🚨Patient Safety🚨

I’m not sure people really understand why doctors are up in arms about this government trying to substitute doctors

Why we think it will affect patient care?

So let me explain to you what it has taken me to train to become an NHS consultant, necessary to uphold the standards, as per our Royal Colleges:

🔴 Competitive selection to Medical school - 5 years

🔴 Competitive selection to Intercalated Degree - 1 year

🔴 Competitive selection to Academic foundation programme (first two years of training once you graduate as a doctor) - 2 years - Moved city a few times due to distances

🔴 Multiple papers published, in my own time, paid for myself

🔴 Multiple courses attended, on my own time, paid for myself

🔴 MRCS exams and study materials and courses (entrance exam for surgeons), in my own time, paid for myself

🔴 Competitive Selection to Core Surgery training (2 years, another move for most, I managed to stay in same city)

🔴 Multiple courses attended, paid for by self

🔴 Surgical portfolio kept, paid for by self

🔴 More projects, audits and published papers, in my own time

🔴 Very competitive selection to Trauma and orthopaedic speciality training - Moved city again

🔴 Rotated around 5 hospitals, majority of time have had 2 children and 4 hour commute. Childcare hours don’t fit NHS Rotas or working patterns - huge debt because of childcare

🔴 Attended countless courses, paid for by self

🔴 More papers, portfolio and audits in own time (research time we get doesn’t cover extent we have to do)

🔴 FRCS (consultancy exam) paid for by self, revised in own time

🔴 Cannot count how many times have attended extra unpaid lists just to ensure getting what is needed

19 years on. Multiples of tens of thousands of pounds later. I’m still not finished, though nearly there

This is what it takes to become a consultant in the NHS, different timings for different specialties but equally gruelling. GPs highly trained generalists with similar expectations in competency

Is it any wonder your doctors are incensed that doctor-substitutes are suddenly being paid more than them and being allowed to see patients LIKE A GP, after 2 years of training?

There are many MDT highly trained specialists like ANPs, physios and pharmacists who are upskilled to see differentiated or skills aligned patients, they are excellent, but their scope is well defined

Physician Associate however have been let loose unregulated and unscoped, to create a two tier health system. This is unsafe.

The majority of ones I’ve worked with have been enthusiastic, knowledgable of local logistics, helpful and proactive. However, this does not = medical training.

There are plenty of things doctors would welcome help with. Things to reduce the burden of the job. But doing the job of a doctor without the proper training is not it.

Stand up for the quality of your healthcare

We are

@wesstreeting @Keir_Starmer If you would like your elected representatives to put your healthcare first rather than ‘faux-fixing’ numbers in the NHS, by introducing a two tier system, for them to quote to get them elected

Then please write to your MP here:

writetothem.com

Dear Britain,

If I told you that unregulated healthcare workers - who aren’t doctors and nurses, and with no formal surgical training pathway - were performing SURGICAL procedures on you in the NHS

How would you feel?

(Cystoscopy is keyhole into the bladder up the urethra) For context: it takes 6 years of university, a minimum of 2-4 years of working and a very difficult and expensive exam with multiple courses to even just be admitted into THE START of surgical training as a doctor

Then a further minimum of 6 years, but usually longer to finish

They ask why there’s a problem with women in surgery?

@TMitchellFRCS - president of @RCSnews is there genuinely nothing else you could have said? It’s fair to scrutinise, but really, is there *nothing* else you could have said?

thetimes.co.uk/article/patien… Apart from the fact there are now multiple studies that show women have better outcomes than men

Not one flawed one, but multiple huge ones

Where is the reflection? Where is the humility?

It is right to scrutinise the evidence BUT are limitations & ‘associations not causations’ all you had to say?

I want to tell you a story

The story is mine, but the position I was in is not just mine, it’s a position many have been in

It’s about the time I did one of the most frightening things I ever did

And I’ve done a lot of frightening things…

I ‘returned to work’ as a surgeon I did this twice, once after each child

The first time I returned when my child was 5.5 months and had taken 2 years total out for other reasons

I did what I thought I should do, when you work in a historically and majority male environment that rewards confidence…

We ain’t gonna get anywhere if we back down at the slightest sight of distracted media or people ruffled that we might come across ‘arrogant’

It. doesn’t. matter

What matters is the COLLECTIVE action.

The stress felt by trusts, management & government and their coffers The government will try hard, very hard, to convince you the public is ‘turning against you’

They will try hard to drive a wedge between the BMA and doctors on the ground

They will try hard to slander prominent figures

They did ALL OF THIS this last time

Having my asked this question

My conclusions:

Abroad maybe

The older guard say yes more & the younger no - the reality is things have changed and the costs are too high - which some may not understand the impact of.

Also survivorship bias

https://twitter.com/roshanamn/status/1628656331723866112

I love love love orthopaedics. Do I love the ‘job’ and everhthing that comes with it? No. Do I love the cost to me of my training? No. Do I love the rigidity of the system? No. Do I love the systemic bias? No. Do I love the way we are treated? No. Do I feel valued? No.

Iranians everywhere are gearing up for Yalda, a thousands year old tradition

Yalda is Winter Solstice, the longest night of the year

Iranians gather together to welcome the longer days

This year more than ever we wish for a coming to the end of Darkness

A 🧵

#Mahsa_Amani In normal times, families and communities gather together for Yalda

It is almost unheard of for persian gatherings not to include lots of food and dancing, and normally, that’s what would happen

But this year, the Iranian, community don’t much feel like dancing.

I try to talk about things that need change in NHS and UK governance, that I hope reflects the messages many wish to convey

But I’ll be honest, I feel depressed and very alone, about the plight of my fellow Iranians

They are being murdered

Please show the world with me If you have enough time to retweet a tweet about liz truss, Ukraine or a funny cat. Do the same for the people of iran

They are not so different from you. They live further away in a mysterious country but they breathe air, bleed, cry and hope just like you

Dear @Jeremy_Hunt

Congratulations on your appointment as chancellor

I look forward to you undoing the ‘crazy’ pension tax which is penalising NHS Drs as we discussed the other day

And also to you helping junior doctors restore their pay so they can keep working in the NHS It is wonderful that you will now be able to enact your own recommendation 😌

Please see:

https://twitter.com/jeremy_hunt/status/1575917472250613760?s=46&t=XTOAtLb9ES9nBQ4TBkl45g

Non-promotable work & Women

In one firm, by analysing employees’ time, they discovered “whether senior or junior, the median woman spent about TWO HUNDRED more hours per year than the median man on non-promotable work. That’s approximately a month of extra dead-end work.”

2-0-0 ‘The key explanation for these drivers lies in the collective expectation that women, more than men, will do the unrewarded and non-promotable work’

On a survey of all male surgeons I know, a vast majority of them have partners who work part time:don’t work (I know some who’s partners do, but majority don’t)

Of female surgeons I know all their partners work full time

Let’s think about what this means for women in surgery? I’ve wanted to tackle this for a while but I don’t want to offend anyone by suggesting life is easier for one set over the other, it’s not easy for anyone, but unless we acknowledge these differences it’s hard to change things - like why there a high attrition rate of women

Today I’m cooking Iranian food to cheer us up!

I will tweet progress, as many of you know Iranian food takes forever to cook

🥦Step 1:

Defrost broad beans

I have fond childhood memories of sitting on the floor on a mat peeling broad beams for this dish. 🍚 Step 2:

Rinse and soak the rice. Iranian rice is 👌🏾 but we cook it very differently to English rice.

IMO no other long grain rice produces as good an Iranian rice as Tilda Basmati.

Rinse and soak the rice, with salt, for several hours before starting the cooking

I am waiting for the ‘oxygen molecules in the atmosphere to cuddle up to the iron molecules in this mask’ according to SpaceNK...

🤔 Oh bloody hell its actually really good good

So what are surgeons doing during COVID Crisis?

A quick confer with colleagues across various hospitals:

😷 Some of the more junior team are being redeployed

🦠 Where possible, eg. day case, elective work being attempted - problem here is lack of anaesthetists, nurses, beds 💉 Inpatient elective operating, in most hospitals I’ve discussed with, has come to a halt. Not enough anaesthetist, nurses and theatres turned into ITUs

🦠Emergency operating going ahead, but even this in some hospitals is an uphill battle - again not enough of the other staff

I’m always weary of an organisation or business where someone described it as ‘founded by’, ‘run by’, ‘built by’

‘I’, one person

Having been involved in the genesis of multiple businesses and organisations I can tell you that is almost never the case It gets even weirder when you consider...

One person cannot build, run etc such an organisation by themselves, and if they’re not willing to share the ‘kudos’ then that’s a pretty worrying sign in itself

I genuinely challenge any trust executive to have a talk with me about this

If you care you will listen

https://twitter.com/roshanamn/status/1321726633112424448

Step up step up guys and gals

‘NHS staff are at risk of COVID because of small spaces’

Yeah because doctors offices got turned into shit holes and management offices which means we have to all jam into a packed room to try and do anything

Nurses staff rooms are about 1 squared metre, if they exist at all Now they give a shit about it because COVID.

But when it was just plain impractical, unpleasant, stinky and offensive it’s all good - carry on

I miss Iran

I keep having flashbacks of sitting in the courtyard of Abassi Hotel in Isfahan having a huge bowl of Aash Let me take you on a tour of my last trip 7 years ago. I don’t know when or if I’ll ever be able to go again.

I used to go every year for part of summer. All my extended family was there. I have none in the UK.

Since nazanin-zaghari so many of us have never dared to go back

See what he’s doing here?

Appealing to Brexit supporters to undermine the validity of what the press has uncovered

The guys a snake. Pull the two things together, start a narrative

https://twitter.com/skynews/status/1264234446779187206

He is quite a thing to study. Cynical to the max

So I’ve had a few trust finance people offer explainers.

Just to be clear I have no background in finance this is just what I’ve read and reflection of conversations with people that do

THREAD

https://twitter.com/roshanamn/status/1246318563129991168

One trust finance director described it thus (I paraphrase, but the ‘f’ word is part of the original description):

‘Its the equivalent of someone paying off your mortgage but then reducing ur income by the same amount. It makes F all difference. Worse still they’ve ignored PFI’

So my understanding is that NHS trust debt HASN’T been written off

It has been converted to Public Dividend Capital, which has a higher interest rate of 3.5%

I hear Trust finance directors not happy. Not quite what the headlines are saying is it? I mean that’s just what I’m hearing, please correct me if I’m wrong if you are more knowledgable