1/ Debating whether to dignify this ... but here goes

I think most of us endangered docs/nurses/respiratory therapists/social workers/hospital chaplains are also frustrated re clarity of the campaign &publicly voiced narrative re this administration’s &our nation’s response ->
2/

The ‘it didn’t have to be this way’ - must remind the public, the on the fence voter, of the following:

Pandemic preparedness structures were pared down &not present 2help initial strategy

‘Leadership’ must b holistic/humble - it sits back &listens deeply to expertise ->
3/ if ‘leadership’ respected lifelong career pandemic preparedness experts, we would have:

accepted WHO tests for #COVID19 to apply at the outset

commissioned efforts 2create a new test 2multiple entities 4redundancy as an insurance policy, ie .... ->
4/ .. commercial labs, academic virology labs, the CDC and NIH, and NOT JUST to one entity (CDC). The delay in testing bc of contamination of first CDC test was crippling on both coasts. We had to ration tests to only symptomatic/diagnostic use. We could not map/trace

... ->
5/

‘Leadership’ would be deeply humble/citizen centered. If it were, it would have heard EARLY we must (step 1 in pandemic) mass test/use positives 2map/trace/quarantine 2take gasoline out of exponential rise; step 2 is mitigation and smart shutdowns - we half heartedly did ->
6/ .. step 2 first, and never did step 1

Therefore, our unknown asymptomatic/presymptomatic spread and exposure was wildly more intense than it needed to be

So many lives lost, #healthcareworkers in harms way, with #hero thrust upon them (implies agency ..)

->
7/

Then when we have testing, automated machines to do multiple w 1-2d turnaround, reagents, swabs, to some extent #PPE, what is ‘leadership’ supposed to do?

With each small tic upward in reported infections (ah, transparency) across country, supposed to send huge numbers ->
8/ .. of those automated machines, testing supplies, teams, PPE, facility building teams, and BLANKET those cities, surrounding areas w #ContactTracing .. an eighth of industry was needed 2mass produce said supplies, automated testing infrastructure, .. but no

The continued ->
9/ epicenters internally from the coasts were an even deeper insult to the health and welfare of the nation. The very value of life rejected ..

A dereliction of duty - only a national/federal coordination could have had the scope/financial heft/messaging power to effectuate ->
10/
#medtwitter #meded

These were our patients, colleagues, team members, friends, mentees, mentors

I wish, in the plea for change that is being made in debates, interviews, campaign, that we’d get the events right. This was a narcissistic anti expertise crime

->
11/ .. and it continues w the ridicule of masks/governors/school districts that make decisions they see necessary/widened testing programs/discussion of economic malleability of response necessary

At the very least our ‘leaders’ & ‘institutions’ were supposed 2have our back

fin

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More from @GIMaPreceptor

25 Oct
1/ This past Thurs, I was honored to ‘emcee’ a grand rounds @HofNorthwellDOM, presenting the Candee Award for Education Excellence in Medicine 2our beloved Ron Rosen of @NorthwellDGIM

Ron is a 50 yr general internist who has taught no less than 40 yrs worth of learners -> 🧵
2/ Ron had so much to tell us about his aunt and uncle, who were early family medicine practitioners in the Bronx/Manhattan. Ambulance drivers would take them to a patient’s home. A beautiful sepia tone showing his aunt going to a call, and another of his uncle in the office
3/ We heard about Dr. Rosen’s medical school yrs @nymedcollege in the early 60s &how he knew the civil rights movement, the movement for reproductive rights, the attempts to mitigate poverty and the birth of Medicaid and Medicare would affect all his future pts &his work ->
Read 15 tweets
25 May
1/ Had a really interesting day on #medtwitter today, re: #advocacy #activism #primarycare courtesy of @MParshleyMD @sagar_ankita @EricLast3 @gabrieldane @meggerber @mmteacherdoc @sulane7 @SusanHingle @dhpomerantz @UREssien

... and of course that made me think #baseballcards ->
2/ I was reminded that one hobby I have to relax me when pandemics, hubris, RVUs and #disparities are driving me bonkers 😜 = old ⚾️ cards.

On my recent B day my nieces/nephew bought me a pack of 2020 (?lost season) cards. Decided to open them ->
3/ they are new, shiny, the photography is awesome. Look at that Bryce Harper! The Laureano catch!

Rizzo for the Cubbies. Alfonzo of my Mets. -> getting back to the #advocacy in the environs of our institutions, promise ... Image
Read 10 tweets
25 Apr
1/Many of my colleagues and I have not been redeployed to the hospital during the #COVID pandemic. We have been doing the ambulatory care of pre/non hospitalized patients, helped w admitted pts and starting to see post discharge pts.

Many thoughts/advice points:

A 🧵THREAD
2/ First our #primarycare triage function in this process is crucial.

Workflows/teamwork/infrastructure have to be worked out and optimized.

An updated list of daily follow up #telehealth covid pts must be kept. Day of illness, daily update notes and tracking has to happen
3/ Key points:

Age, comorbidities matter. And yet, there are those healthier patients that get sicker, hypoxemic/stormy as well

Don’t completely know (like so much in this illness) the grouped likelihood ratios for the following but these are things to ask to be complete ..
Read 20 tweets
26 Mar
1/ Hey #medtwitter #proudtobeGIM

cc @mmteacherdoc @templeratcliffe @tony_breu @meggerber @laurelfick @adamcifu @DrSinhaEsq @SusanHingle

Received a text this AM from division’s admin coordinator

‘What a beautiful day it would have been for opening day - Let’s Go Mets ..’
->
2/ 2which my Chief of DGIM responded:

The one constant through all the years, Ray, has been baseball.

America has rolled by like an army of steamrollers. It's been erased like a blackboard, rebuilt, and erased again. But baseball has marked the time.

This field, this game->
3/ it’s part of our past, Ray. It reminds us of all that was once good, and what could be again.

Ohhh, people will come Ray. They most definitely come

To which I responded ->
Read 5 tweets
23 Sep 19
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
8 Jun 19
1/ #medtwitter #twitternists #proudtobeGIM

I've been sitting on a @SocietyGIM #sgim19 debrief #medthread since the meeting, and thought I might finally take a swing at it - here goes ..

I am considering whether I can do more division/systems leadership in coming years .. ->
2/ Theme of the conference was 'Courage to Lead', and single best workshop for me was :

Leading Change: Tools/Tips for Change Management

Crediting Alfred Burger, Emily Fondahn, Brent Petty, Nathan Spell, Dan Steinberg - can't find them on Twitter, so giving proper 🗣🗣.
3/ would like to share key concepts for all of us trying to lead in academic medicine or in #advocacy spaces.

First key Slide/thoughts:

The hard stuff - barriers to change .. ->
Read 16 tweets

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