@hayfestival.bsky.social April book club choice is Paul Kalanithi's When Breath Becomes Air.
I'll be discussing the book with @drrachelclarke.com & Sarah Perry, both writers I admire enormously.
Please join us online, Thursday 23rd : 7 - 8pm BST
It's free: book for tix share.google/FOowlQLkNNzM...
I start most palliative care consultations with "what's bothering you the most"
NHS critics should know that the answer for my American colleagues is often "money". Since health insurance doesn't pay for all chemo, bankruptcy (eg mortgaging own home to pay for chemo) is common ("financial toxicity")
I don't think I'd have been able to refrain (and I thought fainting [vagal overactivity] was different to behavioural arrest [GABA release in periaquaductal grey]?)
But if you or anyone knows of an evolutionary explanation for fainting, I'd love to hear it if anyone knows of one.
Being ill can be frightening; raise both questions about the future and practical hurdles. My impression is that some clinicians have lost the art of hearing. What baffles me is that most nurse/medical students can do it. So it feels like something gets lost once encultured into hospital life
"By moving money away from delivering care that generates health gains more cheaply to drugs that generate health gains at greater expense, the NHS could end up less able to improve overall health from the same budget" - @healthfoundation.bsky.social
www.health.org.uk/features-and...
Would switching the NHS to an insurance model fix it? Our new research says no.
🎥 IPPR head of health, @sebrees1.bsky.social breaks down why changing the funding model is a distraction, and what would actually make a difference.
🔗 Read more: www.ippr.org/articles/bismarck-versus-beveridge-revisited
Private firms providing services to NHS made £1.6bn profit in two years, research finds www.theguardian.com/society/2026...
As guest editor of an EoL & palliative care special edition of @futurehealthj.bsky.social from @rcphysicians.bsky.social, it was important to me that a patient voice was given space.
Mark has #MND (ALS).
He wrote his entire article using eye-gaze technology.
Read on ⬇️
Me wearing a visor in front of raised veg beds I've just made
#Ophthalmology query: do you see fewer eye injuries amongst clinicians since covid?
Since Jeremy Hunt forgot to buy the PPE stockpile he'd promised, we bought/made our own as best we could. Since my garage is now awash with various visors, my eyes are better protected during DIY than ever before.
The supplementary appendix gives a stylised example of how we use this approach in practice (spcare.bmj.com/content/earl... )
NOT A DICHOTOMY
Polytitration vs serial monotherapy are continuum rather than dichotomy
E.g. for less severe pain, I’d start several PRN analgesics (parallel initiation) to guide drug selection and avoid overuse of PRN opioid but might only change one regular analgesic at a time (serial titration)
DISADVANTAGES
Benefit not always fast (eg ketamine can act within minutes or take several days [has multiple actions, some faster than others]; so risk rejecting a drug too soon)
Polypharmacy (though once pain is controlled, offer serial dose reductions to remove any not contributing to benefit).
ADVANTAGES
Often reduces severe pain quickly
Minimises regular dosing (RCTs find higher doses with serial monotherapy than parallel titration; refs in paper)
In the lab response not always apparent to single drugs (ie A+B effective despite no benefit from A or B alone; I’ve seen this at the bedside)
TECHNIQUES
Drugs selected via pain mechanism, tolerability etc
Benefit easier to see if rapid onset, so if oral Tmax >1hr, given subut or buccally (e.g. lacosamide, methadone)
For more detail, see summary paper (link in 1st post)
spcare.bmj.com/content/15/6...
RATIONALE (2/2)
These act as ‘test doses’; response (or lack of) guides which to start/increase regularly
Also reduces problem of PRN opioids being repeated despite marginal benefit and/or increasing opioid-induced neurotoxicity (drowsiness, delirium, myoclonus, hyperalgesia etc)
RATIONALE (1/2)
Pain often responds within 1-2hrs with newer analgesics and new regimens for older analgesics (eg, clonidine, lacosamide, methadone, ketamine, parecoxib)
Thus we initiate multiple PRN analgesics in parallel as 1st, 2nd, 3rd line etc.
spcare.bmj.com/content/13/e...
POLYANALGESIC TITRATION FOR OPIOID-REFRACTORY PAIN
In pall care, conventional approach is serial monotherapy
Non-opioid analgesics one at a time
If partial response, add a 2nd; no response, switch to 2nd.
But this takes time. Here we describe an alternative approach
spcare.bmj.com/content/earl...
Are we getting a skewed understanding of dying from the stories that gain media attention?
I was delighted and honoured to be invited to close the day at End Well 2025. Here's my take.
bit.ly/EndWellStory...
You can download @futurehealthj.bsky.social EoL Special here:
sciencedirect.com/journal/futu...
It's been a pleasure to work with all the contributors, and I'm very grateful to the referees who responded with such willingness to help shape the papers.
Great team effort, everyone!
15/
@donnawakefield.bsky.social @libbysallnow.bsky.social
& colleagues envision Pall Medicine 2050: rapidly growing demand will continue, & new ways of working, in collaboration with communities, will be vital to meet the need.
See their synthesis & ideas at
sciencedirect.com/science/arti...
Genuinely so excited to see our paper exploring “ #PalliativeMedicine in 2050: How will people live the last part of life” 📖
Thank you @drkathrynmannix.bsky.social for the invitation to contribute to this special themed edition of @rcphysicians.bsky.social @futurehealthj.bsky.social 📚
A Telegraph headline that reads "There's a reason young people like me hate the NHS", by Joanna Marchong
The reason Joanna Marchong hates the NHS is that she's paid to do so by the right-wing Adam Smith Institute, which lobbies on behalf of the private healthcare industry.
🚨 EXCLUSIVE: More than a million teenagers across England have missed out on meningitis vaccines at school during the past nine years www.thetimes.com/article/eaa3...
I was delighted to discuss 'talking about dying' with @dralexispaton.bsky.social & Sir Bod Goddard for their #SickSociety podcast.
Should we teach death education in schools?
Do doctors fail to recognise dying?
What's the impact of failing to explain dying?
Is CPR over-rated?
Listen in.
Links ⬇️
🚨 JUST IN: New research shows nearly 1 in 3 people don’t get the end of life care they need.
This is unacceptable. Dying people deserve better.
The UK government must make end of life care a priority so everyone feels cared for, comfortable and pain-free when they’re dying.
👀 Did you post this to my office? Written with pink/purple ink? I'd really like to talk to you if so, I can protect your identity but what you sent was really important but not enough on its own. Get in touch via DM email etc... Pls RT.
Cancer patients ditch NHS for private chemotherapy share.google/fKKhDJVQqyrf...
12% ⬆️ from 2021 to now. So if I did my maths right.. is less than a 2.9% annual increase in activity.
While the NHS thinks chemo activity increases 6-8% annually. In other words.. private sector under delivering
Maximise your savings by registering early for EAPC 2026. Gain access to cutting-edge research, expert-led sessions, and invaluable networking opportunities. Register now via our website and save!
Early bird registration fee expires on 28 February 2026.
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Skills to integrate into your current role. Join us!
🚨 Clare Welch pleaded for help from NHS 111 as her dying mother screamed in pain in the other room. Told a dr would call, 4 years on she is still waiting for that call back.
New @mariecurieuk research has found 170,000 people die in pain every year: www.thetimes.com/article/7552...
