Dr Miv

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Dr Miv 🧠MindOps - Precision Lab (Founder)
đź©ş15yrs Emergnecy Medicine Doctor
đź’‰ Doctor Led Aesthetics + Ultrasound (Founder)

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11/09/2026

Lady Joan Branson, wife of Sir Richard Branson, died from a pulmonary embolism after suffering a cardiac arrest.

Lady Joan, 80, was admitted to hospital after a fall that left her with a fracture and significant immobility — placing her at very high risk of developing DVT and pulmonary embolism.

However, the inquest heard that she did not receive prophylactic anticoagulation during her hospital admission, and a bleeding-risk assessment was not completed on admission.

She subsequently developed a DVT → pulmonary embolism → cardiac arrest, and died.

The coroner concluded that the lack of anticoagulation likely contributed to, and probably caused, her death, although she did not classify the case as neglect.

A stark reminder:

Immobility + fracture + hospital admission = think VTE risk.

Sometimes preventing a fatal PE starts with getting the basics right.

10/09/2026

Case is on the BBC news -

A 32-year-old man. A&E. Headache and dizziness. One missed investigation — devastating consequences.

He presented as he had recently undergone treatment for a brain tumour and had also been diagnosed with multiple sclerosis. He presented to Warrington Hospital with significant headaches and dizziness.

He was assessed and discharged without a CT brain scan.

A week later, fluid had accumulated around his brain. He suffered a cardiac arrest and catastrophic brain injury.

He survived, but is now almost completely paralysed, requiring tubes for breathing, feeding and toileting, and communicating largely through blinking.

The NHS Trust has accepted a breach of duty for failing to request the CT. It was accepted that, on the balance of probabilities, the scan would have identified the fluid build-up and led to surgery.

The lesson isn’t simply “do more scans.”

It is about recognising red flags, clinical context, deterioration and risk — and asking whether the diagnosis you’re considering actually explains the whole presentation.

In emergency medicine, sometimes the most important investigation is the one you stop and think about before deciding the patient is safe to go home.

The basics matter.

03/09/2026

🚨 DOCTORS MISS SEPSIS — WHY?

You assess a patient.
You treat them.
You send them home.

Hours later, they return in septic shock — and die.

Now you’re sitting in a coroner’s court, having to explain whether the deterioration could have been recognised earlier.

So why does this happen?

Because sepsis is a clinical diagnosis — not a single number or blood test.

A patient can have infection with a relatively reassuring BP, oxygen saturation or temperature. Sepsis should not be ruled in or ruled out using a single biomarker or diagnostic test.

In the UK, NEWS2 is an important risk-stratification tool, but it must be interpreted alongside clinical judgement. NICE specifically says that additional clinical concern should raise the assessed risk, even when the NEWS2 score itself appears reassuring.

Then there’s cognitive bias.

You diagnose a UTI.
A viral illness.
Dehydration.
Pneumonia.

And once you’ve found an explanation that fits, anchoring can make you stop searching.

The most important question may therefore be:

“Is this patient getting better — or getting worse?”

Look at the trajectory, not just the snapshot.

Increasing respiratory rate.
New confusion.
Falling urine output.
Worsening perfusion.
Persistent tachycardia.
Or simply a patient who looks more unwell than the numbers suggest.

Current sepsis guidance emphasises rapid assessment, lactate measurement when appropriate, blood cultures where indicated, timely antimicrobials when sepsis is likely, source identification and continual reassessment.

And NICE’s current guidance is particularly important: if there is further deterioration or no improvement, escalate and reassess — don’t simply rely on the original risk assessment.

Don’t let a reassuring number reassure you more than the patient does.

STOP. REASSESS. RECONSIDER. ESCALATE.

21/08/2026

Doctors are useless, doctors can’t help, doctors cannot diagnose……why…….under skilled? Patient failure, system failure, doctor failure……. MindOps - The Precision Lab

14/08/2026

Dissection missed ….. patient’s life ended…..simply because you rushed to diagnosed a heart attack. Now you are in coroners court and about to lose your licence. Here’s what to do instead …… MindOps - The Precision Lab

07/08/2026

Trop was fine but patient died……because you missed the opportunity……..MindOps - The Precision Lab

30/07/2026

D-dimer won’t save you, you could end up killing a patient , end up in coroner court, end up losing your licence. This is why ……. Follow MindOps - The Precision Lab

29/07/2026

Ladies are losing their ovaries because gynae doctors refuse these patients and miss the diagnosis. Blood tests won’t show it, investigations won’t show it. Advocate for your patients, learn more here at MindOps - The Precision Lab

20/07/2026

Andy Burnham as Prime Minister could completely reshape the NHS.

But what would that actually mean for doctors, patients and taxpayers? 🏥

His vision appears to focus on:

🔹 Prevention over treatment — shifting healthcare towards stopping diseases before they happen, tackling obesity, smoking, mental health and long-term conditions.

🔹 Social care reform — fixing one of the biggest causes of NHS pressure: patients stuck in hospital because there is nowhere safe to discharge them.

🔹 More political control of the NHS — reducing the independence of NHS England and bringing more accountability directly to government.

🔹 More local decision-making — expanding the Greater Manchester model, where billions of pounds of health and social care spending are controlled closer to communities.

🔹 The NHS workforce crisis — the biggest challenge remains the people delivering care: doctors, nurses and healthcare staff facing recruitment, retention and pay pressures.

The NHS is not just a healthcare system — it is one of the biggest employers and biggest areas of government spending in the UK.

The question is:

Can Andy Burnham deliver a healthier nation… or will the NHS challenges prove too big for any politician?

👇 What do you think — would his approach fix the NHS or create more problems?

15/07/2026

Forget learning cyp 450 mnemonic…..do this instead ……

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