Geriatrician and a former president of the @RCPEdin. CASBS Fellow 2018-19 @CASBSStanford. Interests all things bedside + all things older.
Edinburgh. Scotland.
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Honoured to be elected next President of the Royal College of Physicians of Edinburgh. Thanks to everyone who has sent messages of congratulations, support and encouragement. @RCPEdin
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Agreed.
And as a single example here is a starting list of causes of breathlessness.
Medicine is Difficult.
Seeing undifferentiated patients in specialties such as general practice and emergency medicine is very challenging. To an outside observer, much of the work may seem routine or straightforward but this is only the case if the clinician is well-trained and highly experienced.
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“The increase in service-based “Locally Employed Doctor” posts is a matter for serious concern, not celebration.
The increase is produced by a training gap - a huge and growing mismatch between the numbers of graduates and the number of structured training posts available.”
The College has responded to today’s gmcuk workforce report. Read the full statement from our President @AndrewElder: rcpe.ac.uk/news/college-comm…
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My personal take on Anticipatory Care Planning.
heraldscotland.com/opinion/1…
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An outstanding radiologist tells clinicians that we should set more store on our own judgement.
And scan fewer people.
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A real honour - and thanks to all my colleagues at @StanfordDeptMed, @JohnsHopkins , @uabimres, @Bedsidemedicine and many others for including me in their work on bedside teaching in recent years. @cuttingforstone
We are pleased to announce that our President, Professor Andrew Elder, has become the first doctor practising in Scotland, and only the second in the UK, to be awarded a Mastership of the American College of Physicians. Please visit our website for more: rcpe.ac.uk/college/professor…
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The world needs more geriatricians!
I couldn’t have made a better career choice - particularly with a name like Elder!!!!
Today we’re launching #ChooseGeriatrics – our new campaign which celebrates the variety and rewards of working in older people’s healthcare. Find out more and how to get involved! 👇
bit.ly/47JlgBr
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Honoured to receive MACP at the @ACPinternists meeting in Chicago. Thanks to all my colleagues and friends in the USA for their support. @cuttingforstone @Bedsidemedicine
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Seen on the bedside stand of an older patient with extremely poor hearing. Communication this way takes longer, but is time well spent. @Bedsidemedicine
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At a time when concerns about NHS staff wellbeing have never been higher this is a deeply worrying decision that @RCPEdin will contest.
@RCPEdinTrainees
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My thanks to this group of doctors from Sudan, all working in the NHS at the moment, for coming to @rcpe to discuss how our UK and international medical communities can provide support at this very difficult time.
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Better care of older people, and faster discharge from hospital, and community prevention of admission all need more OTs. ( and physios!)
Let’s push that up the agenda
attoday.co.uk/almost-three-q…
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How much data, repeated how many times do we need to see before we understand that “social” care must be fixed?
And not just to help treat people at the front doors of our hospitals, but to support those people stuck in hospital who don’t want or need to be.
@RCPEdin @GeriSoc
A&E rising demand isn't driving long waits in A&E. Attendance rates are not dramatically up from pre-pandemic levels. The real issue is collapse of social/community care provision & some increased acuity. This is driving longer stays & means fewer open beds for ppl to go into
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Today we have issued a joint statement with @acutemedicine on the current situation in acute medical care across the UK rcpe.ac.uk/college/joint-sta…
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Geriatricians.........Make today the day you look in your patients' mouths.......you'll be amazed at what you might find.......#GeroTwitter
Off to deliver some #mouthcare prompt cards and pens for Albion wards away day on Monday. Which their ward manager will be delivering.
#mouthcarematters
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Physicians take note :
Our systems and structures of hospital care do not match the needs of all of our patients.
A timely reminder…..
Interesting letter in JAMA.
Even short periods of boarding in the ED can precipitate delirium in pts with dementia.
Effects detectable at 4hrs. Non-linear interactions with wait time and age.
jamanetwork.com/journals/jam…
@RCEMpresident @adamgordon1978
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The world needs more geriatricians.
📢 REPORT OUT TOMORROW!📢 "We need conversations to support recruitment, retention & support for a workforce caring for older people. This starts with recruiting the #geriatrician numbers that we need."
'The case for more geriatricians' is out tomorrow! #MoreGeriatricians
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This abdomen did not get like this overnight. "His medical history was notable for untreated hypertension and hyperlipidemia." .....and the fact that nobody had ever examined his abdomen, or if they had, had failed to detect this. @Bedsidemedicine
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Think very short answer questions should replace best of five? Here is our roundabout take on that, featuring a riddle and a bar! #meded @medicalaxioms @cuttingforstone amjmed.com/article/S0002-934…
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Attention all those who prescribe statins to older patients, or want to stop them! More ( reasonable quality) evidence that current risk thresholds lead to overprescribing.
annals.org/aim/fullarticle/2…
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"The best diagnostician may be the clinician who makes the diagnosis using the fewest resources"
Diagnostic excellence requires
- ↓ preventable harms from both underdiagnosis & overuse
- non-punitive feedback to calibrate how practicing clinicians think
Our proposal for diagnostic performance measurement & feedback w/ @AshleyNDMeyer @JAMA_current jamanetwork.com/journals/jam…
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Physicians should be aware that respectful and patient-centered communication may be medicolegally protective in the event of an adverse outcome.
annemergmed.com/article/S019…
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The key to unlock the problems of the front doors of our hospitals lies at the back doors.
Social care shortage compounds NI hospital pressures bbc.in/3GAkBqe
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Dementia is not going away anytime soon.
High quality, fairly funded care is needed - it is a health problem, not a social problem.
We welcome @alzscot Long Term Care Commission report and urge the Scottish Government to take forward its recommendations. Read the statement from our President @AndrewElder rcpe.ac.uk/college/long-term… #DementiaAwarenessWeek
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Many NHS units I know of couldn’t function without the input of SAS doctors.
Whether it’s In-patient or out-patient work, we need you, value you and thank you!!
#SASWeek2023
@RCPEdin @RCPEdinTrainees
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Discontinuity of care also happens in hospital and causes duplication of effort and frustration for patients and doctors. Has the impact been studied? @DrLKVaughan
Seeing the same GP better for patients and doctors, study says bbc.in/3wpR9Ax
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My own personal apologies to everybody affected by this. We’ll do everything we can to reschedule sittings just as soon as possible. @RCPEdin @RCPEdinTrainees
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A huge thanks to Dr @KerriBaker20 our @RCPEdin Director of Education and Dr Ishwinder Thethy Chair of the Organising Committee for putting together such a successful St Andrew’s Synposium.
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Important message in this letter which I signed on behalf of @RCPEdin
Multimorbidity already is - and will continue to be - the new normal for many patients. Healthcare systems, guidelines and clinical research must all adapt to that reality.
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Good to see @RCPEdin leading on education in this difficult area.
ME/CFS - a multisystem disease, often with an infective or other immune trigger (but trigger may not be identified).
Defining characteristic is (delayed onset) Post-Exertional Malaise (PEM) - exertion can be physical, cognitive, sensory, emotional.
- Karen Leslie #rcpeMECFSLC
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Can't forgive Johnson for “The noblest prospect which a Scotchman ever sees, is the high road that leads him to England.” but I'm with him on knowledge.
And just because there's more "knowledge" on our phones, doesn't mean to say that doctors need to know less.
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I’ve long thought that doctors don’t speak enough about - or have a place to speak about - errors they think or know they have made.
So, great to see a session at #rcpetrainees24 on the topic of errors, leading off with a talk from Dr @AddyMcleod @RCPEdin
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Good to see my good friend’s @abe_verghese fabulous new novel - The Covenant of Water - on the shelf of a Glasgow bookshop.
Dr Digby Kilgore has come home!
And if you want to understand that comment, give it a read!
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So….I bought this orchid in a major supermarket chain about 6 years ago. It has flowered about 3-4 times a year since then, always well, but this time eclipses all past performances. Occasional water, feed it its own petals- that’s it.
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Do hospital doctors know as much about “acute brain failure” as they do about acute cardiac or respiratory failure?
They should…………
🔬⚗️The challenge of #delirium pathophysiology research.
🧠 Multiple routes to brain disruption
Current practice = Rx triggers, normalising physiology, Rx symptoms, rehab.
❓ Will we have effective drugs for delirium in the future?
🔗 nature.com/articles/s41572-0…
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"Doctors who are warmer and more competent are able to set more powerful expectations about medical treatments." Can a Nice Doctor Make Treatments More Effective? nyti.ms/2S3k7k2
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I am increasingly uncertain about the difference between what we call “health” care and what we call “social” care.
The distinction appears illogical and anachronistic and ultimately simply serves to permit means testing for “social” but not “health”.
Social care has been let down by successive government of all hues.
The starting point for #SocialCare reform needs to be the solid building blocks of a system we can all aspire to and want to invest in, says @NatashaCurry123 in her latest blog. nuffieldtrust.org.uk/news-it…
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Thinking fast and slow is a great book.
And we should all heed this great quote.
“A reliable way of making people believe in falsehoods is frequent repetition, because familiarity is not easily distinguished from truth.”
@CASBSStanford
Daniel Kahneman, who changed psychology and economics forever, dies at 90.
Thanks for everything.
We remember him in 10 great quotes:
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Important paper regarding statin use in the old and older old..... ---- get out there and #stopastatin today!
bmj.com/content/362/bmj.k335…
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And Dr@hannahpreston and Lily show just how to co-chair a meeting!
With Dr Fiona Duthie too. @RCPEdin @RCPEdinTrainees
Amazing @RCPEdin giving us a whole room to chill out and feed in before this little one helps chair the later session at the #rcpejointspecialty24 !
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Understaffing is bad for patients and bad for staff. Our older people, and those who work to care for them, deserve better. @GeriSoc
This report is useful and a timely reminder of the extent of understaffing in older people’s healthcare which must be addressed. We will continue to push for additional action to tackle vacancies and invest in the dedicated workforce that cares for the health of our older people.
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Good to see a rapid change of change of mind here.
Now aligns with decision in Scotland, which we heard about last week.
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Great team of examiners out early on a Saturday morning at a great
@MRCPUK PACES centre in Perth Royal Infirmary.
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After direct patient care, the most important role of the doctor is to teach and train those who will follow them. We must ensure that all doctors, and consultants in particular, have the time in their job plans to deliver teaching and training.
We have published a joint statement with @rcpsglasgow and @RCPhysicians, welcoming @gmcuk's plans to develop, revise and adapt education and training for medical students and doctors: rcpe.ac.uk/college/joint-sta… @AndrewElder
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Poor care at the front door of our hospitals often reflects poor care at the back door.
We can’t get people in because we can’t get people out.
Both groups deserve better - our
@RCPEdin manifesto for the general election stresses this crucial matter for the next goverment.
Being forced to treat patients in inappropriate spaces is unsafe, undignified and unacceptable.
Our new report launched today shows the extent to which corridor care has become normalised and demands action to eradicate it across the UK.
Read more. bit.ly/3V7CRNw
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Great talk from Dr Beth Routledge @sefkhet on managing acute medical problems in pregnancy. #rcpeTrainees24
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How much data, repeated how many times do we need to see before we understand that “social” care must be fixed?
And not just to help treat people at the front doors of our hospitals, but to support those people stuck in hospital who don’t want or need to be.
@RCPEdin @GeriSoc
Situation 'getting worse instead of better'. Another grim set of A&E stats - these statistics would have been unthinkable a few years ago
'Deplorable' A&E waits see one in 20 spending more than 12 hours in emergency units heraldscotland.com/news/2424…
heraldscotland.com/news/2424…
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Eggsactly.
Quite embarrassing for @JAMA to continue to publish these horribly confounded nutritional epidemiology studies.
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Case based learning remains vital - and cases presented by early post-grad colleagues are always special. Congratulations to Drs Deyvani, Agarwal and Roy for speaking so well at our @RCPEdin meeting in Cardiff.
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Two Palo Alto octogenarians introduced me to Go Wish. One way of starting difficult conversations? gowish.org/ @drkathrynmannix
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Thanks all, I enjoyed it.
A massive thank you and farewell to our Medical Director of 5 years, Prof @AndrewElder. We wish him all the best with his Fellowship at Stanford University.
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Just some of our superb @RCPEdin faculty speaking at the #JSIM22 in Amman today. @DundeeChest @LatanaMunang @nimbulteel
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A compelling and deeply personal talk by @AmieBurbridge on misdiagnosis, how it effects patients and how it effects doctors. We really should have a symposium on the topic.
@RCPEdin @RCPEdinTrainees @Bedsidemedicine
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Honoured, delighted, and no little daunted to be appointed as the Presence CASBS Fellow @CASBSStanford A real chance in my life to stand on the shoulders of giants - and study where they studied! @cuttingforstone
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“Care has implicit worth—we will continue to experience the problems we currently see if we fail to grasp that fact.”
@DrDMacaskill @scottishcare bmj.com/content/381/bmj.p861
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