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/
“But I’m not a character. I represent myself honestly without deception” you tell me.

Stop deceiving yourself. You are not the same person you present on here any more than I am. 4/
I laugh when I see people get worked up about Prasad or Mandrola. Scared or angry. As if those guys don’t know what character they are crafting on this platform. 5/
Little kids know The Joker is bad and Darth Vader is evil.

Adults know they have many fans. There would be no Batman or Luke Skywalker without them. 6/
Some may say this isn’t play acting. These aren’t movie characters. This is real life.

Certainly seems real sometimes, doesn’t it?

That’s why we go to the movies. To holler at the bad guys on the screen, jump with fear, cheer on our heroes. 7/
What you feel on Twitter (and what compels you and me to come back again and again) is catharsis.

Catharsis (from Greek κάθαρσις, meaning "purification" or "cleansing" or "clarification") is the purification and purgation of emotions—particularly pity and fear—through art. 8/
Catharsis is the purification and purgation of emotion through art or any extreme change in emotion that results in renewal and restoration originally used by Aristotle comparing the effects of tragedy on the mind of a spectator to the effect of catharsis on the body. 9/
(It’s Wikipedia) 10/
We know cathartics in medicine. The are medicines that make you poop.

Theatre and drama do the same for your emotions. 11/
This platform is a stage. Not a news show or a documentary or an autobiography or an X-ray for truth.

It’s a theatrical stage with costumes, characters, story lines, conflicts and adversaries.

The people who do it best know this. Like glaucomaflecking. A one man show! 12/
Who also happens to be played by a lovely kind man in real life. 13/
Now you tell me: This is not a movie. It’s real life!! The stakes are high!! We are influencers changing public opinion!!! People make life and death decisions based on these “characters” we “play” on this “stage.” 14/
I know this argument. You listen to “gangster rap” and play video games and you become a mass murderer.

I’ve never bought that argument.

People can tell the difference between violent lyrics, movies and games and real life. 15/
So ask yourself. Can you tell the difference between Twitter and real life? 16/
We each play a role and each role is important.

Margaret Hamilton played Almira Gulch and the Wicked Witch of the West but she loved kids. It’s called acting.

en.wikipedia.org/wiki/Margaret_… ImageImage

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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/ Image
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/ Image
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
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
24 Aug
The least capable medical students and residents used to be the least satisfying to work with.

A situation I used to call “The Double Punishment.” An essay. 1/
The Double Punishment goes like this:

Your student/resident lacks motivation/ability.

So you spend extra time on everything.

The results are poor.

Mistakes are made, patients, nurses and colleagues are mad.

Days are long. That’s the first part. 2/
The second punishment is in writing the evaluation. It’s no fun. You have to think a lot. You have to try to figure out how they can get better. You know you can’t sell this broken glass as a gemstone.

Then you get feedback on your feedback. Not gentle enough, etc. etc. 3/
Read 17 tweets

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