One thing we don’t teach you in med school or residency is how to call in sick. 1/20
I will tell you an embarrassing story. 2/20
Twenty years ago, my then wife’s dad committed suicide on a Tuesday. 3/20
She called me at work in the middle of the afternoon. It was a ridiculous day in clinic. Three exam rooms full and a waiting room filling up. 4/20
The call caught me by surprise. Her dad had not notified my that he was going to jump to his death that day. 5/20
On the phone, I asked her if she had someone there. Then I made my mistake. 6/20
I said, “I have all these patients to see. I’ll be home as soon as I can.” 7/20
In my defense, I had never once in my med school or residency put a personal event ahead of my professional responsibility. 8/20
Quite the contrary. I had watched a vascular surgery fellow get told his wife was divorcing him, hang up the phone, and continue rounds without a shred of emotion. 9/20
This was the culture of medicine I was raised in. Ruthless prioritization of word over family was part of “professionalism.” 10/20
My wife survived until I arrived home a few hours later. She had spent most of the time on the phone with her siblings.

You can imagine other circumstances where I would not be immediately available.

That’s not the point. 11/20
The point is, I did not know how to leave my professional life in the event of an emergency. I honestly had never seen anyone do it. I had no role model and never done a role play.

I had no equipment for this important moment. 12/20
Here’s the most important part: 13/20
You people can survive without you. Everyone in a doctor’s life has learned to adapt to their absence. We force this lesson on our loved ones repeatedly throughout our careers.

“I’ll be home at 6.”

“Make that 7.”

“Uh oh you can go to sleep things are going the wrong way. 14/20
There are 2 main points:

1) The fact that people tolerate being #2 to your career doesn’t mean you shouldn’t sometimes make them #1 and

2) I delivered sub-standard care to those patients I saw that afternoon 15/20
No matter if your father in law kills himself or any other of a hundred tragedies, this is the essential part.

You have to be able to recognize when you are sufficiently impaired by your emotions not to be able to practice medicine. 16/20
When a colleague comes to you and says “I have to leave I am facing a situation.” You have to be able to say, “I’ll cover you go do your thing.” 17/20
It has to become more part of our culture. We can’t expect people in the midst of a personal tragedy to continue to practice medicine like a computer healthcare kiosk. 18/20
I was fortunate. To the best of my knowledge, I didn’t make any serious mistakes that day.

If I had, I would have compounded grief with guilt. This is not a situation we should expect medical colleagues to tolerate. 19/20
That means on the other end you may have to pick up the slack when a colleague steps out in the midst of a personal crisis. 20/20

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More from @medicalaxioms

15 Sep
Let’s discuss 3 facts:
1. You and your parents before you have been managing and balancing RISK v. DOING STUFF your whole life.
2. Over time your risk of dying of COVID will shrink beneath other risks.
3. We’ve been happily killing each other with infectious diseases forever. 1/
Like it or not (and style notwithstanding), this is the debate people like @VPrasadMDMPH and @drjohnm are trying to have right now.

And all of us will have sooner or later. 2/
Let’s look at my column together (from @CDCgov).

I’m 45-54. You could easily reduce some of my TOP 10 risks of death by:
- outlawing cars: unintentional injury
- outlawing firearms: homicide, suicide
- outlawing tobacco and alcohol: liver/lung dz

But… 3/
Read 13 tweets
14 Sep
“If you don’t get your A1C under 8 you will die.”

“… don’t take this Lipitor you will die.”

“If you take lisinopril instead of Entresto you are dead.”

I’m not sure who teaches med students and residents this approach but it will fail more than it succeeds. 1/10
Hyperbole and threats somehow seem effective with less educated people.

They aren’t. Most patients have already tried your “deadly experiment” and lives to tell the tale. 2/10
They can see right through your bullshit and the superior sneering attitude behind it. 3/10
Read 10 tweets
13 Sep
In case you haven’t figured it out, Twitter is not real life. It’s a fictional place full of made up characters.

Many of the stories are made up. Many of the accounts are just flimsy cardboard cutouts of people. Like a CGI crowd in a movie. 1/ ImageImageImageImage
It’s not a documentary. It’s more like Disneyland. The Disney princesses are just people at work. Creating an illusion. Because it’s their job.

The “people” you “like” play heroic lovable characters. 2/
The “people” you hate or who make you angry have written villainous characters.

Sometimes by accident and other times intentionally. 3/
Read 17 tweets
1 Sep
There are 5 realms you will master if you want to be a good doctor. 5 bodies of knowledge about which we teach 3 in medical school. 1/
1. Diseases. You must learn their traits and character. Their prey and weaknesses. Their mimics and behavior. In some fields there are hundreds. In internal medicine we have tens of thousands. 2/
2. Bacteria and other infections beings. If you are an orthopod you will become an expert in staph aureus. OBs know Group B strep. Ophthos know that pseudomonas.

It’s weird to get to know some microorganism better than you know your neighbor on your block but you should. 3/
Read 7 tweets
31 Aug
I spent lunch on Google Scholar reading ivermectin in COVID papers (of which there are a lot more than I thought).

Tons of bias. Zero RCTs. I wouldn’t be surprised if it helps a little. I also wouldn’t be surprised if it does absolutely nothing or causes harm.
That being said, I wouldn’t take it if I got sick.

More “promising” meds end up failing than succeeding. Every year we kill some people trying to test and find new medicines that end up being harmful.
Vaccination, masks, and social distancing have worked for me and the doctors I know who have spent countless hours in high risk close proximity to hundreds of patients sick and dying with COVID.

Only ~4% of my group has gotten sick in 18 months.
Read 5 tweets
30 Aug
Unpopular opinion: rote memorization is the foundation of true understanding in many subjects. @efunkEM
I agree with this. Without training your brain to organize and recall the facts, you will not be able to think on the fly or spot rare diseases when they are sitting right in front of you.

You are not a chip. You have to be the whole computer. Storage, display, everything.
I have worked with residents who won’t bother to memorize the 3-20 item DDX for all the common things: anemia, fever, elevated WBC, delirium, AGMA, etc.

They make rounds SO FUGGING SLOW!!!!!!
Read 4 tweets

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