An insiders view of neurosurgery. Always breakdown the GCS. Have you transferred the scan? Tweets are not the neurosurgical SpRs advice, 97.3% sarcasm.
So the divide and conquer tactics have started. Our trust is offering ยฃ200/hr to trainees to work on strike days. Stay strong people, short term pain for long term gain (for patients and staff).
First they came for our housing, we said nothing.
Then they took our offices, we said nothing.
Then errored pay, we said nothing.
Then replaced us with MAPs, we woke up.
Now they are actively firing GPs!
Time for an all out Primary and Secondary care joint strike! All grades
@zackferguson
I know youโre trying to get an easy laugh but this is not helpful. The junior doctor who was essentially bullied should not have their experience trivialised for a laugh.
Today I discovered we have a PE nurse specialist. They come see the patient after theyโve been diagnosed and treated by the ward team. Their only input โDoctor to refer to thrombosis nurse and clinicโ.
Literally what is the reason for their existence?!
@TheSalariedPA
Probably just going to medical school and doing GP training will do?
Iโve done 5 years of medical school and 10 years as a doctor and guess what, even Iโm not allowed to work as a GP!
This is concerning. As a doctor if I saw a referral with a GMC number and signature at the end I would assume it is a doctor referring.
So what chance does anyone else have of knowing whoโs referring? Especially as surgeons write Mr/Miss and not Dr.
Maybe with all these new โConsultantโ titles being added to every allied healthcare profession title we should go back to introducing ourselves as Dr XX?
I think we are partly to blame for going so casual and introducing ourselves by our first names.
In my department we have a team of MAPs who do ward rounds, bloods, DC letters and follow up for simple cases. They are very good. They donโt go and operate. Not once.
It is lazy senior doctors and struggling hospitals who are using PA/MAPs unsafely.
@msteggy
Iโm a neurosurgery SpR with over 10 years experience as a doctor and I have to run every case by my consultant.
Not sure how someone with a 2 year diploma, and most cases no prior healthcare experience, can do independent practice.
Cutting the lawn this morning and had a thought. Why not turn the narrative?
If MPs think consultants are paid well we will agree to a 6% rise if MPs agree to a 35% pay cut and any future raise should be matched to civil service raises?
@BMA_Consultants
@BMA_JuniorDocs
@DoctorMayJay
Iโd wait till that person who said I canโt drink on the ward needs me to do something and at that moment Iโd say that will have to wait, Iโm going for a drink and walk off the ward. And after that Iโd drink on the ward.
@gem1509
None. Iโve got SHOs on the ward that could be doing these procedures. The PAs should be doing the admin work. Itโs lazy senior doctors who have allowed this to happen.
Agree with this. It is senior doctors who are to blame for lost training to doctors and blurring of lines.
The lazy seniors donโt want to train a new bunch every 4-6 months and would rather train PAs. These ones are obvious with their outpour on X with replies blocked.
I too am a Trainee Neurosurgery Consultantโฆ. But they keep calling me a โjunior doctorโ.
Youโre either a trainee or a consultant, you canโt be both
@RotherhamNHS_FT
๐คท๐ผโโ๏ธ
#ItsOkToAsk
The consultant pay offer is a landmark in the future of medicine.
If you vote yes you are voting to train MAPs with no control.
Itโs an underhanded way to force this change in the wake of doctors being aware of their worth. Think hard. It will affect who treats your family.
โ Training Medical Associate Professionals (ie. PAs, AAs) built into job plans and SPA time
โ Failing to fix critical flaws in the DDRB that will undermine all doctors, not just consultants
๐ Real terms pay cut for many consultants worsening pay erosion
(2/3)
PAs taking over doctors roles. Next the nurses will be doing the PAs original role and the HCAs doing nurses role.
What will doctors do I hear you ask?
Probably the HCAs role to service their ยฃ100k student debt!
Upskilling they call it. Dismantling the profession I call it.
@Doc_IonaCollins
Nice! Getting paid more than I am working 9-5. Just about to start a marathon weekend on call as the only neurosurgeon who will physically be in the hospital looking after a population of 4 million people.
@MDCearns
Itโs very honourable of the person who stayed but they really shouldnโt. If anything went wrong then legally they wouldnโt be covered and I bet the hospital would turn on them in a heart beat. Secondly if the shifts covered then thereโs no problem so
Iโve been an advocate of rotational training, itโs invaluable learning more than one way to do a surgery and sharing knowledge.
But if rotation is the reason seniors prefer non-medical HCP over medical trainees Iโd be in favour of getting rid of rotations.
Everyone thinks they can be a GP!
GPs really need to stand up and be counted instead of training those who think they can replace you. ๐คฆ๐ผโโ๏ธ
Is it weird that in 2023 in the UK I am worried about making a political statement on an anon account on X due to fear of the police tracking me down and ruining my career and livelihood?
We criticise other countries but we really need to look in the mirror.
@Dr_Done_
@DrJonathanD
@askNasha
@mphillips1996
@Lamboozler
As an ST3 I was doing solo trauma craniotomy, EVD, CSDH and shunts. All of which are life saving time critical procedures. I was also doing solo nights.
Barring ICP bolts, I doubt a PA is doing any of the above let alone take the responsibility I did as an ST3.
@Iromg
@Warrenphotog
Mate I am a โtraineeโ but I guarantee you at least 90% of emergency neurosurgery is done by the neurosurgery SpR on call. And guess what, they are a โtraineeโ.
Carry on & unless youโre very wealthy and have private medical insurance soon you wonโt be able to afford my service.
@RCSEd
Only works if consultants facilitate it. Consultants invest in your trainees. You are training people who will be looking after your family in the future. These are the opportunities the junior trainees need but RCS is advertising scope creep.
@manLikeTeaa
@NHSHandSan
@Dr_Done_
@Xeon4f145d96s1
This persons supervisor needs to be reported to their senior or GMC. Sending in someone on their own whoโs โneverโ been taught paeds is irresponsible! Itโs like me doing an operation Iโve never done before. Itโs a strict no no!
Common locker room conversation: there was a rota gap so I had to cover for it. They knew about it but โcouldnโtโ get it filled.
After FPR or during the negotiations please can
@TheBMA
@BMA_JuniorDocs
tackle this next. If thereโs a gap and itโs not covered, the moneyโฆ
@ollieburtonmed
It wonโt work. PA/SCP can stand and watch but they wonโt be operating. Why would I want to take responsibility for their actions? The trust can pay them to watch but canโt force me to let them do anything.
@Parody_RCGP
I can just see the volume of referrals coming though โitโs been reported but can you please review the scans?โ Itโs like the stroke NP/ANP referrals we get currently but magnified.
Why canโt the NHS just employ one person who can do the job instead of employing 5 who canโt?!
@NeuroAlx
Also publish, do audits, present, be a researcher and a leader! Whilst not forgetting to have a life or youโll get an email from HR reminding you to get rest or youโll burnout but donโt forget to do your mandatory learning!
@Lamboozler
But you got to understand Simon that in our days the tuition fees were not this high. Living costs were low. So I donโt blame anyone whoโs leaving. Everyone should do whatโs right for them.
@veggieequallife
Who says this? This is terrible! If youโre not operating mostly independently by the last two years of training and almost entirely independently by the last year of training then your programme has failed you.
Radiologist please can you stop putting โneurosurgical opinion advisedโ on your reports!
Clinicians can make up their mind if referral is required.
Once itโs documented people feel obliged to refer. ๐คท๐ผโโ๏ธ
โฆthat would have been paid to the locum should be given to those covering at BMA rates. No more free labour. The trust will only care if budget is affected.
Well what do we expect. This guy expects me to plan surgeries on peoples brains sitting in a corridor whilst the PAs get given โconsultantโ titles and chair on boardsโฆ
Thereโs a lot of talk about getting rid of national rankings to allocate Foundation Dr jobs.
The youngest generation however havenโt lived through an era of nepotism, which theyโll get from if national rankings are removed.
As someone who doesnโt fit the old boys club mouldโฆ
@TharushaGunawa4
@veggieequallife
@JonnyGucks
@MsBethanJ
I have the bravery to clip an aneurysm or manage a venous sinus bleed. But Iโll be honest, IRL Iโd be worried to speak out sometimes as I know it will ruin my career. So yes anon accounts are a force for good.
@VictoriaAtkins
I donโt think you actually have any real mandate, youโre merely a face to sprout the party rhetoric. Just buying time. Conservatives will be out of office soon but sadly your alternative will be no better. Maybe it will be the year of the independents ๐ค๐ฝ
@Lamboozler
I read the pile on, ignore it. Continue to encourage the young minds. This wasnโt even a person who cared about/wanted a career in neurosurgery they were just keen to see it. And people were stepping on it. People encourage mediocre, they hate passion, makes them look lazy.
@Parody_RCGP
@dr_irfan_malik
The Consultant Diagnostic PA will report all your scans for you. But since they are not a doctor if you follow their report and miss something itโs your fault.
@GMCharlatan
@medicalmodelbri
Does UMAP count as a union? If your supervisor limits your scope you donโt really have a case. Otherwise the F2 would be clipping aneurysms and showing me the middle finger.
Door salesman: have you had a good day?
Me: on night shift so just getting ready for work.
Salesman: what do you do?
Me: a doctor.
Salesman: what like a brain surgeon? Haha ha ๐
Me: yeah I am actually.
Salesman: ๐ณ
On my way out the hospital this morning I saw an elderly gent walking with two sticks and an elderly lady walking behind pushing a wheelchair.
One doesnโt want to burden the other with his weight and the other doesnโt want him to fall.
So much
#love
๐
@Dr_Done_
@Aidan_Baron
Iโve been a surgeon for 8 years. Doesnโt mean I can be a scrub nurse! Half the time I canโt even change the craniotome! And 90% of the time I shout why isnโt this working instead of actually knowing how to fix it.
A brain surgeon with 10 years of experience (plus a minimum of 5 years at medical school) earns ยฃ28 an hour.
@theBMA
Strike Ballot will be going out by post to junior doctors in England tomorrow. Vote YES for full pay restoration.
#PayRestoration
#BMABallotReady
What everyone thinks
#Neurosurgery
do vs. what they actually do!
(Jokes, Iโve never taken a met out like that, I use the middle finger, itโs longer!)
@ReddicalMedge
@gem1509
Iโd add to that they donโt care as they will retire and I, the future neurosurgery consultant, will be left with a work force which is undertrained.
The MAPs will work 9-5 and Iโll be up at 4am teaching and ST5 how to do an EVD!
(Ps. Not talking about my unit)
@docbenh
@Xeon4f145d96s1
@parthaskar
I hope you put a complaint in?! Otherwise someone else down the line wonโt be so lucky.
Once regulated GMC will be inundated.
I know some medics hate rotational training but personally I like it. Because 1) you get to learn from different people and 2) if you have a particularly bad rotation/trainer you know thereโs a definite time when that rotation will end. Iโve had lots of the 1st and some of 2nd.
@MDCearns
Next time it happens management are under less pressure to cover it as โsomeone will step up in the endโ. The only way you get results in this economy is unfortunately though financial penalties. Disclaimer: I have been that person who
@Disgruntled_SHO
I can see and write for the patients I see.
I can also operate on my own too, itโs faster then teaching juniors. But I spend MY TIME teaching.
Also, you donโt know it, but rounding with your seniors teaches more than books. But sure go do the TTOs if you prefer.
@TheSalariedPA
Fine, sit the FRCGP exam and prove what youโve learnt โon the jobโ?
@DrRichardPile
is a GP who has a private company which outsources services. He probably benefits from ARRS funding thus he has an agenda to push. Putting patients first? ๐ค
Iโd rather CCT and locum as a SHO in my current trust (who btw has been short of at least 2 SHOs for the last 4 years) then do this fellowship at
@GSTTnhs
Maybe itโs deliberately. Job unfilled, cue enter PA to fill roles.
@bbcemt
Your article has a lot of inaccuracies. The vertebra is not crushed, thatโs a different pathology. Also CES has a spectrum and it is not a clear cut diagnosis until it is. You may wish to read up on incomplete CES.
I remember sitting in the car park of the place I worked at during medical school eating cold risotto, overdraft fully gone and not knowing where Iโd get money to get me to my next pay-check. The uni wasnโt very helpful/understanding either.
Support the
#LiveableNHSbursary
@traineENT
Everything gastro - I wonder why it takes these doctors 5 years in a training program to specialise when a GP (
@DrAmirKhanGP
)can teach it to non-medics in 1 hour!
When the neurosurgeon says send us the scan and Iโm not giving an opinion until Iโve seen the scan itโs because we donโt trust peoples ability to read scans.
And with this becoming more common, it become imperative we see the scans ourselves.
@RCRadiologists
@halliday_kath
What the hell is going on here? Is there an alternative route to consultancy that doesnโt require medical school, radiology training and FRCR? Members will expect a swift and comprehensive reply to this nonsense.
@AlexNevard
Sometimes the worst referrals come from the consultant, I think they feel they are too senior to bother with referapatient.
The referral should come from the person whoโs seen and knows the patient.
@BMA_James_Steen
They can pass what ever they want. Ultimate if the consultants refuse to supervise them then thatโs nothing the management can do. This is why our is important to REJECT the proposed CONSULTANT contract.
@zackferguson
Doctor: when did the headache start?
Patient: sometime this morning.
Doctor: what time was that?
Patient: in the morning around breakfast time.
Doctor: what time do you have breakfast?
Patient: early in the morningโฆ
@DrJSherrington
Iโve seen a lot of penis. Never found one with poor hygiene/smell that doesnโt have a foreskin. On the other hand ones with foreskinโฆ Iโve had to hold back vomiting many times!
@Parody_RCGP
Itโs about perception.
1. Hospital doctors - no appointments = too busy
2. GPs painted as not working hard/part time by media
3. GPs not as respected by public as before as seen as โnot specislistโ - just a route to hospital โspecialistโ
4. Public apathy to failing NHS
@Dr_Done_
This is a misrepresentation of what I said. I did not say they are planned. I merely stated that Consultant is not a protected title - we already have Consultant nurses and Consultant radiographers (and probs others).
@drcolinm
Interestingly in his reply
@drcolinm
never denied seeing the use of the โconsultantโ title as an issue.
He denied saying it but if someone else said it he may have agreed or at least not seen it as an issue.
Is it just me or is medicine being made more of a โworking classโ job in the name of โaccessibilityโ?
The pay will be rubbish but the hard working, aspirational individuals who believe theyโre doing the โgreater goodโ will be drawn to it?
We are making careers in medicine more accessible by launching the first 200 doctor apprenticeships in the NHS.
This is an important step with
@NHS_HealthEdEng
to grow the workforce and ensure anyone with the ability and passion for medicine can be a doctor.
Very jealous/inspired of how Queens Square are helping and are proud of their SHOs! The rest need to step their game up! Be proud of the surgeons (and humans) you help to mould.
#neurotwitter
#mentoring
10
@QSNeurosurgery
SHOs were shortlisted for National selection. They are all brilliant Drs ( humans). I have no doubt that the ones not successful this year will have a National training number next year.
@QSNeurosurgery
will do everything we can to make that possible