Dr Rachel Clarke Profile picture
Palliative care doctor 👩🏻‍⚕️ Author 📚 Rep: @AitkenAlexander 📝 Co-founder @hospiceukraine 🇺🇦 Over on the other place at @doctoroxford.com
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Mar 5 9 tweets 2 min read
Dismayed to see you sharing such a misleading & potentially deeply frightening video, Kim.

If someone is in 'unspeakable pain' at the end of life, they should see a palliative care doctor like me - & I can promise you there is always something I can do for your pain. (1/n) If they don't see a palliative care doctor like me - because we are such an appallingly under-resourced service (if only the committee cared as much about *this* issue as they do AD) - then that person is being failed unforgivably. They are not receiving appropriate care. (2/n)
Feb 27 14 tweets 4 min read
🧵/ This heartbreaking case highlights why so many doctors like me have begged @NHSEngland & @DHSCgovuk to stop endangering NHS patients by substituting doctors with non-medically trained PAs

We've been dismissed & smeared as "toxic bullies".

Please read this thread & decide. Image When Pauline Marking, 77, started vomiting blood & went to A&E in severe abdominal pain, her family had no idea she was treated by a PA, not a doctor.

The PA independently treated & discharged Pauline, with no doctor oversight.

They diagnosed her as having a nosebleed.
Feb 22 10 tweets 4 min read
We need facts as never before.

3 years after Putin invaded Ukraine, I spent 24 hours with combat medics on the Ukrainian frontline.

Their courage, compassion, dedication & skill are astounding.

Please read (@guardian link below) & please never stop standing up for Ukraine 🇺🇦 Image This is Viktoriia Kovach, former obstetrician, now Chief Medical Officer of the Third Assault Brigade. She told me how Russian troops violate the Geneva Conventions, targeting doctors & patients:

"If a medical team tries to evacuate them, they will be hunted and killed, too.” Image
Feb 16 16 tweets 5 min read
🧵/ I agonised over whether to write this piece in today's Sunday Times.

Whipped-up emotion, hate & vitriol now dominate discussions of assisted dying on here - appallingly.

We have to be able to converse in good faith - & concerns should not be dismissed as "noise". (1/n) Image
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I was honoured, daunted & apprehensive about being called to give evidence to Kim Leadbeater's bill committee.

I am not anti assisted dying at all. But - based on my years of experience in palliative care - I am painfully aware of the need to get the safeguards right. (2/n) Image
Jan 16 19 tweets 3 min read
Thread/

Today, a devastating report from the @theRCN, based on the testimony of over 5000 NHS nurses, has rightly catapulted the national shame that is NHS 'corridor care' into the headlines once more. (1/n) Image This winter, nurses describe being forced to give care in corridors, cupboards, toilets, car parks & hospital gyms on a daily basis – locations without lifesaving equipment such as oxygen & bedside monitors, meaning that patients are “routinely coming to harm” or dying. (2/n)
Nov 23, 2024 7 tweets 2 min read
Misleadingingly contextualised piece, @NickTriggle, which relies, predictably enough, on those infamous anonymous NHS senior sources.

The crux of the issue is not, as you claim, 'the speed at which [PAs] are being recruited". 1/n

bbc.co.uk/news/articles/… Rather, it is the replacement of doctors with PAs in multiple different safety-critical settings, despite their radically shorter & more superficial training (a 2 year course, not a 5 year medical degree; no post-grad medical training). 2/n
Nov 12, 2024 7 tweets 2 min read
What troubles me most about ⁦@kimleadbeater⁩’s bill is that it places a legal obligation on the Secretary of State to ensure that assisted dying is available to patients for whom he’s under no such duty to provide adequate palliative care. 🧵 bills.parliament.uk/bills/3774/pub… Her bill, she says, has world-beating safeguards to prevent coercion of vulnerable patients to end their lives prematurely.

But “existing palliative care provision” is not “excellent” as she claims. Far from it. We are desperately underfunded & struggle to meet patients’ needs. Image
Oct 17, 2024 5 tweets 2 min read
🧵 This week - under a Labour government - NHS community services for the entire population of Wilshire (half a million people), were handed to a private equity backed company, @HCRGCareGroup, formerly known as VirginCare. 1/n Image A consortium of NHS, local authority & charities also made a bid to run the community services - as they were already doing. But no, the contract was awarded to an outfit whose owners celebrate realising 'significant tangible wealth' via, for example, 'corporate carve-outs'. 2/n Image
Sep 18, 2024 18 tweets 4 min read
🧵/

This is, I believe, unprecedented in the history of UK medicine.

28 eminent UK doctors have written publicly to @LaylaMoran, the new chair of @CommonsHealth, to report something nothing less than scandalous.

Read their letter here (1/n) 👇

bmj.com/content/386/bm… The signatories, all Fellows of @RCPhysicians, believe that their College, the @gmcuk & @DHSCgovuk essentially colluded to mislead parliament in claiming that the College approved legislation going through Parliament this year to regulate physician associates (PAs).

(2/n)
Jun 15, 2024 11 tweets 3 min read
I’m simply horrified to see @NHSEngland now literally breaking the law in how it misrepresents physician associates & other allied health professional - who are NOT doctors - to the public.

These posters are from the Bradford District & Craven Health & Care Partnership. 1/n
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I downloaded the posters from their website, here:

“Physician” is a title that’s protected in law - to protect you, the public, from the dangers of fake doctors masquerading as the real thing. 2/nbdcpartnership.co.uk/download/96/gp…
Jun 11, 2024 5 tweets 2 min read
Well, I’ve read the @Conservatives manifesto on health so you don’t have to.

Aside from the expected unfunded nonsense on those 40 fictitious new hospitals, cutting managers & using AI to ‘free up’ doctors & nurses etc, here’s a stand out out example of its vacuousness. 🧵 Image What even is this verbiage? A ‘plan’ to prevent cancer from occurring, but also to give patients the best possible care? When over 235,000 cancer patients have had their treatment delayed in the last 3 years?

Come on, @Conservatives, this is offensive. Image
Jun 9, 2024 9 tweets 2 min read
BREAKING/

This is a scandalous moment in UK medicine.

Over 80 Fellows of @RCPhysicians have just declared their lack of confidence in the College.

Why?

Because they believe its stance on physician associates (PAs) is recklessly failing patients.

Pls read - this matters. 🧵 Image The Fellows - over a quarter of whom are professors - are appalled by @RCPhysicians' role in in enabling the government's project of replacing doctors with cheaper & less well-trained doctor substitutes (PAs) in an extraordinary array of medical jobs across the NHS.
May 29, 2024 13 tweets 3 min read
The GMC have tweeted this in response to widespread alarm from doctors at a video showing an 'AA' (anaesthetic associate) openly bragging about using "local governance" to get away with less supervision by doctors.

I find the GMC's position deeply concerning.

Here's why. 🧵 The video in question was recorded at a GMC conference in 2022.

AAs, like PAs (physician associates), are not doctors.

They have neither a medical degree nor anything like the depth & breadth of doctors’ training, yet are being used increasingly as doctor substitutes.
May 13, 2024 4 tweets 2 min read
Astonished to see @timspector doubling down on his reckless comments re: boosting 'cancer immunity' by stopping using SPF year round.

The study on which he bases his claim is in mice, not humans - & one of the study's own authors has publicly disputed Spector's conclusions. 1/3 Image As a doctor, how can he possibly imply we should use less sunscreen in order to reduce cancer risk?

Vit D deficiency from lack of sunshine can be addressed by diet.

But fatal skin cancers, as I know all too well in palliative medicine, cannot. 2/3 Image
Mar 30, 2024 15 tweets 5 min read
🧵 Whatever your views on assisted dying, one thing I’d hoped we’d all agree on is that the topic is ethically fraught & complex.

Not so Matthew Parris.

For him, it’s simple. Old & frail people *should* be killed - to save society the cost of looking after them. 1/n Image In no sense am I twisting Parris’s words.

Here he rehearses an argument often used by opponents of AD to fight legal change - that with time, it will lead to people feeling pressured to end their lives prematurely (for it would be socially irresponsible of them not to). 2/n Image
Mar 21, 2024 15 tweets 3 min read
Dear 🇬🇧,

The current state of UK medicine - a brief 🧵

Exactly 1 week ago, I felt I had no choice but to resign from giving a keynote speech at this year's @RCPhysicians annual conference.

The behaviour of the College leadership left me no choice. 1/n

The @RCPhysicians had been forced by its Fellows to hold an Extraordinary General Meeting - the third ever held in its >500 year history.

Fellows were appalled at the College's key role in driving through the government's plans to replace doctors with cheaper substitutes. 2/n
Mar 20, 2024 16 tweets 5 min read
Dear UK public,

Yesterday, hot on the heels of widespread concern among doctors at the govt’s project of replacing NHS doctors with doctor substitutes, @gmcuk released a blog about its future intentions.

It left doctors like me reeling.

Here's why 🧵

gmcuk.wordpress.com/2024/03/12/dev…
Image @gmcuk First, a reminder of what the GMC is.

Founded 166 years ago, the GMC protects the public by maintaining a register of drs in the UK, controlling entry to the register & suspending or erasing members if necessary.

It sets standards for all UK doctors.

Weighty, vital stuff. 2/n Image
Mar 18, 2024 17 tweets 4 min read
Dear 🇬🇧,

Please read - this NHS scandal potentially affects you all.

🧵 Having studied the data, just released, from the @RCPhysicians members' survey on PAs, I couldn't be more disgusted by the lack of probity, honesty & fairness of those who lead my Royal College. 1/n Image Last week, @RCPhysicians leaders were forced, against their will, by members & fellows to hold an extraordinary general meeting: only the 3rd in the Royal College's >500 year history. 2/n
Mar 9, 2024 11 tweets 3 min read
🧵 Doctors are depressingly used to being smeared by govt ministers.

But likening us to intimidatory "drug dealers" is a new low from @JimBethell.

He's trying to delegitimise our genuine patient safety concerns about @DHSCgovuk's roll out of PAs as doctor substitutes. 1/n The crux of the issue is this.

The government (reasonably enough) looked at ways of reducing the NHS staff bill.

Physicians assistants - less qualified & cheaper than doctors - would assist doctors in admin/straightforward tasks, freeing them up for more complex work. 2/n
Feb 18, 2024 5 tweets 2 min read
"Staff members were buying rain ponchos from Amazon because they offered better protection than what we had."

Please read this devastating interview with Dr Nathalie Macdermott, who caught Covid after being denied PPE by her hospital. 1/3
thesun.co.uk/tv/26011843/br… Nathalie, a former runner, is so severely disabled by Long Covid, she has to use a mobility scooter.

Like so many NHS staff, she was treated like cannon fodder - even as the government told the public (dishonestly) there were no problems with PPE supplies.

It's scandalous. 2/3
Feb 17, 2024 9 tweets 2 min read
🧵 Underlying the govt's decision to replace doctors with doctor substitutes in a huge variety of roles (including, incredibly, putting PAs on senior registrar on-call rotas), is something deeply concerning that we need to address.

Namely, the devaluing of a medical degree. A 5 year medical degree (4 years, at a push, if you are a grad entry student), is a gold standard, a benchmark, an assurance to the public that the NHS doctor treating you has an vast breadth & depth of knowledge & expertise - right from day one of their clinical practice.