My name’s Mike Farquhar. I’m a consultant paediatrician, specialising in sleep medicine

I have a couple of professional side-interests in parallel to my main job

One is the impact of shiftwork and sleep deprivation on NHS staff

The other is around advocating for LGBT+ people ImageImage
I’ve spoken often about what I’m about to speak about again here; much of the content comes from a plenary talk I gave @RCPCHtweets 2019 Conference

But, for reasons that’ll hopefully become clear, I think it’s important to restate some of this yet again

twitter.com/i/events/11327…
I came out late in life; I grew up in this country at a time when the idea of being gay was viewed with a huge degree of negativity and hostility

At the time that I was realising I was gay, the prevailing cultural idea was that gay men were a threat, specifically to children Image
Powerful voices, including the then Prime Minister, made it clear that homosexuality was something to be seen with concern and suspicion; that children and young people should not be affirmed if they said they were gay, and to do so would “cheat them of a sound start in life” Image
Those attitudes were enshrined in law

The “promotion” of homosexuality in schools was made illegal

Schools were forbidden to teach homosexuality was acceptable, and the law described homosexual relationships as “pretended” Image
The message, from the Prime Minister down, codified in law, was that being gay was wrong, it was harmful, immoral, that gay men were a threat to others (specifically children), that diseases like AIDS were the consequence of a “lifestyle” that was seen as sinful and wrong ImageImageImageImage
Daily Mirror, 1991, after Freddie Mercury died: “For his kind, AIDS is a form of suicide”

Daily Mail, 1993: “abortion hope after gay genes found”

Boris Johnson, 1998: “tank-topped bum boys”

In my teens/20s it was still seen as acceptable to talk about people like me like this ImageImageImageImage
If you’re a young person realising they are gay, growing up with that political and cultural attitude around you causes harm

It makes you afraid, makes you scared to speak about how you think and feel, internalises all of that negative emotion - and that has consequences ImageImage
We know that growing up in the 80s/90s caused harm to huge numbers of LGBT+ people

The story of the damage it causes is literally told by scars on my body

BUT
Thatcher was wrong
Section 28 was wrong
The papers were wrong
The churches were wrong
The prevailing attitude was wrong Image
Just because powerful voices say something, just because the media echo and amplify, just because official voices prevaricate or pontificate, it doesn’t mean they’re right

What I needed more than anything as a kid growing up was to hear the voices of those standing in opposition ImageImageImageImage
The attitude towards trans people in this country today is hostile, driven by ignorance, often by bigotry and by a determination by some to portray all trans people as a threat, to individuals and to society Image
Just as in the 80s gay men were caricatured as being a threat to children, much of the public discourse about trans people today is filtered through a lens of concern about trans people being a threat to others
If individuals commit offences they should be prosecuted, whoever they are

We must not demonise an entire group of people because of an inflated sense of perceived threat by some

Trans people just want to be themselves and to live as safely and happily as they can
When prominent voices in media and politics amplify ignorant, outdated and wrong ideas about trans people, harm ripples out and gathers the strength of a tsunami

It makes trans people, especially young people, feel isolated, scared, makes them turn inward Image
We know that as a consequence trans young people are at significant risk of harm to their mental health, to self harm, and to attempt suicide

Those young people need to hear voices around them challenging those who amplify those hostile attitudes, need to be able to feel safe Image
And this matters Image
As paediatricians, I think one of our most important responsibilities is to give voice to children/young people where they themselves find it hard to speak up and be heard

We know having just one supportive adult in their corner can make a world of difference to LGBT+ teens
We have a responsibility to educate ourselves, to be aware of the issues, and to be able to clearly advocate on behalf of young people who absolutely need us to be an ally

thetrevorproject.org/resources/guid…
I run an adolescent sleep clinic

If you’re trans, your chance of having disrupted sleep also goes up significantly; sleep is often affected when dealing with stresses and worries

I talk to trans teens, and their families

I hear their stories, do my best to understand and help
Please listen to the voices of trans and gender-diverse people themselves, don’t just listen to people speaking about them

Here’s some places to start: ImageImageImageImage
So, as a cis gay man, I stand with my trans siblings #Pride

As a paediatrician, I stand with trans young people who need to be seen, need to be heard, and who need voices to advocate for and with them

I think that’s needed more than ever

That’s where @RainbowNHSBadge came from

Kids like I was need people to listen, to understand, who will help and be a voice when they’re too scared to find it for themself

LGBT+ young people today need *us* to be those people, to make #TinyChanges that start to make a difference Image

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More from @DrMikeFarquhar

1 Nov 20
Seems a good time to remind yourself that how you are thinking and feeling is likely a NORMAL response to EXTRAORDINARY circumstances

There is support and help out there

It is absolutely OK to not feel OK, but don’t ignore it

@DrShreeUnadkat

blogs.bmj.com/bmj/2020/03/16…
(usual caveat that, because this was published in the BMJ, “healthcare professionals” was changed to “doctors” in the headline but, clearly, this isn’t just about doctors)
And this, more than ever:

“When the pandemic is over, and we return to some sense of “normal” again, we will need an even more vigorous discussion about what safe staffing, safe resources, and a safe model of care really mean in the modern NHS.”
Read 5 tweets
24 Oct 20
Whether you’re the parent of a toddler (or an adolescent) or, like @WelshGasDoc, an overtired shiftworker, many people know the frustration of trying to get themselves or someone else to sleep but, no matter how tired they seem, they just won’t do it

Sleep has rhythms Image
How sleepy we feel, and how much we *need* to sleep don’t always match up

The simplest example of this is the post-lunch sleepiness many of us feel

Even if we don’t sleep, we usually feel *less* tired a few hours later when we’ve been awake longer

Weird, huh? Image
Sleep is a complex process, but we can simplify how we think about it into what is called the “two process” model of sleep

This describes sleep/wake as the interaction of two elements: Sleep Pressure (S), and Circadian Rhythm (C) Image
Read 39 tweets
23 Oct 20
The @gmcuk annual training survey is out, looking in particular at the impact of COVID19 on medical trainers and trainees

gmc-uk.org/-/media/docume…
As always there is lots of granular data in the report but at the high level:

~25% of trainees & ~20% of trainers score “high” or “very high” on Copenhagen Burnout Inventory questions in the survey

40% of both trainees and trainees describe work as emotionally exhausting
And almost half report feeling tired/fatigued at the end of the day

(though, as always, I think the phrasing of the question “are you exhausted in the morning at the thought of work” is quite an existential way of asking it!)
Read 10 tweets
22 Oct 20
Maybe I’m not educated enough either but I genuinely struggle to understand how this Government can’t find money to support this, when so much has been frittered away elsewhere

That Tory MPs, including a consultant paediatrician, can in conscience vote against this amazes me
Also: @RCPCHtweets @RCPCH_and_Us ... I know @MarcusRashford has an MBE now, but surely he deserves recognition from us as well, in view of how determined he is to give voice to children and young people and advocate on their behalf?
Very relevant @bmj_latest article, quoting @maxdavie @RCPCHtweets amongst others, on this, from a few weeks ago

bmj.com/content/370/bm…
Read 4 tweets
11 Jun 20
I have two twitter accounts: a professional one (this one), a personal one, and I run a third account for @RainbowNHSBadge

I’ve been trying to decide which account to post this thread from but I think it has to be this one really
My name’s Mike Farquhar. I’m a consultant paediatrician, specialising in sleep medicine

I have a couple of professional side-interests in parallel to my main job

One is the impact of shiftwork and sleep deprivation on NHS staff

The other is around advocating for LGBT+ people
I’ve spoken about what I’m about to speak about here before; much of the content comes from a plenary talk I gave @RCPCHtweets Conference last year

But, for reasons that will hopefully become clear, I think it’s important to restate some of this again

twitter.com/i/events/11327…
Read 25 tweets
20 May 20
I had a wee stint in our adult ICU team as part of COVID19 redeployment and, for some of that time, had an actigraph on

Actigraphy, worn like a watch, uses a number of sensors (mainly motion and light) to give an overall impression of sleep routine and pattern
Shift pattern was 3 long days/3 days off/3 nights/3 off, then repeat cycle

LOTS of caveats about this data:
- on shift, actigraph was in a scrubs pocket, often under PPE
- it isn’t directly measuring sleep
- one day I forgot to put it on at all...
- etc

But...it gives an idea
Some other points/caveats:
- black lines: motion/activity
- coloured lines: light exposure
- blue shading: sleep
- yellow: wake
- red: night shift
- purple: day shift
- I took some time to rest/recover on “off” days, but was generally doing “normal job” work on those days as well
Read 21 tweets

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