This is Ramsey. He is a mail delivery dog. Shipping is free, and while packages might not be handled with care, they are handled with enthusiasm. 14/10

Yay! It’s #DogsAtPollingStations day!

Celebrating annual leave (and apparently 20 years in the nhs this year) by bagging some more trigs

It’s Ed Shear-ram! (Escaping the madness for a day)

Bloomin’ tired. And realised I’d intended to book annual leave in my diary and never actually booked it. Oops, but explains why an evening with a book is needed!

Always a pleasure to teach! Thanks to the rest of the faculty and the candidates for making it fun! (Even if we do look like we are staring at a blank flip chart)

Delivering bad news as an ICU doctor is one of the harder parts of the job. Here are some lessons I've learned along the way👇 1. Always sit down 2. Don't just jump into it. Spend the first couple of minutes with introductions to yourself, your team (if present), but more importantly who all is in the room (patient, family etc.) 3. If you will be needing consent for something (procedure, palliation etc.) as part of the discussion, ensure you know who the decision maker(s) are. 4. Preface the bad news "I have to share something that might be hard to hear" 5. Clearly in <30 seconds deliver the bad news then STOP TALKING. The biggest mistake I see is people give the news and keep going. It takes time to process what may be the worst news they've ever received. Silence is the solution here. They will talk or ask questions when they are ready... it could be 10 seconds, 1 minute, or 10minutes. Give them the time they need before you proceed. 6. Ask if they have any questions about what you have delivered. 7. Be prepared to answer 'what comes next' .. 8. Ask about spirtual / religious beliefs when appropriate and offer support if that is available. 9. Let them know you or someone from your team will be available to answer questions that might come to mind... often in the moment, questions slip people's mind but come to them minutes after you leave. Make sure they know how they can have them clarified. Just some thoughts here... any others? Bonus: Don't construe family members becoming angry as them being angry at you or the team. Anger when faced with this news is common, normalize it and realize it likely isn't directed at you!

Waggy retirement Cilla!

Not many colleagues retire at 13 but therapy dog Cilla is hanging up her lead 🐾 From ICU visits to school reading sessions, she’s spent 7 years bringing comfort, confidence and smiles to hundreds of people. Wishing Cilla a very happy and well-earned retirement. 💛

Reflecting on an overwhelming sense of ‘not again’ for this. It’s the impossible problem. I’m not sure what can (reasonably) be done. Pulling residents out of work for a 50% turnout harms their training and wages, for limited if any gains. A farce from the militant bma. Again.

Electronic systems don’t reduce errors automatically, they simply change the nature of those errors. Safety should be designed in to avoid unintended consequences

Having done a lot of ‘down below’ lists needing legs up, it’s always keep going, keep going, nope, too far, back up a bit. Perfect.

Welcome to the nhs! instagram.com/reel/DO71ct8DG…

Facebook reminded me of this from a long time ago, but still rings true. Not sure if the bit about chasing efficiency or new hospital buildings is more accurate…

The number of hospitals across the country using our #EPR continues to grow. It’s set to support nearly 14,000 beds across 29 hospitals, including some of the country’s biggest and busiest. It will empower more than 120,000 #NHS staff who provide care for up to 10.5 million people. All on one cloud platform that’s built to bring providers together. Several of our deployment programmes have come to an end; others are mid-deployment. And next year, more NHS trusts will embark on digital transformation journeys with us. We can’t wait…