Discover and read the best of Twitter Threads about #MedTwitter

Most recents (24)

Thread on how #inclusion, or lack thereof, affects #Wellbeing:

⚠️: upcoming #vulnerability moment

Do you ever feel Iike you don’t belong in the spaces you occupy?
I do.
The feeling is isolating & discouraging.

The reasons why are complex, complicated. /1
#medtwitter #burnout
I will confess here that being in #dermatology and in #academia magnifies these feelings.

Being courageous, stepping outside comfort zones, making your voice heard... it’s good, necessary, but the way you’re perceived and received matters. It has impact.

It’s complicated.
/2
The cycle of self-confidence can be a positive or negative one, and often starts early in youth, affected by things such as parental upbringing, privilege, etc.

That cycle can build on itself, and have huge implications for one’s professional and personal wellbeing.

/3
Read 14 tweets
“What does a surgeon look like?”

A story for all ages, written by @JJcolemanMD , illustrated by @gracie_leo

#ilooklikeasurgeon #womeninmedicine #medtwitter #meded #foamed #storytime
Story thread below...
She woke up one morning and asked the Mirror, “What does a surgeon look like?”

But the Mirror did not answer.

She asked the World and asked “What does a surgeon look like?”

And the World did answer.
The World said,

“He is TALL and NOT small.”
“He is not too young or too old.”
Read 10 tweets
#medtwitter

I love to provide structure for my learners. A couple years ago I adopted a set of rules for rounds and ward teams. These continue to evolve.

I share them on day 1, and refer back to them frequently while on service.
👇

#TeamRules #MedEd
What are your #teamrules?
Rule 1: We treat patients, not diseases or numbers.

Always always put the disease and number into context for that specific patient. And get to know the patient.

It’s good medicine, and makes the job so much more interesting.

#SDOH #IllnessInContext #EBM
Rule 2: Rounds are done by noon.

Come prepared and we will get the work done together

Stick with the 4 Ds - decompensated, discharges, diagnostic dilemmas, the C Diff patients last. Stop wherever we are at 11:30 and finish running the list.

HT @thecurbsiders ep157

#efficient
Read 7 tweets
Today we learned about Lyme disease and it’s classic symptom: a bullseye rash (erythema migrans) formed around the area of a tick bite.

A classmate of mine asked, “How is this diagnosed for those with darker skin?”

Our professor struggled to give him a clear answer. 1/5
After class I decided to google what we learned to see what images came up. I wasn’t surprised by what I found: a homogenous representation of the bullseye rash on white skin.

It’s no wonder our professor didn’t have a good answer to answer my classmate’s question. 2/5
I’m learning more and more that medicine is taught in a way that is often times exclusionary and the treatment and manifestation of disease in those with melinated skin is treated as an afterthought, a “special case” of illness that students must do extra work to understand. 3/5
Read 5 tweets
Syphilis! RMSF! Hand-foot mouth!

Slow down there, Tiger! Let's dive deeper into:

ACRAL RASHES - a #tweetorial/#medthread
(aka rashes on the "palms and soles" - kind of 😉).

#MedEd #FOAMEd #medtwitter #dermtwitter #dermatology #dermatologia pc:@dermnetnz
1/
No where else on the body does a rash evoke more of a knee-jerk differential. That's not wrong per se, as we all learn this in med school, but it's more complicated then starting doxycycline and checking an RPR!

Let's start with a definition - what does "acral" actually mean?
2/
Technically, "acral" just means our distal body parts. So while we often think of palms and soles, it's actually inclusive of the whole hand, the whole foot, ears, and some include even the nose!

I actually didn't learn this until #derm residency, which was shocking to me.
3/
Read 20 tweets
Medicine is ultimately about relationships. I’m transitioning to GYN only, do a lot of pessaries in the elderly. They’re social visits mostly, we talk about gardens, my kids, their grandkids during these visits. Seriously, these are my favorite type of appts. 1/
I get to know these women well. They get to know me too - I talk about family life, my veggie garden, taking my oldest off to school. They know my vacation plans. They give me advice on dealing w/ a teen boy. 2/
A few of these ladies have transportation issues. If they show up, I see them. Rural areas have little transportation. I have a pt who shows up frequently. No appt, but I will work her in. Last month though, I was out of town when she showed up. And she coded in our office 3/
Read 5 tweets
Hey #medtwitter, can you help me?

I’m leading a session today for the Ohio #derm association/@AADskin career launch Bootcamp on...

THE POWER OF TWITTER!

Could you help RT & like to help me prove the reach of this platform!
Thank you!
#dermtwitter #dermatology #dermatologia
@AADskin Thanks to all! This is what we ended up with the presentation. Appreciate all of #medtwitter's help!
Read 3 tweets
1/ Alright #medtwitter and #askrenal, in honor of our CJASN publication "Associations of Opioid Prescriptions with Death and Hospitalization across the Spectrum of Estimated GFR," I'm attempting my first #tweetorial. Here's what you need to know about opioids in CKD.
2/ First of all, pain is common for people with kidney disease because of vascular disease, diabetic neuropathy, and pain syndromes unique to kidney patients like osteodystrophy and calciphylaxis. In fact, an estimated 58% of people with advanced CKD experience pain.
3/ People with kidney disease have limited options for pain control. NSAIDs can lead to Na/K/H20 retention, AKI and CKD. Tylenol is okay, but never seems to work. As a result almost half of patients with advanced CKD are prescribed opioids.
Read 19 tweets
A short #medtwitter thread about one of my best friends.

He is brilliant, vibrant, loud, proud, caring, and joyful.

One of the most magnetic and mesmerizing people I've ever known.

So, of course he was diagnosed with cancer two years ago.

1/
It was a rare cancer of his salivary gland.

By pure serendipity, he lived in my city, and his cancer was my specialty.

I walked him through the diagnosis, went with him to doctor visits, was there with him through a disfiguring surgery and the agony of chemo and radiation.
2/
He slowly got better.
Learned to eat again, this time with a prosthetic hard palate and teeth since half of his upper jaw was gone.
He moved to Houston, started a new job.
We planned a trip to NOLA this July to celebrate his recovery.

Then he called me--his legs felt funny.
3/
Read 10 tweets
Physical signs of chronic stress /burnout that Howard hears from his patients.

Pulmonologist in the room immediately adds breathlessness!

#ERSCongress #ERS2019
And now emotional signs - important to recognize in yourself but also in colleagues who may react differently than you do. #ERSCongress #ERS2019
Behavioral signs of burnout:
Howard re clinicians who treat substance abuse (as we all do) - "it won't ever happen to me" - - but it does. Awareness is, again, critical.
Recs @jratey book Spark about relationship between exercise and mental health. #ERSCongress #ERS2019
Read 10 tweets
1/
Attempting some #tweetorials on urine electrolytes with the hope of improving my understanding & appropriate clinical utility of these tests. I welcome any and all feedback. Without further ado, lets get started. First will be urine sodium (UNa).
3/
From here on, Aragorn will be our patient.Just re-watched #TheTwoTowers so this name came to mind. While I enjoy Gimli & Legolas, there is not much literature on Dwarvish or Elvish physiology so I am forced to stick with the world of Men(though Dúnedain lifespan is quite long)
Read 27 tweets
Let's go back to the basics today, and talk about some #morphology in the #dermatology exam.

Today's #tweetorial/#medthread will be about evaluating....

SCALE!

#MedEd #FOAMEd #dermtwitter #medtwitter #dermatologia pc:@dermnetnz
1/
Before we get too far into it, how do we think about #scale? Meaning, which one of the following is it?
2/
When we say "primary lesion," we mean the most basic element of a lesion/rash (papule, macule, patch, plaque etc).

SECONDARY CHANGE (which scale is) means the extra exam element that occurs on top of the primary lesion!

Tertiary/Quaternary isn't a thing. I'm just a jerk.
3/
Read 15 tweets
#PIP #DISLOCATION

Dorsal most common
Patients often reduce themselves
DIGITAL BLOCK

Flex wrist & MP to relax flexors, then gently reduce by PUSHING DISTALLY on P2 base rather than just pulling traction

Volar&rotatory dislocations oft require open reduction #medtwitter #foamed
MUST assess stability & xray post reduction

Good lateral is vital to make sure jt is concentric & no fx

If stable even in extension & no fx, buddy tape x3-6 wks

If unstable, dorsal blocking splint at 10 deg more flexion than unstable point

Or just refer to Hand

#medtwitter
Is this a concentric reduction? High-5 time?

NO!

The "dorsal V sign" indicates subtle instability that if untreated would lead to PIP arthritis

PIP arthritis SUCKS

PIP is the "soul of the hand"

#saveasoul
PIPs aren't simple!
=Presents Incredible Problems
#MEDTWITTER #foamed
Read 3 tweets
Quick Tutorial Thread for Twitter

Psychiatric Cardiology 101: QTc

Wherein a psychiatrist tries to teach cardiology (and hopefully doesn't embarrass themselves)

#psychtwitter #medtwitter #MedEd #psychchat #somemed #somepsych

Warning: MATH
What is QT? (Yes yes, it can be your texting shorthand to get your groove on)

QT refers to the interval on the electrocardiocgram, in milliseconds, between the START of the QRS complex to the END of the T Wave
(as the graph shows, if you wanna be super fancy, we calculate the end of the T wave by intersecting the maximum slope with the isoelectric baseline)
Read 14 tweets
1/#Tweetorial! The @Aaimonline Collab on Learning & Working Environment Optimization released a conceptual model to guide LWE improvement.

But how do you actually USE the model?

We suggest 3 simple applications for #meded at the front lines:

amjmed.com/article/S0002-…
2/One quick question before explaining our three proposed approaches. In your opinion, is there a difference between a “Definition” of a thing, and a “Model”? Poll below and feel free to explain your answer:
3/Merriam Webster defines “Definition” as “A statement of the meaning of a word” or “A statement expressing the essential nature of something.”

A definition is, by definition (ha), reductionist. The goal of a definition is clarity, sharp lines, exactitude, immutability.
Read 16 tweets
1/

A TALE OF TWO STENTS

a #twitternist #clinicalreasoning and #implicitbias reflection

Wanted to share 2vignettes with you #medtwitter, w permission (identities, some details changed)

Both involve rapid thinking, stretched foci of attention, unanticipated clinical events->
2/ first vignette :

Seeing last pt in morning session, 45 mins back

Finishing up, see another pt’s e mail & message on desk phone

Need 2finish up w pt in front of me, but odd message left in both places

Call back - 72 yo man, remote preDM but got that BMI to 23 long ago, ->
3/ mild lipids on lo dose statin, chronic bronciectasis, reflux. Know him 15 yrs as pt.

Pt: Dr. C, I feel better now, but ..(uh oh) when I woke had a discomfort in my L neck, felt sweaty. That’s all gone for a few hours now, I think I’m fine. But I don’t have my appetite ->
Read 16 tweets
I'm going to go outside of my regular comfort zone a bit today, and try out a #tweetorial/#medthread a bit more applicable to #medtwitter in general. So here goes....

A beginner's guide to the use of #PREDNISONE!

#MedEd #FOAMEd #dermtwitter #dermatology PC:@dermnetnz
1/
Ah, prednisone. One of the most frequently used drugs in our specialty, and in many across the board in medicine. Useful for quick suppression of an overactive immune system, whether that be because of autoimmunity, or acute infection. But how does it work?
2/
The point is that there are so many potential mechanisms, that it's hard to point at one particular enzyme or pathway to explain all its effects. This paper address many of them, but my main takeaway is that we don't know everything! ncbi.nlm.nih.gov/pmc/articles/P…
3/
Read 20 tweets
History of Diabetes. A thread.

1550 B.C: “Too Great Emptying Of The Urine”

First ever recorded mention of diabetes in Ebers Papyrus, written around 1550 BC, excavated in 1862 AD from an ancient grave in Egypt.

#EndoTwitter #Diabetes #MemoryLane
@JoyYWu @StanfordMed @MedscapeEndo @TheEndoSociety @Endocrine_News Around the same time, Indian physicians seemed to stumble upon a mysterious illness with "Honey Urine" which attracted ants and flies. They started to use the ants to diagnose the illness.

#EndoTwitter #Diabetes #MemoryLane
@JoyYWu @StanfordMed @MedscapeEndo @TheEndoSociety @Endocrine_News 230 B.C

Egyptian healer/historian, writer of 'On the Names of the Parts of the Human Body', Apollonius of Memphis, names the illness "Diabetes" (dia – through, betes – to go].

#EndoTwitter #Diabetes #MemoryLane #MedTwitter
Read 13 tweets
THREAD!

I've posted about this already, but "FIRST DO NO HARM" is:
* Not from the Hippocratic Oath
* Not accurately translated from Hippocrates
* Not actually a goal of medicine
(How could I say such a thing?!)
* Is very poorly understood.

#medtwitter #MedEd #hippocrates
If we did no harm, we would never do surgery. We would never give meds. We would never anaesthsitize patients, or attempt to replace lungs.

The actual goal (and oath!) is to BALANCE BENEFIT VS HARM so we endeavour to do more good than harm. We minimize harm when possible.
The Greek ὠφελέειν ή μὴ βλάπτειν (incorrectly translated to Latin as "primum non nocere") is a passage from the Hippocratic treatise on Epidemics "In illnesses one should keep two things in mind, to be useful rather than cause no harm".
Read 8 tweets
Not every day you get to speak to the Medical Deans of Australia and NZ on disruption and #MedEd #FOAMed & #SoMe in a plenary chaired by the indomitable @forrest_kirsty together with @LSchuwirth and Dr Joe Kolars from @umichmedicine 🙏🏽@forrest_kirsty for this opportunity.
Shout out my @MedEdStuffnN partners in disruption @GongGasGirl @hypoxicchicken including @char_durand @drlauraduggan & @MedEdUnicorn for their input. Plus thank you @aoglasserfor sharing & 🙏🏽@NEJM @tony_breu for impeccable timing ... why is a cow indeed?! Let’s embrace curiosity.
@MedEdStuffnN @GongGasGirl @hypoxicchicken @char_durand @drlauraduggan @MedEdUnicorn @NEJM @tony_breu A few people have asked for the talk so here you go a thread on disruption in #MedEd. Challenges facing medical education: medicine, social media and the digital age. Session moderated by @forrest_kirsty Prof KForrest Dean of Medicine @BondUniversity #MDANZ19 @MedicalDeans
Read 33 tweets
Lots of discussion the past few days set off by the @WSJopinion piece about the role of social justice in medicine.

A brief thread for those who missed it or want a refresher:

1/x
Things started with an attention-grabbing op-ed with an even more cringe-worthy title, arguing that climate change, population health, and other similar areas of study have no place in medical school: wsj.com/articles/take-…

2/x
One unforgettable bit:

"Why have medical schools become a target for inculcating social policy when the stated purpose of medical education since Hippocrates has been to develop individuals who know how to cure patients?"

Obviously, no one could be interested in 2 things.

3/x
Read 13 tweets
#MedTwitter has been discussing “Take Two Aspirin + Call Me By My Pronouns,” an op-ed claiming social justice is taking time from sci ed + decreasing the quality of #MedEd.

So here’s my take:
“Take Two Aspirin + Read a Curriculum”
THREAD.

#MedTwitter #SoMeDocs #DoubleDocs
As always, I start threads with my POV: #LatinasInMedicine #DoubleDocs student in year 2 of #medschool. I have interests in both #MedEd + #HealthJustice. I am about to finish my term as diversity rep on our med student govt. I care a lot about advocacy.
Let’s take a moment to learn about the author: Stanley Goldfarb is a nephrologist, *former* assoc dean of curriculum at UPenn Med. He graduated from med school in 1969. Ffolks who studied at UPenn have brought up negative experiences with Dr. Goldfarb.
Read 55 tweets
THE OBESITY PARADOX IS NOT A PARADOX

A tweetstorm by a frustrated epidemiologist

I was disappointed to see an "obesity paradox" article in @AmJEpi

Instead writing a letter to the editor, I decided that Twitter is a better way to reach ppl on #epitwitter #medtwitter

1/
Before I begin: I have the utmost respect for @easchisterman and the @AmJEpi team. But, I have a particularly strong reaction to articles claiming to have evidence of a “true” obesity paradox.

Science moves forward through scholarly debate. Let’s keep the discussion courteous!
Also, PLEASE RT and share with colleagues on #epitwitter #medtwitter #statstwitter #academictwitter

I'd love to engage and answer any questions you may have!

Here's the article I'm tweeting about:
ncbi.nlm.nih.gov/pubmed/31504124
Read 11 tweets
A #tweetorial/#medthread on…

CONSULT ETIQUETTE – for the consultant!

(This is the 2nd in a series on consult etiquette. See the end of this thread for a link to my other tweetorial for primary teams calling consults).

#MedEd #FOAMEd #dermtwitter #medtwitter #dermatology
1/
So you just got paged for a consult…. What do you do?

2/
Of course we all think #1, yes?! Realistically though, it can be stressful to get consults. They are unpredictable, can come at any time, & the primary team may or may not listen to what you have to say. Here are some tips I’ve come up with from my time on #dermconsults.
3/
Read 12 tweets

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