Thread for those who do not understand why I might be against Anaesthesia Associates or whatever they might want to call themselves.

Anaesthesia is high risk area - one colleague used to say my job involves giving sublethal doses of dangerous drugs & wakening you up at the end. During my career we made huge advances in patient safety. New monitors were introduced e.g. pulse oximetry to measure the oxygen in your blood, capnography to measure the carbon dioxide and monitors that allowed us to measure the anaesthetic agents. But did you know we also

This single post has really hit home - and truly upset me.

Perhaps people don't realise why so many doctors, pathologists, public health doctors, virologists and so many more professions spend their time on here voluntarily trying to help you understand. 1/n

https://twitter.com/Shepherdess77th/status/1824153388789141680

We have nothing to gain.

Most of us are clear about our identities - you can find us and where we live. Indeed lots about our background. To spell it out WE DO NOT HIDE WHO WE ARE!

We are not selling anything - we are just concerned about your welfare... 2/n

Well I never knew that the IEA are pushing the use of Physician Associates. So who are the IEA and who funds them?

Would it surprise you to learn that the Institute of Economic Affairs is very guarded about its funding. 1/n

https://twitter.com/ExplosiveEnema2/status/1804584980523225171

Have a look here to learn more
Report prepared by opendemocracy rates think tanks by how open they are. 2/nopendemocracy.net/en/who-funds-y…

I confess I'm really puzzled tonight. BMJ Public Health published an article about excess deaths during the pandemic 2020-2022. The article is authored by Paediatric Oncologists with no history of interest in public health. The 'research' is funded 1/n

https://x.com/ActuaryByDay/status/1799439284833030192

by Foundation World Child Cancer but then perhaps this is because of the fact they fund the hospital (@prinsesmaximac )where three of the authors work. Oh and 2/n

https://x.com/KlaasvanDijk5/status/1799476799560200282

These graphs echo my timeline in the NHS as a Consultant. I started under Thatcher in 1989 as probably one of the youngest Consultants (31). I then worked through Major and then the golden years of Brown and Blair. When I started waiting lists for hips were 18 months..1/n

https://twitter.com/theAliceRoberts/status/1776323433191674339

by the end of Blair Brown era they were typically 18 weeks. Any wait longer than 4 hours in A&E was fully examined for fault and to see what we could do better.
Things got done, good ideas for improvement got funded, we had education programmes on improvement based on best 2/n

The role of Physician and Anaesthetic Associates has hit the headlines recently – if you haven’t heard of these roles before, they are what were previously called Physician Assistants. Physician Assistants have been around since 2004 but the name was changed in 2014 to 1/n ‘Associates’, currently there are around 3200 employed across hospitals and Primary Care. Their role has become increasingly controversial as moves have been made to have them registered through the General Medical Council (GMC) – a move that has not happened for any other 2/n

Fionna is correct here. Indeed the thought of implementing unproven technology in the NHS fills me with fear as a Clinical Safety Officer for safe introduction of IT. However technology covers more than IT - it includes devices, implants such as joint replacements, software 1/n

https://twitter.com/fascinatorfun/status/1741395150503317506

Apps and of course AI or 'Machine Learning'.
I believe we have a system to manage these fairly well but still mistakes have been made. Want some examples? Then read on.
Laser Arthrectomy for Peripheral Vascular Disease - expensive and poor results and never caught on.
2/n

In all honesty I am so fucking pissed off!
Those who know me know I never swear despite 30+ years working in the NHS. So why?

I am pissed off with grifters who are amassing a following on YouTube with their 'pseudoscience educational videos'. FFS think about your actions 1/n I am pissed off with those who push antivax agenda for pregnant women. We now know that Covid is a serious issue for both mother and foetus (yes the unborn child) and so mothers need to be protected by vaccination.
So FFS think about your actions. 2/n

Difficult thread this - so here goes. So Dr Steve James hits the headlines after having ago about mandatory vaccinations in the NHS. He now has an ardent following of antivaxxers who are referring everyone who challenges him to the GMC. Bottom line feel free to refer me. 1/n I am retired anaesthetist who was Clinical Director of Anaesthesia, Theatres & ITU for many years. I came out of retirement to help vaccinate. I like many others want to help people survive this, not just the fit and well but those adults and children with coexisting diseases 2/n

Lot about pulse oximetry on twitter today.
This technology didn't exist when I started as an anaesthetist back in 1983 - indeed all we had a was a shared green Rigel ECG which was just a glorified oscilloscope and about as much use. So thought I would do a thread on oximetry. The secret of pulse oximetry is in the name 'pulse' - the system is designed to measure oxygen content using the pulse of blood through your finger tip, ear lobe or wherever the probe is placed. This is the first important point - it depends on detecting that pulse of blood.

In the absence of any leadership from this government then I suggest the following for those who wish to protect themselves and others.
TL:DR - keep to the basics we all know
1. Wear a mask when indoors - consider buying better FFP3 masks online and ensure they are a tight fit if you are spending a long time with people indoors who are not wearing masks e.g. cinema/theatre.
Easy to find videos on fitting e.g.
2. If you can avoid indoor situations with lots of people shouting/singing -pubs, clubs, choral society (choice is yours)

'The NHS is not under pressure.
The NHS is under water… drowning in demand and not enough people to cope.
The sooner we admit it, the more likely we can get it back in its feet.'
@RoyLilley hits the mark and offers a sensible approach to the crisis
: conta.cc/3BPsNhn I'm adding this on here as it's straight to the point.

https://twitter.com/seahorse4000/status/1450098330147688463?s=20

Just a thought from a retired doc helping with the vaccination programme.
I reckon thousands of us (docs, nurses, midwives etc) have come back from retirement gladly to help our NHS colleagues.
Speaking to colleagues we are here for as long as needed but in truth that is not 1/6 forever. We need to bring this pandemic under control in our country and then concentrate on helping others. If we don't then we are dammed to an eternal battle with an evolving virus that twists and turns and is currently attacking the young. Just look at the age of patients 2/6

So lessons learned of 2 days vaccinating with my local South Hambleton and Ryedale Primary Care Network GP colleagues.
1. Incredibly well organised - local volunteers as marshals directing people (and shovelling snow!) to make sure it went smoothly. 1/6 2. Smooth flow of patients so no huge numbers waiting at any one time.
3. Well ventilated with all doors open (yes chilly) centre ensuring maximal safety.
4. Everyone in masks - no hassle and those arriving with a mask not required to change their mask 2/6

I resent the virus and what it has done to us. I resent the stress and strain on my colleagues in the NHS but in particular those nurses and doctors just starting on their careers with no experience to help 'protect them'. I resent that I cannot see my children and hug them 1/n I resent that I cannot see my Mum in Scotland and hug her (I'm not foolish enough to think I can manage the Christmas Armistice). I resent I cannot see my new nephew even though he is now 6 months old. (I recognise for lots of people that will be grandchild).
I resent the 2/n

The problem with ignoring Covid-19.
I am really concerned that the idea we can just carry on and ignore Covid as if it was flu has gained some traction. In particular with people who should be better informed e.g. Tory MP's.
This is a short explanation of why this is an issue.1/n The NHS has one of the lowest bed numbers per 1,000 people in the world. Below is picture of slide I used in China some years ago to demonstrate how similar our health services were!
Trust me it has got worse. 2/n

@JohnWest_JAWS I've not replied to this tweet but created a fresh start. This is my take based on the facts I can find and information from colleagues. The Nightingale will take patients who have been intubated and ventilated. The plan is that only those without failure of

https://twitter.com/JohnWest_JAWS/status/1245252170452209664

another organ will be sent to the unit. So sicker patients will remain in normal hospital ITU facilities. There is an issue with this simplistic separation as it appears many of those requiring ventilation have multi-organ failure. So I suspect the use of the Nightingale will