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Individual Daily Risk Profile picture
@medicalaxioms
Sep 4, 2020 • 7 tweets • 2 min read • Read on X
Raise your hand if you suggested your 14 year old daughter listen to this new song you heard about called #WAP before you read the lyrics. 🙋🏼‍♂️🙋🏼‍♂️🙋🏼‍♂️
Thus leading to an informative discussion about which emoji means vagina.
🍑?
🛶?
🌮?
👛?
And all the penis emojis.

🌂🐓🍌🍆🌭🥍🖍
Then why a common anatomical term like clitoris doesn’t get a suggested spelling. It is a body part. Like the skull. ImageImage
Anyway even a 14 year old can recognize how weird we are about body parts. And bodily functions. And sex. All of which are basic aspects of human existence.
No wonder we in medicine have this uphill battle trying to discuss body parts and educate people around sex and sexually transmitted diseases.
Sometimes I forget we left Europe and made America because they weren’t puritanical enough back there...

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More from @medicalaxioms

Individual Daily Risk Profile picture
Dec 8, 2023
Here’s the K-M survival curve from the recent #semaglutide #ozempic paper in non diabetics from the NEJM.

I’m going to teach you how to read a KM curve in a few steps.

First, let’s discuss the deception presented here.

Lincoff AM, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S, Hardt-Lindberg S, Hovingh GK, Kahn SE, Kushner RF, Lingvay I, Oral TK, Michelsen MM, Plutzky J, Tornøe CW, Ryan DH; SELECT Trial Investigators. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023 Nov 11. doi: 10.1056/NEJMoa2307563. Epub ahead of print. PMID: 37952131.
Image
This is actually 2 KM curves superimposed on one another. The honest KM curve is shown here.

If you are reading this correctly, you should be unimpressed. Which is why the authors chose to add a magnified version on top of all that white space. Image
Here’s what they added. It’s like a photo of the other curve taken under a microscope.

It makes the effects look much bigger (and faster). Which is a fair goal if you are trying to impress… Image
Read 8 tweets
Individual Daily Risk Profile picture
Sep 7, 2023
The container on the left has 3,820 balls in it. 3819 white and one green. On the right: 4525 white and one green.

The rules of the game are simple. Shake up the container and draw 1 ball a day. WHITE ball means you play again tomorrow. GREEN means you’re dead. Image
I assign 8,399 people into two groups:

Enalapril: 4212 people
Entresto 4187 people

and have them play for 1260 days.

Here are the survival curves of the two groups playing this game. Image
For comparison, here is the survival curve (death from any cause) from JJ McMurray and M Packer’s 2014 Paradigm HF trial in NEJM. PMID: 25176015 Image
Read 11 tweets
Individual Daily Risk Profile picture
Jul 5, 2022
“Primum non nocere” is a necessary fantasy.

I take a call from the ER about Miguel McJohsonberg in room 13. While I’m on the phone I open up his chart and start reading his personal business. His labs. His meds. The DC summary of his last admission. …
All the while he has not given me expressed permission. It is a violation.

We all agree to this violation. He bought his ticket. He knew what he was getting in to. …
Twelve hours later he is unconscious and intubated and the surgeons get permission from his friend to disarticulate his left leg at the hip for a necrotizing skin and soft tissue infection. …
Read 14 tweets
Individual Daily Risk Profile picture
Jun 19, 2022
A doctor must be selfish. 1/20
It goes against your nature.
It offends the good kid your parents raised.
It will make you feel guilty and upset the people you love.

Still you must be selfish. 2/20
You can’t give away what you haven’t got.
You can’t draw water from an empty well.
3/20
Read 20 tweets
Individual Daily Risk Profile picture
Jun 17, 2022
If it’s hang on a rope or hang up the stethoscope, that choice is easy.

Quit medicine. 1/10
No job is worth dying for. 2/10
It’s not normal to be able to tolerate exposure to all these stories, all this pain, all this tragedy, death and dying.

It’s normal to have a limit. It’s normal to reach capacity. The people who can do it for a lifetime are the oddballs. 3/10
Read 10 tweets
Individual Daily Risk Profile picture
Jun 10, 2022
Your employer wants to burn you out. 1/x

(For those who don’t know my schtick, I often start with a controversial statement like this. While it’s true, it’s not the point of this essay. You have to keep reading…)
Your employer is smart.

They know what they sell—completed, signed notes. They need lots of them. Big ones. Procedural ones. It doesn’t actually matter at all who is writing them as long as they are good enough to sell for revenue. 2/x
The one thing your employer does not want is a bunch of expensive grey haired doctors shuffling around caring about stuff. That business model stinks.

The work is slow. They cost of labor is high. Old doctors are finicky. What a disaster.

3/x
Read 23 tweets

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