Physicians are among the most resilient people I know.

We don’t need more resiliency training.

This is a system problem.

We need to fix the system.
The system is set up to maximize “efficiency” (ie profit), even as returns are diminishing. But cost (ie outcomes, complaints, burnout) is borne by individuals.

This is a system problem. This is why I’m thankful I work for an independent group with AGENCY to balance trade offs.
When you don’t work on the front line or pay the cost of your mandate, regulation, prior auth requirement or other directive, it’s easy and free to ask physicians to do just one more thing or make another compromise.

nytimes.com/2019/06/08/opi…
We need to change the system.

A good start would be to recognize that physicians are not commodities and we are not waste.

Stop setting us up for failure.

Stop breaking us.

It’s important. #WeAreAllPatients in the end.

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More from @amychomd

13 Dec
Congress has been working for years to solve “surprise billing.”

I’ve been trying to explain this issue - and EMTALA for years now.

Congress hasn’t been able build consensus or pass a bill for years.

On Friday a deal was announced. At 5:45p, a 300 page bill released.
It will be attached to a must-pass omnibus or COVId relief bill.
The 300 page bill was released on a Friday at 5:45p. The word from staffers is no changes will be entertained. Others say that and changes need to be done by EOD Monday. (So it can be included in a must-pass omnibus bill.)

No hearings. No public comment. No stakeholder review.
Read 30 tweets
15 Nov
A finish line is in sight. We can do this. Time to hunker down.

What I’m doing:
-keeping littles home from preschool
-pulled all kids from indoor sports
-no gyms
-continue online church
-takeout only
-no indoor gatherings without masks, even with our bubble
Our family is planning for #ChristmasInJuly. It’s not easy but I’ve worked Thanksgiving/New Years or Christmas holiday every single year since I’ve been an emergency physician (long time now 😬.)

Holiday traditions are important but they don’t make families. People do. Image
It’s really hard to tell my kids they can’t do sports or get together with anyone. But we can get through this. There is a finish line and the prize is worth the sacrifice.

But it *really* helps knowing that it’s not forever and the payoff is worth it.
Read 4 tweets
9 Oct
Apparently unpopular view:

A decrease in hospital stay from 15 days to 10 days from Remdesivir is a VERY meaningful outcome and benefit.
Hospital bed capacity (or more accurately nurse/RT capacity) is limited. A decrease in the LOS and recovery time translates directly into increased capacity.

100 nurse days/15 days per patient = capacity to care for 6.6 patients

100 nurse days/10 days = 10 patients

>50% ⬆️
We know that as hospital systems get overwhelmed, excess, unnecessary mortality increases: from COVID patients who can’t get admitted because they aren’t “sick enough,” inadequate care in the hospital and for all the other patients who can’t access care. scientificamerican.com/article/covid-…
Read 5 tweets
6 Oct
Lots of folks say “you must be brave” when they find out I work in the ER.

It’s true that I don’t (usually) get upset at the sight of blood. But there are plenty of things that scare me.

A non-exhaustive list of things this emergency physician is afraid of:
Choking

Because I’ve seen a child choke on a hot dog or grape that wasn’t cut lengthwise.
Door slamming

Because I’ve had to repair way too many fingertip amputations in little kids.
Read 20 tweets
9 Aug
As teachers go back to school, I think it's important that they learn from what we have learned in hospitals. I will share some things and hope others chime in with their best tips.

#MedTwitter #NurseTwitter #teachertwitter
First of all, if folks have any potential symptoms, they need to get tested and STAY HOME.

Common symptoms:
*Fevers/chills
*Shortness of breath
*Cough
*Fatigue
*Sore throat
*Headache
*Muscle aches
*Loss of taste/smell
*Nausea, vomiting, diarrhea

cdc.gov/coronavirus/20…
Unfortunately, though, we cannot effectively screen out all of those with active infections because some don't get severe symptoms.

Some folks who are infected are:
*Minimally symptomatic
*Pre-symptomatic
*Asymptomatic

However, we believe they can still spread infection.
Read 23 tweets
17 Mar
(Author unknown)

This post is for my healthcare workers, docs, surgeons, Nurses, aids, and ems, but also support staff.

There is no emergency in a pandemic
You as a healthcare worker are a force multiplier. Your training and experience is invaluable moving into this crisis. So, you're going to be faced with some very difficult moments. You're going to have to put your needs first.
I'm speaking specifically about PPE and your safety
If you're an ICU nurse, or an ICU doc, and you become infected, not only are you out of the game for potentially weeks (or killed) But your replacements could be people without your expertise.
Read 13 tweets

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