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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
Thread: Tell me about the good times (#residency)
1/Obviously, so many threads about the tough times in training. Neg experiences, disrespect, fatigue, depression. I began to wonder if I had imagined having a great residency experience. How could mine have been so different?
2/I wouldn't put it past me to have amnesia about the whole thing. So I texted some of my co-residents? Was I seeing things thru rose-colored goggles? Nope-they all said "Great time and Hard Work." Which is what I recall. With so many new interns preparing to start....
3/ Can you share with me some of the good times you remember? Because we surely don't want them all to start a new experience expecting doom and gloom. #MedTwitter #Twitternist #ProudToBeGIM #TipsForNewDocs
Read 8 tweets
#twitterreport
55 yo ♂️s/p RenalTx 10+yrs ago tacro/aza immunosuppressive, gardens & recent travel to home (Philippines), presents chronic progressive cough, constitutional features & single skin abscess, with non-cavitary RUL consolidation + diffuse ggo refractory to Levaquin...
100.1F, HR110s (near baseline), RR18 97% RA. Found to have mild AoC kidney injury, AoC hyponatretomia , mild hepatocellular injury. Procalcitonin 0.7.

Do you start antibiotics? If Yes: tell me which ones in comment
So before starting treatment...maybe should think about therapies....this was my 🐔 scratch DDx on back of article —> Think their stable and more Abx won’t help things I’m worried about acutely at this point
Read 10 tweets
Day 15/15 #PCPOnTheWards Two more admissions and I’m done! Going through my head:
❓1 week or 2 week stints next year?
❗️I’ve set the wheels in motion to go up for promotion!
📖Resident brought up desire for specific #EBM “rounds.” Brainstorming if after lunch best time?
(1/ )
📖Morning rounds/identify question/research #evidence/present to team ~130pm. Would #housestaff buy in?
🙌🏾Daughters coming home for weekend
💪🏽Workouts need to be kickstarted
🍩Food w holes (bagels, donuts) do help team morale.
Hope you all are having a great Friday!
(2/ )
Thoughts on the post lunch brief team rounds to run evidence for our decision making, #MedTwitter? #Twitternist @COREIMpodcast @ShreyaTrivediMD @medicalaxioms @cacace_frank @LaurenKuwikMD @ORourkeJr @meggerber @SusanHingle
Read 3 tweets

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