoint, about always unthinkingly doing as I'm told.

I made myself unpopular in my ED rotation by making sure I did the LPs for suspected meningitis cases. I'm more than happy to continue making myself unpopular by saying: Unless there is another clinically unwell patient, the LP should be happening in Emergency Departments.

@Dr_JSA Or, if you'd prefer it more GP oriented, if a GP reg turned up at your practice and decides that they were going to initiate penicillamine for RA or offering ear syringing & microsuction, how would you suggest that be managed?

@Dr_JSA That can only effectively work when employees of those services work within those constraints. So, in that context, when do you think it's appropriate to go off piste and disregard your employers direction on what can and cannot be offered?