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Balazs

@cannulaservice.hibalazs.net
1.2K followers 1.2K following 1K posts

Anaesthetist with interest in ICU, paeds, and TIVA. Unapologetically AuDHD.

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Balazs @cannulaservice.hibalazs.net · 25/03/2025
They can apply to any speciality. There's no workforce planning or ringfencing for specialities/regions most in need. I've no doubt these doctors are suitably qualified. But amidst ongoing NHS crises, how can we provide training for up to 300 Saudi drs & yet not our own? 6/8
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Balazs @cannulaservice.hibalazs.net · 25/03/2025
It seems the agreement is expected to be renewed in 2030 when it expires. This is so backwards. UK drs are emigrating unable to get training & yet trusts are being paid by foreign govts to train their drs here. Why can't we put money into training the drs we already have? 5/8
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Balazs @cannulaservice.hibalazs.net · 25/03/2025
What little comfort it may provide, it doesn't seem to take away from the pool of UK training nos. I'm sure these doctors are highly capable & they do need to meet the same benchmarking standards. But UK drs are expected to go through the CV & application rat race. Why? 4/8
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Balazs @cannulaservice.hibalazs.net · 25/03/2025
NHSE said they didn't give or receive any money, but confirmed that Saudi govt pay UHB directly. (I have separate FOIs still pending about this). Why UHB? The "prestigious" trust often in the news for toxic leadership has historical working relationship with Saudi DoH. 3/8
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Balazs @cannulaservice.hibalazs.net · 25/03/2025
During covid in 2020+ as UK doctors faced redeployment, exam cancellations & delays, recruitment mishaps, moral injury, @england.nhs.uk, HEE, UHB were busy helping support a growing no of Saudi doctors enter UK training. 2/8
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Balazs @cannulaservice.hibalazs.net · 25/03/2025
As UK doctors face yet another disaster in job applications & ⬆️ competition ratios, let me tell you how Saudi Arabia pays Univ Hosp Birmingham to allow their drs to side step into UK speciality training. No competition. Guaranteed places. All with @gmcuk.bsky.social & @england.nhs.uk approval. 1/8
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Balazs @cannulaservice.hibalazs.net · 02/03/2025
Also please ignore the vignetting, I'm using a DX lens on a film camera and Nikon's annoying changes mean it cuts off 35mm film.
clouds in black and whitea busy intersection of regent street in london, at night, in black and white
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Balazs @cannulaservice.hibalazs.net · 02/03/2025
Taking inspiration from @robjimfleming.bsky.social I'm sharing some of my own #photography. I've never been a very arty or creative person, but the process of shooting and developing black and white film helps cover up the lack of skills. Shot with Nikon F80 on Ilford HP5+ film.
tree branchesview of a single road ahead lined by small bushes and a few big trees on either side, with a monument at the end of the road in the middle of the picture.wooden fence at a train station platform, with a sign saying to keep behind the yellow line, in black and whitetree branches, in black and white
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Balazs @cannulaservice.hibalazs.net · 05/02/2025
- Supervisor & institutional involvement in shaping individual PA's role in the team key to ⬆️ motivation & acceptance of PAs. - Roles need to be tailored & organically developed: PAs can't slot in from one environment to another as lots of knowledge local & MDT specific. 12/18
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Balazs @cannulaservice.hibalazs.net · 05/02/2025
- Supervision seen as burdensome. - PAs liked on personal level but much ambiguity about role leading to comparisons w/ other HCPs rather than defining unique role. - Staff unsure of what PAs could do, to what standards, what support they needed & max level of competency. 10/18
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Balazs @cannulaservice.hibalazs.net · 05/02/2025
Staff perception of PAs: - Main incentive for introducing PAs was dr shortages & ⬆️ locum costs. - Senior NHS leaders v keen to employ PAs, but front line staff less so (more 'resistance'). - Concerns about role clarity & scope (even from PAs). 9/18
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Balazs @cannulaservice.hibalazs.net · 05/02/2025
Despite tight time pressures, Prof Greenhalgh has delivered on a systematic review: - Multi-database searches - Limited to UK practice - From the last 10 years - Research in nature (ie, not descriptions) This is how we decide if any generalisable conclusions can be drawn. 2/18
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Balazs @cannulaservice.hibalazs.net · 05/02/2025
A thoroughly excellent systematic review from @trishgreenhalgh.bsky.social on the evidence base around physician associates & anaesthesia associates. Currently shared as a pre-print a/w publication, I'll summarise her findings. A 🧵 1/18
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Balazs @cannulaservice.hibalazs.net · 09/12/2024
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Balazs @cannulaservice.hibalazs.net · 29/11/2024
My entry for the @sivatrainees.bsky.social #SIVA24 infographic competition. Is there one model to rule them all? Well tbh I think it doesn't matter all that much, as long as you know your model well! You can find a more detailed explanation on my website: hibalazs.net/anaesthesia/... #ansky
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Balazs @cannulaservice.hibalazs.net · 18/11/2024
Ravioli tablet? What sorcery is this?! I slaved away!
Man with glasses leans over table, on it a wooden board, wearing black gloves and carefully pressing ravioli with fillings into shape. At the top of the wooden board there are three ravioli carefully cut into individual squares.
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Balazs @cannulaservice.hibalazs.net · 17/11/2024
Many of us have been asking how these PSDs & prescribing works. The regulators are ignoring their duties. I don't get how all these people have no problem in unregulated HCPs dishing out drugs no-one else can. Is the CPS looking into it? Isn't it unlawful? If not, who is?
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Balazs @cannulaservice.hibalazs.net · 17/11/2024
& before the usual suspects complain about the respondents, plenty were invited & responded, it wasn't just a small crowd of doctors voicing their views.
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Balazs @cannulaservice.hibalazs.net · 17/11/2024
Why aren't employers engaging? It's difficult to understand the lack of response to a proper consultation by a royal college, but employers are the first to tweet incoherent babble when their behaviour is questioned publicly. If you don't engage, don't come to complain.
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Balazs @cannulaservice.hibalazs.net · 17/11/2024
What does guidance mean in practice? Enforcement? Always big questions. Many like UMAPs reject college position. Yet plenty of guidance *is* relied on by the courts in cases of negligence. & how do employers meet guidance in reality?
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Balazs @cannulaservice.hibalazs.net · 17/11/2024
Lack of consistency & concerns of uncertainty a common theme. How to balance training needs of doctors vs ensuring new HCP role are made to feel welcome? Clear worries about role boundaries not being defined & blurred.
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Balazs @cannulaservice.hibalazs.net · 17/11/2024
I know it's hard to come up with single doc when there is disagreement, but that should merit reflection by leaders. If role isn't clear & everyone is asking for clarity, who is going to provide that clarity if @rcphysicians.bsky.social & GMC won't & DHSC bogged down in politics?
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Balazs @cannulaservice.hibalazs.net · 17/11/2024
As per Dr Chadwick's previous tweet, the point of the document was to help "set out clear guidance for supervision". Yet the overwhelming feeling was that it fundamentally fails to do this.
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Balazs @cannulaservice.hibalazs.net · 17/11/2024
I know Dr Chadwick has worked incredibly hard on college guidance, but the impact & views of the document depend entirely on how clear it is. The results are in: Few respondents think it will help doctor training & less than half think it will help supervising PAs.
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Balazs @cannulaservice.hibalazs.net · 17/11/2024
Not sure if I missed this from @rcphysicians.bsky.social but it's an illuminating report conducted by an independent research org. A short 🧵from the executive summary:
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Balazs @cannulaservice.hibalazs.net · 13/11/2024
I'm sure this improves safety, but you'll never convince me to put the label horizontally across the barrel of the syringe like that.
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Balazs @cannulaservice.hibalazs.net · 12/11/2024
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Balazs @cannulaservice.hibalazs.net · 12/11/2024
6. Debugging: Test response to small bolus of propofol (if unexpectedly high BIS/arousal) or Response to vasopressor bolus if concern deep state may be cerebral perfusion related.
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Balazs @cannulaservice.hibalazs.net · 12/11/2024
5. With emergence: return of brainstem reflexes caudal to cranial & replacement of delta & alpha waves with beta & gamma.
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Balazs @cannulaservice.hibalazs.net · 12/11/2024
4. Limitations of BIS: Value paradoxically increases with age as doesn't adjust for relatively higher beta & lower alpha power (unlike Narcotrend). Suppression ratio is *not* included in BIS algorithm below a cutoff of 40%.
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Balazs @cannulaservice.hibalazs.net · 12/11/2024
3. Dominant frequencies depends on age / brain maturation, as well as anaesthetic agent. Physiological age & developmental delay will alter patterns too. Contextualise EEG to your patient & set DSA power limits based on this.
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Balazs @cannulaservice.hibalazs.net · 12/11/2024
2. Look at EEG during induction: progress to predominantly large amplitude delta & alpha waves. Use as guide to time airway manipulation / ready for muscle relaxant. Differences in pattern progression based on induction speed: increase in alpha power w/ slow induction ("top down").
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Balazs @cannulaservice.hibalazs.net · 12/11/2024
Thoroughly excellent talk from Dr Mark Barley & Dr Tom Blanks on advanced pEEG interpretation at #SIVA23. My main takeaways: 1. Appreciate changes in amplitude & not just frequency (+ turn off 2Hz filter)
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Balazs @cannulaservice.hibalazs.net · 12/11/2024
We just need to share this three times to summon him.
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Balazs @cannulaservice.hibalazs.net · 12/11/2024
Fair enough, obv use what you have, can't ever have all the equipment we want! I've used the EMMA by Masimo and it's pretty great, pocket sized mainstream capnograph not reliant on external monitoring.
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Balazs @cannulaservice.hibalazs.net · 08/11/2024
It gets tiring to keep answering these questions from pro PA advocates when the litany of info is easily accessible. & shows their assumptions to be entirely wrong. & yet those expressing their concerns are frequently made out to be the bad eggs. where's the good faith? t.co/WvhU...
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Balazs @cannulaservice.hibalazs.net · 03/11/2024
Ollie makes some excellent points. The interesting thing to me is that the conflict & professional identity crisis arising from not having these difficult conversations isn't a new concept. It's well described by Prof @alisonleary1 herself. A Sunday evening🧵: t.co/8LEOGKvzn9
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Balazs @cannulaservice.hibalazs.net · 01/11/2024
They can hold as many meetings, write as many press releases as they want, but @UMAPsUK are showing their cards. They're scared. They're scrambling. They don't know what to do. Rather than reflect on college decisions, they lash out with legal action. I wish them the best.
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Balazs @cannulaservice.hibalazs.net · 31/10/2024
Yet another royal college supports halt in PA recruitment. AND Nationally defined scope of practice for PAs. When will GMC & our leaders listen? You can't keep ignoring the leading speciality voices. www.rcpch.ac.uk/news-events/news/rc…
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Balazs @cannulaservice.hibalazs.net · 31/10/2024
The Reg 28 responses to sad death of Susan Pollitt are online. The GMC's response is... illuminating. A whole page on the history of PA regulation (not the point imo). Governance: Make no mistake, it's the supervisor & drs who will hold responsibility. tinyurl.com/Reg28Pollitt
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Balazs @cannulaservice.hibalazs.net · 29/10/2024
I wonder if @pa_StephenNash or @UMAPsUK would verify this is a statement issued by them? To be clear any such behaviour is repugnant & criminal, and has no place in society. It's also deeply concerning that UMAPs is the only place victims feel able to turn to. No police? News?
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Balazs @cannulaservice.hibalazs.net · 28/10/2024
Tbh the only conclusion I can draw is this is all smoke & mirrors. Another hurried plan very thin on details. There's just enough big words: "Ltd" "congress" "national executive committee" to fool you at 1st glance. Never holds up to close scrutiny. It's a scare tactic. t.co/wFnrZxu4T5
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Balazs @cannulaservice.hibalazs.net · 24/10/2024
Tbh I think the focus on "level 7" misses the point. Qualification levels help set *academic* expectations for entry & study. It's not about course specific curriculum. Specialised knowledge at level 7 doesn't = licence to see undifferentiated patients. t.co/clp1vS12uP
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Balazs @cannulaservice.hibalazs.net · 10/10/2024
Still radio silence from @pa_StephenNash on the many errors, but I got a DM I've been given permission to share. The AA whose name is also on the @UMAPsUK press release is an @NHSEngland ambassador & works at Sheffield! Sheffield appears to be getting their house in order tho! t.co/Z...
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Balazs @cannulaservice.hibalazs.net · 09/10/2024
Isn't it silly the GMC justify leaving the scope of PAs in the hands of the employer yet when it comes to doctors they recognise & explicitly monitor high risk employers. Sorry mate, you can't have it both ways. twitter.com/Mike88881221/status/184…
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Balazs @cannulaservice.hibalazs.net · 01/10/2024
"The clinical knowledge and skills required for the assessment and examination of children in these circumstances, are such that they are far beyond the level at which a PA should be working, even under supervision." The professional body has spoken. t.co/BRek8e1Roq
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Balazs @cannulaservice.hibalazs.net · 01/10/2024
👏 👏 👏 Tho I fear it's too late to halt this b/c GMC & health leaders won't acknowledge the omnishambles, I am grateful that a royal college is able to clearly set out their concerns & appropriate suggestions to safeguard patient care. t.co/5mkAB3CerF
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Balazs @cannulaservice.hibalazs.net · 18/09/2024
AAs contributed to the @RCoANews draft scope document. This includes 3 phases of increasing scope & responsibility. I'm not being funny here, but what do these other AAs want? If you don't want a ceiling, go to medical school & train as an anaesthetist like we did. t.co/obJ1cP1AuE
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Balazs @cannulaservice.hibalazs.net · 12/09/2024
A lot of bold claims are made about the utility of non-doctors filling medical roles to support the workforce. Let's take a look at an analysis of primary care in England, rather than making assumptions from poor data in other countries & systems. A 🧵 1/17
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Balazs @cannulaservice.hibalazs.net · 11/09/2024
Whilst denying any involvement with scope of practice it's obvious that GMC are 💯backing "timely extension" of "clinical knowledge and skills". That's scope creep. What everyone denies would happen, being pushed by Charles Massey. Is his resignation next?
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