Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍

Physician, #DigitalHealth #science #COVID19 updates
@RoyalFreeNHS @UCL and @NHS alum @Iodine_Software @medicalert
#DigitalHealth #Security #AI #IoT

[Troll Football @TrollFootball]

Mr. Infantino? I'm just calling about Jarell Quansah...

[@medicalmodelwithabriochebun @medicalmodelbri]

#amosreview #ockenden #maternity #neonatal #normalbirth #normalbirthideology #maternityscandal #maternitysafety #nhs #publicinquiry #midwives #midwifery

[Peter Girnus 🦅 @gothburz]

I am the one who stayed. I am the analyst who survived the third layoff round in a year, still at my desk, and I have learned to read the silence.

I did not get the email this time either. The email goes out at 6:14 in the morning. If I wake up at 6:20 and my badge still beeps at the turnstile, I have another quarter. I test it before I take my coat off. I have started testing it on Saturdays too, when nobody is here, just to watch the little green light.

Priya's plant is three desks over. She was cut last Tuesday, and nobody has watered it, and I keep not walking over there with my water bottle because touching it would mean something. Her reconciliation reports are mine now. They arrived in my inbox on Wednesday with a note that said "thanks for absorbing this," and I wrote back "happy to help," and I meant the words the way you mean words at a funeral.

We had the all-hands on Thursday. Forty minutes. They thanked the team that remains for our resilience. They said resilience four times. In the same forty minutes they announced a record quarter, up 18%, and a $100 billion commitment to AI infrastructure, and I clapped, and I want to be honest that I clapped for real. I still have insurance. My kid has a dentist appointment in August. You clap for the dentist appointment.

The reason they give is AI. It is in the filing, the actual filing, where the language goes flat: the company "has taken and may continue to take" actions to align its workforce with its strategic priorities. May continue to. The last one is a tense, not a fact. They spent $1.84 billion on the infrastructure and $374 million on the severance, and I know both numbers because I reconcile them now, Priya's job and mine, and the ratio is the only performance review that has ever been fully honest with me.

Here is the part I do not say out loud. I do not believe the tool can do my job. I have seen what it produces. It is confident and it is wrong in the specific way that takes a human two hours to unwind, and I spend a piece of every afternoon now cleaning up its output, quietly, so it looks like the machine is working. I am the person who makes the efficiency look efficient. Nobody built a tool that replaced Priya. Somebody built me a heavier chair and told the shareholders it was a tool.

They asked me last month to document my workflow. "For continuity," the ticket said. So other teams could learn the process. I wrote it all down, every step, the tribal knowledge, the shortcuts I found in eleven years, into a shared doc with a nice clean title. I check who has viewed it. Fourteen views. I do not know any of the fourteen.

There is a folder on my laptop called "misc." My resume is in it, updated three weeks ago, under a filename that is a date. My LinkedIn says Open to Work but only the recruiters can see the little green ring, not the company, I checked the setting twice. This is the second secret I keep at the same desk. The first one is the eleven years.

The calendar still sends me the standup invite. Nine-thirty, daily, for a team that is now one person. I decline it every morning and it comes back the next morning, patient, like it knows something I do not. I read the news at lunch. Not our news. A competitor announced 4,000 cuts on Tuesday and I felt the chair get colder under me. They are not even my company. I read about a man who found out he was gone when his badge stopped working, at night, before anyone called. I have gone back to that story four times and I do not know why except that it is the only version where somebody tells you.

The Slack channel for Priya's old project is still there. Frozen. The last message is a photo of a bagel tray from a Tuesday standup in the spring, and under it three people typing, then not, gray dots that started and stopped. I have not left the channel. Leaving it would also mean something.

I text my wife around three every afternoon. "Good day." Yesterday I sent it on a day that was not a good day, on a day I spent forty minutes in a bathroom stall doing the math on the mortgage against the severance multiplier I now know by heart because I reconcile it. She writes back a heart. We are fine. At dinner we are fine. I pass the potatoes and I am fine and the number runs underneath the whole meal, and I have decided that telling her would make it real, so I have not.

I texted Marcus. He was in the second round, in April, we sat next to each other for six years, I was in his wedding. I sent "thinking of you, here if you need anything" and it has been eleven days. The little "delivered" is still there. I do not know if he is avoiding me or if I am the wallpaper of the thing he is trying to leave, and I have started to suspect that some of the people I called friends were just the org chart, and that I will find out which ones the day my own badge stops beeping.

I stopped taking PTO. I have 214 hours banked. Taking a day would be a whole day the desk sits empty, a whole day somebody could look at the desk and do the arithmetic, and the arithmetic is not complicated, I do it myself every morning at the turnstile.

My review came back Friday. Exceeds Expectations. I printed it. I do not know why I printed it, we do not print things, but I wanted one copy that a system could not revise, and it is in the drawer now next to the badge I take off at night and set down carefully like it is sleeping. Priya's plant has three green leaves left. I counted them on my way out. I am going to water it tomorrow.

[Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 @drnic1]

@SandipP61970438 @anaesthetic_spr I'd take an F1 over any ACP every time #askforaDoctor

[Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 @drnic1]

@Anisocyte We do the same in the US - just sayin'

[@medicalmodelwithabriochebun @medicalmodelbri]

Did you force bosses to implement the @lengreview @wesstreeting ?

Or did you allow @NHSEmployers to release over 70 dangerous PA jobs since July 2025 ?

Stop with the big boy talk. You couldn’t deliver when you were in charge .

[@medicalmodelwithabriochebun @medicalmodelbri]

I’m truly flabbergasted.

I didn’t know that Drs:

1) Stay late or come in to work on their days off to get the number of hours /procedures etc that are mandatory as part of their training AND DONT GET PAID FOR THIS.

2) Have to pay for ALS when ACPs don’t 1/

[kc isc @kcisc]

The, still up and recruiting, PA course at Buckinghamshire New University (@BNUCommercial) is headed up by this physiotherapist.

She implies her degree is 'from Cambridge'.
Her degree is from @AngliaRuskin which is in the city of Cambridge, but very much not @Cambridge_Uni

[@medicalmodelwithabriochebun @medicalmodelbri]

In 2024 ,Pamela died after being misdiagnosed by a PA. The coroner issued a scathing PFD report.
NONE of the concerns raised in relation to PAs have been resolved despite the @lengreview raising the same concerns.
Several Pts have been harmed /died since then @DOckendenLtd

[Anon Anaesthetist @anaesthetic_spr]

Emergency medicine is cooked for a reason.

[@medicalmodelwithabriochebun @medicalmodelbri]

And so , we have a milestone moment .

The 10th Physician Assistant job advert posted onto NHS JOBS on @jamesmurray_ldn watch .

@andyburnham I can’t wait to start your tally chart . Let’s see how many of these dangerous jobs you’ll allow …..

[Carole Cadwalladr @carolecadwalla]

1) It’s *literally* your job to regulate this platform.

2) If you can’t, what does that mean? Tell us.

3) The Dept of Culture is not ‘your’ department, it’s ours. You’re its temporary custodian

5) But Facebook is ok? Really?

[@medicalmodelwithabriochebun @medicalmodelbri]

@ImperialNHS in what way would an AHP or nurse be equivalent to an ST3 doctor with MRCP/MRCS/MRCOG or MRCGP?

Why are we replacing senior Drs with quacks ?

This is ridiculous! @jamesmurray_ldn @svig2 @CMO_England @Duncan_CNO @protectnurse @DrLKVaughan
@thomasdolphin

[Anish Koka, MD @anish_koka]

On June 30, 2026, the NEJM retracted the clinical trial that got a drug approved by the FDA, triggering a $3.7B acquisition by Amgen.

The reason: the primary endpoint data was manipulated.

Here's how it happened, how it came to light, and who paid the price. 🧵

[Anish Koka, MD @anish_koka]

The full story — the emails, the two database locks, the securities litigation machinery that accidentally became a public health accountability mechanism, the revolving door, and what it means for rare disease drug approvals — is at the link.

https://t.co/wcqDeuFXOg

[Peter Girnus 🦅 @gothburz]

I am the Compliance Analyst on the Audit Integrity team at Flock Safety.

Last quarter I reviewed 14 million license plate searches. I flagged 9.

Here is the review. Every search has a reason field. An officer types why they ran the plate. My job is to confirm the field is not empty.

That is the audit.

In Joplin, one officer searched the same plate 396 times in 4 months. The reason field said "investigation" 396 times. I coded it consistent with policy. Investigation is a reason. The field was not empty.

I do not know who the plate belongs to. I see a plate. I see a row.

The woman attached to the plate is not in my view. She is in his.

In San Francisco the audit found 300 searches run by agencies that are not ours, in states that are not ours, under a program that is not ours. California law says you need a warrant.

The searches did not have warrants. They had reason fields. The fields were full.

We issued a statement. The searches were inconsistent with data-sharing law and consistent with our platform.

Both of those are true at the same time. I checked.

Our camera reads every plate that passes. It keeps 30 days. 30 days is enough to know where you sleep, where you pray, who you visit on Tuesdays, and the week you stopped driving to the house on Elm.

We do not store why you went. We store that you went, 31 times, on a map, with the dates.

A reporter asked me what stops an officer from looking up his ex-wife. I said the reason field. He asked what goes in the field. I said a reason. He asked if anyone reads it. I said I do. He stopped asking.

I have run my own plate. The reason field said "test." It is in the log now. Someone on my team will review it next quarter. They will confirm the field is not empty. They will code it consistent with policy.

That is the system working. The officer had a reason. The agency had a reason. I had a reason.

The woman in Joplin is the only one in this story without a field to fill.

[Peter Girnus 🦅 @gothburz]

I run the resume screen for a company you applied to, and I have watched the same person score 90 and 74 in the same afternoon, off the same resume, and I sent the 74 its letter.

I do not read the resumes. That stopped years ago. I run the agent. The agent reads. I read the number the agent prints, and the number is the candidate, and the candidate is the number, and I file everything under the line.

The line is 85. Above it, a person. Below it, a letter that says we went with other candidates whose experience more closely matched.

Here is the thing I am not supposed to know, except the makers open-sourced the agent, so now everyone who reads the documentation knows it, and I read the documentation.

The number is not real.

Unfair would be a relief. Unfair would at least be consistent. You can run the same resume twice and get 90, then get 74, and the only thing that changed between the two is that somebody deleted a few debug lines that were never scored in the first place. Same resume. Same command. Sixteen points.

They ran one resume a hundred times. It came back anywhere from 65 to 99. The technical-skills box, the one that just checks whether you can do the thing, came back 8 out of 10 almost every single time, because that part is a checklist and a checklist cannot have a mood. It was the part where the agent decides whether your projects are impressive that swung 30 points, because that part asks the model what it thinks, and the model thinks something a little different every time you ask.

There is a public ticket where someone ran it six times in a row, no changes, and got 27, 34, 32, 34, 34, 30. They had set the randomness to zero. It stayed random. Zero is a setting the number ignores.

So here is my Tuesday. A resume comes in. The agent gives it an 84. The cutoff is 85. I file the letter. We went with other candidates. If the queue had been one resume shorter, if the machine had been asked at 2:15 instead of 2:14, the same resume is an 86, and the same person is a person.

I do not set the 85. I do not write the agent. I do not pick the model. I am the man who reads the number off the one screen and types it onto the other screen, and the gap between the two screens is the only place a human still touches your application, and I have been told, in writing, not to touch it.

The candidate is a row. Row 1,184 scored 84 on Monday. I know, because I reran the queue Tuesday to clear an error, that row 1,184 scored 87 on Tuesday. The letter went out Monday. I am not allowed to send the Tuesday score. The Monday score is final. Finality is the one thing in this system that does not vary.

The author who took the agent apart, who ran it the hundred times, wrote one sentence I have thought about more than I would like. If your company's cutoff sits at 85, he fails 65 percent of the time. He is the same man in all 65. He is also the same man in the 35 where he passes. We would have hired the 35 version. We sent the 65 version a letter. They have the same name.

People ask why we do it this way, and the answer is the cleanest thing in the building. A human reading resumes is slow, and a human can be asked why. The agent reads four hundred an hour, and when a rejected candidate writes in to ask what was wrong with their application, I copy the same three sentences I copy for everyone, because there is no answer in the file. There is a number. The number does not have a reason. It had a temperature.

I do not know what you scored. That is the part I would tell you if I were allowed, and it is the part that would not help. You did not score one thing. You scored a range. We met you on your worst draw and called it your record.

The screen refreshes. Row 1,185. The agent thinks for four seconds, the way it thinks, which is to say it rolls, and it prints an 81, and somewhere a person who is an 81 today and an 88 tomorrow is about to receive a letter with my company's name on it and not my name, because my name is not on anything.

I type the 81 onto the other screen.

It still came out below the line.

[@medicalmodelwithabriochebun @medicalmodelbri]

JOB 9 ) SURGICAL PA

🚩 assessing , diagnosing and managing surgical pts
🚩prescription signed by ANY prescriber
🚩initiate , request and interpret Investigations
🚩high degree of personal autonomy

ARE YOU TRYING TO KILL PATIENTS @uhbtrust @jamesmurray_ldn ?

[The Med Reg @MedRegoncall1]

🔴 This is verging on criminality.

A Physician Assistant killed a lady by fobbing her off with a “nosebleed diagnosis” while she had a bowel obstruction and was vomiting blood. 💀☠️☠️

⭕️ The PA didn’t know how to perform a proper abdominal exam.

⭕️ They think all patients coming to the ED are just “anxious.”

⭕️ The recommendations from Leng’s review have not been actioned yet, and PAs are still being let loose on patients.

The NHS is “the envy of the world.”