🥳🥳PAPERBACK out now!🥳❤️🐘❤️🐘❤️🐘❤️🐘❤️🐘 and it looks amazing and has *READER REVIEWS* which are just gorgeous. It does actually help and I’m so happy 🥂😁🥂😁
Ok here’s the plan. This winter’s going to be 100% sh*t. There will also be snow, floods, a norovirus outbreak +/or other biblical event. So we must be 100% kind to our patients, carers, families, colleagues. Everyone will do their best.
Why is coming back into hospital a ‘re-admission’ in a young person and a ‘failed discharge’ in someone older? A new seizure, fever or even a fall in someone who was stable prior to discharge may not be a failure of care. Bad words lead to bad feelings 😟
601 CT head scans. 5 bleeds, 4 of which predicted by high risk status. So 596 people no benefit from scan and many will have had unseen harm- a trip to ED, fear or pain in scanner, a hospital stay, ‘deconditioning’ aka ‘got worse in hospital’ - we need to change this!
Going to have a rant. 82yo lady post hip fracture. No HF symptoms but someone does a BNP. 11000. Echo EF 19%. Cardio reg + HF nurse spiro, dapagliflozin and sorry while I compose myself ENTRESTO. Pt euvolaemic + asymptomatic. Read your own guidelines guys. I’m stopping them all.
Isn’t it interesting how many people are ‘telling’ their older relatives what to do? How about asking them, discussing with them? Finding out their wishes hopes fears re isolation vs infection risk ...
I’m sad when families get told we can’t diagnose dementia during an acute inpatient stay. That’s rubbish. A good history of what was happening before the acute event allows a confident diagnosis even when there’s other things like delirium.
Actual gold!!!!!! I didn’t know and I am so so happy, thankyou dear
@sanditoksvig
@MichaelJBooks
@Taffyagent
, this is THE BEST moment and I truly hope this book is going to help people getting older and those who love and care for them woooohooo
Many frail older people are being rapidly discharged to interim placements eg hastily commissioned beds in care homes with limited therapy or social work input. And often distant from own 1ry care team.. what can hospital teams do to mitigate risks?
@GeriSoc
@adamgordon1978
Just coming off a stupidly busy on call with the most fantastic team of young doctors. And some very dear senior colleagues who came to help despite fatigue, holidays, strikes and all that. Bloody amazing the lot of them.
I’m not sure I can bear it that Hospital notes, hospital at home notes and GP notes are still all on different systems and that each cannot access the others. AWFUL for EVERYONE.
I’m bowled over. I’ll be talking to a heroine, the
#fortunately
indignant
@janegarvey1
- it’s incredibly exciting (frankly terrifying) but so important. I hope I’ll do the right thing by older people and their friends, families and carers. 😳🤞❤️🐘🍾😁thankyou
@BBCWomansHour
'We need to talk about getting old', next wk
@lucypgeridoc
will be discussing what she's learnt as a geriatrician caring for older people. If you have a question or concern about getting old yourself or caring for an elderly relative, tweet or email us ➡️
It really is madness. It makes patients sad and anxious. It wastes time, energy and precious planet’s resources. It’s unethical. We need to have a re-think.
@lucypgeridoc
from my father today- 84 yesterday and wouldn’t have cake as had been told he needed another Hba1C following last weeks abnormal one! He’s 84! Normal bmi and previously normal hba1c! Finally persuaded him he could have some birthday cake. We need to stop the madness
@nkl_17
I do wonder how many people with a long term catheter are still taking tamsulosin 😬😬😬. Record breaker recently 2016 LTC. Still carefully alpha blockaded 5 years later 💔jeepers.
Just finished what may be my last Christmas Day on Medical take (because it won’t come round again for a while). Bowled over by patients/ families -poignant sad funny brave - and staff born in this hospital or on the other side of the world ❤️🌍❤️🎄❤️🌍❤️🎄❤️🌍
Loving
#ButFirstADrink
A QI project to improve hydration in older people in hospital . Just offer a drink, every one, every time you say hello
@GeriSoc
well done Nicole Vourliotis
@DrSandyThomson
please pass it on !
Our youngest has gone to uni and I’m so happy for her but miss her with a passion and I learn that this is called DEVELOPMENTAL SADNESS which it may well be but I still feel SAD.
‘suitability to admit to hospital’ is being conflated with ‘suitability for ICU’. Many with moderate disease will need o2,abx, mx of comorbidities. They do need hospital if wanted and may benefit. Message that there’s no treatment for covid is WRONG..
@mancunianmedic
@GeriSoc
Is excitement syncope a thing? Ready to read proof edition and my heart is hammering thankyou
@MichaelJBooks
I so want this to help us talk about the stuff that matters 😁❤️😁❤️
Asthenia is a side effect of over 150 drugs in the BNF and almost no Drs know what asthenia means. Asthenia means **weakness**. That’s an important side effect. Be careful! thankyou
@DrLindaDykes
for all the
#FOAMed
This article is terrific. Patients and families, you need more power. Doctors, we MUST make time to listen, and respect people’s wishes. This happens all the time. It’s wrong. I’m so so angry. Thankyou
@guardian
- and
@NICEComms
please read
Flowers missing from our patients bedside tables, due to no visitors. 60 posies made by friends and their children, jars alcohol wiped! Thank you so much, lots of smiles yesterday 💐😊❤️
@LoveMusgrove
Youngest returned to university on Friday. She said I’m going to miss you sooooo much and I turned to reciprocate but she was talking to the dog ❤️❤️❤️
👏👏
@markhoro
on ‘the overmedicalisation of normal human emotion’.
Some people need antidepressants. Lots don’t. And for many, very careful tapering is needed 👏👏
Outdoor activities more efficacious than antipsychotics for treating physical aggression in people w dementia Comparative Efficacy of Interventions for Aggressive and Agitated Behaviors in Dementia: A Systematic Review and Network Meta-analysis - PubMed ()
@FFAFrances
Here’s a study we did about the experience of older survivors of CPR 👏Dr Ella Burden Dr Camilla Paget and 👏👏our patients and their families
Woooohoooo it’s real! I hope this book will help our patients and those who love them.
#geriatricmedicine
the most rewarding specialty
@GeriSoc
A huge thankyou to amazing Louise Ariel Clare
@MichaelJBooks
and magic
@Taffyagent
and my saintly colleagues and family ❤️😁❤️😁
We are DELIGHTED to share that we'll be publishing
@lucypgeridoc
brilliant and insightful The Book About Getting Older this July!
#DrLucy
met a number of booksellers already this week and we're thrilled to share this book with you all over the coming months!
I have had it with VTE prophylaxis which allows no clinical nuance, and RCAs that only look at VTE, never at bleeds or other harm. Current practice (NHS standard contract) is dangerous 😡😡and risks harm to frail older medical inpatient. Thoughts
@mancunianmedic
@gerisoc
?
I’ve worked hard not to be drawn into the PA debate on Twitter, as it’s impossible to have nuanced reflection in limited space.
However, as we come to end of the year, I reflect that without the PAs in our dept, service would have collapsed at times.
Valued & valuable.
Really important. Treating high BP in older people admitted for non cardiovascular reasons (ie lots of people) causes them
HARM. Stop it please.
#NoStatAmlodipine
When someone gets a proper palliative diagnosis (weeks/months to live), it would be very nice if our systems would *automatically* stop inviting them to eg Hypertension and diabetes reviews, AAA screening, metal on metal hip reviews ☹️
#DoLessButBetter
😊better things to do
Cardiologists focus on hearts, gastroenterologists on guts respiratory physicians on lungs. Geriatricians focus on…let me just check… the whole older person
#TheCluesInTheName
#BGSconf
❤️👏
🥳 our FOUR new geriatrician posts in Somerset are out! The right people can choose acute, community, a subspecialty, or a blend. And live in a beautiful place w fab patients and colleagues ❤️🐘❤️🐘
@NahidaBashir1
@morris_vikky
👏👏👏👏👏👏👏👏👏👏
In completely crazy news, Giles my OH and Matt his mate may arrive in Dingle this Sat. And if they do, it looks as if this will be a new WORLD RECORD Atlantic west to east which is insane I had no idea I’m busting with pride anyway. 🤪🤪🥁🥁🤪🤪🥁🥁🤪🤪
‘The concept of overdiagnosis should be taught from an early stage’ 👏👏I watch young doctors learning a new form of medicine - investigate everything, treat everything, merciless activity. They see it as normal now. Reset needed! Centre care round human values.
please don’t fluid restrict in heart failure. Makes life miserable and doesn’t help. If drinking gallons have a chat. Low Na in overload comes up with loop; fluid restriction not usually helpful 😞😞
Sometimes I think geriatricians are like Ginger Rogers, doing the whole dance backwards, in heels. You have to know all the things you could do for your patient - and work out (together!) when not to do them ❤️🐘❤️
@gerisoc
@JKDhesi
proud of our colleagues
#BGSconf
have fun!
This tweet got some attention and here’s what I learned. 1. There’s no evidence for treating asymptomatic heart failure. But we all knew that…2. If you want to treat it despite the lack of evidence (as you know the HF meds help some symptomatic people) you MUST find out…
Going to have a rant. 82yo lady post hip fracture. No HF symptoms but someone does a BNP. 11000. Echo EF 19%. Cardio reg + HF nurse spiro, dapagliflozin and sorry while I compose myself ENTRESTO. Pt euvolaemic + asymptomatic. Read your own guidelines guys. I’m stopping them all.
I know it’s absolutely none of my business but I think lots of us are hoping
#PrincePhilip
gets to make a careful kind plan that reflects his hopes and wishes. Maybe even see a geriatrician? ❤️🐘❤️
Thinking about publication day this Thursday. And about being on call tomorrow, and the extra wards that will be open since last week, and the people in them. And kids and parents and school/no school. And makers of vaccines and teamwork. Solidarity and courage ❤️❤️❤️
Here’s a special thing. We think this week’s PACES
@RCPhysicians
exam
@GSTTnhs
may have been the first ever with a majority of female examiners? Huge well done to
@danfurmedge
and his fab team. Brilliantly organised, kind patients, brave candidates 👏👏👏👏
We need to focus some education towards doctors who find it hard to listen to families advocating for those with end stage dementia. There are nuances but on the whole families speak wise words and need to be respected
My Dad is in a care home dying of end-stage dementia and the GP keeps wanting to admit him to an ED corridor as his pulse is 40. I told him to stop the beta blocker. Dad is singing in his room and happy. GP doesn't get it. Very distressing.
Oh goodness this is sooooo beautiful I mean the logo’s making me breathless obv but also the lovely reader reviews. Oh wow 🥳🥰❤️🐘❤️thank you
@MichaelJBooks
@Taffyagent
for backing 🐘🐘- and the people I don’t know who wrote these things 🙏🙏
The thing is, I can hardly bear that frail older people, often w dementia, are subjected ALL THE Te to ‘routine’ ‘pathway’ ‘bundle’ ‘standard care’ treatments and tests that do not help and inadvertently cause suffering. How do we stop this? It’s not good care 😬😬
@timricketts_
Older people w covid in hospital are often sure they’re going to die. 4/5 don’t but stay in a long time. So if you think they’re going to get better do say so. It’s so frightening and lonely.
Fab letter by
@muirgray
- we don’t want to live forever but we do want to live healthy independent lives. And we can share the knowledge on how to do that, for free, as individuals and as a society ❤️👏❤️🐘❤️
Here’s the future! our visit to rural complex care GP team today. Guess which is the hospital doctor! Ella and I learned tons thank you
@DebGompertz
- what a network of people who know how to get things done 👏👏
@GeriSoc
@jupiterhouse1
They’ll be here in the next hour or so. Can’t promise to post anything as will be in pieces 👏👏🚣🏻♀️🚣🏻♀️👏👏thank you all for the amazing kindness and good wishes helping them fly along ❤️❤️❤️
In other news, today an orthopaedic colleague said ‘ No that patient definitely should not be under medicine. We’ll take him’ ❤️❤️❤️🥳🥳🥳🤪🤪❤️❤️❤️my life is perfect now
"The word
#deprescribing
can have negative connotations. They think that the health system is giving up on them or cost-cutting. Instead, explain to the person that it is about gradually reducing the dose of a medication or a trial without a medication."
I’m aware you may know about this already 😊but Happy New Year dear twitter. I’ve learned so much this year and met good people. Soldier on, it’s all going to get better in the end 🤞❤️🐘❤️
I got in a strop about these new mask towers + wrote rude emails. In fact they’ve been tested. They work. I just need to slow down. Put my stuff on the table provided. Gel. Take mask carefully. Gel. Pick up stuff. Have a little Zen moment each morning. Sorry, IP&C team. 😳🙏
My lovely husband has decided to row the Atlantic next year. Preparation so far has been a good lunch in London and a hernia repair. I’ll keep you posted 😳🌊🛶
Interesting! Yellow card if you see this! Treatment with the direct oral anticoagulants (DOACs) apixaban and rivaroxaban associated with significant worsening of behavioural and psychological symptoms of dementia (BPSD) | BMJ Case Reports
This is EXCITING on a winter day: on Fri 11 Feb I'll be talking funny serious important stuff - with tea and questions - for Age UK Somerset. Please RT dear twitter as I'd dearly like a sellout for a fab charity. Bring grandad/bf etc for a happy afternoon
Super article and a cry for joint working between geriatricians + cardiologists ‘the rise in cTn is specific to myocardial suffering, whether ischemic or not’ ❤️👏❤️
@GeriSoc
@Age_and_Ageing
Never promise I won’t put you in a home. Or if you do, please don’t feel guilty when you get to a stage where that needs to happen, because in certain situations it’s just not possible to keep someone at home. And a good care home lifts the burden kindly and expertly
@parkinsonsdis
@Trisha_the_doc
@drkathrynmannix
It is good to discuss care home placement, KEEPING IN MIND that there might be a day you cannot care for them at home even with supports. I see families who promised to not place the loved one in care home struggle with guilt when it has becomeimpossible to care for them at home
@noodles_nood
Ask your ENT colleagues . I get this, it’s horrible and over a weekend lovely ENT teams have the solution. If otitis externa, abx drops w steroid work near instant magic 🤞🤞
Open discussion w medical students about racism is a v good start. Giving people a list of suitable responses may help. Like ‘the nhs I work for does not allow such language. I’m sorry we are therefore unable to treat you’ .
‘Can I have a white doctor?’ The answer is simply ‘No, you bloody well cannot’. You can have a doctor. A surgeon. And that is the only defining feature you need to know. 1/2
I’ve had a lovely day thanks to friends, colleagues known and unknown, family, the best editor, publishers and agent ... and many many strangers. I think this book will help older people and those who love them. In it together ❤️🐘❤️
Happy Publication Day to this special book and author
@lucypgeridoc
is so full of wisdom and helpful advice and does it all with such warmth.
#TheBookAboutGettingOlder
will help a lot of people 🐘
Watch this space! Somerset Hospital
@Home
roles coming soon 🌳🐣💐❤️🐘❤️all the best bits of medicine in one lovely place. It’s going to be an amazing team! We need GPs, geriatricians, ACPs, therapists, pharmacists (Hereford’s nice too if you must.)dm for deets!
@lucypgeridoc
Y’know with a bit of thought we could make a directory of jobs at various levels where people can enjoy some Geris work. I meet so many frazzled Med Regs & think “you need to decompress in a community role for a bit” - and great for developing autonomy whilst still supported.
I’ve had this little fern since I was a medical student more than 30 years ago and every winter it looks dead and every February it does this and I love it
This makes for a very contented Sunday evening! Just delighted to have that message from someone I really admire. In fact, kind messages from my most admired gerimed colleagues both senior + junior has been an unexpected bonus.Thank you
I’m reading
@lucypgeridoc
Excellent. Thought-provoking, compassionate. Funny: check her daughter’s reaction to having the urethra explained (to be fair, for a quiz; she’d asked). In geriatrics we must discuss attitudes, not just knowledge. A great guide to how to do that.
Indeed. Lessons I’ve learned 1) bilateral cellulitis ‘doesn’t exist’ 2) it’ll be varicose eczema and needs steroid and good emollient (not aqueous) 3)Crusting? It’s eczema. Blisters? Maybe cellulitis. 4) there’s more oedema than you think. 5) stop the CCB
Clinicians beware
Bilateral red legs often has a non-infective cause
31% of patients admitted from emergency department are wrongly diagnosed with lower-limb cellulitis
85% of these have avoidable hospital admission
92% receive unnecessary antibiotics
Hold tight. We’re all in for a very bumpy ride. The chaos and pressure in the system is real, and patients and families suffer. Better communication won’t fix everything but it helps ❤️
They have no idea how many people have watched that tracker and cheered them on . Thank you so much all and for the kind messages and donations to their terrific charities. Nearly here ❤️🚣🏻♀️❤️🚣🏻♀️❤️
Made a den like a 4yo and started recording the audio book ...OK it’s not Abbey Road and I’m no Beyoncé but ‘recording studio’ is not in my daily vocabulary so I’m hopelessly overexcited😁😁😁thankyou
@MichaelJBooks
@Taffyagent
My son teases me: gerries is not so much ‘life and death’ as ‘death and death’. Wrong, my dear son. All about life. Every geriatrician should have a copy of this
@drohanlon
❤️🐘❤️🐘❤️