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/
We’ve already decided (especially in the US) to strike a balance between SAFETY and FREEDOM. 4/
If you work in a LEVEL 1 trauma center like me, you know people die every day because of the decisions they—and other people—make.

COVID, masks, and vaccines are not some new novel factors in public health. They are ~joining~ a million other ones. 5/
We already balance RISK and SAFETY in the US. If you haven’t noticed, this is not a static nor universally jolly process!!! 6/
It’s contentious and personal and always leaves a lot of people unhappy. Sometimes the MAJORITY of people. 7/
What we see in states like Florida as compared to Vermont, California or Colorado is different balance points being tested. This is okay. We have np been doing this every day of your life. 8/
It’s fun to be furious and dogmatic but the “mask nihilists” who say we should be dropping masks especially for kids are just picking a point a little bit towards facial freedom and a little bit away from safety.

It’s okay. We have to discuss the balance point. 9/
Unlike cars, cigarettes, motorcycles, guns and they myriad of other dangerous yet fun stuff we have to balance between freedom and safety, COVID will vanish. 10/
It may not ~completely~ vanish, but it’s going to shrink beneath our other risks we love to fight about.
So in addition to picking our balance point today, we do have to anticipate a future when you can sneeze on someone on the subway or get sneezed on just like the good old days in 2017. 🤧🤧🤧 11/
In summary, calm your ass down. Leash your dogma. Stop making it personal and discuss the ISSUES not the PEOPLE.

Realize you will abandon your current stance over time if you have any brains. This chart will become accurate again in a few years. 12/

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More from @medicalaxioms

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
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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