1/🧵 I’m surrounded by an #AntiVaxxer govt now willing to hurt kids!
 
👎 My home state of #Tennessee made the BONEHEADED decision to halt outreach to kids on ALL #Vaccination, NOT just #COVID19. I’ve lived here since 1997. I’m embarrassed, angry & sad.
 
bit.ly/3B9VoOP
2/ Our Department of Health is halting “all adolescent vaccine outreach for ALL diseases.” What? So we aren’t going to protect our precious kids against Tetanus, Pertussis, Diphtheria, Rotavirus, H flu, hepatitis, pneumonia, meningitis, HPV (which leads to cancer)?

#BARBARIC
3/ GONE are Postcards to teens to remind them to get a second #COVID #Vaccine shot...but adults still get the postcards. Why? “Potential solicitation to a minor.” WHAT? No, this is called #PublicHealth.

Why should adults get promotions toward #wellness and not kids?

#Prejudice
4/ My state’s government in Tennessee is actively dialing back efforts to #vaccinate minors at exactly the time in their lives when they could be taught the meaning of preventive medicine, self-worth, #dignity, and also charitable giving to their fellow citizens.
5/ We even fired our top vaccine official Dr. Michelle Fiscus, who issued a scathing statement stating, “I’m AFRAID for my state.” Well, so am I!

@DrEricDing…👇
6/fin 💔
These actions send every WRONG message. They are anti-science & anti-medicine. Head-In-Sand Thinking. It’s embarrassing.

We shouldn’t stand for it now or ever. I’m so sad every time I admit a new critically ill patient to our ICU w #COVID, and now this!

#Help #Please

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More from @WesElyMD

8 Jul
1/🧵 Giving & Receiving Advice:

My medical advice is not infallible. Maybe I’m wrong and maybe my patient knows it? Maybe that’s one reason she/he is non-compliant. Even if I am right, it might not be the time in that person‘s life to hear the message.

#selfcare #medtwitter
2/ A pt may seem to be listening & carefully taking it all in. But later that morning she/he may leave against medical advice (AMA). What are we to think when we give our best #advice and others don’t take it? Especially in the medical field?
 
#tipsfornewinterns #tipsfornewdocs
3/ First of all, of course, unsolicited advice is #criticism. Especially when I’m not with a patient, I try to resist all urges to give unsolicited advice.
Read 13 tweets
7 Jul
1/🧵 Addiction is a family disease:

Drinking three 8-packs of Budweiser Nitro Gold daily for 10 yrs takes its toll on the entire family. I told my patient, “All you have to do is the next right thing.” Then…

#MedTwitter #Nurse
2/ His family was very upset when his “next right thing” was to check out against medical advice. I shared a quote from @MalibuMelB (M. Beattie): “Others don’t know what’s best for us. We do not know what’s best for others. Our main job is to determine what’s best for ourselves.”
3/ Terminology: Addiction vs. Substance-Use Disorder…there are many things people can be addicted to besides “substances.” Addictions to things like exercise, love, money, control of others, etc. For this🧵, I am referring to addiction broadly…and how it robs people of joy.
Read 7 tweets
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
5 Jul
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
Read 5 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

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