💊 Doctors' Order: More Medical News

Hmm, I’m looking at your blood results. It’s not what we would have hoped for…
It shows that you're diabetic.
You’ll probably need some metformin. But I’ve always been the eccentric, Dr House type. So I’ll prescribe you some more medical news. That’ll do the trick 👍

👋 Happy Friday. Here’s what we got:

If you want to read any previous editions of The Handover, you can on our website.

The time is near.
You’re lying in pre-op. It’s 7 am.
You haven’t eaten in precisely 12 hours and 37 minutes. 

Some joker in scrubs asks if you’re hungry.
“Yes, Kevin Hart 🙄.” You think to yourself.
“I’m starving. I’m also wondering why I’m being tortured”

For almost 80 years, pre-op fasting has been the way.
Craving a cup of canteen yoghurt? Forget it.
Want a coffee with milk? We may have to PHQ-9 you for suicidal ideation.

You see, the big bad word clinicians are trying to avoid is aspiration. 

In 1946, a Dr Mendelson first documented the link between aspiration of gastric content and lung injury.
In the 50’s, studies came out and concluded that gastric volumes of >25ml or a pH <2.5 increased the risk of aspiration. However, these studies were done in animals like pigs and monkeys(it was the 50’s 🤷)

Although uniformly accepted as markers for the risk of aspiration in human patients, the endpoints were never shown to predict aspiration or pulmonary complications in humans. 

So the motto has been better safe than sorry, and we’ve been fasting ever since. 

That was until this group of unruly researchers did a study and claimed there was…

Very bold… Let’s investigate. 

This meta-analysis and systematic review, published in Surgery, took an alternative approach to fasting and aspiration. 

The aim was this:

Rather than looking at surrogate measures(gastric volume or pH), it decided to look at human-witnessed aspiration as the primary outcome. Then, pool together all the relevant studies to see if preprocedural fasting actually leads to increased aspiration and pulmonary complications in humans. 

The team looked far and wide for adult studies of differing fasting regimes that reported on clinical aspiration, gastric volume and pH. After purging and screening over 3500 RCT’s and observational studies between 2016 and 2023, they landed on 17 key papers included in the final analysis. 

What did they find?

Well… No association between preprocedural fasting and witnessed pulmonary aspiration. 

They even went so far as to do a special test called a Trial Sequential Analysis that indicated that doing more studies is unlikely to disprove these results. It’s reached “statistical futility” 

The results sound pretty damning… the top huncho of the study took to X to flex his findings, and a heated debate between anesthesiologists and surgeons ensued. 

Have a look for yourself. What do you think?

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So… outside work, how do you make ends meet?
Shockingly, that big, prestigious medical degree doesn’t leave a ton of options…

Locum shifts are dwindling…
The juice isn’t worth the squeeze with tuition…
Pick up the camera and become a medical influencer… perhaps not. 

Keep quiet. Suck up. Wait for Consultancy.
Sound like a fair deal to you?

What if you could do something better with that clinical noggin of yours?
Meet Mercor🤝

Mercor connects doctors with paid opportunities to help train the next generation of AI.

You’re not diagnosing ChatGPT’s headaches; you’re applying your knowledge to shape how future medical models actually think.

They take you as you are (a clinician with years of expertise)
From where you are (the comfort of your living room)
With task-based jobs paying anywhere between $100-$340 an hour.

The more senior you are, the better
Genuinely great opportunity, but roles do fill up fast.

So don’t wait for Consultancy to make it all worth it.
Sign up to Mercor today and start getting paid for the one thing they always underestimate: Your brain.

Check it out using the link below 👇 (and filter for most pay):

*P.S. Consultants reader, don’t feel left out. The best side-gigs extend especially to you, too 👆

You’ll never guess what.
No, your next rota still hasn’t been released. Even better!

Remember the Mental Health Act?
That old thing that governs when and how people are treated in acute mental crises?

Well, after nearly 40 years of running, the devs (government) have finally dropped a new update. officially upgraded the Mental Health Act 1983  to the Mental Health Act 2025.

What’s Happened?

Everyone’s favourite health sec, Wes Streeting, announced the plan is to “transform lives” by “tackling disparities” and “rebuilding a mental health system.” 

Big promises. But will the new Act actually meet the mental health needs of today’s population?

Let’s take a look at the patch notes:

The MHA 2.0: Key Changes

They’ve tightened the criteria for detention. Now, detaining someone under either section 2 or 3 requires evidence that “serious harm” may be caused to the health or safety of the patient or another person.

No guidance as of yet as to what constitutes “serious harm”. And how exactly do we go about evidencing it?

It seems good for questioning whether deprivation of liberty is really a necessary step to take. Conversely, it could pose problems for escalating in a timely manner🤔

The ‘nearest relative’ has been formally retired. Long live the Nominated Person!

Patients can now choose anyone to advocate for them, be it a sibling, partner, dentist or mate.

This NP™ can:

Who would’ve guessed?

The 2025 Act removes police cells from the definition of “places of safety” for sections 135 and 136

(At least… acknowledged)

For years, we’ve known that Black patients are significantly more likely to be detained, restrained and subject to compulsory treatment under the Act.

MHA 2025 places explicit duties on services to:

Community Treatment Orders (CTOs) are 8x more likely to be issued to Black patients. After debate over scrapping the concept completely, the government has decided to place CTOs under ‘review’.
What does that mean? …we dunno yet🤷

Much remains to be seen if the implementation will succeed.
But it’s a legal acknowledgement and a step in the right direction. 

Other highlights of MHA 2.0 include:

So What Does it all Mean?

Well … we have lots of unknowns.

Sure, the intentions are there. Issues that have long plagued psychiatry are finally getting a legislative upgrade.

But we also know that implementation is key to determining change.

So MHA 2.0 is now live.
Time to see if it lives up to the hype⏱️

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Prescription ≠ Safe: Addiction Risk Is Back in Focus

So a host of pretty common medications have had their warning labels enhanced to warn patients and clinicians alike of the risk of addiction that they secretly carry. Medications like Benzodiazepines, Gababpentioids and Z-drugs have flagged by the MHRA as causing very real, very serious dependence issues.

Whilst this may seem like common knowledge, the MHRA safety review suggests the awareness wasn’t up to scratch. Full list here

Appendicitis: Antibiotics vs Surgery

The beauty of academic research is that it’s rarely ever black and white.

This study, published in JAMA, took a stab at asking the ye’ olde’ appendicitis debate – manage with definitive appendicectomy or just manage with antibiotics alone. 

It followed adults with CT-confirmed uncomplicated appendicitis for 10 years to see how well antibiotics alone work compared with surgery. About 38% with antibiotics had appendicitis recur, and 44% eventually needed surgery. The authors suggest this to be a convincing argument to avoid surgery, but idk… it seems a bit glass-half-full

Another JAMA published meta-analysis argued the opposite(granted it was in a paediatric population).  Check out our write-up on that study here 

Patient Powered Payment(PPPs)

Have you heard of this? Outlined in the NHS 10-year plan, the big idea is to pretty much let patients decide how much you’ll get paid for your services. In this “innovative new funding flow”, patients are rung up after discharge and asked to decide whether providers deserve the full payment for the cost of care… wtf 

The idea is “torecognise and reward high-quality care”, but the doctors aren't so sure; comparing it to paying 80% for a meal, “based on the fact you didn’t quite like it”. A very funny concept indeed.

Handover Over 🫡

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