Patients get discharged from the hospital when they are STABLE. This is such a fundamental principle that many of us have the word “stable” templated into our discharge notes.
Stable means that their vital signs are acceptable over time and that their clinical trajectory is not dynamic. Put plainly, the patient needs to be boring, without new and changing stuff happening, to send them out of the hospital.
A patient who has vital signs changing / fluctuating in a concerning direction, new test results, new treatments all happening over a short amount of time IS NOT STABLE and IS NOT GOING HOME
Even considering it is completely contrary to the “out of an abundance of caution” we heard the other day
Even with an advanced WH med unit (would love to hear more about this), if can’t flex to ICU level care, leave him where he is

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More from @choo_ek

4 Oct
Welp it happened... my daughter crashed my news segment 😩🤣
I could feel my face getting bright red and staying that way for the rest of the interview
Daughter afterwards: “I wanted to see what was going on”
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3 Oct
As an ER doc, I’m used to working off partial and sometimes conflicting information. But this is confusing on a different level.
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Ultrasound for ... what, exactly? Heart? Why, if he’s doing so well?
If he was on oxygen but isn’t now what was the context for his oxygen need? Walking? Sleep?
Why in the world would he be out of the hospital in 2-3 days?
Read 4 tweets
2 Oct
Is it odd that I don’t believe it?
Look, I thought October was going to come with a huge ramp up of reassurances about Covid to begin with
A diagnosis with a rosy-looking President and First Lady, spending the rest of the campaign trail crowing about how it's nbd... letting the public health fallout of that false reassurance occur any time after Nov 3rd... It's a plausible tactic.
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27 Sep
This is a remarkable piece by the @latimes on the newspaper’s own deeply racist roots and how its orientation and largely white leadership and staff perpetuated racist storytelling over the past century. It ends with an apology and a way forward.
I would love to see this from companies of all kinds: a full exploration of its own history, not shying away from critique of even its most honored leaders, to pave the way for a different future.
So much that’s painful to read, including the paper’s neglect of the murder of 39-year-old Eula Love by police in a dispute over a bill https://t.co/b1IL0kwYJ7 Image
Read 5 tweets
22 Sep
I wish more health disparities research would move beyond describing the problems to understanding and solving them.
"Our hypothesis is that X patients will have [more of a bad outcome] [or] [less of a good outcome] in this health issue"

"This is innovative because this has not been adequately examined in this particular TINY SLICE OF DATA"
We're so comfortable in our incrementalism we forget there are lives at stake and the point of science is to have health impact

When COVID is long over, people will still be writing papers like "Observed racial disparities in COVID mortality across 17 counties with cold weather"
Read 5 tweets
17 Sep
All my papers are late. All my emails go unanswered until a second poke, except a tiny random sample that I answer within one hot second. All birthday wishes are belated. My grants go in late or not at all. Workouts have gone out the window. So have quotas on chocolate.
I’m reading 1/2 dozen novels at odd hours. My kids have unlimited iPad time. Their nails are not trimmed. My house is dusty. I probably owe you a call. I often cope by shopping online for accessories that will startle people in future Zoom calls.
I changed six lightbulbs yesterday and my husband and I agreed it was a highly satisfactory day’s accomplishment. I also decided that censoring myself by not swearing during talks is too much of an extra effort, so know if you invite me I’m swearing unless...
Read 6 tweets

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