David Carruthers

@thomasdolphin @ThomsAdrian @RCoANews “Hotline”

@ThomsAdrian @RCoANews It's a peculiar condition but fascinating that we accidentally and unfortunately found the right molecules to induce it in patients. So rare that most of the people manning the MH hotline in Leeds have never seen a case directly themselves, I gather!

It's twenty years today since I started my anaesthetic training, at Charing Cross Hospital. In that time I've looked after many thousands of patients, placed innumerable cannulas, injected rivers of propofol, and stuck a pine tree's worth of needles into people. 🧵

@trussliz Is she talking to the cactus?

“What is legal and what is true is governed by people you cannot hire nor fire.”  The civil service system doesn't work. Government should be run by those elected by the public, not unelected bureaucrats. Watch The Liz Truss Show now.

@drokane @brookmanknight Possibly the best articulation of the issue I have seen.

For doctors, most diagnoses come from the history and examination. In many non-medical pathways, it can feel like the reverse: very little diagnosis from history/exam, and a heavy reliance on tests or onward referral, sometimes with no working diagnosis at all. If someone doesn’t understand what history and examination are for, it’s easy to skip them and default to “do tests” or “admit/refer so a specialist can diagnose”. The problem is that tests are then interpreted without a Bayesian “a priori” anchor. Without a pre-test probability built from a good story, a focused exam, and an understanding of how common conditions are so you’re left with results that can mislead, over-diagnose, or generate incidental findings. And if you don’t have a detailed grasp of disease patterns, you don’t know which questions to ask or what to look for to diagnose dementia or depression or diabetes or diphtheria. You can’t form a meaningful differential if you don’t know what’s common, what’s dangerous, and what’s discriminating. So the whole process drifts into secondary referrals and scanning as the default route to certainty. In parallel, some non-medical exams don’t require a deep knowledge base, so people are expected to “look it up” in real time under pressure. That isn’t the same as understanding, and it’s hard to expect consistently good outcomes from it. The final issue is that often one doesn't know what one doesn't know. This can lead to overconfidence or a very defensive position. Finally if you want to be seeing patients and making good diagnoses there is course for this called Medicine. Exams do expect knowledge.

@junglemandan Why do so many poker players have so concept of counter-party risk?

While I’ve got your attention, this word class scumbag Mike Segal seems to think he can get away with running off on a private game. Mike has apparently screwed a kid named Jeffrey for 360,928 $

@Hughwilliam8 @DrHWazir Increasingly they aren’t. If you aren’t prepared to act to help retain our doctors then please don’t complain when you are on a trolley for 12 hours before being seen because there aren’t enough doctors.

@DrHWazir If it’s so bad why are any of them bothering? Surely they would be better off in another job?

We underfund students at medical school, forcing some to drive Ubers just to get by. They graduate thousands in debt, then start NHS work as a doctor on £18.62/hr. Poor funding drives drs out. Fair student finance & pay restoration is how we keep them. lbc.co.uk/politics/uk-po…

@RpsAgainstTrump Do Americans really say "flutist" rather than "flautist"? Genuine question.

Trump: “They came up to my father, they said, ‘your son is brilliant at music. He can be an incredible musician…I played for very short periods of time, the flute…Can you believe it? I could have been a flutist.”

@DrDiGiorgio @moltar81435 @doclauravater "But that isn’t always realistic" within the current system, no it's not. I strongly suspect @doclauravater was advocating for improving the system. The first step to improving the system is acknowledging its current defects.

@moltar81435 @doclauravater I assumed it was the second. But that isn’t always realistic. Elective cases need to get done. Neurosurgeons can’t always schedule days off after they’ve been on call or else clinic and elective cases pile up.

The patient with a subdural and a blown pupil at 2am needs a craniotomy. Not all needs are equal.

@medic_southside @drmeenalviz You are in the minority then. Juniors rotate out in a few months but the matron will be there for years. Most consultants make the judgement that it will cause them less grief in the long run to turn a blind eye.

@drmeenalviz I would want any junior to tell me if this had happened. I would them have a "chat" with the matron...

I was in the middle of a long night shift. Looking after too many sick patients to count. At 3am, a nurse made me a cup of tea. The matron called us both in at 8am for an informal disciplinary meeting.

@DrHWazir SHO , resident on call over weekend. Had worked over 40 hours, no sleep, barely any time to eat or drink. Summer, hot. HDU nurse berated me for having a drink of water from "their" water cooler.

Overworked, underpaid, and subjected to unnecessary hostility. An NHS doctor was prevented from accessing the ward kitchen for a simple glass of tap water. It’s no surprise so many doctors are leaving for countries where they’re valued, respected, and treated with basic dignity.

@t_blom If a medical AI makes a mistake and a patient comes to harm, who takes responsibility? Who gets sued?

I think this is true of doctors and lawyers too, but maybe a year or two later. We're going to have an abundance of incredibly high-quality knowledge work at very low prices. Instead of living off gruel, everyone's going to have bananas and kiwi fruit for pennies. But the farmers will need to find something else to do with their time.

Software engineers are highly-paid farmers, tending their crops by hand. We just invented the combine harvester. The world is going have a lot more food and a lot fewer farmers in very short order.

@Microbedoc2 IV has +++ placebo effect. Patients get to impress their friends and family by how sick they were because they needed “IVs!!!!”.

Bacteria don't know how the antibiotic got there. If the drug has good oral bioavailability, the patient doesn't have absorption issues and the bacteria is susceptible. Then there is little advantage in IV vs oral.

@DrNeenaJha Quite agree. "Simple" and "complex" are retrospective judgements. It's never "It is simple", it can only ever be "it was simple".

Simple symptoms do NOT equal simple diagnoses As a GP, some cases that presented as “simple” symptoms: “Tummy bug” ➡️ brain tumour “Runny nose” ➡️ sepsis in newborn “Shoulder pain” ➡️ pneumothorax “Bit of a headache” ➡️ meningitis You cannot separate cases into “simple” vs “complex” until AFTER a consultation. In short, PAs cannot “just see the simple patients” & are woefully under-qualified to see undifferentiated patients.

@DrAnimeshSingh The fundamental problem is rotational training. It sets up perverse incentives that lead to preferment of PAs and is miserable for doctors. It needs to end.

20 years ago as I was finishing medical school, physician assistants (as they were then called) were sold by those in power as a solution to removing the significant admin & service related tasks from junior (resident) doctors.

We just dropped in on Liz Truss’s pro-Trump speaking tour with a remote-controlled lettuce banner. She didn’t find it funny. 🥬

@NikhilSegel @AllenKessler "Prizes over $500,000 will be paid in Monopoly money"

@AllenKessler What is the discount if I may ask Allen?

It looks like I have to take the annuity or a "discounted" lump sum.

@hlnewey How does this work? Are you randomly assigned a rank and the higher your rank the more likely you are to get your first pick foundation job?

I have a previous degree. I have received exam merits every year. I have a distinction for my final medical degree award. I have prizes and a reasonably decent engagement in surgical portfolio crap already. The previous system was poor but this is fucked.

@DrEilidhMaria From perspective of consultant PA are good as they only need to be trained once and don't move on. Incentive for consultant to train "junior" doctors is reduced to less training for "juniors". Long term whole system becomes deskilled as current cons retire.

4. Seniors with a ‘pull the ladder up’ attitude 🪜 Often, a lot of the medical professionals in power are those who graduated many decades ago and are incredibly out of touch with reality. They care about lining their pockets more than caring for the juniors who prop up the system. This is another frustration for juniors who feel as though these seniors push forward agendas (such as SCPs in surgery, as a recent example) that do not benefit the junior medical or surgical workforce in the slightest.

@Geiger_Capital So why doesn't he pay a dividend?

Warren Buffett on valuations today… “I don’t think anyone at this table has any idea of how to use it [$189B in cash] effectively, and therefore we don’t use it. We only swing at pitches we like… today things aren’t attractive. We’re not using it at 5.4%, but I wouldn’t use it at 1% either. But don’t tell the Federal Reserve that. I don’t mind at all, given current conditions, building our cash position. When I look at the equity markets and the composition of what’s going on in the world, we find cash quite attractive.”

Paddling, sending it, graaaaaaaah 🏄‍♂️😵 @ValtteriBottas #AusGP