@danielleofri

@danielleofri

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WesElyMD

@WesElyMD

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

WesElyMD

@WesElyMD

Trigger alert 🚨: Hard to stomach but this hits so hard I want to face it. Segregation of Blood🩸by color of skin went on until 1972 & the “1-drop rule” persisted until 1983 in my home state of LA. 😩 👀 labels.
I pledge to fight #racism & lift each person.

#medtwitter #MedEd

1/ Dr. Charles Drew, an African-American surgeon & father of blood banking, perfected techniques that saved countless lives. Yet he was prohibited from donating blood himself over “fear” of his black blood. Read #2 w/ ✍🏻
bit.ly/2IRvJDW
#MedTwitter #MedStudentTwitter

2/ Dr. Drew ✍🏻 this letter of protest because he wasn’t being allowed to🩸: “I think the Army made a grievous mistake, a stupid error in first issuing an order to the effect that blood for the Army should not be received from Negroes. My 3 reasons are...”

Read 7 tweets

WesElyMD

@WesElyMD

1/ #COVID19 Journal: New Yorker

Dr. @danielleofri has gifted us w/her #COVID journal. Her beautiful edifying ✍🏻 is a treat for your 🧠 and super instructive about #Pandemic.

👀Excerpt next tweets...

bit.ly/36vddL7

#medtwitter #TipsForNewDocs #tipsforolddocs #MedEd

@danielleofri

2/ Dr. @danielleofri writes in NYer:

“On Friday, the magnolia tree next to the #covid tent bursts into riotous blossom despite the chilly weather. Until now, the flowers have been delicate cups of pink and lavender, spaced along the spindly gray branches...”

(She shared pic...)

3/ Dr. Ofri continues...

“Now they’ve abruptly reversed their concavity, spilling open into an unbroken blanket of defiant white.

Normally, the inner workings of the hospital are invisible to doctors and nurses. We show up every day and the patients are there, the beds...”

Read 6 tweets

WesElyMD

@WesElyMD

1/ In #COVID19, we must learn from #BRAIN masters Engel & Romano, who described #DELIRIUM to #DEMENTIA relationship in the 1950s! Here are my TOP 10 CLASSIC quotes from their famous 1959 article:
bit.ly/2SePA1a

#medtwitter #meded #tipsfornewdocs #neurology #geriatrics

2/ The problem of delirium is far from an academic one. Not only does the presence of #delirium often complicate and render more difficult the treatment of a serious illness, but also it carries the serious possibility of permanent irreversible brain damage.

#dementia #COVID

3/ The deficiencies in the education of many physicians ill equip them to recognize any but the most flagrant examples of delirium.

#A2Fbundle #tipsforolddocs

Read 12 tweets

WesElyMD

@WesElyMD

1/ Most indicative of my ignorance as a young ICU doc in 1990 was my off-service note for a 28 year old w/ PROFOUND post-ARDS #PICS: “However, amazingly enough, she still manifests only single organ damage (lungs) w/ good renal, GI, & CV fxn.”
#medtwitter #pulmcc #TipsForNewDocs

2/fin #longhaulcovid

Apparently, neither her brain nor neuromuscular system were on my 🧠radar, because both organ systems were newly, severely, & permanently diseased as I penned that statement. Beware now in #COVID

#medstudenttwitter #dementia #TipsForNewDocs #tipsforolddocs

By the way, of course, I showed that note 📝 and use this patient’s example with written permission from her son who wants others to learn from the experience of his mother.

Read 3 tweets

WesElyMD

@WesElyMD

1/ Vaccine Hope in #COVID19: JAMA

Mechanism & Facts -
After #COVID, only 1/3 have Ab w low spike Pr titers & viral neutralizing. Given variability in Dz severity, this is expected. Highest Ag burden & Ab titers seen in severe disease.

bit.ly/32lhQ87

#medtwitter #meded

2/ Vaccine Hope in #COVID19: JAMA

SARS-CoV-2–specific CD4+ and CD8+ memory T cells are also generated across asymptomatic to severe disease that express antiviral cytokines, control viral replication & should prevent recurrent severe infections.

#tipsfornewdocs #pulmcc

3/ Vaccine Hope in #COVID19: JAMA

Abs to #SARS-CoV-2 spike protein show there may be 10X more SARS-CoV-2 infections than reported cases (=40-50 million or 15% of US population) to date.

#tipsforolddocs #criticalcare

Read 4 tweets

WesElyMD

@WesElyMD

1/ CXR Rounds ⏰ #26:

Mediastinum refresher!

See anatomy below. Look at CXR. What compartment is this lesion in?What is the differential dx of lesions in this space?

bit.ly/2YuB2OR

#tipsfornewdocs #medstudenttwitter #medtwitter #pulmcc

2/ CXR Rounds ⏰ #26:

CXR on tweet #1 was Adenoid Cystic cancer in MIDDLE + POST MEDIASTINUM.

You can’t distinguish those two compartments easily on CXR so they go together for Diff Dx! See these other masses below in the same space. What are they?
#radiology #tipsforolddocs

3/ CXR Rounds #26:

First, what is the Diff Dx of lesions in Mid/Post Mediastinum?

Answer: Bronchogenic Cysts. Infxn – Mediastinitis. Neoplasia – goiter, cancer, lymphoma, mets, esophageal CA. CV – Aortic Aneurysms. Traumatic Hemorrhage. Hiatial Hernia

Read 4 tweets

WesElyMD

@WesElyMD

1/ #Sedation & #Delirium in #COVID19:

The cornerstone of best sedation practice in #COVID is not a specific drug. It’s about lightening whatever you use to allow the brain to take over again as captain of the body’s ship.

#medtwitter #tipsfornewdocs #medstudenttwitter #pulmcc

2/ Personally, & this is a share of my own weakness, it makes a huge difference when my patient is awake & not sedated. Awake patients immediately become humans with real lives beyond the ICU.

#meded #sccm

3/ The outer shell of patients changes in my mind’s eye when they are lying in a drug-induced coma - the person becomes disembodied. I am blind to the person, who doesn’t seem to be with her own body. I know this is a defect in my own abilities as a physician.

#tipsforolddocs

Read 5 tweets

WesElyMD

@WesElyMD

@benmattlin

1/ of 13:
QOL & #Disability: NYTs Classic

PRO TIP: do NOT project onto a person her Quality of Life. Ask & learn instead!

@benmattlin w/ incurable spinal muscular atrophy writes beautifully:

“I never walked or stood on my own.” Read on...
nyti.ms/2E7jK2g

#MedTwitter

2/ Mattlin: For people like us, simply enduring can feel like a tremendous victory. One bad cold, though, could spell our end. If our lungs fill with phlegm, we lack the muscle strength to cough them clear. Pneumonia is common.

#MedStudentTwitter #meded

3/ Mattlin: It’s not generally acceptable in my segment of disability community to harp on our defenselessness. Rather, the idea is to assert core competencies, to distance ourselves from the Jerry’s Kids’ model and anything else remotely pitiful.

#TipsForNewDocs #tipsforolddocs

Read 13 tweets

Farhad Peerally

@FarhadPeerally2

As #ChangeOver wednesday beckons and my twitter feed fills up with #TipsForNewDocs, I thought I'ld buck the trend and share some #tipsforolddocs based on my 11 years as a junior doctor, 7 (and counting) of which as a registrar. A thread (1/n)

Your F1s weren't born Drs
Don't assume what you've learnt over 5, 10, 20 years is common knowledge to them. No other profession comes close to the relationship of a jedi master/ young padawan as what we've in Medicine. Nurture and cherish this relationship. #tipsforolddocs (2/n)

Repeat after me, "I will remove the phrase "back in my days" or other similar phrases from my vocabulary." You aren't in your juniors shoes. So stop comparing. Makes you sound like an old prick. (3/n)

Read 11 tweets

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