π¨New study
@BJGPOpen
Q: What was it like accessing contraceptive care during first wave covid-19 lockdown in the UK?
A: Not easy for some!
Thread π§΅
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Access to & use of contraceptive care during first COVID-19 lockdown in the UK: a web-based survey
Hi
@wesstreeting
- about direct access to specialists, I have questions ... thread π§΅
You have a lump in the back of your head, you want to see a dermatologist. Why not a surgeon?
What if the lump was in your neck. Is it a gland swelling, a lipoma, cancer? Who do you see now?
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Medicine is complex right? Who do you want to sift through the myriad of possibilities? Sometimes give you advice on what is most likely given the epidemiology, your demographic/history, family history, examination findings?
You need GPs, we are trained to do all that.
6/6 end
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
@twicezer0
@wesstreeting
No.
You need more GPs, not a silly policy of allowing everyone to self-refer when the system is already on its knees to deal with the current demand.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
My turn!
#NormalizingHIVChallenge
Name: Richard
Age: 48
Home: London/Brighton
Occupation: doctor (GP)
Children: no thanks!
Married: in relationship
HIV status: diagnosed 2008, CD4 120
ARVs: they work!
#Undetectable
within months. Doing triathlon few years later!πββοΈπ΄ββοΈπββοΈ
#uequalsu
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Knee pain- orthopedic surgeon surely? What if you have pain, swelling & stiffness in your fingers - see a rheumatologist? What if you also have psoriasis - how do you know it is not psoriatic arthritis? Do you see a dermatologist now?
Wait till I tell you about STIs & SARA.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Dizziness - oh this will be fun. Is it vertigo/balance issue so go to an ENT? What if you had really slow or fast heart rate or heart valve prolapse - would a cardiologist suffice? What if it is a problem with your BRAIN - how about a neurologist? Maybe you're just anaemic?
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
2nd day running I have been in my surgery since 8am. Not sure I have the appetite, or the emotional energy to spend my Saturdays doing the same. 9 to 5 on a rota they say but hey, that will turn into 12 hour days in no time. You need more GPs not more hours from same tired lot.π
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Depressed? Want to see a psychiatrist? Good luck with that.
Tired all the time? Where do we start?
People always worry about cancer. You will need more oncologists than what you have now. By then maybe they might be too overwhelmed to see people who ACTUALLY HAVE CANCER?
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
I haven't finished.
Shortness of breath & cough. Sounds like for a chest physician? What if you had poor heart muscle/heart failure & your lungs were full of fluid? Cardiologist surely? Night sweats, fever, & gland swelling too - lymphoma? Maybe you are anaemic (again)? HIV?
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Dear David. As a GP Partner I've unblocked toilets, mopped floors, moved furniture, done blood tests, cleaned the patio, fixed IT problems, but I really rather other people did them to let me get on with my own job because apparently people are having difficulties seeing GPs
@Azeem_Majeed
@DoctorJLam
In Sheffield we had a neurology lecturer who used to present with acetates. He would start with a simple illustration, then add layer after layer or flip to another set to illustrate where the nerves came and went. Modern day equivalent of PowerPoint animation.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Every GP training scheme should start their year with a talk by
@MichaelMarmot
to fire up their motivation to understand deprivation, how it affects the patients they see, and what they can do about it.
#RCGPAC
#woncaeurope2022
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
A reminder: STI treatment from GPs can now be endorsed with "FS" for FREE SUPPLY (England only). You can also just tick a box on EMIS.
15 years after I first raised it at DH I am glad we finally got it sorted. Thanks for everyone who made this happen! ππ
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
@twicezer0
@wesstreeting
Successive governments have promised more GPs, but they say nothing when media demonised us, at the same time created unrealistic demands and working conditions leading to GPs leaving the profession in droves. I am one of the few left to hold the fort. One day I too will break.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Meanwhile I got a job as GP registrar. I am eternally grateful to my training practice who took me onπI learned about inequalities & social justice. I became a feisty GP trainee who wasn't going to take any shit from anyone.
So that's how I got to stand up to the racist.π¦ΈββοΈ
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
A group calling itself "Clinical Advisory Network on Sex and Gender" is holding a "conference" in the same building as
@rcgp
headquarters. A group of us at
#PrideRCGP
π³οΈβππ³οΈββ§οΈ are asking the College to pull the meeting, and here are the reasons why.π§΅
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
A thread about how I called out a GP trainer for being racist:
CW:
#racism
I was one of the GP registrars in a large training practice. We had a joint breakfast/tutorial one morning a week with registrars from another practice, led by a partner from either on a rota system
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
I hate this mentality. Life is muddled. It's our job to help people make sense of it. One day a clinician will miss something important by insisting on "one problem only". I don't buy the "self preservation" argument either.
Delighted to accept an
#NIHR
Academic Clinical Lecturer position based at Centre for Academic Primary Care
@capcbristol
@BristolUni
π. Can't believe it all started 9 years ago with an In-Practice Fellowship at
@Imperial_PCPH
. Forever grateful π Exciting times ahead!π
#phdchat
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
In other news, a patient's key worker didn't just ask me how I was, they did one better - they commented on my outfit. They said I looked "fabulous".
I'm now
#FiftyAndFabulous
π π
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Shared this wisdom from
@A_AMilne
today with a patient about how we coped like Piglet π½π·during the first few months of lockdown. We were both desperately trying to be useful we forgot to be scared. It made us laugh. π
βItβs hard to be brave,β said Piglet, βwhen youβre only a Very Small Animal.β
βIt is because you are a very small animal that you will be Useful in the adventure before us,β said Rabbit.
Piglet was so excited at the idea of being Useful that he forgot to be frightened. ~A.A.Milne
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
@alisoncook12
@wesstreeting
Having a healthcare professional you can trust with their advice and treatment is important. Reduces a lot of anxiety, unnecessary investigations and referrals. But they can also sense if something is not right and refer earlier. For most people this is their GP.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Hi
@DrHilaryJones
, GP living with HIV here πPeople with
#HIV
& undetectable viral load are unlikely to infect others. This includes health care workers like surgeons
#uequalsu
. I wrote about this 10 years ago
@bmj_latest
free link:
@DavidJCrook
@wesstreeting
Absolutely. This risks lengthening waiting lists which are already impossible to manage, and delays in treating those who could really benefit from specialist input.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
@drmeenalviz
I am forever grateful to everyone who got the vaccines out there so quickly all over the world. People forget its contribution in getting all of use safely out of the pandemic. There are countries with low vaccination rates seeing high mortality rates right now. β€οΈβ€οΈβ€οΈ
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
@MichaelTun1
@mgacsm
So sorry to hear about your dad. He did the right thing to highlight the problem what a shame it was too late for him sadly, hope the hospital is now doing three right thing. From a fellow Burmese doctor. RIP π
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
One year after a tentative Twitter poll asking women about access to contraception during the lockdown, we report our findings of an online survey today at
#SAPCASM
- Session 3D Women's Health
(watch the Zoom acrobatics as I am also chairing this session π¬)
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
That Telegraph front page about Prince Andrew and a bathtub ...
It suggests sexual assault/rape could only happen in certain places/conditions. Just another level of gas lighting his people would use to defend him.
It's just f**king ridiculous & insulting to victims.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
To pre-empt vicious abuse from certain followers of some accounts (I have seen the emails),
@trishgreenhalgh
has been using an app to block people. If you have been caught in the crossfire- let me know, I will compile a list to ask her to unblock. Easier than sending loads of DMs
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
@Ads302
@wesstreeting
You know this is what happens already privately but ppl pay Β£200-300 for a scan, get a report which they do not understand and we end up spending ages talking about incidental unimportant findings when the original problem could have been sorted with one appointment!
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
@SarahMNeilson
@DrJenGunter
I just conducted focus groups with 16 to 19 and 20 to 24 year old women talking about contraception. Some wished their parents were more comfortable talking about sex with them. So no, it's not creepy.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Well I tried
@Nigella_Lawson
's clementine cake today. It was sooo easy to make (so easy that I forgot to add the baking powderπ). It really is moist and delicious π No flour or butter needed! The finished bake looked almost like the one on the website!π
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
I have two words: Bawa-Garba
I still have questions why a white doctor (Dr Stephen O'Riordan) was allowed to get away (he literally ran away to Ireland to practise after the case) while a black doctor was struck off.
GMC infected by racism?
A ruling from Reading employment tribunal found that the GMC had discriminated against Karim by continuing an investigation into him when it did not investigate the same allegation against a white doctor.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
@DrNighatArif
I am sure a different Oxford professor
@trishgreenhalgh
would agree with the points you made about masks especially with airborne transmission.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
How on earth are all those people still catching Covid when we're all still mandated to wear masks which protect us from catching Covid? It's a mystery, it really is... π
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
One positive thing from Ashraf the bigoted orthopaedic surgeon's tweet is the outpouring of allyship and support the medical community has for their
#LGBTQ
peers. Look at the replies and QTs!
Thank you everyone ππ½ππ₯²
π€π€π€β€οΈπ§‘πππππ³οΈβππ³οΈββ§οΈ
#Pride
#PrideRCGP
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
It's the Whittington VTS GP Trainers away day at Cumberland Lodge and I taught them
#Jerusalema
dance challenge during the break. I think they were pretty good considering they only had 10-15 minute tutorial! π
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
It is not easy to retaliate when you belong to a group that is often oppressed, made worse by power imbalance (eg trainer vs trainee). I didn't feel brave, I almost had a panic attack standing up to a senior! It highlights importance of allyship as some feel powerless to act. 4/6
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
@FishMcFace
@wesstreeting
We have in fact a self-referral system for minor illnesses to see a pharmacist for advice, physiotherapy, podiatry, dietician, psychological therapies and antenatal services. If inappropriate, they send back to GP. This system works for low risk and less complex problems.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Iβve been told of a doctor who was encouraged to sign off as covid on 2 heart attacks & one person sadly dying from a stroke in just one day. The total opposite of Germany where underlying cause of death is recorded on death certificate. Fascinating how figures are correlated?
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Got my booster ππͺand a little treat. βΊ shush π€«!
I got the most auspicious batch number for a Chinese person. I'm going to "prosper, easily prosper" 𧧠π
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Later, the other registrars and I had a debrief.
"You were very brave standing up to [the trainer]" one remarked.
Why did *I* have to be "brave"?
Why didn't anyone say anything?
Why was it up to me?
Also, why did that trainer think they could get away with being a prick?
3/6
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Today is a good day to show solidarity and support for all
#LGBTQ
patients and peers. You are safe and welcome in the NHS. Thank you
@RainbowNHSBadge
π³οΈβππ³οΈββ§οΈ
#PrideRCGP
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Crazy day duty doc- sat here for almost 12 hours! πππ
MSK, child health, dermatology, psychosexual counselling, home visit, trauma care (x3!), depression, trans care, joint injection, neurology, ENT (Epley manoeuvre!) Also managed to give 3 flu jabs opportunisticallyπ
#TeamGP
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Erm hello. I have been a part time GP for 20 years in the same practice. I am the only GP in this practice who has offered continuity to the same patients and their families for 20 years.
NHS CEO Simon Stevens has said that continuity of care has decreased in the past few years, largely due to GPs 'choosing to work less time full time' in practices
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Decided to wear scrubs to work. Last time I wore them was as an SHO and I feel like I'm in my 20s again!π Does it stop me from bringing bugs home? No idea! But I feel like an extra from Casualty π€·ββοΈπ
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
My latest dance is dedicated to those retired/ tired old health care professionals who need to write to national newspapers to manufacture outrage against other health care professionals just to get attentionππ
#STFU
Sound on π
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
It's hell.
We have slots at 10min intervals starting at 8:30 for any econsult/tel triage appts.
The list is now at 23:40 - ie 90 people to call back/contact. It's only midday.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
I have no problems with increasing capacity in general practice in whatever form but if you want to increase the medical workforce surely you need to stop them from leaving in the first place? You don't treat a haemorrhage with more IV fluids or blood transfusions as far I know.
Exclusive: NHS England are set to run pilots of staff and associate specialist doctors in general practice, in a move that the BMAβs GP Committee England has βsignificant concernsβ around
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
@DrWillMurdoch
@carolinegee13
@wesstreeting
Luckily we have a minor surgery service. No need to be referred to secondary care! Fund general practices and the primary care services properly!
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
I have heard enough disparaging remarks from journalists to a pharmacist from Warwickshire about what GPs have been up to during this pandemic. I don't need their opinion or validation. Our patients appreciate our efforts during this time and that's enough for me. π
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Context: I almost didn't complete GP training due to my immigration status at the time. BMA: useless, course director: lost, the GP Dean: "meh". I left the VTS, involved my MP (
@HackneyAbbott
π) & immigration lawyers. The process cost me emotionally, personally & financially 5/6
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Am I the only person obsessively getting rid of frivolous things from the "Problems" list from new patients' notes?
Why do people feel they need to clutter the list? What value do they add to the clinical content?
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
@d1_david
@imnotnorse
@Telegraph
Dear David. As a GP Partner I've unblocked toilets, mopped floors, moved furniture, done blood tests, cleaned the patio, fixed IT problems, but I'd really rather other people did them to let me get on with my own job because apparently people are having difficulties seeing GPs
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Friends and allies, please support us to ask this meeting to be moved from the RCGP headquarters. You can use the feedback form here:
#TransRightsAreHumanRights
/ends
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Shout out to a humble country girl born during the war in a remote village in Burma, who travelled to Rangoon to train to be a nurse/ midwife, met my dad, emigrated to Hong Kong not speaking a word of Cantonese, & brought up 3 kids.
#Tigermum
#InternationalWomensDay
#MothersDay
π₯°
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Most of the FY2s we've had had never really taken a history, used their clinical skills to come to a set of working diagnoses and managed a patient from the beginning to the end of an episode until they set foot in general practice. That cannot be how you train tomorrow's doctors
Sadly yesterday that FY1 didnβt see any patients clinically. Why? Doing Discharge Summaries and βchasingβ results
Bad IT is dangerous to
#PatientSafety
because it slows Clinical Care when diseases are only slowed by treatment
Bad IT also destroys training opportunities
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
@tariqjenner
For crying out loud. As if medical staff don't have enough to worry about and deal with. You have people like this who do not believe covid exists and wants to discharge their relative home to receive VitAMiNS instead. π€·Disinformation costs lives!
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
As if being a single handed GP in a deprived part of London wasn't hard enough,
@fhussain73
tries to reduce knife crime in her area! Absolute respect π
#RCGPAC
#woncaeurope2022
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
I've spent a week studying a piece of choreography to Ed Sheeran's Give Me Love. Today I think I've done the best I could. Need yoga to get more supple. Can't quite manage the graceful & purposeful movements as the original though. My toes hurt π
#lyricaljazz
#dancingdr
#lyrical
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Our
#PrideRCGP
π³οΈβπ programme aims to challenge attitudes, homo/bi/transphobia. We recognise this has to start with our own peers & institutions. Having more
#LGBTQ
healthcare professionals being visible is a good start.
β€π§‘ππππ
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
Why πcan'tπpeopleπwithπcovidπ symptomsπ getπ aπ test πfromπ their πGPπ and πrecord πthat πonπ the πcovid πappπ if πthey πtestπ positive?
π€·ββοΈ
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
While we believe we need honest & respectful discussions to improve care of gender-questioning young people, we should not have to share a platform with people who invalidate or dehumanise lived experiences of trans/non-binary peers/patients. Our community does not feel safe.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
That is why trans people are voting with their feet and flocking to our practice as the only hope in North London. We now have nearly 100 pts we are caring for. Reminds me of the days when clinics used to have a list of "HIV friendly GPs". You say unfunded, I say discrimination.
You will see other speakers who are known for their gender critical views, oppose gender affirming care, and have a history of transphobia. Some also have questionable views on trans people in general. The RCGP are clear the conference DO NOT share their values.
#PrideRCGP
π³οΈβππ³οΈββ§οΈ
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
10 years ago it was just PCTs. Now the number of organisations that need GPs to engage and have meetings with have trebled: PCNs, GP Federations, CCGs. More GPs are needed just for meetings it seems, but not sure if the person hours spent are effective.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
The list of speakers might seem respectable, including a well-known obstetrician, a high-profile GP, and until yesterday, the immediate past chair of the RCGP [the reasons for withdrawal not known]. But look under the veneer of "safeguarding" and "evidence based policy"....
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
This event would worsen the already little trust the LGBTQ community has with general practice. It is also hurtful to know this would undo years of work
#PrideRCGP
π³οΈβππ³οΈββ§οΈ have done to build relationships between LGBTQ community and general practice and improve their care.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
This meeting might give an air of credibility and face validity, but it is the accidental endorsement by the RCGP, which will do the most damage. LGBTQ+π³οΈβππ³οΈββ§οΈ patients already feel unsafe and have difficult relationships with NHS when accessing care due to perceived discrimination.
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Richard Ma PhD 馬ε―ζ ππ³οΈβππ³οΈββ§οΈπͺπΊ π
A patient I see regularly had been feeling hopeless for years and mentioned their pet as their only reason to keep on living. I bought their pet a small present for its birthday. It wasn't expected and their mood lifted. It was better than any painkiller or antidepressant.
OK, by popular demand, will you share the kindest thing you did in 2019? Not for personal glory, but to show society is strong and kind and never, ever loses its way completely?