👋 Happy Friday. A happy Friday indeed. Strike day 1. I’m sure you all know the drill. Brace for impact. It’s going to be an interesting 5 days.

Here’s what we got:

• 🦀 Crabs Assemble: Time For Strikes

• 💉 ⚠️ Two Types Of Doctor. One Misunderstood Drug

• #TheMoreYouKnow: Other Top Stories of The Week

NHS NEWS

🦀 Crabs Assemble: Time For Strikes!

So here we are. Claw in claw 🦀. United against pitiful pay-rises and Wes Streeting. Today is the first of 5 days of strikes. 

I won’t drag you through every grim detail, but here’s the topline: 

• From last year’s general election to date residents have got a combined pay rise of 22.3%. Nice start but still 20% less than 2008.

• In March 2025, the DDRB was formally requested to review pay by BMA. Aired for a month.

• BMA were not having it so threatened strike action. Aired for another 3 weeks.

• The BMA doesn't make empty threats. Ballot for Strikes confirmed 2nd May

• Wes offered a “thoroughly deserved” payrise of 5.4%(on average) + £750 consolidation pay for resident doctors. BMA said it was “woefully pitiful”. 

• Ballot was not called off. Results came in on July 8th. Strike action prevailed. 

• One last chance to settle was offered this week. The BMA received the final proposal on Tuesday. It was–as predicted–underwhelming.

• And so: here we are

The strikes are divisive. Public opinion is split. Even some seniors think we’re wrong. So let’s talk about that. Let’s run through a few of the greatest hits from the “Why Are You Striking?” crowd:

“But it’s unfair/harming to patients!”

This seems to be a checkmate argument posited against doctors for striking. Shouldn’t your duty to ‘do good’ outweigh your selfish financial gain?

Well… no. Lets break it down.

1. Patient safety is protected: As per the Strikes (Minimum Service Levels) Act 2023, critical(A&E) services must be maintained even during times of strikes. This means that those most in need are protected.

2. The facts: Let’s look at the evidence - this systematic review of industrial action found no clear evidence of increased patient morbidity or mortality during strike period. But plenty when broken systems go unchallenged

3. Tough love: It’s time to stop treating strikes like tantrums. They’re triage. Underfunding, unsafe staffing, and burnout quietly harm patients everyday. Pay is how you fix that: it keeps doctors in the job, attracts new ones, and stops the rest from packing for Perth. 

“You’re already well-paid – what more do you want?”

At this point, we should all understand the weakness of this argument. To refute it in 3 steps :

1. Junior doctor pay had fallen by over 25% in real terms since 2008. It’s not a pay rise. Just pay us what we deserve.

2. Many residents earn less per hour than baristas once you factor in unpaid overtime, antisocial shifts and weekends. Despite 5-6 years of study, £70-100k in debt and life-or-death responsibility.

3. If we don’t strike, the situation will continue to progress. This drives a more apathetic view to the career and worsens the NHS for everyone. We don’t want that. You don’t want that.

“It wasn’t like this in my day – just get on with it.”

To the old fart, who insists hardship is part of the job: 

Exactly. It wasn’t.
In your day, pay hadn’t been gutted by 26%, rent didn’t swallow half your salary, and the NHS wasn’t bleeding one in three juniors within three years of qualifying.

What used to be a vocation is now an endurance sport—longer rotas, fewer staff, higher burnout, more litigation, and less pay in real terms than the people training us.

And “Just getting on with it” is how we got here. If every generation shrugs and suffers, nothing changes. Striking is getting on with it. Just in a way that might actually fix something.

Now, young Padawan. You’re armed with three solid arguments, a decade of frustration, and a system worth saving. Pick up your placard… and strike!

RESEARCH UPDATE

💉 ⚠️ Two Types of Doctors. One Misunderstood Drug

When it comes to haloperidol, there are only two types of doctors in this world.
The ones who tremble at the thought of ordering it IV…
And the ones who prescribed without a blink.
Which camp do you belong to?

Because when Delirious Dani starts wielding her plastic breakfast knife like it’s a katana, flinging juice cups like grenades, and trying to leave the ward via the window(we’re 6 stories up), “conservative management" starts feeling a little… optimistic.

Insert Haloperidol. 
The delirium saviour. Taking Delirious Dani back to Just Dani in no time at all. Great!

But Haloperidol has a problem– ⚠️WARNING “QT prolongation. Risk of sudden cardiac death.”

That’s enough to make even seasoned geriatricians double back. No one wants sudden cardiac death. Yes, QT prolongation is well documented. But are we actually sure about that risk of cardiac death?

These Canadian researchers were not. Warnings about major adverse cardiac events (MACE), were based on lower-quality evidence such as case reports. They wanted to step it up and run it by the mother-of-all-academia… a meta-analysis. 

Published in PLOS ONE, this meta-analysis aimed to summarise high-quality evidence on the frequency and nature of MACE’s associated with haloperidol compared to placebo.

Method:

• They included 84 Randomised Control Trials, including 12,180 participants.

• They only included studies focused on adults(>18 years) comparing haloperidol(IV, IM or PO) to placebo or active comparator. 

• The patient population included Psychiatric, delirium/dementia, critical care, surgical, neurologic, substance use. 

• Primary outcome measure was a composite of MACE’s, including all-cause mortality, cardiac arrest, ventricular arrhythmias, seizure, and syncope

And what did they find?:

Out of more than 1,100 MACE events, nearly all (97.8%)were deaths. But crucially, there was no statistically significant increase in risk with haloperidol compared to placebo.

• MACE risk ratio: 0.93 (95% CI: 0.80–1.08)

• Mortality risk ratio: 0.91 (95% CI: 0.78–1.06)

• IV haloperidol mortality risk: No increase (RR 0.88, 95% CI: 0.72–1.08)

Torsades? There were two cases. And both were in a critical care trial where the patients hadn’t even received haloperidol in the four days leading up to the arrhythmia. So, not exactly an open-and-shut case for cardiac doom.

So what does this mean?

Well, it means haloperidol isn’t the death sentence some EMR alerts make it out to be. It means that in a well-monitored, appropriately dosed setting, the risk of major cardiac events is (statistically speaking) not actually elevated. And it means that when Delirious Dani is on the loose, you might not need to hesitate so much.

When it comes to haloperidol, there are only two types of doctors in this world.
Maybe now, we all know which one we should be.

QUICK BITS: OTHER NEWS YOU SHOULD KNOW

• Self Test Kits Kinda Suck: Yes, those kits you buy from Boots and Superdrug are kinda unreliable according to this study in the BMJ. Of the 30 included in the study, 14 made statements on test accuracy, only 8 stated who should be doing the test in the first place and only 7 suggested what to do after getting a positive result. Not really ideal for at home HIV, prostate and bowel cancer tests. Unsuprisingly, it’s better to just go see your GP.

• A Hayfever Messiah: It really really sucks to be assulted by pollen in the summer. It seems to get worse every year! NICE have just approved an new immunotherapy called betula verrucosa. This drugs pretty much cures you of hayfever forever if you use it consistently for 3 years. Pretty big commitment, but my hate of sneezing is greater.

• AI Can Interpret ECHO Now: Everyday, the idea that AI can do our job comes closer and closer to reality… It can now interpret Echocardiograms with expect level precision. Chat. Are we cooked?

• Over-The-Counter Depression Awards: And the OTC depression medication award goes to… St. Johns warts, saffron, probiotics and vitamin D. For the patients who’d prefer not to use antidepressants and don’t have access to CBT, as relatively conservative measures, we could suggest some of the products above as adjucts to treatment according to this study.

Handover Over 🫡 

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