I think Eliot's description of the dysfunction of democratic institutions can apply to the NHS too. Even worse when those within an organisation see the performance as the aim, rather than seeking the outcome of meaningful patient safety actions, in whatever guise that may take.

The events of the last 24 hours show why it's important to build functional verification structures in public and counterpublic spaces to resist the authoritarian erosion of our democratic systems, as described in this thread.

I agree that front loading senior decision making has benefits throughout the system. In our Trust at least, that requires significant expansion of those senior staff numbers. Consultant's can't be at the front decision making when their bandwidth is taken up fire fighting patient safety/crowding

The US truly is a foreign world Recognition of ordinary dying is a core emergency medicine skill that allows patients and their family dignity and to prioritise what is important for them No family *wants* their relative to die, but it is our job to counsel and support them, not offer false hope

In a new blog on corridor care, Claire Cox argues that to have a significant impact, guidance needs to move beyond what 'should' happen. ▶️ www.pslhub.org/learn/improv... #patientsafety

It was good to see @samfr.bsky.social say today that "the main reason for lengthy A&E waiting times is the lack of hospital beds for people who need admitting, which gums up the whole system as they have to keep being treated by emergency staff." samf.substack.com/p/optimism-o... #rstats #ggplot2

Musing today that decision aids in EM can lead the unwary (more junior colleagues especially) into quite rigid and narrow assessments/thought processes, when people are a lot more varied and complex and nuanced. And then how as seniors can we mitigate this and educate in the busy modern ED 🤔

Until and unless we have a political class willing and able to state these basic truths about social care, reform its provision so it doesn’t carry on destroying local govt, and actually raise the taxes needed to fund it properly, we are, not to put to fine a point on it, f***ed on this issue.

Make it make sense...🤦 *Screams* in Emergency Medicine

I'm particularly enjoying the tulips and daffodils this year. They seem especially abundant and vivid. I can't decide if that is because the weather conditions have been just right for a particularly good crop this year, or I'm noticing them more as I missed the season last year

One of my favourite quotes from Pope Francis, who said he would be a “Pope of the poor”. He spoke out against injustice, emphasizing the need for compassion, calling for peace & strongly supporting the Palestinian people under attack. Rest in peace.

I can't recall who proposed, as way of analogy, the use of formal consent quantifying the risks of hospital admission in older people. But I really wish I had figures at the tip of my tongue to help challenge the notion that admission is "safer" when relatives are refusing to allow discharge

I enjoyed this episode. You don't know the talent you are missing unless you allow it in. And sometimes (often) that needs people to actively invite those not previously considered. Diversity. Equity. Inclusion. Good things.

Whilst I'm very glad journalists continue to expose more details of this particular war crime, I remain flabbergasted that Israel is able to continue to flagrantly ignore international law daily without consequence

On the anniversary of the sinking of the Titanic, we thought we'd answer a question that's often asked, "If they raised the Mary Rose, why not raise the Titanic?" Allow our scaled diagram to explain...

"they hate our beef because our beef is beautiful and theirs is weak" our beef:

I love learning new things! I did not know this. Another complication to add to the list of why *measles is a bad thing*

🧵 I want to follow up this earlier thread by examining why the USA finds itself in the state it does at the moment; the process of disordered discourse capturing state institutions and how it inevitably results in a slide towards authoritarianism, a process we're seeing unfold before our very eyes.

We can upload 3 minute videos now. YOU KNOW THE RULE

HE'S LITERALLY READING A SALES PITCH

Happy International Women’s Day. I’m fortunate to have brilliant women in my life as friends and colleagues along with male allies prepared to stand up and be counted. Keep on keeping on. #IWD2025 #wingwomen

Important point. I am extremely pro-defibrillators and CPR. When you have a primary CARDIAC problem causing cardiac arrest, with a rhythm that can be shocked, quick defib gives an excellent outcome, even in older or more clinically frail patients 1/2

Once upon a time, some villagers came across a large, ornate wooden box in the local woods. On the side of the box was a message: “Whatever money you put in this box will, in future, grow to become 2.5 times larger.” 1/

Watched many movies where the "bad people" are signposted as bad by wearing black/growling/uniforms like SS etc. What role does media play in peoples inability to recognise real badness when in reality it comes dressed in pompoms/fireworks/multicoloured glory presented by "nice" smiling people 🤔

Can't access the paper, but I can say that, yep, it's more complex than just getting the assay/guidelines. Sampling logistics & patient flow are key. There are implications for 4hr standard in where indeterminate risk patients are held awaiting 3rd sample. SDEC not 24/7, but don't need admission 🤔

1/ I thought I would post some highlights from the talk I'm giving for a local Trust here. I used to do a lot of this on the hellsite, and it seemed to be well received. My talk to night is entitled "Becoming a Specialist - how to have an alternative career", subtitled "introducing the #SASsix".

How to protect democracies from falsehoods? By empowering the young with open-source investigation skills, argue @bellingcat.com founder @eliothiggins.bsky.social and @drnataliemartin.bsky.social from @cmpcr.bsky.social in this new piece reutersinstitute.politics.ox.ac.uk/news/how-pro...

This is not just a "pause." It is an unlawful destruction now. Foreign aid is a cornerstone of national security with diplomacy and defense. USAID's work reaches 100s of millions worldwide and America will be harmed. Here are some of the lives at stake.

neurosymptoms.org is a fantastic resource for patients and clinicians - I've found their leaflets explain the processing/signalling errors of FNDs in clear language. They help to explain how different "reprogramming" therapies and treatments work too - akin to mirror therapy for phantom limb pain

An astonishing exploration of the reality of ‘DEI’ in this excellent @drkevinfong.bsky.social podcast about 1970s NASA. The testimony from older male astronauts on how female excellence changed their minds is memorable. podcasts.apple.com/gb/podcast/1...

This article is about US practice, but there are some parallels to the UK. Many patients don't actually need the specialist palliative care provided by palliative care services, but most need someone with the expertise and crucially the time to discuss realistic goals and advanced care planning

Did you know… Purple isn’t real. It’s a pigment of the imagination! www.snexplores.org/article/colo...

Ep 4 #16Sunsets New Frontiers. Worth a listen on this day more than most. #NASA has always pushed back boundaries in space & here on Earth. In 1978 it selected the Thirty Five New Guys, at the time the most diverse astronaut class in its history. podcasts.apple.com/gb/podcast/1...

Auschwitz was at the end of a long process. It did not start from gas chambers. This hatred was gradually developed by humans. From ideas, words, stereotypes & prejudice through legal exclusion, dehumanization & escalating violence... to systematic and industrial murder. Auschwitz took time.

How do you balance legitimate public interest with the fundamental right to healthcare confidentiality? We all want answers, but we may not get all we want. I do know that adolescent mental health is both fiendishly complicated & vastly underfunded

It is often easier to be despondent from the sidelines, to tut and shake one's head & take comfort in criticism shared amongst friends. Bishop Budde delivered her sermon with quiet conviction and dignity. Moral courage like this gives hope - it shows us that it is ok to politely but firmly say no.

‘Acceptance of failure’ - so what’s the alternative? Not ‘fix social care’ - I mean today? What is the alternative *today*?

Time for a ski before the thaw. Bit of a walk in as daren't risk the unploughed/untreated roads

Coverage of ongoing crisis is good. But please @rcem.bsky.social can we stop the BBC from referring to Emergency "Wards". If my department was a "ward", the patients stuck there for >24hr would have access to more than a solitary toilet between them, meal services, washing facilities etc etc

Storms & shifts colluded to prevent me getting out for a ride (commutes excepting) in over a month. Snow & ice aplenty still on the small roads of North Cumbria. Suboptimal ride conditions, but darn good for the soul.

This makes me happy. Skiddaw Forest may lack some of the drama of other Lakeland areas, but it is my "local" playground and can feel like a magic wilderness. Can't wait to see what habitat restoration brings in the coming decades

Walked up Carrock Fell yesterday then ran/bog hopped over to High Pike. Blustery but finally a clear day amongst the general winter mizzle. Skiddaw moody in cloud whilst I basked in apricity.

A new convert to this podcast. Yes it's acute medicine, but plenty of relevance to EM folk too. The format really works for my learning style: case based diagnostic puzzles with some great learning nuggets of human factors and common decision making biases along the way 👍

Fatigue is a funny old thing. I can blast out a quality turbo session in the morning, hitting PBs for power with expected HR for effort (i.e not fatigued). Then the same afternoon I can struggle on a gentle riverside amble and need a powernap to recover

I like the "surprise" question: would you be surprised if this patient died tonight/during this admission/in the next month? If I wouldn't be surprised, I believe I have a duty to ensure that it isn't a surprise to the patient and their family. I don't always achieve this, but I try

This is a ubiquitous experience amongst emergency physicians. Too often we see patients with evidently terminal diagnoses come to us in extremis and it seems we are the first to actually tell them that they are dying and there is nothing we can do to stop that. It is emotionally exhausting.

Perpetually firefighting in the ED leaves no time for quality training and negatively affects the quality of care delivered. Firefighters are given room to rest & train in order to respond effectively to complex emergencies. EM staff deserve the same

As there is almost no down time left, many A&Es struggle to maintain training standards, equipment checks, maintenance, administrative tasks, and the preparation required for high stakes case load. 🪫👉🪫 .../6

editorial from @bmj.com and paper: Poor staff retention is associated with higher patient mortality. Have said it before & I’ll say it again. If you don’t care for the carers, they cannot care for their patients. www.bmj.com/content/387/...