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Joined May 2008
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Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 retweeted
One of the most terrifying job ads for a PA that I’ve ever seen ( and I’ve seen a lot )
@ShaunLintern non Drs and non prescribers managing vulnerable frail pts health & medications in care homes /at home .
This isn’t ‘ minor conditions ‘ is it @YvetteCooperMP @rcgp ?
This is how a President at UMAPs is currently operating.
Promoting their aesthetics clinic using their PA credentials - against GMC direction not to do so.
Stating they are the clinical supervisor - when they themselves should not be working as a PA without doctor supervision.
Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 retweeted
Six measles deaths in Pennsylvania is a shocking scandal and a health crisis
RFK Jr Staffer: “We're not gonna talk about measles”
HE’S THE GODDAM HEALTH SECRETARY OF THE UNITED STATES
When you have PAs registering the address of their ltd co.s as the ward, along with a dr, in some hospitals, nothing surprises me now.
How the heck does something like this even happen! 😮
“A 'mystery' surgeon operated on a breast cancer patient at a scandal-hit trust and ran a private clinic inside hospital grounds - but bosses have no record of him on the staff.”
thenorthernecho.co.uk/news/2…
Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 retweeted
US measles cases in 2026: 4,080.
All of 2025: 2,289.
That's 78% higher, with almost three months still to go.
This is a country that declared measles eliminated in 2000.
Failure
Ditto
I was not discharging anyone as a houseDog without my *brilliant* registrar approving
Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 retweeted
Every medical/ICU consultant enabling this practice should be publicly named and shamed! Clearly ‘noctors’ rarely care about patient safety and outcomes, and corporate managers care only about money, but how many more people have to die before we see significant change? Terrible!
The biggest problem imois “being forced”
My license
My choice
My liability
Seems pertinent to point out that in the tragic case of a child dying after being discharged from the ED reported by @JanetEastham the ANP involved tried to place responsibility for the discharge on an EM resident doctor. So sad and totally avoidable
Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 retweeted
When you read stuff like this, always look to see if someone is a medical doctor.
This person has a PhD and is a therapist spewing absolute nonsense.
Get your mammogram and colonoscopy. It might save your life.
I will never get a mammogram or a colonoscopy again.
Not because I don’t care about prevention. Because crushing breast tissue under massive pressure, forcing a scope through the colon, or sticking a needle into a mass is not prevention—it’s provocation.
A tumor is often the body’s way of containing what it cannot safely eliminate. When you smash, cut, or biopsy that containment, you can rupture it. Bacteria, debris, or cancer cells get driven into surrounding tissue. Lymph nodes that were already overloaded get disturbed. Then the next scan looks “worse,” and everyone acts shocked.
Why do we still treat these invasive procedures as the gold standard when they can create the very problems they claim to catch early?
Eloquence worthy of Bill the Bard
“𝗜 𝗯𝗲𝗰𝗸𝗼𝗻 𝘆𝗼𝘂 𝗻𝗼𝘁 𝘁𝗼 𝗳𝗮𝗹𝗹 𝗶𝗻𝘁𝗼 𝘁𝗵𝗲 𝗗𝘂𝗻𝗶𝗻𝗴-𝗞𝗿𝘂𝗴𝗲𝗿 𝗰𝘂𝗿𝘃𝗲”
Replying to @daprofile @mmamas1973
Your analogies are false equivalence. Complex knowledge being built on foundational knowledge is different from tangential education to said complex knowledge. There can be some overlap, and the argument for an early breadth of exposure before specialization can surely be made.
That being said it is evident to me that your understanding of medicine is incorrect. The tasks you may find trivial require an immense amount of knowledge and ground work. It may look easy because a seasoned practitioner is able to explain what they are doing very well, but you dont witness the mental processing and evaluations happening in the background.
I beckon you not to fall into the trap of the Dunning-Kreuger curve.
The resounding and incredibly important point for everyone to understand here is
“Ask for a Doctor”
And then confirm they are
I would not be offended by anyone who asked me that question although they never needed to as i had an appropriate badge and introduced myself as such
If physician associates are able to train in "medicine" and are magically able to see patients independently in two years - why does it take doctors 5 to 6 years medical degree and 10 years postgraduate training before achieving independence?
We have to decide whether we want a safe healthcare service delivered by fully trained doctors or go back to a free for all where anyone can practice medicine with a cursory level of knowledge/ training and do away with medical degrees / medical training
It's like living in a parallel universe where simultaneously you need over 15 years of training to be considered safe as a doctor but anyone else can do a simple course and get stuck in.
Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 retweeted
One of the best bits :
Judge - who told you that there would be a job or role for you at the end of your PA course ?
Permission … DENIED 😬
#shouldvedoneyourresearch
Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 retweeted
Apparently my medical degree is an "indoctrination certificate"
Would you say the same about a pilot's flying licence?
Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 retweeted
Polite reminder. Trump & Brexit are not 2 different things. They are the same thing. Same companies. Same data. Same Facebook. Same Russians. Same Cambridge Analytica. Same Robert Mercer. Same Steve Bannon. Same Breitbart. Same Alexander Nix. Same Donald Trump. Same Nigel Farage.
Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 retweeted
I am a member of the Norwegian Nobel Committee.
There are five of us. Five people, appointed by a parliament most of the planet could not find on a map, who decide, once a year, which human being the world has agreed to call good.
I know. I know. I think about it on the tram.
We meet in a building on Henrik Ibsens gate, a street named after a man who wrote almost exclusively about people discovering they are frauds, which nobody on the committee finds funny except me. There is a room with a long table and the portraits of the dead laureates looking down, Mandela, the Dalai Lama, a great many earnest men in spectacles, and one portrait we do not discuss, which is Kissinger, 1973, awarded while the bombs were still falling, after which two of our predecessors resigned and the satirist Tom Lehrer said political satire was now obsolete. We keep him on the wall. A reminder. Every family has the uncle.
It is October in Oslo, which means the sun gives up around four in the afternoon like a civil servant, and it rains the particular Norwegian rain that isn’t quite falling, just hanging there, judging you. I arrive with wet shoes. I always arrive with wet shoes. There is coffee, because this is Norway and there is always coffee, we drink more of it per person than almost anyone alive, and someone’s wife has sent kanelboller, the cinnamon buns, and we sit, five Norwegians, damp, caffeinated, sugared, and we decide the moral standing of the entire species.
Let me tell you how it actually works, because the world imagines a cathedral and it is, I promise you, a book club with a mandate.
287 nominations this year. 208 people, 79 organizations. Anyone can nominate, that’s the secret nobody understands: a professor, a parliamentarian, a former laureate, so the “nominee” list is meaningless, it’s a suggestion box, and every autumn some congressman nominates his own golden retriever and the press writes “SHORTLISTED.” Nobody is shortlisted. There is no short list the public ever sees. There is us, and the coffee, and the rain, and the portraits, and a Norwegian stubbornness that is older than the prize itself.
We read reports. The institute’s advisers write them, thick dull documents, and we argue. Our chairman told the BBC once that in the final meeting “there is a high temperature.” High temperature, for a Norwegian, means someone slightly raised an eyebrow and then apologized for it. We don’t do high temperature. We do a long silence, and then Kristin says “well,” and everyone knows exactly what “well” meant, and it’s settled. That’s our shouting. “Well.” You’d have to be raised here to hear the violence in it.
Now. This year. I will not say the name, because we never say the name, but you know the name.
A certain head of state wanted this prize the way a child wants a thing in a shop window, which is to say loudly, and in public, and with the full belief that wanting it was itself the argument. He said he deserved it. He said he’d ended eight wars, a number that grew most times he said it, like a fish. He had other heads of state phone us. Israel’s prime minister posted it on the internet, “Give him the Nobel.” The leaders of Cambodia and Pakistan announced they’d nominated him, as though announcing it were part of it, as though we tally mentions. A man flew around the globe collecting endorsements for a Norwegian committee the way you’d collect signatures for a petition to the council about a noisy dog.
And here, uff da, is the detail I treasure, the one that makes me smile into my coffee. The nomination deadline is the 31st of January. He took office on the 20th. So for all the phone calls, all the posts, all the gilded lobbying, the only nominations that could possibly count for this year’s prize were filed in the first eleven days of his term, before he had, by his own arithmetic, ended a single one of the eight wars. He campaigned all year for a prize whose window had shut while he was still hanging up his coat. We didn’t have to reject him. The calendar did. We just watched. Norwegians are very good at watching. We have long winters.
People think we sit there weighing his deeds. We don’t. That’s the thing I can’t make the world understand. We’re not grading his homework. We don’t owe anyone the prize for a ceasefire, however real, however loud the announcement. “He made peace” is not a sentence that ends in a medal, the way he believes it does, the way he believes every good thing ends in his name on it. The will of a dead Swede says the prize goes to whoever did the most for fraternity between nations. A dead Swede, I should add, who made his entire fortune inventing dynamite and selling arms, and spent his last years horrified at his own obituary, which called him a merchant of death, and so bought his way to immortality as a man of peace. The whole prize is one guilty arms dealer’s attempt to launder his name. We are, all of us, administering a dead man’s public relations. I find this clarifying. It keeps me humble. It should keep everyone humble, and it keeps, by my count, no one humble at all.
So who did we give it to?
An eighty-five-year-old woman. A judge. Born in Durban, under apartheid, granddaughter of a Tamil man who came to South Africa as indentured labor, a bus driver’s daughter from the poor Indian quarter, who became the first non-white woman to run a law practice in her province, who defended Mandela’s people when defending them was dangerous, who sat on the Rwanda tribunal and the court at the Hague, and who, at eighty-five, is right now a judge weighing whether a genocide is a genocide. When we told the world, our chairman said the rule of law “underpins the system we have set up to ensure peace,” and that “peace requires justice.” She wasn’t even in Oslo. She was in Nuremberg. In courtroom 600. The actual room where they tried the Nazis. You cannot stage that. God staged that, and God, it turns out, is a better satirist than any of us.
She did not phone us. She did not post. No prime minister demanded it for her on the internet. She had, as far as our deliberations are concerned, the one qualification the loud man could never manufacture, which is that she wanted the work and not the medal. The medal finds those people. It flees the ones who chase it. This is not a rule we wrote. It’s just the only pattern the hundred-odd years of our mistakes has ever shown.
The reaction from across the ocean was immediate. His spokesman posted that we “place politics over peace.” Ja. Perhaps. We’re five damp pensioners in a rainy city; of course it’s political, it was always political, it was political when we gave it to a sitting American president nine months into his first term for the promise of things he had not yet done, and we have been quietly embarrassed about that one for fifteen years, so believe me, we had a particular reason this year to prefer a woman with fifty years of verdicts behind her over a man with eight wars in front of him and a deadline already behind him.
Here is what he will never understand, the thing I’d tell him on the tram if he ever took one. We are the one prize he cannot buy, cannot post his way to, cannot have a friendly dictator phone in for him. Not because we’re incorruptible, nei, we’re as vain and wrong and human as the portraits on our wall. But because the entire point of the thing, the only power a small cold country’s book club has ever held, is that it goes to the person not performing the wanting. The moment you demand it, you’ve proven you don’t understand what it’s for, and proving that is itself the disqualification. He ran the most expensive campaign in the history of the prize and the campaign was the reason. He was never losing to Navi Pillay. He was losing to the concept.
It’s dark now. Four o’clock dark. The buns are gone. Kristin said “well” an hour ago and we all went home. I’m on the tram with my wet shoes, and somewhere across the water a very powerful man is explaining to a camera that the prize is rigged, that we’re corrupt, that he’ll win it next year, and he genuinely might, we’re only five idiots and we’ve been wrong before, Kissinger is still on the wall.
But not this year. This year an old woman in Nuremberg, in the room where the law once stared down the exact kind of man who thinks wanting a thing loudly enough should make it his, got a phone call she didn’t ask for.
That’s the job. We don’t reward the man who ends the war and announces it.
We reward the woman who spent fifty years deciding what a war was.
He’ll never see the difference. That’s rather the whole point of him.
Takk for i dag. I have to change trams.
Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 retweeted
Just published @TheLancet
Global threats to health in the 21st century
an opus, 59 page comprehensive dissection of all the threats we face
thelancet.com/journals/lance… @IHME_UW
Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 retweeted
Medicine is the only profession where you could lose your right to work for years or more because a patient didn't like something you said.... case in point... Spoiler alert! The patient ended up having a migraine, and a doctor's professional life was nearly destroyed...
A state medical board can review a doctor’s case, find nothing wrong, and close it, and the report to the National Practitioner Data Bank still stays.
That’s what Aysun Alagoz, an OB/GYN in Texas, says happened to her.
In 2011 she had a solo practice in a small town, about nine years in. A hospital executive called and told her to come to an urgent meeting. Nobody would say what it was about. She was accused of mismanaging a colleague’s patient while she was on call, a pregnant woman with high blood pressure. She wasn’t allowed to see the written complaint, and in two days there was no way to get a lawyer.
She was given a summary suspension and walked off the premises. She had until Monday to resign her privileges or be reported to the data bank. She says a summary suspension is an automatic referral anyway, so she refused, to keep a paper trail of her side.
What followed, in her account:
1. A small committee of physicians reviewed the case and wrote that she should be allowed to resign rather than be reported.
2. The executive committee reported her anyway. The board of directors gave the same answer, with no explanation.
3. The Texas Medical Board took about a year, found nothing wrong, and closed the case.
4. The data bank entry stayed. She was told she could add her own comments, but she says nobody reads those. She couldn’t find a job for about two years and lost several jobs once they queried the data bank.
She says the patient’s diagnosis turned out to be a migraine headache, and the colleague who filed the complaint never called her to ask a question. Her bylaws allowed an outside review, she says, and none happened.
Her argument about why this keeps happening: the Health Care Quality Improvement Act of 1986 makes people who sit on peer review committees immune to lawsuits. She has heard of doctors who sued for bad faith, spent hundreds of thousands of dollars, and lost.
Her advice if you get the call:
Delay the meeting if you can.
Go with a lawyer, or at least consult one who represents doctors in peer review.
Don’t agree to anything.
Don’t be afraid.
The line she was given about the data bank: “Once it’s on the data bank it stays on the data bank.”
Listen to the full conversation on The Podcast by KevinMD. Link in the replies.
Search "The Podcast by KevinMD" wherever you listen to podcasts
What would you do in the first hour after a call to an urgent peer review meeting with no reason given? #ThePodcastbyKevinMD
OMG, this gets worse by the minute! @theRCN ACP nurse says she doesn't need to read the @rcgp GP's referral note before seeing the patient. This is truly a scene straight from hell!
Replying to @Megsenmumdr
At Dylan’s inquest in May 2024, ANP said it “wouldn’t be unusual” for her to assess children without reading their GP’s referral.
Ms Hayden reasoned that practitioners “shouldn’t be led directly” by a GP’s assessment
@RCollEM is this what you teach YOUR ACPs/ANPs ?
Ñick van Terheyden, MD -Dr Ñiçk 🇺🇸🇬🇧🇮🇪🇳🇬🌍 retweeted
Replying to @Megsenmumdr @RCollEM
Did the ANP accept accountability at the Inquest?? No -tried to blame ED Reg 🙄
-?lied Reg had been informed Dylan had abdo paint- Reg said No
- ANP“believed”Reg would review- but didn’t ask Reg to & completed discharge paperwork as Flu
-Dad’s repeated concerns brushed off


































