I agree; there’s a theme there to be explored.
We have a tendency to overcorrect, to gravitate to extremes.
And to get overemotional or snarky when advocating for what we think are best clinical practices.
I’m guilty too. But I think there are downsides.
1/8
We have a tendency to overcorrect, to gravitate to extremes.
And to get overemotional or snarky when advocating for what we think are best clinical practices.
I’m guilty too. But I think there are downsides.
1/8
https://twitter.com/MikeRoseMDMPH/status/1303493390072508421
First, our own practice & quality of care suffer when we think in extremes and absolutes.
Second, we can communicate oversimplified or wrong messages to learners who don’t have the same contextual knowledge.
Some examples of such misunderstandings...
2/
Second, we can communicate oversimplified or wrong messages to learners who don’t have the same contextual knowledge.
Some examples of such misunderstandings...
2/
#NeverFOBT 😡, people say.
What about CRC screening?
What about this stool, which might be blood or food pigment? Or the self-evacuated black stool of a patient who’s on iron or pepto, and is tachy today?
I’d Guaiac that, and change management if overtly + vs -.
3/
What about CRC screening?
What about this stool, which might be blood or food pigment? Or the self-evacuated black stool of a patient who’s on iron or pepto, and is tachy today?
I’d Guaiac that, and change management if overtly + vs -.
3/
Don’t treat asymptomatic hypertension in the hospital, we preach. #TWDFNR, great article.
But suddenly there are people who are riding 180-200/90-110 for DAYS and they’re not on lisinopril, or amlodipine, or nothin.
Wait, was it “don’t treat” or “treat differently?”
4/
But suddenly there are people who are riding 180-200/90-110 for DAYS and they’re not on lisinopril, or amlodipine, or nothin.
Wait, was it “don’t treat” or “treat differently?”
4/
“Elevated lactate does not equal fluid-responsive hypoperfusion” gets reduced to “checking or trending lactate is useless.”
The rolled eyes 🙄 at d-dimers for their non-specificity ignore the fact that if it was negative, it would be very useful, or save a scan.
5/
The rolled eyes 🙄 at d-dimers for their non-specificity ignore the fact that if it was negative, it would be very useful, or save a scan.
5/
“Why did this patient get a troponin?!”
Maybe because we miss MIs all the time in folks (especially women) who present with atypical symptoms, and pre-test probability for detecting significant myocardial injury should be << 10%.
6/
Maybe because we miss MIs all the time in folks (especially women) who present with atypical symptoms, and pre-test probability for detecting significant myocardial injury should be << 10%.
6/
Pyuria does not equal UTI!
Asymptomatic bacteremia should not be treated with antibiotics if not pregnant!
We 🙄 hard when we see unnecessary abx.
Then someone brushes off pyuria + bacteriuria + pelvic pain + fever and I’m like hold on hold on UTIs do still exist.
7/
Asymptomatic bacteremia should not be treated with antibiotics if not pregnant!
We 🙄 hard when we see unnecessary abx.
Then someone brushes off pyuria + bacteriuria + pelvic pain + fever and I’m like hold on hold on UTIs do still exist.
7/
I’d love #medtwitter to share more examples. But to summarize:
Do we overuse many labs and treatments? Yes. But we should teach high-value care with nuance, context, and caveats. To describe optimal use, rather than demonizing or canceling various tools.
8/8
Do we overuse many labs and treatments? Yes. But we should teach high-value care with nuance, context, and caveats. To describe optimal use, rather than demonizing or canceling various tools.
8/8
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