NETRAG+ episode 0

In our much anticipated 5th episode, Shal speaks to different members of the Physician Response Unit (PRU) which is a pioneering Community Emergency Medicine service which aims to deliver safe, effective and patient-centred emergency care in North East London. It is delivered in partnership with Barts Health NHS Trust, London’s Air Ambulance Charity and the London Ambulance Service. Part 1 sees Shal speaking to Dr Tony Joy (EM consultant at the Royal London Hospital and Clinical Lead for the PRU) and Bill Leaning (Senior Flight Paramedic and Clinical Manager for the PRU) as they describe the evolution of the service in accordance with changing patient needs, healthcare resources and a global pandemic. They also share some of their own lessons for working with other disciplines as part of the wider healthcare system, providing holistic care that is tailored to the patient in front of you and preventing compassion fatigue. Part 2 sees Shal speaking to Megan Popplewell (Senior Sister at the Royal London Hospital and Emeritus PRU Nurse), Matt Dibble (PRU Emergency Ambulance Crew (EAC) and Dr Annie Chapman (EM ST4 and Emeritus PRU Fellow). They all share their own experiences of working within the service, the road to PRU application and how their time with the PRU has impacted upon their professional practice in their 'day jobs.' What is clear from speaking to the team is how the patient is at the heart of everything the PRU does and the primary aim is always to enhance overall patient well-being and experience however indirect benefits in the form of greater cross-disciplinary working, recruitment and retention of emergency staff, education and development of the team and, where appropriate, a reduction in ambulance conveyances, ED attendances and inpatient bed occupancy are also experienced by the wider system. Read more here: https://www.londonsairambulance.org.uk/pru Should you wish to learn more about the service or request an observer shift, please email: [email protected]

In our much anticipated 5th episode, Shal speaks to different members of the Physician Response Unit (PRU) which is a pioneering Community Emergency Medicine service which aims to deliver safe, effective and patient-centred emergency care in North East London. It is delivered in partnership with Barts Health NHS Trust, London’s Air Ambulance Charity and the London Ambulance Service. Part 1 sees Shal speaking to Dr Tony Joy (EM consultant at the Royal London Hospital and Clinical Lead for the PRU) and Bill Leaning (Senior Flight Paramedic and Clinical Manager for the PRU) as they describe the evolution of the service in accordance with changing patient needs, healthcare resources and a global pandemic. They also share some of their own lessons for working with other disciplines as part of the wider healthcare system, providing holistic care that is tailored to the patient in front of you and preventing compassion fatigue.  Part 2 sees Shal speaking to Megan Popplewell (Senior Sister at the Royal London Hospital and Emeritus PRU Nurse), Matt Dibble (PRU Emergency Ambulance Crew (EAC) and Dr Annie Chapman (EM ST4 and Emeritus PRU Fellow). They all share their own experiences of working within the service, the road to PRU application and how their time with the PRU has impacted upon their professional practice in their 'day jobs.' What is clear from speaking to the team is how the patient is at the heart of everything the PRU does and the primary aim is always to enhance overall patient well-being and experience however indirect benefits in the form of greater cross-disciplinary working, recruitment and retention of emergency staff, education and development of the team and, where appropriate, a reduction in ambulance conveyances, ED attendances and inpatient bed occupancy are also experienced by the wider system.  Read more here: https://www.londonsairambulance.org.uk/pru Should you wish to learn more about the service or request an observer shift, please email: [email protected] Episode analytics

In our most recent episode of NETRAG+ Shal explored how we might better navigate any difficult conversations regarding vaccine hesitancy with family, friends, colleagues and patients. Our first speaker is Rula Awad who has a background in machine learning and media transparency tools. Rula is currently working with various governments to help combat misinformation and disinformation surrounding the COVID vaccine rollouts and explains some of the drivers underlying vaccine hesitancy.  Our second guest speaker is Sue Rubenstein who has a background in leadership and organisational development. Sue is currently the Vice Chair for the People and Culture committee of an NHS Mental Health Trust. Sue proposes a framework that healthcare professionals (HCPs) might adopt to better navigate these complex conversations.  What's clear by the end of this episode is that having difficult and uncertain conversations,  particularly when past experiences colour important future decisions, being scientifically 'correct' is not valuable unless we are also influential. COVID is new, unpredictable and frightening and any usual confidence in healthcare systems and professionals is not as assured as it would be otherwise. If someone is hesitant about the vaccine in the context of a deadly pandemic we can assume that the person is anxious and frightened. Try to understand and empathise with their position. Share information in a neutral manner and refrain from judgement. Offer them the opportunity to pause and reflect. Be a reassuring and approachable presence should they wish to discuss further. Influence is not binary so, whether or not you have shifted their perspective this time around, the next time they experience either a personal or public health crisis, their next healthcare professional might have a more positive and mutually respectful relationship to work from. Read more here: https://netragplus.wordpress.com/2021/03/15/episode-4-navigating-conversations-on-vaccine-hesitancy/

In a world before exam grade U-turns, shifting travel restrictions and evolving hot/cold pathways, the concerns of most staff working within the ED were much more 'precedented.' For the majority of us, these concerns could essentially be reduced to: Keeping patients safe Keeping the department happy Keeping your own sanity Bonus points for keeping your own pen However it always seems to be at exactly 2am, when there is a 3 hour wait to be seen, a full resus, someone belting out 'Hero' by Mariah Carey on repeat (with the occasional duet from the intoxicated patient next door) and an actively suicidal patient trying to abscond, that these three most basic of aims are at greatest threat. Its here that I often begin to re-evaluate my career & life choices. This month, NETRAG+ discusses two major challenges in this all-too-familiar scenario: the impact of night shifts on healthcare workers, and the disruption that can sometimes arise when caring for patients with personality disorders. Whilst these are recognised and necessary features of our working lives in ED, this by no means renders us impervious or more innately resilient to them than our colleagues in other disciplines. We hope that this episode not only starts a conversation about such challenges, but also provides some practical pearls on how to better identify and navigate them, beyond a 2am yearning for emollient prescriptions, for the wellbeing of our patients, our teams and ourselves. Read more at here: https://netragplus.wordpress.com/2020/09/17/episode-3-night-shift-anxiety-and-patients-with-personality-disorders/

At the time of recording, the London Borough of Newham was reported to have the highest COVID-19 death rates in the UK with Brent, Hackney and Tower Hamlets not too far behind. It is no coincidence that Newham is also one of the poorest boroughs in the country as the pandemic lays bare our existing social, economic and political inequalities. These glaring disparities are likely to be exacerbated in the years to come given COVID-19's triple threat to health, education and income on both a national and global scale. Hot on the heels of our first episode on "Racism & COVID-19", the NETRAG+ team had the opportunity to sit down with three health leaders working in distinct roles in Newham to listen to their personal and professional experiences of the pandemic thus far: Director of Public Health for Newham, Jason Strelitz - working tirelessly with other local authority partners to advise schools, businesses and care services, and to support those who are vulnerable through food distribution, prescription delivery and befriending via ‘Help Newham’ hubs. Emma Young, an EM consultant at Newham University Hospital, who describes the all-too-familiar transition from operational inconvenience to adrenaline-driven alarm reaction and, now, burnout and moral injury despite working in a specialty that is well-versed in problem-solving and dealing with uncertainty. Esther Murray, a health psychologist working in Barts and the London School of Medicine and Dentistry. Esther expands upon the concept of moral injury and its relationship with grief, guilt, minimisation and leadership. But is it possible to heal moral wounds - particularly at a time of social distancing when access to our usual support systems may be limited? Moral repair programmes for veteran soldiers suggests yes and, conveniently, its managed by conversations such as these - by sharing our stories and experiences with our peers. As Esther explains - we are each other’s most important resource. What’s clear from episode 2 is that, amongst the very real tragedies of COVID-19, great compassion has emerged with a desire to look after each other and protect the wider community. There is, however, also outrage. Outrage for what has been long-apparent in Newham but which some of us had started to forget: inequality kills. So as we move through this first wave - on to a second wave or recovery or whatever else befalls us - how do we use this outrage to rebuild better, respond better and, ultimately, do better so that all society moves forward and no one gets left behind? There are a few other recommended resources on the accompanying blogpost here - listen, share and comment below to let us know what you think! Shal NETRAG+

Both the COVID-19 pandemic & the treatment of humans like George Floyd have very publicly exposed the inequalities which lie at the heart of our societies and political structures the world over. But what does that have to do with treating patients & working as an emergency physician, you might ask? The answer: an awful lot - and much more than I've ever understood in the past. Back in March, the guests for our very first NETRAG+ podcast, academic Darren Chetty & clinician Rageshri Dhairyawan (though they both have several other roles & hats) wrote a Discover Society article analysing these very issues: would the anticipated overwhelming of NHS resources by patients critically unwell with COVID-19 expose already deeply unequal outcomes between ethnic groups? And how do these relate to structural racism? This challenging read linked well to a training day we were due to hold for our trainees around education & public health (you'll hear more content from this soon) and I was delighted when they agreed to a virtual chat around their motivations for writing the article. We touch on many things: unconscious bias, The Marmot Review Ten Years On, the preoccupation with the biological over social explanations for health disparities, shameful racism & unethical research in the history of medicine, problems with physicians' interpretation of pain in females & BAME groups, and so much more. Visit the Wordpress blogpost for recommended reading (both Rageshri & Darren wear several other hats!) Listen, share and comment below to let us know what you think! Chris NETRAG+

NETRAG = North East Thames Regional Academic Group - the name for educational days for higher trainees in emergency medicine in NC/NE London. Our podcasts will give you learning in audio format on a wide range of topics for the emergency physician aspiring to be excellent. Coming soon - episodes 1-5 with content including: managing the ED night shift anxiety calling a childrens' acute transport service patients with personality disorders the patient with cardiogenic shock Bookmark the pod, or follow us on Twitter/Insta & the blog at netragplus.wordpress.com The NETRAG+ podcast team