1/🧵Human Error in Decision Making and Judgment:
 
For those who loved @NobelPrize Laureate’s book Thinking Fast & Slow, there is a new Kahneman book called Noise reviewed @TheLancet. It’s worthy of a bit of commentary…

bit.ly/3hzD7RR

#MedTwitter #ScienceTwitter
2/In statistics, #NOISE refers to random scatter, ie, variations in our judgment that are NOT caused by individual judgment. #BIAS on the other hand is systematic deviation in judgment.
 
@nataliexdean @EpiEllie @f2harrell – teach us more & did you read Kahneman’s book yet?
3/ Kahneman himself (see quote in @TheLancet review👆) acknowledges that this book is somewhat data-o-penic. We need much more knowledge about “noise”…it’s a limitation in science at this point. In Medicine, he claims #Psychiatry is an extreme noise factory…@APAPsychiatric
4/ No doubt our approaches to the #MentalHealth disabilities of #LongCOVID pts are jammed full of noise & bias. @CIBScenter we are studying numerous aspects of #COVID with our psychiatrists, so this book is going to be on my mind. @f2harrell
5/fin
As a Physician Scientist in the ICU, I love our expanding trove of data, but acknowledge that in #COVID19 there had to be an immense amount of noise in our day-to-day care decisions. I’d love to learn others’ thoughts. @iwashyna @DogICUma
 

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More from @WesElyMD

6 Jul
1/🧵Wake-Up to how #SLEEP flushes waste from your brain 🧠 @JAMA_current
 
I may get more done when I 💤 less, but I lose the long-game! #Evolution dictated that we gain an advantage by spending 1/3rd of our lives asleep.

I’ll tell you WHY? bit.ly/3qPgzAA

#MedTwitter
2/ Why do we sleep? Brain rest? To process bad decisions or incomplete conversations? Maybe. But the coolest reason is removal of #amyloid & #tau proteins that cause #dementia. Our #glymphatic system does this most efficiently during deep sleep.
 
3/ Have I mentioned that I’m fascinated by the glymphatic system? It’s the lymph system for our #brain & serves as the “garbage” removal program to keep our #neurons healthy. Wanna know more?
 
Read 12 tweets
5 Jul
1/🧵COVAX was created to get #COVID19 #Vaccine to ALL countries. Hailed as a “heroic effort to transcend limits of human ingenuity,” it fell short globally because we “rich countries behaved worse than anyone’s worst nightmare.” @TheLancet
 
bit.ly/3yskwxJ
 
#MedTwitter
2/ At COVAX’s pledging summit, it finally secured US $8B ask for procurement & delivery of #vaccines for 92 eligible low-middle-income countries (LMICs) this year. But even with full financing, the COVAX roll-out is moving too slowly compared to high-income countries.
3/ “Today, ten countries have administered 75% of all COVID-19 vaccines, but, in poor countries, health workers and people with underlying conditions cannot access them. This is not only manifestly unjust, it is also self-defeating”, UN secretary general António Guterres said.
Read 7 tweets
1 Jul
1/ Serious End-of-Life 🧵

…He told her, “Never give up on me because I’ll keep fighting to live.” What does it mean when a person valiantly asks this of a spouse & then illness leads to #transplant, #infection, and eventually #life support that doesn’t help?
 
#medtwitter
2/ First I just listened to her heartache and saw their immense love. “I made a #promise, Doctor.” My personal commitment became to help this couple uphold that promise, yet medical options had long since run out & failed him. I asked her to come into the hall.
 
#nursetwitter
3/ Always go out outside a pt’s room to discuss anything you don’t want the patient to hear, even when he is in a dense coma. Assume dying pts hear everything said & respect their dignity as your number one goal in all interactions. Here is what I said…
 
#PalliativeCare
Read 10 tweets
30 Jun
1/🧵🎥 Hepato-Jugular Reflux (HJR)?
 
Neck Veins tell us a lot about how much fluid people have in their body. Look at this video & you’ll learn a trick doctors use that tips us off about blood volume! (Movie w perm)
 
#medtwitter #nursetwitter #TipsForNewDocs #TipsForNewInterns
2/ My patient had kidney failure & too much fluid, making him short of breath. I press down over his liver & watch his neck veins pop up (or not). When they do, it correlates w high pressures in the heart from too much blood volume.
 
bit.ly/2UDAVkl

#MedStudentTwitter
3/ Another way of seeing this is the CXR (see pic). This simple measurement from a vein to an artery called the Vascular Pedicle Width (VPW) also tells me the heart pressures are too high. His VPW is 84 mm and > 70 is way too much. So he needs to pee a LOT!
 
#LASIX #DIURETIC
Read 5 tweets
29 Jun
1/🧵What do CONDOMS have to do with the #COVID Vaccine?
 
The Pelzman Effect is currently threatening societal safety.

What is it & why is it important? Let’s unpack.
 
#MedTwitter #Pandemic
2/ The #vaccine, heralded as a panacea to the pandemic, risks further weakening adherence to other safety measures like social distancing & masks 😷. When people respond to safety measures with a compensatory ⬆️ in risky behavior, it’s called the “Peltzman Effect.”
3/ Example: medications allowing HIV preexposure prophylaxis (PrEP) dramatically lessened risk for HIV transmission AND were associated with decreased use of condoms, higher numbers of sexual partners, & more STDs. 😤
 
bit.ly/3xVTqPu
Read 11 tweets
28 Jun
1/ 🧵🎥 Chronic Pain

#Pain comes in all shapes & sizes. Let’s explore how we process pain. Watch & Listen to what Anderson Cooper tells Stephen Colbert about #grief and #suffering: “You can’t have happiness without having loss and suffering.”
2/ My lucid & kind patient (pic w written perm) uses scalding water as a coping mechanism for abdominal pain from pancreatitis. He wants to share his rationale.

#MedTwitter #ChronicPain #nurse
3/ Before I share what he told me, I first want to make my mindset as his #physician clear: My first job is to believe in him. Then to understand him. Then to devise a plan to help him.
Read 13 tweets

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