Nick Mark MD Profile picture
Feb 2 8 tweets 4 min read
Do you want to improve working conditions for residents/fellows in WA?

The WA legislature is voting on HR1764 which would allow interest arbitration in collective bargaining.

This would go a long way towards correcting the power imbalance between administration & residents.
1/
Under the current system of negotiation, residents can *request* certain changes: safe working conditions, sufficient PPE, hazard/overtime pay, etc.

Administrators (who are often non-clinical) just say NOPE.

Because residents can’t/won’t strike they don’t have much leverage.
2/
When we formed the UWHA/@RFPU_NW resident union we spent YEARS fighting with administrators over these issues.

Ultimately we got lucky. Pressure from the city council & media attention helped us break the logjam.

There ought to be a better way.

3/
dailyuw.com/news/uw-medica…
Here’s where interest arbitration comes in.

Instead of disagreements between employers & employees leading to impasse, under interest arbitration, an neutral arbitrator reviews both parties testimony & proposals.

The arbitrator, not the employer, decides what’s “fair.”
4/ Image
Interest arbitration is usually reserved for collective bargaining groups that can’t strike, such as public safety (police, fire, etc).

HB1764 would expand interest arbitration in WA and expand it to cover residents/fellows too.

As Biden would say, “this is a big… deal”.
5/
BUT it’s not a done deal yet.

#HB1764 made it out of committee. There will be a public hearing tomorrow (Thursday 2/3). This will largely determine the

This is where YOU can help.
6/
3 things YOU can do to support residents bargaining rights:
1️⃣Note your support for HB1764 in the legislative record (takes just 30 seconds)
bit.ly/3Ho1e1D

2️⃣Submit written testimony (takes 5 min) bit.ly/3GnM1Ms

3️⃣Testify virtually
bit.ly/3L5hHdd
7/
Summary:
1️⃣residents/fellows are frontline workers in the pandemic, often asked to work extra shifts w/o extra pay
2️⃣administrators have little incentive to bargain when they can just say “nope”
3️⃣interest arbitration is an key tool to level the playing field
#ISupportHB1764
8/8

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More from @nickmmark

Feb 1
Instead of proposals to cap RN pay I’d love to see legislation that:
1️⃣mandates safe RN staffing ratios nationwide
2️⃣enacts a “50 state medical license” w/ straightforward reciprocity
3️⃣imposes limits on executive compensation for any hospital/org that bills CMS
For those doubting these reforms are possible. A couple points:

There already is a federal law calling for “adequate numbers of licensed RNs” 42CFR 482.23(b) The issue is that this is too vague.

15 states have passed laws that go further. CA & MA explicitly stipulate RN ratios
The CA law, enacted in 2004, mandates 1 RN to 5 med/surg patients & 1:2 for ICU patients.

After implementation RNs cared for one fewer patient on average. There was a decrease in hospital mortality & increased RN job satisfaction. ncbi.nlm.nih.gov/pmc/articles/P…
Read 6 tweets
Jan 21
The ivermectin crazies are now recommending hydroxychloroquine too.

Their “protocol” includes a dangerously high dose of diuretics & recommends high dose steroids in people not on supplemental O2.

This has crossed the line from (mostly) harmless nonsense to actual harm.
Supporting Evidence:

A 2021 Cochrane meta-analysis (the 🥇standard) concluded that HCQ “has little or no effect on the risk of death and probably no effect on progression to mechanical ventilation. Adverse events are tripled compared to placebo…”

cochranelibrary.com/content?templa…
A more recent meta-analysis in @NatureComms that included unpublished studies went further, concluding “that treatment with hydroxychloroquine is associated with increased mortality in COVID-19 patients”

nature.com/articles/s4146…
Read 9 tweets
Jan 20
Just 3️⃣simple acts of compassion can go a long way

Important RCT just published in @TheLancet shows that a family support strategy consisting of 3 extra family meetings can substantially reduce family grief 6mo after the death of a loved one in the ICU
thelancet.com/journals/lance…
1/
Pre-pandemic, ICU mortality was often ~20%

In the US, 30-60% of ICU deaths were preceded by a decision to withdraw life support

We are experts at providing comfort focused care for patients but in many cases, families feel grief months afterwards

What can we do about this?
2/ ImageImage
The COSMIC RCT studied this.

The intervention was 3 family meetings held following a decision to withdraw life support:

1️⃣family conference to prepare relatives for the imminent death
2️⃣ICU-room visit to provide support
3️⃣meeting after death to offer condolences & closure

3/ ImageImage
Read 7 tweets
Jan 17
To those who are unvaccinated because of worries about “unproven mRNA technology” you know you can get:
- the J&J vaccine (🇺🇸)
- the Oxford-AZ vaccine (🇬🇧&🇪🇺)

Both can prevent hospitalization or death from COVID. Neither are mRNA vaccines. So why not get vaxxed today?
To those worried about blood clots after J&J, as of April 2021:
-there were 15 cases of TTS
-out of 8 million J&J doses

That’s a risk of less than 1 in 500,000. cdc.gov/mmwr/volumes/7…

The risk of getting struck by lightning is higher than that! cdc.gov/disasters/ligh…
The vaccine efficacy (VE) of the J&J vaccine *is* slightly less than the mRNA alternatives: 68-71% VE to prevent hospitalization (compared to ~90% for mRNA vaccines). That’s still much much better than being Unvaxxed.

(N.B. this is pre-omicron data)
cdc.gov/mmwr/volumes/7…
Read 5 tweets
Jan 16
Updated WHO severe COVID treatment guidelines bit.ly/3rhGgKW

Recommended
🟢Steroid (#Dexamethasone)
🟢IL6 blocker (#Toci) or 🟢JAKi (#Baricitinib)
🟠±mAb in seronegative people

NOT recommended
🔴#Hydroxychloroquine
🔴#ivermectin
🔴#remdesivir

Lots to discuss, a🧵
1/
Remdesivir (RDV) is in the “We suggest no remdesivir” category.
At some level, this isn’t too surprising & is old news.
Despite initial hype, RDV never moved the needle much on patient centered outcomes (risk of mortality or requiring IMV) & many of us had stopped using it.
2/
In #ACTT1 RDV did improve outcomes on an ordinal scale, but the effect was modest. It shortened time to clinical improvement but not hospital LOS (patients stayed in the hospital longer to receive it).
RDV did NOT improve mortality or risk of IMV.
ncbi.nlm.nih.gov/pubmed/32445440
3/
Read 19 tweets
Jan 15
I was alone on an elevator today when I began hearing a voice.

It asked me if I “still support President Donald Trump’s ambitious agenda?”

I look around. No one here.

Hmm that’s weird
1/
Then the voice asked me if I’d like to “make a donation to support President Trump and the America first agenda he enacted?”

Pause

Umm no. This is an elevator.

Pause

The voice said “Aha.”

Then it continued “I’m sorry. Thank you bye bye.”

2/
So either:
A. I’m having a pro-Trump command auditory verbal hallucination or
B. His campaign robocalled the elevator’s emergency phone

3/
Read 7 tweets

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