Hans van Huellen

Anaesthetics and intensive care registrar interested in things medical & beyond - MedEd, clinical communication, patient safety, politics. All views my own

[Hans van Huellen @_hvh_]

@LukeFlower1 @FICMNews @TRICNetwork Congratulations, great talk!

[Hans van Huellen @_hvh_]

Thanks for having me!

[FICMNews @FICMNews]

Some of our intensivists in training are presenting on their abstract posters. Here’s Hans Van Huellen talking about tabletop simulations as a multi-disciplinary teaching:
#FutureIntensivists

[Hans van Huellen @_hvh_]

@AndrewJD Agree with lots of it, but also think the medicine year could be super valuable if we set it up better. E.g. some cardiology block with clinics and built in time to get to FUSIC heart

[Hans van Huellen @_hvh_]

@mattbaker126 @AndrewJD But, going back to @AndrewJD original point, I agree that given how long training is already, we should make every year count and the medicine top up year is certainly an area for improvement. Sadly I think how this is run varies hugely by region and probably also by funding..

[Hans van Huellen @_hvh_]

@mattbaker126 @AndrewJD Hi Matt! I think it is getting harder and the ICM workforce will be increasingly single specialty (looking at trainee intake). But I think espec DGH units will find it hard to create job plans for pure intensivists and dual anaes/ICM training works very well for those settings

[Hans van Huellen @_hvh_]

@DrAJHall @amit_pawa @L_D_White @Jameswrighty @jeffgadsden

[Hans van Huellen @_hvh_]

@CartlandDavid I thought you were a GP? So you should know that sadly young woman can get breast cancer, too, which is why her awareness campaign was so important.

Also she was diagnosed over a decade before the COVID pandemic so stop misusing her story for your own misinformation campaign.

[Hans van Huellen @_hvh_]

@VirtueOfNothing @andymoz78 Does BNP fall in the same category as TFTs, as in, useful in the outpatient setting but probably fairly meaningless in the critically ill? That was my impression

[Hans van Huellen @_hvh_]

@DrRobgalloway Excellent article rob

[Hans van Huellen @_hvh_]

@sib313 Re 2., agree but while budget isn’t infinite it is also not fix, and it’s primarily a political choice rather than (solely) an economic necessity. NHS surely has inefficiencies, but it cannot be value-optimised beyond a point.

[Hans van Huellen @_hvh_]

@asanyfuleno @LarcombePeter @drjanaway Then clearly then your tax money funds my salary in the same way as it funds every other public sector worker?

[Hans van Huellen @_hvh_]

@asanyfuleno @LarcombePeter @drjanaway It’s a misconception to believe that doctors in postgraduate training equate to students who are actively taught and not providing value. In fact the majority of out of hours on-site cover is provided by these “junior doctors”.

[Tim Cook @doctimcook]

Thanks for asking

As some one who has worked in the NHS for 35 yrs and examined its working throughout that time my list of what needs changing would start with

Stop breaking the system by defunding it in the name of efficiency. It is way beyond the point at which trying to cut things can improve efficiency. It is doing the opposite. Now not enough diagnostic centres, not enough doctors, not enough beds (numerous reports - ask @NuffieldTrust or @TheKingsFund or @HealthFdn)

The rest are relative minutiae but areas to address include

* understanding that promotion of the private sector as a realistic alternative to the NHS is flawed. The private sector can do sone things well (low risk procedural
stuff) but is no substitute for real NHS hospitals with the full gamut of services (staff, systems, space)
https://t.co/5UEr0DJIGc

*don’t dumb down medicine.
There appears to be a concerted effort to suggest that medicine has become less complex, easier to learn, answers available on google etc and as a consequence medicine can be taught over a shorter period and the role substituted by others who are notably less trained/qualified.
The truth is that medicine has become more complex, delivered to ever older more complex and more comorbid patients with ever higher expectations (most of which are actually met). https://t.co/MBvAISjraq This all happens in the framework of an environment in which litigation (certainly costs and numbers to an extent) is mushrooming. https://t.co/96MGGYPbjc While there may be value in working in new ways the lie that doctors can be replaced by less qualified alternatives because the job has become easier is misplaced, disingenuous and dangerous (as well as quite likely being cost-ineffective). There is a danger these systems will be brought in without testing of efficacy, safety or cost effectiveness.
https://t.co/KQM8KMpNO1

https://t.co/oFAYdi3s4n

* IT systems that are slow, outmoded, inefficient and don’t talk to eachother. Wasting thousands of hours of clinicians time every day.

Hope that is enough for now.

At the core it is FUNDING.
No point in reform without funding.

[Hans van Huellen @_hvh_]

@TheCornishPasty How this man still holds a GMC license is utterly beyond me. Let’s not forget he spread some accusations that COVID was linked to some
Jewish world conspiracy.. completely aside from calling healthcare workers murderers

[Hans van Huellen @_hvh_]

@DocEd On the other hand, I worry about retaining airway skills in intensivists who do little or no regular anaesthesia when we know that ICU intubations are already higher risk and as consultant the buck stops with us

[Hans van Huellen @_hvh_]

@DocEd I suspect many of us feel this way, but especially in bigger centres this is becoming a rarity I think.

Problem is, both specialties getting more complex - maybe it’s too much to ask to expertly manage complex ICU patients AND be great at regional AND do regular airway lists?

[Hans van Huellen @_hvh_]

@Matt_L_Nash @DrHuw @Matt_ParaACP @Dr_Done_ @VirtueOfNothing @FICMNews I think crux of this debate is learning to safely perform a specific procedural skill (which mostly I agree you don’t need MBBS for) vs employing this skill in a wider clinical context, knowing when / when not to use it and manage the repercussions.

[Hans van Huellen @_hvh_]

@VirtueOfNothing @rosieICM In fact, one of the things which I have noticed most about myself as I progress through training is that I feel increasingly more comfortable saying “I don’t know”, and I think that’s a good thing.

[Hans van Huellen @_hvh_]

@VirtueOfNothing @rosieICM I think it’s great from a human factors point of view. Also acknowledges that there are very few absolute certainties in medicine and on the whole clinicians but also patients value this admission I think. Using it a lot on ICU, too.