wrighty

All 3 of them have in common that they were coached/pushed/supported by fathers from an early age, setting them on a path to a professional approach to their chosen sports. I don’t think any characteristics shared by 2/3 are relevant.

I’ve been. Very spread out but I’d guess the number attending is several thousand. Only stayed an hour or so, with queues coming in as we left.

I like this. Write a paper entitled “A non-transitive ordering of a 24-tuple” and submit it for a Fields Medal.

Metal, lol.

Having a breast surgeon that takes part in a general surgical rota is no longer a viable model. Surgeons of all sorts are becoming more and more specialised, such that these days a newly qualified, fellowship trained breast surgeon is unlikely to be comfortable dealing with an emergency abdominal condition. And that's what they need to be able to do on a general surgical rota. So if you think a part-time or visiting model is less than suitable what do we have left? We'd probably be better having a full-time breast surgeon seconded here from a suitable larger UK team, maybe two weeks on, two weeks off in rotation or something like that. In that way we get a suitable surgeon and he or she is able to maintain expertise and connections. It's not a particularly attractive way of working for the surgeon concerned though - many downsides and no benefits. How do you think it should be? I don't think there's a solution that combines the needs of everyone.

We lack economy of scale. Breast cancer is a multi-disciplinary specialty, and to do it properly requires surgery, radiology, pathology, chemotherapy, radiotherapy, and that's just the medical side of things. In the UK most breast units will consist of a team of surgeons, which is considered best practice. We don't have the numbers to justify that, so recruiting a single surgeon to be permanent and resident will likely prove impossible. Ditto radiology, and the jobs market there is even worse with plenty of unfilled posts in the UK. The model I think should be pursued is on-island diagnostics, but off-island major surgery in the form of reconstructions. Alternatively a visiting service such that surgery done here is by surgeons who get to keep their skills up to date by working in a bigger unit. You say it's been one of the worst cases of succession planning/recruitment you've seen. Who's responsible for that would you say?

An MRI scanner uses some of the most powerful magnets there are - 10000x stronger than the earth’s field. I haven’t seen an epidemic of the vaccinated having their arms ripped off. Or I could just say ‘no’🙂

Feel free to PM me with details of SIK, A, xyz, B etc and I’ll see if I can help.

I have identified issues with patients that go across for treatment, but I don't think it's due generally to consultants ripping off our NHS. It's more like that in the middle of a busy clinic in Liverpool they don't necessarily check a patient's postcode before determining onwards referral or need for follow up. For example, say I send someone across for a complex op that we can't handle. It gets done, patient goes back for follow up, and then mentions another, more simple problem that we could easily sort out here. Instead of referring back, which is what should happen, the team across will often follow their usual referral pathways and send to their colleagues, resulting in more off-island travel and procedures and cost. This is being looked at, actively, by Manx Care to try and repatriate patients who don't need to go across. I don't know what 'SIK' is, but if it's a very obvious problem that you seem to understand and know how to sort, why has he/she had to be seen more than once?

I don't see how this would mean 'ripping the NHS off' - we don't get paid per clinic visit, and as everyone knows we're not short of people that want to be seen. And as far as I'm aware there is no private practice going on so we're not artificially bumping up waiting lists to generate NHS to Private transfers. I'm what's known as an 'aggressive discharger' - I only review patients where there's a good chance the review will add something to their management. I get a few complaints from patients who want to be seen again, even though in my opinion it's not necessary. Sometimes I feel we can't win.

Just heard a disturbing (if true) story of community nursing staff being 'mugged' coming out of a pharmacy for lateral flow kits. Unbelievable. I can't understand the demand for them. They're only really useful in symptomatic cases - in my view the false negative rate, especially when asymptomatic, is too high to be meaningful. Are LFTs the 2021 equivalent of last year's toilet paper wars? If asymptomatic and vaxxed - get on with life, while being responsible in public enclosed spaces. That is all.

Professionalisation. It starts in all walks of life. In the olden days it was raw talent and a bit of application that won the day, but when things get professionalised with modern training plans we turn out clones. For example: Snooker - We all loved the hurricane, then Steve Davis came along and won everything because he could hit a white ball up and down for 2 hours in his practice routine. Now they're all the same having copied the successful model that Davis pioneered. Golf - the flair of Ballesteros, compared with the manufactured modern players perhaps started by Woods F1 - Senna vs Prost, Hunt vs Lauda - compare with Lewis Hamilton etc To be the best these days you have to devote everything to it like your competitors all do. It's taken the soul out of sport. Music has gone in a similar direction.

Because apart from covid, there’s literally zero health risk from everything else that people put in the bin. I had a similar conversation with a cleaner worried they could catch covid from cleaning a toilet - presumably before covid they didn’t bother washing hands and were quite happy to generate aerosols while cleaning out the bowl

BMJ article today - LFT specificity 99.94%, so if it says you’re positive you’re almost certainly positive. It’s sensitivity that is suspect, overall only 40%. So if you’re negative you may be positive!

I can't be more specific due to confidentiality reasons, but that statement is false. I can tell you though that given the cases we've had in the past few weeks we'd have expected about 80 admissions because of covid, and about 8 deaths (and the average age of the positive cases is 23 or 28, depending on which average you use, so these would have been relative youngsters being admitted and dying). Vaccination works.