🐀Sewers, 🫀Strokes and 🦀Six More Strikes

Do you suffer from intense cravings for medicine-related events?

Do you wake in a cold sweat, traumatised at the mere thought of a world without short, witty medical updates?

…that’s really odd. You should speak to a doctor about that.

Then ask them if The Handover is right for you(start on the lowest dose, then up titrate to max tolerated dose)

👋 Happy Friday. Here’s what we got:

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

Put your finger down if…

Your patient comes into the clinic complaining about their heart racing…
Textbook History. 

ECG: irregularly irregular. Atrial fibrillation. No problem.

You rhythm-control them. You CHA₂DS₂-VASc them up. They need anticoagulation.

You skip the Warfarin because… come on. 
You avoid the Rivaroxaban because you read The Handover last week.
You land on Apixaban.

They’re stable. They’re happy.
Just another day as your friendly neighbourhood GP 😏

Your patient suffers an ischaemic stroke 24 hours later.

Yeah… Even among patients optimally anticoagulated, strokes can still happen. The instinct is immediate: “The DOAC didn’t work.” And if they do recur, what the hell do we do about it? What's the next step?

Let’s see if this meta-analysis can answer that. 

Published in Neurology, this study set out to compare the effectiveness and safety of these anticoagulation strategies in patients who had an ischaemic stroke despite already being on a DOAC. (Yes, it’s a long sentence. No, it doesn’t get better the second time.)

Looking specifically for the occurrence of recurrent ischaemic stroke, intracranial haemorrhage (ICH), any stroke, and all-cause mortality across the studies chosen. 

After toiling, perusing and filtering, they settled on 8 observational studies that included a total of 14,307 patients who fit the bill(met the inclusion criteria). 

So… what's the right answer? 

Whilst this meta-analysis does have its shortcomings (no RCT data, just 8 studies, and study design differences). The study authors leave with this

"Checking for adherence issues, inappropriate dosage, pharmacologic interactions, and whether the stroke was truly attributable to AF rather than another competing etiology seems paramount."

We personally leave with this: Don’t touch that  Warfarin.

In the hospital, it's pretty obvious you're the doctor.

You've got the stethoscope. The slightly-too-confident walk.
The bright yellow "Hello, I'm the doctor" badge, in case there was any lingering doubt.

But outside the hospital… who even are you?

How will the world know you spent 10 years learning how to take a pain history if no one around you is in pain?

You need a subtle flex. And I've got one.

A free @doctors.org.uk email address from Doctors.net.uk 

The de facto email address for UK doctors and medical students(yes, you get one too), wanting their cold email to actually be replied to. 

Wait, there is more… Your free email comes with:

It's free. It takes five minutes. And frankly, it looks sick.

Join over 270,000 clinicians using Doctors.net.uk today using the link below 👇

Psst kid👀

You’ve heard the legend of the Big Apple, right?

Not the Steve Jobs kind, scarier than that …

Rumour has it that consumption of just ONE of these mysterious objects (police sketch: 🍎 [2026, colourised]) each day could threaten the entire healthcare industry.

You think the resident doctor job crisis is bad now? You ain't seen nothing yet.

Imagine a world where ALL patients chow down an apple a day, a world where our very livelihoods become obsolete. Chills.

And yet, the dominance of the apple as the threat to doctors' employment might soon change as a new cure-all looms large …

STEPS

I know what you’re thinking.

Yeah, yeah, heard it all before. Serial marathoners, run club die-hards, the girlies on their daily hot girl 10k, of course, the folks religiously closing all their Apple Watch rings are gonna be reaping the health benefits. Duh.

Heck, you’ve probably had the 10k a day mantra drilled into you since the pedometer competitions in primary school.

But what if I told you steps might be even more powerful than we thought?

The Lancet has published a big fat systematic review challenging the 10k doctrine and investigating the effect of daily step count on a host of health outcomes. 

Here’s how they stepped up to the task: 

And what did they find? 

So even if you’re a freak in the streets smashing out a daily 10k, turns out the added health benefits are only marginal.

In a nutshell, 7,000 is the new sweet spot🤌 (And much more achievable for your average co-morbid pt too)

But hold on, apples aren’t quite de-feeted👟 just yet:

And yet, with so many studies AND health outcomes included, it’s looking like Steps might be vying for the top spot in the How Best to Avoid Seeing Your Dr™ rankings.

But hedge your bets, folks, it’s down to the wire:

Strikes, Strikes, Strikes

The pressure continues…

The BMA’s Resident Doctors Committee(RDC) announced on Wednesday another round of strikes. These strikes are set to run from the 7th April to the 13th April this year.

The story of how we got to this point remains the same. Talks between the Gov. and BMA start. Talks between the Gov. and BMA stall. Talks between the Gov. and BMA reach an impasse. Strikes are consequently announced. 

The Review Body on Doctors' and Dentists' Remuneration (DDRB) crunched the numbers and recommended a 3.5% pay uplift for 2026/27. The government seemed to like this number, as they agreed to go ahead with it.

RDC Chair, Dr Jack Fletcher, had this to say on the matter:

"As talks progressed, it became clear that the money proposed for pay increases was now going to be spread over three years. This is combined with today’s pay review body (DDRB) recommendation of a 3.5% uplift, pointing to yet more years in which our pay, at best, barely treads water.”

Treading water is just slow-motion drowning. Let’s hope we can make some progress.

Worried Well: The Influencer Testing Epidemic

An interesting article in The Guardian about patients coming in to request tests because an influencer suggested doing so. Reminds me of the PSA palava from a few months ago.

A good read and relevant in case patients come in asking for a full body MRI because Kim Kardashian said so.

HRT for the Fellas

Oestrogen patches(yes, the HRT ones your mum might use) work just as well as standard hormone injections for locally advanced prostate cancer. A UK trial of 1,360 men across 75 centres found near-identical 3-year metastasis-free survival (87% vs 86%). Same cancer control, fewer hot flushes (44% vs 89%), better bone health, cheaper, and self-applied at home.

The catch? 85% of patients developed Man boobs(gynaecomastia). 

The trial authors diplomatically call it "a different side effect profile that patients and doctors can weigh up together." We think there’s a case to be made

The GMC Wants to Redesign the Consultant Pipeline

The GMC have submitted a new draft bill, aiming to shake up the way residents become consultants. The bill includes clauses that remove the speciality register entirely and grant it sole power to issue CCT. Real Big Brother vibes going on there. Not the ITV show, the classic George Orwell novel! 

There is a Twitter thread from a Dr Matt Kneale, who is much more qualified to explain what this all actually means. Read the thread here

Detecting Colorectal Cancer with Toilet Water

Fit test step aside. Scientists are now testing sewage water for bowel cancer biomarkers. Not individual samples, though. Entire neighbourhoods, through their drains.

A proof-of-concept study measured CDH1 (a colorectal cancer RNA marker) in wastewater across high-incidence areas of Kentucky. High-risk neighbourhoods showed levels up to 8x that of controls.

The idea: passive, population-level early warning before cases even hit hospitals. No compliance issues. No awkward FIT test instructions. The toilet does the work.

I just hope this never becomes a mandatory clinic skill. I did not sign up to be traversing sewers like a mutant ninja turtle when I started med school!

Handover Over 🫡

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