“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
People with an 8th grade education probably recognize an empty threat better than we do with our 800 years of education. 4/10
It’s a tragedy that an honest discussion of the actual math and strength of evidence is viewed as “too subtle” for regular people. 5/10 @VPrasadMDMPH@drjohnm
Now it’s true you can confuse people with your jumbo jumbo. 6/10
And some people don’t have much respect for diploma-associated authority. Especially if you can’t talk honestly about the strength of the “the data” that you seem to love so much. 7/10
Idle threats of death don’t scare people who live close to its edge every day.
Find another way.
Every time you tell someone they are going to die and they don’t, you look dumber for it. 8/10
I’ve changed my script from “this statin will help you avoid a heart attack” to “I give this medicine to a lot of people and a few of them will avoid having a heart attack. I don’t know which ones!” 9/10
The beauty of medical practice is we each get to pick a style and figure out what works.
Threats of death without compliance doesn’t work for me and I used to use it all the time.
Have some respect for the intelligence of your patients. It’s a good place to start. 10/10
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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.
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
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/
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.
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.
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/