Dr Philip Lee Profile picture
FY18 Doctor. Consultant Physician in Acute Medicine and Medicine for the Elderly. Still not a Member of Parliament. All expressed views are personal. He/Him.
Chris🌟 #FBPPR #RejoinEU #FBPE #FBPPR💙 Profile picture 💙 Charlie Helps FRSA 🖤 Profile picture Marco Smith 🇬🇧 Profile picture Stephen Cheshire Esq #FBPE Profile picture 4 added to My Authors
7 Apr
The chances of developing an HITT like reaction based on the number of cases/doses so far with AZ vaccine is 0.000344%

The chances of developing an HIT with heparin is around 0.2%, we give nearly all hospital admissions a form of heparin to prevent blood clots.
This really is a true "abundance of caution"
To be clear, I am not a vaccine expert, nor am a pharmacovigilance expert.

I suspect the decision might well have something to do with Moderna, Janssen, and Novavax coming online by the time we vaccinate under 30s.
Read 6 tweets
17 Mar
This appears to reflect more that Pfizer vaccines are made in Europe, and Astra Zeneca is produced in the UK; and that on the continent there's higher vaccine manufacturing capacity.

Besides sending OxAZ to EU to end up in the 🗑️ might not be the best use.
I find the whole "who made what where" argument distasteful. We need Europe to vaccinate as much as we do to protect us, as well as them. Having large outbreaks in your closest neighbours risk a vaccine resistant variant entering the UK.
The part where VdL made it clear that countries with a higher roll out rate than in the EU will be targeted for export bans is especially galling.
Read 4 tweets
1 Feb
Not a virologist or epidemiologist, but I think it'll be a big challenge to persuade people that *some* level of social distancing measures need to remain even after all the >50 and clinically extremely vulnerable have been vaccinated.
The current strategy seems to be having the vaccinated to act like a shield wall, containing the virus in the less vulnerable population and prevent serious disease. This should stop healthcare systems being overwhelmed.

However, the virus will still be around.
With a lack of data in whether vaccines prevent asymptomatic/low grade symptom transmission, it's not safe to assume once you've had the vaccine you will not pass it on. (Though it'll be interesting to see what comes out of UK and Israel)
Read 6 tweets
31 Jan
One of my favourite facts about Paris, it's one of the few cities with an entirely separate "grey" non potable water supply, from the canal de l'Ourcq, for street cleaning, fountains, watering parks etc.
Visitors will often notice (well I do cos I'm weird) water running down the gutters gushing from what might look like water leaks.

They are in fact deliberate, directed by a roll of old rug the street cleaners carry
Which then allows the hard working men and women in green of Propreté de Paris to sweep the gutters clean.
Read 8 tweets
23 Jan
I see that Germany, France, and Austria are considering mandating FFP2 masks in crowded places.

Frankly negligent of them not also mandating the Omnipotent White Plastic Apron (OWPA™®) as per UK guidance.
🇪🇺: oh yeah wear that mask on the 🚉

🇬🇧: wear what you want loser but when you come to work in a hospital have this surgical mask and an apron
👩‍⚕️*gets covid*

it's because of this flimsy mask when someone coughed in my face

🇬🇧Well were you wearing your PPE?



👩‍⚕️well I took off the goggles

Read 4 tweets
22 Jan
France: non French Healthcare workers put their lives on the line for us, please have a French citizenship.

England: oh thank you for your service but if you don't have British passport then no vaccine for you.
It's been pointed out to me that this is not the dhsc/nhse position, and that staff should be vaccinated regardless of whether they have an NHS number.

This does not negate the fact that at least one trust has taken the position not to vaccinate without.
For an organisation that has extensive requirements for training and awareness about indirect discrimination, the NHS trust seems blithely unaware how their policy will disproportionately affect staff less likely to have an NHS number.
Read 4 tweets
19 Jan
If I hear any medical student ever describe the work of HCAs as menial, rest assured I would not want your assistance, paid or not, on our wards.

In fact you can go home, stay there, and never come back to the hospital.
Whilst I sympathize completely with having upcoming exams, needing time to study, and I will make the utmost effort to continue teaching you despite everything else, the most important lesson is that there is no task that is beneath anyone in healthcare if it helps the patient.
Also, here's a bit of training for free. If you ever find yourself writing a letter like this, write it, leave it for 12-24 hours, read it again (ideally get someone else to read it too) and think about how it comes off, then send it.
Read 4 tweets
17 Jan
Meet Lily, she is a cat who lives in Sum Shui Po, Hong Kong, in a grocery store with her owner Meher

Prepare for a while ride ImageImage
Twenty hours ago, Lily was outside the shop where she lived, she was well known in the neighbourhood.

Suddenly a middle aged woman picked her up, and ran off. The was captured on the dash cam of a nearby vehicle. ImageImage
Passers-by and store owners tried to stop the women, telling her that the cat has an owner, to no avail.

Distraught, Meher called the police.
Read 13 tweets
10 Jan
Under normal circumstances, most NHS acute hospitals will have several types of inpatient areas

1. Assessment unit
2. Specialty wards
3. Intensive care

As well as outpatients, emergency department, day case surgery etc.
Patients admitted from A&E would go to 1, then move to 2. Some might go directly to 2, sickest ones to 3.

In many hospitals, the assessment unit is vital to flow of patients out of Emergency Department.
Read 12 tweets
9 Jan
Forgive my naivete and general lack of understanding of fiscal matters, but it seems that the HMRC system of making the seller abroad pay VAT when selling to UK individuals either weirdly overcomplicated, or deliberately so to deter companies from selling into the UK.
Surely a more reasonable system would be:

1) seller takes payment without vat
2) seller goes to HMRC site, declares value, customs label and unique reference number generated
3) URN emailed to UK customer, who pays the tax and vat direct to HMRC
4) on arrival in UK, parcel is scanned, if VAT and tax paid, consignment sent straight to customer.
5) if not, consignment held until uk customer pays, or returned to sender.
Read 4 tweets
1 Jan
Common nonsense I hear about covid, a thread
"PCR has a lot of false positives"

PCR picks up genetic material, it doesn't tell you whether the virus is active or inactive. It does tell you the virus is there.

We use to same technology to convict criminals based on DNA evidence, is that good enough for you?
"well if covid is so deadly how can some people have no symptoms?"

Well idk both of these are car accidents how come people can walk away from the first one?
Read 8 tweets
31 Dec 20
All of our junior doctors. Every last one of them.
It's been a long year. It's been a tough tear.

You've fought bravely, proudly for your patients, your friends, your colleagues.

You're a special group. You've found in one another a bond that exists only in adversity, among brothers.
You've shared tears, comforted each other in dire moments.

You've seen death and suffered together.

I'm proud to have worked with each and every one of you.

You all deserve long and happy lives in peace.
Read 4 tweets
22 Oct 20
Periodic reminder that conservativism fundamentally object to the state being a provider, that assistance from the state breeds laziness in the worker.

And that unfortunately, much of Britain remains very conservative.

Therefore no one should be surprised by what's going on.
This is one reason BUI, despite *gestures at everything* will never catch on in the UK or at least England, because of the fear that it will discourage contribution to the economy.

Untrue, of course, but since when has politics been about truth.
Another major reason is the fear that someone, somewhere, may be taking advantages, and therefore the system must become a Kafkaesque Draconian labyrinth, in order to prevent this. No matter the cost.

See "benefit cheats" and "health tourists"
Read 5 tweets
17 Oct 20
"Coronavirus is just bad normal seasonal flu"

A thread
Seasonal Flu COVID-19
Seasonal Flu COVID-19
Read 18 tweets
24 Sep 20
Fleabag as the acute medicine consultant, a thread
When the medical director tells you about a patient that "absolutely must be admitted"
When the patient actually tells you their story about the problem
Read 15 tweets
24 Sep 20
Can we have a Brooklyn 99 set in China called 九十九号派出所 please
Casa Cuartel noventa y nueve
Prefecture de Police quatre vingt dix neuf
Read 5 tweets
23 Sep 20
Hospitals are not like parking garages, we don't just "need a space" for a patient. To have cancer treatment like surgery you need nurses, doctors, staff, and ICU that also needs that staff.
In March and April, much of the staff we would use for routine treatment like anaesthetists, theatre nurses, ODPs were deployed to cover ersatz intensive care beds. We had normal wards staffed by outpatient nurses, and acute medicine and surgery nurses moved to ICU
Read 6 tweets
11 Sep 20
How the England rule of six will affect households from your favourite TV shows, a thread
Friends: whilst Rachel and Monica can have Joey and Chandler over, rules are broken if Ross or Phoebe come over (>2 households)

However they can all meet at Central Perk, socially distanced Image
Big Bang Theory: Sheldon is unlikely to admit anyone to the flat, in theory Penny can come over, or Raj or Howard. But the full case take away dinners are OFF

Additionally Howard's Mother would likely have been shielding, so he'll have to stay indoors Image
Read 9 tweets
11 Sep 20
When you see people not wearing masks in public, don't confront them, just move away.

Firstly, you don't know whether they have a legitimate not to wear one, and picking on them won't help.
Secondly if you get into a confrontation, voices will likely be raised. If they're carrying Coronavirus chances of it spreading will increase.
Thirdly, if they're not doing it because of libertarian beliefs, they'd probably relish a confrontation and validates their view that everyone is out to get them.
Read 4 tweets
11 Sep 20
In medicine, there is a time period when a deteriorating patient is just stable enough to be moved to critical care/theatres.

This is known as the transfer window.
This came after an independent review led by a renowned Belgian professor of intensive care.

It is called the (Prof. Michel) Bosman Ruling.
Sometimes, we might move a patient to an empty bedspace, to create room for a new patient to come into a designated area (eg HDU)

This is called a Free Transfer
Read 4 tweets
8 Sep 20
*Me, dyed completely purple*

Well yes, I did rob the bank, but only in a very specific and limited way
*Me, herding sheep across London Bridge without being a Freeman of the City of London*

Well yes, I did break the law, but only in a very specific and limited way.
*Me, conducting military drills on Hampstead Heath*

Well yes, I did break the bye law, but only in a very specific and limited way.
Read 6 tweets