Discover and read the best of Twitter Threads about #primarycare

Most recents (17)

As a physician, and a patient, I am deeply frustrated and saddened that our government chooses to prioritize elective surgical waitlists over our primary care system in order to achieve savings. Primary care is the foundation of the Canadian health care system. (1/12)
Alberta is the highest ranked for #PatientMedicalHome in Canada. Innovations like complex modifiers, which compensate physicians for spending the time required, enable us to provide comprehensive and preventative care. The value to our system is there if you look for it.  (2/12)
HQCA reported that by providing comprehensive care we can save the system more money than our physicians cost it. Patients have fewer ER visits and hospital admissions. If each Albertan received excellent comprehensive care, it could save the system $1B per year. (3/12)
Read 12 tweets
Join in and share your insights!
Today, I’ll be tweeting ideas & thoughts about #Integrating #ONhealth care as part of an amazing learning conversation with @wwodchis @JodemeGoldhar @Dr_KerryK @jayshaw29, @baker_ross, @Dr_SteeleGray @wwodchis & @Anne_Wojtak from @ihpmeuoft
A map of our current #ONhealth system shows various functions, structures and organizations, but without a clear shared purpose:
So then, without a clear shared purpose, how can #patients, caregivers & providers have an experience of an #integrated #ONhealth system?

Start by building up from the core of care delivery:
Read 23 tweets
1/ Fatigue in Primary Care

It’s that time of year, many of us (myself included!) feel fatigued 🥱

Fatigue is one of the most common presentations in #PrimaryCare yet can be challenging to investigate & manage 🤔

Here’s a #tweetorial on an approach to fatigue 😴

#MedTwitter
2/ Intended Learning Outcomes

💡To recognise fatigue red flags

💡To develop a diagnostic approach to fatigue

💡To outline a fatigue management plan for those with no red flags
3/ What is fatigue?

‘A state characterised by a lessened capacity/motivation for work usually accompanied by feeling weary🥱, sleepy😴, or a loss of ambition😔’

Fatigue is the most common unexplained complaint in #PrimaryCare, but remember it’s a symptom, not a diagnosis!
Read 11 tweets
1/ Cognitive Bias in Clinical Medicine

I love teaching #MedStudents about #CognitiveBias & #DiagnosticErrors & so thought I would create my debut #tweetorial on cognitive biases in clinical medicine 🧑🏻‍⚕️👩🏽‍⚕️👨🏼‍⚕️

🤔Now which bias that?!

#MedTwitter
2/ Intended Learning Outcomes

💡To recognise common cognitive biases in clinical medicine

💡To identify strategies to overcome them

#MedTwitter Ready? Let’s go!
3/ Cognitive Biases

💡Are cognitive shortcuts
💡Used to aid decision-making
💡AKA heuristics

✅Helpful time-savers
❎Risk leading to diagnostic errors
❎Diagnostic error rate in Australian #PrimaryCare is ~15%

qualitysafety.bmj.com/content/22/Sup…

Let’s look at common cognitive biases 🧐
Read 12 tweets
PACKED start to our #WRES event with @yvonnecoghill1 @Prerana_Issar - proud to prioritise this event with my team 💪🏾 @WRES_team @NHSEngland
Infant mortality globally and in England - shocking figures however many times you see it #WRES @WRES_team @NHSEngland @yvonnecoghill1 @Prerana_Issar
AND this is echoed in the death rate more broadly, with disadvantaged populations are also AGEING faster ‘premature ageing’ #WRES @WRES_team @yvonnecoghill1 @DrHNaqvi @NHSEngland @matthew_cripps1
Read 28 tweets
QUICK RANDOM HANDOM TWEETORIAL TIME

attention every1 in #primarycare #urgentcare #emergency care #EM or #ortho #radiology

Here's an injury that gets missed SO FREQUENTLY

but not by you anymore, bc now YOU'RE GONNA CATCH IT!

Hx: punched a wall, pain
1/3
#medtwitter #foamed
What's that? You want another view?

BRILLIANT SUGGESTION, here it is
Think you spot the problem?

Keep scrolling!
2/3
#medtwitter #foamed
CMC DISLOCATION

The MC5-hamate articulation is outlined in orange dots

Best appreciated on a 30 deg pronated oblique

Sometimes these are subtle on AP and LAT but always a dead giveaway on the oblique

Remember THREE VIEW HAND>>TWO VIEW HAND
#2viewisNoVIew
#medtwitter #foamed
Read 5 tweets
#TRIBECON begins #Pravara; felicitations to #AbhayBang @SearchGad & #sudarshan #VGKK for their inspiring work on #TribalHealth; @DrLahariya @whoindia among others felicitated
#abhayBang #healthsystem design for tribal communities need to be relooked for #UHC; strategies & schemes must adapt with local social & cultural context; recollects #Brainstorming with @DesirajuKeshav at @SearchGad leading to #ExpertCommittee #tribalhealth @TribalHealthIND
#TRIBECON #AbhayBang notes with happiness increasing interest in #tribalhealth research, yet this continues to be “off the beaten path”; congratulations to #pravara medical college in bringing this together; the proposed #Bandardhara declaration to improve #tribalhealth research
Read 81 tweets
Yesterday I gave a talk to my #primarycare residency on PTSD in ICU Survivors. It's a topic I've learned a lot about here on Twitter (special thx to @Potato_Chip and @brookevitti), so feels appropriate to share as my first #Tweetorial. #PCCM #MedHumChat #TraumaInformedCare
Modern medicine has developed the tools to bring people back from the brink of death. What is life like for patients after surviving the previously unsurvivable? How can we provide better care for them?
~10% of ICU patients die during their hospitalization. 90% survive. (ncbi.nlm.nih.gov/pubmed/28800866)

~20% of ICU survivors will develop symptoms of PTSD by 12 months (ncbi.nlm.nih.gov/pubmed/31186070)
Read 14 tweets
I listen to ~90 #Podcasts on a (semi) regular basis. Let me give you a rundown of ALL of them and why you should listen to some amazing #FOAMed, especially for all the new #EmergencyMedicine interns. #FOAMed #MedEd #medtwitter
First of all, you need a good podcast app. I absolutely love Downcast. Great app, gives you more control over playback, downloading, and allows you to categorize your podcasts into playlists (picture 2). This is where you get to customize your #FOAMed experience! #medtwitter
In no particular order,

- Anesthesia and Critical Care Reviews and Commentary (ACCRAC). Great insight into Crit Care from an anesthesia perspective. Coming from EM, this is great to listen to- much different from my day-to-day! #FOAMed #FOAMcc #CriticalCare
Read 88 tweets
1/6 What is the usefulness of inflammatory markers such as CRP, ESR and PV in #primarycare? My #PhD findings may make you think carefully about doing these tests. A thread 👇bjgp.org/content/early/…
2/6 Inflammatory markers have an overall sensitivity of <50% so are not a useful 'rule out' test:
3/3 1000 inflammatory marker tests generates:
236 false-positives ...resulting in an additional
710 GP appointments
229 phlebotomy appointments
and 24 referrals
....in the following 6 months
Read 7 tweets
1/ Ok by special request from my dear mentee @dn_charles: here’s my version of the HPI for new #primarycare patients.

Key points: welcome them and get to know them as people.

Don’t worry, it takes no longer than usual! I still see 8-10 pts in a morning.
2/ Here are some prompts I use to get a quick overview of my patients’ life stories, including trauma history.

I also try to reflect and synthesize what they’ve told me so that we are on the same page about their strengths/hopes/fears/root causes of any troubles.
3/Then, the medical part of my HPI. Here’s where I ask about what is typically called the social history: sex, drugs, alcohol and cigarettes. This is too narrow to call a social history. I call it ‘habits.’

I skip the Fhx and do it on the second visit.
Read 5 tweets
1/ It’s been a week.

It’s well into Friday evening & I just got off the phone with a patient who had urgent radiology results. This was after spending > 40 min on the phone w another patient discussing the same this afternoon.

(18 more to come; stick with me.)
2/ I only got 2 items on today’s long “to do” list done — but that’s on me. I was finally able to sit down for a couple hours uninterrupted and dig deep into a few patient cases from the week.

(And I “don’t work” on Fridays.)
3/ As I hung up the phone, I reflected on how #directprimarycare has enabled me to get to the heart of medicine & the doctor-patient relationship.

During that call, my patient’s spouse broke down and — through sobs — simply said: “Thanks for being so kind.”
Read 19 tweets
(Thread)
I’m going to discuss how physician payment rates in the US are set and suggest a reason why #primarycare is poorly valued from a salary standpoint in the U.S. I’ll also suggest how anyone interested can work to improve payment for #primarycare.
1/
I am targeting younger physicians and medical students - this may be too simplistic for some, and go into the weeds too much for others. But the whippersnappers are the ones that are more likely to lead change, and so that is the audience here.
2/
Disclaimer: I am an academic #pulmcc physician, not a #primarycare physician. So I’m in a procedure-heavy specialty. I'm also not an expert in health policy, so feel free to gently correct anything that seems off.
3/
Read 27 tweets
#TodayWe announced 5 major systems entering two-sided Accountable Care Organization contracts. But what about independent primary care providers? We haven't forgotten about you! /1
In parallel with #BluePremier, we have an exciting new opportunity to help independent #PrimaryCare physicians in North Carolina thrive. More advanced than medical home models, it is a glide path to greater financial opportunity directly tied to total cost and quality of care. /2
We are working with @AledadeACO @Farzad_MD to accelerate the success of these independent practices in accountability for their patients. Aledade will arm practices with workflow technology, analytic insights, and risk mitigation. /3
Read 6 tweets
1/ Is willpower myth or muscle? Using eating & #dieting as an example, let’s discuss the science behind #willpower, when willpower fails, and what we can learn from all of this to help us break bad #habits. A long thread, but follow along to learn why willpower is really a myth.
2/ If you're a #primarycare provider trying to help patients lose weight, a #nutritionist trying to get someone to stick to a healthy #diet, or simply trying to eat better yourself: Do you ever feel frustrated, helpless or like a failure in changing #habits?
3/ Why is habit change so hard? Have we not come up with the perfect strategy? Do we simply need more #willpower (or a kick in the pants)?

For years you’ve been told that willpower is the 🔑 to breaking bad habits… but what if I told you that science says otherwise?
Read 18 tweets
First day back at work and I saw the "moral injury" with clear eyes statnews.com/2018/07/26/phy…
I think one of the things that people who are not poor don't understand is just how unstable and violent the bureaucracy of poverty is.
Case in point: being dropped from your health insurance without warning for obscure bureaucratic reasons. Having to navigate complex paperwork to reapply. Being denied because you make a dollar over income.
Read 7 tweets
[THREAD] Over the weekend, I ran a poll on initiatives aimed at improving access to #NHS #primarycare. While respondents probably aren’t representative of the wider population, I think the results are striking: what people want most is convenience. (1/5)
@harrylongman’s much larger survey of patients of 12 GP practices using @askmygp shows that only 15% of patients prefer face-to-face appointments as the default. (2/5)
Meanwhile, @GPatHand – while hugely popular with its patients – breaks the NHS’s traditional #placebased funding model. pulsetoday.co.uk/news/gp-topics… (3/5)
Read 5 tweets

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