Dr Louella Vaughan

😁

Sadly, you are probably right.

To be subdivided and flogged for apartment blocks.

This is mine!

Lovely! Lucky you.

a woman with red hair is asking " who asked you " what are you talking about ALT: a woman with red hair is asking " who asked you " what are you talking about

Buffy the Vampire Slayer.

Australian 3/4 acre block outer suburbs...

Andy, this topic is MUCH more fun over on Twitter.

Everyone on Bluesky is too polite.

a baby girl is sitting on a couch with her eyes closed and making a funny face . ALT: a baby girl is sitting on a couch with her eyes closed and making a funny face .

Me after reading the 10YP.

I am so very sorry Trisha.

She was a very lovely one.

Time is running out!

Less than 3 days left to vote in the @rcphysicians.bsky.social elections.

Links to voting in email from Civica.

Vote @drlkvaughan.bsky.social for Vice President!

Please encourage your FRCP colleagues to vote before Monday 14th April

Vote Asif Qasim for President

@drlkvaughan.bsky.social for VP
@respirologist.bsky.social Dr Philip Pearson for Council
@copddoc.bsky.social Prof Nick Hopkinson for Council

#TimeForChange

Thanks both!

Claudia and I found it a very difficult piece of work to do. But was important to document experiences and analyze impact soon after events.

Organisations have VERY short memories.

I've talked to hundreds of Members and Fellows and their views are clear: we need to revitalise the RCP and restore the #VoiceOfPhysicians

Vote Asif Qasim before Monday 14th April

It's time to act: let's make the RCP something we can be proud of

Thanks Fiona!

The algorithm threw you up in my timeline on pretty much my first day on Twitter.

I thought: Oh Cool. Interesting stuff. And followed you.

Here we are, a decade later...

Governments around the world need to face up to the issue that the cost of providing healthcare over the next 2 decades is going to be wildly expensive.

Making the workforce less skilled and less efficient for marginal cost savings isn't the solution.

Fin

half a century. Fully trained doctors provide the best care. It just isn't possible to chunk up the job and outsource it.

Not is it just not efficient in the long run, but it creates other problems. And patients suffer as a consequence.
5/

How do you make one?
How do you ensure safety and accountability?

Especially problematic given that what doctors do (mostly) is to THINK about things and make DECISIONS. The skill stuff is an added extra.

The grand experiment with workforce subs has been going on for over
4/

that not everything a doctor does need years of training. And somethings could (and have been been) be safely done by someone not a doctor.

But the problem is that workforce substitution quickly slides into the existential:
What is a doctor?
What do they do?
3/

anywhere in the world. Except perhaps Germany.

The logical solution is train more doctors and to use carrots (+ the occasional stick). But this is expensive!

So the alternative, since the 1960s, has been workforce substitution. This is attractive, as it certainly is true
2/

Just off the Leng Review call.

Once again it strikes me just how existential the issue of workforce substitution is and what is at stake.

The root cause is not enough doctors. Historically, not enough in rural and remote places. With the coming 'Silver Tsunami', not enough
1/

Why Does This Matter?

Because for the last decade or so, health policy has been led by superficially appealing. but unevidenced ideas and *vibes*.

The only way out is evidence and clear thinking.

The RCP needs to become a powerhouse for evidence-based policy.
Fin.

Louella VAUGHAN | Consultant Physician | MBBS DPhil | Barts Health NHS Trust, London | Research profile Louella VAUGHAN, Consultant Physician | Cited by 1,277 | of Barts Health NHS Trust, London | Read 56 publications | Contact Louella VAUGHAN

8. Miscellany
I have been lucky enough to be able to write about others I think are important. Standards and how they are used. QI. Medicines. Identifying sick patients.

researchgate.net/profile/Loue...
9

Lessons from the pandemic: Infection prevention and control and building design Covid-19 brought about an enormous amount of change in the way that hospitals operated, whether through evolving treatments, the use of space, ventilation systems, oxygen supplies, or use of technolog...

7. Hospital Design
Follows kind of naturally from interest in models of care more generally.

nuffieldtrust.org.uk/research/les...
sciencedirect.com/science/arti...
8/

Independent report on the regulation of advanced practice in nursing and midwifery Nurses and midwives are increasingly taking on more complex, autonomous and expert roles – commonly referred to as ‘advanced practice’. But the application of this title and role type varies hugely an...

5. Regulation
A hot hot hot topic at the moment. I spent months wading around in the international literature on regulation and how it works in the UK and elsewhere.

nuffieldtrust.org.uk/research/ind...
6/

‘August is always a nightmare': results of the Royal College of Physicians of Edinburgh and Society of Acute Medicine August transition survey An electronic survey was used to assess perceptions of the disruption caused by the August transition and explore support for possible solutions. In t…

4. Medical Work and Workforce
Much of the work above includes workforce. But I have written on this specifically. I am esp proud of the piece that persuaded AoMRC to pay incoming FY1s for induction (you can thank me later!).

sciencedirect.com/science/arti...
nuffieldtrust.org.uk/news-item/wh...
5/

Effectiveness of acute medical units in hospitals: a systematic review AbstractPurpose. To assess the effectiveness of acute medical units (AMUs) in hospitals.Data sources. (i) Controlled and observational studies in peer-revi

3. Acute Medicine
LOTS on this. First review paper on outcomes. Structure. Staffing. Care for specific patient groups.

academic.oup.com/intqhc/artic...
sciencedirect.com/science/arti...
sciencedirect.com/science/arti...
4/

Link to study:
journalslibrary.nihr.ac.uk/hsdr/HSDR09040

2. Smaller, Remote and Rural Hospitals
Why closing them isn't a good thing for local people and how to sustain them.

sciencedirect.com/science/arti...
qualitysafety.bmj.com/content/32/4...
3/

1. Models of Care
My special nerd topic. I led the largest piece of research on models of care in English hospitals to date.

Covered lots of stuff:
- what models look like
- do they affect outcomes (not as much as people like to think)
- how do they arise
- staff behaviours
2/

I'm running for Clinical Vice President of the
@rcphysicians.bsky.social!

Lots of complex issues to grapple with at the moment. I have spent 20 years in the health policy space. Here's a quick tour of the work I have done. 🧵
1/