Discover and read the best of Twitter Threads about #TipsforNewDocs

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Rapid Response Series, #2: Hypotension

So in medical school we were all shown a table like this to learn shock, which made my eyes roll back. 🙄 When I’m called about hypotension, I don’t have time to recall a table.⏱️ #MedTwitter #TipsForNewDocs Image
But I do like math formulas 🤓, and using this familiar formula ensures I never miss a potential cause of shock.

Which of these formulas best estimates blood pressure (BP)?
The correct answer is BP = CO (cardiac output) x SVR (systemic vascular resistance). ✅

To take it one step further, what is the formula for CO?
Read 11 tweets
May 9th = Tip #9 #TipsForNewDocs #MedTwitter

One of the biggest lessons from intern year is getting a gestalt for sick vs not sick

This relies on recognizing signs and symptoms that should give you pause

A brief list and crowdsourcing to add to this list!
Tachycardia in a pt w/ HFrEF

Back pain in a pt w/ MRSA bacteremia

Nausea/vomiting in a pt w/ T1D

Syncope on exertion

Syncope while at rest

A non-healing wound in a pt w/ diabetes

Confusion in a pt w/ cirrhosis

Failure to thrive in an older pt

Recurrent falls
Weight loss in a patient w/ hx of cancer

Unintentional weight loss, period

Increased WOB in all pts

Sudden onset dizziness

When a pt says their chest pain is identical to their prior MI

Back pain + hypotension

RUQ pain + fever

Many more to include! Please add!
Read 4 tweets
As a new intern, I was terrified of Rapids.

I admired residents who approached them calmly and systematically.

For incoming interns, here's an approach to the Hypoxemia RRT.

Save to your notebook:…

#MedTwitter #TipsForNewDocs @GlassHealthHQ
This guide is only possible because of the wisdom of Drs. @AlexSpacht and @meerasury who coached me through many tough situations overnight.

#MedTwitter, please send your feedback and suggestions which I'll incorporate and credit on the live link.
I'm sharing this Tweetorial with a shared Glass Notebook page so you can save it to your own notebook.…

So often I come across fantastic Tweetorials and save them to my Bookmarks where they're unsortable, unsearchable, and never seen or used again.
Read 4 tweets
May the 4th be with you! Tip #4 #TipsForNewDocs #MedTwitter

You’ve probably heard this one time and time again: “read more” or “read up on your patients”

Yet no one tells you HOW they read more and make that information stick!

A 🧵 on the system I developed in residency
I have a terrible memory so I have to brush up constantly

Being told to read more was daunting because the amount to read was overwhelming and I may only retain 10% of the UpToDate article, etc

There are 3 areas I focus on

Dx reasoning
Rx reasoning
Patient Centered EBM
Dx Reasoning:

As many on here describe well, it isn’t the reps. It’s the intentionality to those reps and active reflection on cases that improve your dx skills

If your dx is delayed or incorrect in real life, spend time reflecting on your illness script and cognitive biases
Read 16 tweets
What autism topic do you want me to cover next in my Sunday Twitter Space?
FWIW, the cooking one would be aimed at people who are exhausted, brainfogged, executively dysfunctional or dyspraxic, who are trying to eat as nutritionally as possible, with sensory issues around food, and with food sensitivities.
The sensory overstimulation one would be about the various categories of sensory overload and the cofactors (based on my learning to date), and how I've kept my own sensory overload in remission for 6 years, and what results others (adults and children) have achieved.
Read 6 tweets
1/🧵🎥 MAJOR TIPS about #Liver Disease
Why do we ask pts to “hold up traffic”? When people get severe liver disease, “asterixis” is a finding on exam we often see.

What does it mean?
#MedTwitter #NurseTwitter #TipsforNewDocs #Addiction
2/ Asterixis indicates that toxins like ammonia have built up in the body because the scarred liver no longer filters them out. The brain cells no long function normally (#Delirium or Hepatic #Encephalopathy) & can no longer control muscle movements like posture!
3/ These same toxin cause vessels to dilate and develop problems with blood flow in the skin and lungs. A skin finding is called “spiders.” They look like a multi-legged spider, right? It’s a tip-off.
Read 9 tweets
Turns out that that lump on my neck that I spent 5 years trying to get my doctors to work up wasn't caused by a virus. It wasn't anxiety. It was cancer.
You don't have to read the stories in this thread & those in the quote tweets to get this lesson. Ask your patients. Particularly those who are disabled & chronically ill. Those who are people of color, LGBTQAI+, or otherwise marginalized. They'll tell you.

We docs spend a lot of time learning about how to engender our patients' trust in us but what does it say when so many patients don't feel like we trust and believe them? What does it say about our healthcare system when so many patients have the same stories to tell?
Read 3 tweets
1/🧵🎥 Leading #COVID19 ICU Doctor @DavidJanz5 in New Orleans, the epicenter of U.S. #DeltaVariant surge, testified before US Senate Committee on Health, Education & Labor. Here is what he said: “Studies of #FrontLine workers caring for COVID-19 patients have shown…👇
2/ that the risk for the development of #mentalhealth problems (#PTSD #Depression) are like 9/11 Terrorist Attacks & Hurricane Katrina. Recent research shows that over 1 in 3 healthcare workers are experiencing anxiety, depression & post-traumatic stress disorder.
3/ Symptoms of #burnout are experienced by over half of critical care physicians. This is the state of the workforce asked to return to the #COVID19 #frontlines for a second, third, and now fourth wave.
Read 9 tweets
1/🧵 Giving & Receiving Advice:

My medical advice is not infallible. Maybe I’m wrong and maybe my patient knows it? Maybe that’s one reason she/he is non-compliant. Even if I am right, it might not be the time in that person‘s life to hear the message.

#selfcare #medtwitter
2/ A pt may seem to be listening & carefully taking it all in. But later that morning she/he may leave against medical advice (AMA). What are we to think when we give our best #advice and others don’t take it? Especially in the medical field?
#tipsfornewinterns #tipsfornewdocs
3/ First of all, of course, unsolicited advice is #criticism. Especially when I’m not with a patient, I try to resist all urges to give unsolicited advice.
Read 13 tweets
1/🧵🎥 Hepato-Jugular Reflux (HJR)?
Neck Veins tell us a lot about how much fluid people have in their body. Look at this video & you’ll learn a trick doctors use that tips us off about blood volume! (Movie w perm)
#medtwitter #nursetwitter #TipsForNewDocs #TipsForNewInterns
2/ My patient had kidney failure & too much fluid, making him short of breath. I press down over his liver & watch his neck veins pop up (or not). When they do, it correlates w high pressures in the heart from too much blood volume.

3/ Another way of seeing this is the CXR (see pic). This simple measurement from a vein to an artery called the Vascular Pedicle Width (VPW) also tells me the heart pressures are too high. His VPW is 84 mm and > 70 is way too much. So he needs to pee a LOT!
Read 5 tweets
As I embark on #PGY30 , I’m reflecting upon my transition to #Intern year and thinking of the new #Residents starting this week…a short thread 1/

#TipsForNewInterns Image
Don’t listen to the #intern jokes.

You are a doctor now and fully a part of the #HealthcareTeam …a VERY important part! 2/

#TipsForNewInterns Image
Take the opportunity to learn from everyone…especially your #nurses.

Also take note of the ppl who treat other staff and patients rudely.

You’re not too young in the game to gently correct them…as you’ve been part of the #HumanRace for a long time. 3/

#TipsForNewDocs Image
Read 8 tweets
A thread about things I wish other specialties knew re: calling surgical consults. Obvious disclaimer this is based on my experience/my institution, YMMV. Other thoughts welcome, defending consult-callers will be met with 🙄 because this isn’t to bash them just discuss pitfalls
#1 We staff our consults with seniors and attendings. That means there is truly a difference between a curbside and a consult. If you “curbside” me then put “surgery following” in your note I am going to be mad and I am going to make you change your note.
#2 Whenever you call it, we will come. That means if you realize at 3 am that nobody ever called the non-urgent surgery consult so you page it out to be helpful... I am coming to see that patient at 3 am. And waking up my attending to tell them about it.
Read 12 tweets
Our @uchipritzker students start clinical clerkships this week. It's not #tipsfornewdocs but if you have tips for students on clerkships please share them! #tipsfornewMS3
Here were a few of mine in a short thread.
#medtwitter #meded
*Talk to the nurses every day- they are your teachers too. seriously!
*Help your residents- you're an important asset to them, trust me...especially to our new interns who don't know where the bathrooms are or where to get coffee. They need you a lot right now.
*Listen to your patient- they have the clues you need. Ask them what questions do you have and what matters to them?
*Teach your patients every day. Many of our patients might not know their plan for the day or why they are in the hospital so it's good to overcommunicate!
Read 6 tweets
1/🧵#SEPSIS is URGENT. Here it was caught way too late! Sepsis is marked by WBCs (White Blood Cells) either too high OR too low. If someone’s WBC drops from 14k to 6k to 3k WITHOUT antibiotics, that’s a total catastrophe & usually means death is closing in.👇

2/ So hypothetically (& I’m changing details to make this situation unrecognizable to the real patient my comment is based on)…if a month after a knee replacement someone comes in complaining of NEW knee pain and no fever…

#COVID19 #nursetwitter #TipsForNewDocs #nurse
3/ …with a WBC count of 14,000, scans & xrays not showing an abscess, an infected prosthetic joint is still my #1 Dx unless there is a completely obvious other cause of infection. Said another way, this is sepsis due to an infected knee until proven otherwise.
Read 10 tweets
1/🧵An Epiphany: #delirium treated w touch & eye contact, day by day...his mom cried, “He won’t let us help him shake this damned disease.” Finally his mind cleared. “What matters to you? How can I help?” Slowly, surely, he asked, “Doc, can you help me stop drinking?”💔
2/ #GroundZero. What a privilege it is to witness someone enter a long-awaited epiphany that opens the door to so much recovery. Unfortunately, in my early years as a doc, I thought, “Well, this isn’t critical care, so I’ll move on & let someone else take over.”

#shame on me
3/ But what is a doctor for?

1. To reduce human suffering & heal people where they are.
2. Plus the Latin root is “docere,” teacher.

It’s a dual vocation: healer + teacher. Because of the “Law of the Gift,” I know that the more I give, the more I receive, so…

Read 7 tweets
1/🧵 Imagine 2 people, madly in love & married 28 years, in an impossible situation, both lives on the line & separated by different hospitals. Then imagine 2 sets of #nurses & #doctors separately determined to overcome ⛰ of obstacles…
(shared w perm)

#MedTwitter #NurseTwitter
2/ Last night this is what happened…

NOTE: the family wants to share their story to offer a glimpse of love ❤️ on all levels

For 3 years, Mark took care of Sharon, his #bride, as she battled breast #cancer. It relentlessly spread to her bones. He never stopped giving.
3/ She could tell he was spent and getting sick himself. “Mark, let’s get you to the doctor!” “Not until you are well, Sharon.” He remained laser focused on her every need. As she became weaker, he took her to get admitted yesterday.

#marriage #life #caregivers
Read 13 tweets
1/🧵#COVID19 Compassion

Our patient wants to live 3 days to see his grandson graduate. He has #COVID19 pneumonia & is extremely short of breath. He’s chosen NOT to go on a ventilator & is on 100% O2 HiFlow Canula. He’s afraid of tight-fitting a bipap mask.

2/ The intern said, “I never saw a patient whose respiratory rate was twice his oxygen saturation!” Yep, last night his O2 sats dropped to 30% and he was breathing 60 times a minute! By morning he was 85% sat and RR was 28. Better but tenuous.

#TipsForNewDocs #MedStudentTwitter
3/ All of this raises some complicated ethical + treatment questions that I’d like to cover. We addressed this on rounds several times this week & at times it got a bit heated. His #nurse said she noticed herself flushed, mad, and heart rate >130…why?
Read 13 tweets
Here is some unsolicited #TipsForNewDocs advice on the job search

#medtwitter #livertwitter #GITwitter
Wrong: You'll have "all the resources you need"
What are these? Stats, research cores, coordinator pools...
These are...people!
You cant promise a person!

Right: Meet X, 25% of their effort will be directed towards your work if you gel. Or here is $$$ to hire Y.
Wrong: we expect you to do research, quality, etc
Right: we will support your research for X years

The week is 10 1/2 day sessions. Anything not clinical needs protection. 7 sessions is 30% protected. I was protected 3 years by the dept
Then I needed a grant for protection
Read 10 tweets
1/ 🧵 Mentor-Mentee topic: MEANWHILES
Mentees often tell me they feel stuck in time with no progress in achieving their goals. This is a Meanwhile. As humans, we want to get through meanwhiles, but they are important times of growth. Don’t rush meanwhiles!

Some thoughts…
2/ When I was in college, a mentor taught me about the 3 major types of meanwhiles.

1. Uneventful Occurrence.
2. Unknowing.
3. Not Yet.

Don’t let fear drive you past the riches of these meanwhiles!

Let’s break them down…
3/ Meanwhiles of Uneventful Occurrence:
Tedium is not just OK. It’s necessary. Ordinary times are preparation for fruit to come. Let the grace of your routine establish sustainable balance in your life…one day at a time…in this we grow.
Read 8 tweets
1/ #Mentorship 🧵

This woman is my #mentor (pic w perm). Joan W Bennett. She’s in @theNASciences as geneticist & mycologist. Today we are at the Parthenon in Nashville TN where after 35 YEARS, she still provides me council…

#MedTwitter #Sciencetwitter
2/ Dr. Bennett taught me that mentorship is not a job w an endpoint. She assumed this role IN my life FOR life. Today we talked as much about parenting as science. We are in each other’s front row. This is the depth of a true mentor-mentee relationship.
#MedEd @theNAMedicine
3/ Like any relationship, there must be chemistry & connection. If you don’t have that w a “mentor,” maybe you have the wrong person. Build a relationship not a business arrangement. It’s also NOT just a trajectory to promotion. #Mentorship is “whole” person care & development.
Read 11 tweets
Campaign starts TODAY: #AllowAACinTherapy. It's aimed at doctors, psychologists and other clinical professionals, and at the institutions that empower them to disempower disabled people. I have seriously had enough of this nonsense from them.
Doctors do this regularly to one of my friends who is mostly nonspeaking.

A psychologist did it to me when I at a time that I lost speech frequently.

Professionals should #AllowAACinTherapy. #CommunicationFIRST, not 'speech first'. They must stop violating the #CRPD.
People with communication disabilities should not be expected to make appointments using a telephone. You should not have to register as a Deaf person to be allowed to use AAC.

Read 17 tweets
1/11 Congrats to those who matched! I tweeted about an inpatient pocket card set in 2020 and got great feedback. Here is the result of a big overhaul:

Let's review what's inside!

#MatchDay2021 #MedStudentTwitter #MedTwitter #TipsForNewDocs #FOAMed
3/11 First up is a pre-rounding checklist. Be systematic and read all of the notes in your patient’s chart (interdisciplinary care is critical).

H/t @nickmmark for the idea to use a QR code to maintain an updated version! This QR code also has some additional resources. Image
Read 11 tweets
1/ Do data support pt trial off sedation for “SAT” when pt is comfortable on current dose? Yes
Shared w permission:
“Dr. Ely, yesterday our ICU #nurses went over #A2Fbundle in Epic for implementation. Do you recommend SAT at RASS Goal of RASS -1 to +1?
#medtwitter #criticalcare
2/ Excellent #Nurse added:

“We are currently not doing SAT (Spontaneous Awakening Trial) but keeping pt’s RASS -1 to +1.  Just want to make sure we are interpreting #A2Fbundle correctly.”
#medstudenttwitter #COVID19 #pandemic
3/ my Answers:

Great questions. I don’t think +1 (anxiety) is ever a good goal but 0 to -1 is a 👍 default target RASS if we acknowledge there are times when sedation target should acceptably be set as deep as -3/-4 in bad #ARDS or -5 transiently when pt requires paralytics.
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1/ Tinkling of Ice: #Alcohol & Me
Personal Share: As a 1st year #MedStudent 35 years ago (#MardiGras 1986), I was a cyclic, binge-drinker. It threatened my future as a physician & my personal safety. I draw on these experiences with pts.
#medtwitter #tipsfornewdocs #nurses
2/ For me, #recovery meant detaching from harmful zones of behavior. Years of ups & downs. I often share my story w patients when it comes up. I find this builds a powerful connection between us and helps us both. #healing
#medstudenttwitter #academictwitter #nursetwitter
3/ I needed to give up, fess up, make amends, and keep up. I stumbled along the way & am thankful to those who supported me & did not judge me.
#HOPE = Hang On, Peace Exists
#healing #workinprogress #addiction @ASAMorg @AlAnon_WSO @RyanForRecovery
Read 7 tweets

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