1/The White Coat ceremony ideally would disclose what the profession knows about itself, wrote @SaulWeiner

“We have to be candid about our own imperfections. You probably won’t always be treated respectfully. We apologize in advance for that”

“On Becoming a Healer” (2020)
2/“We don’t know which among you have an open heart and an open mind, and which have just learned to appear that way.

We’ve done our best to screen out the latter, but medical school admissions is an imperfect process”
3/“During the early years of training you may be in survival mode..so that you can get through all the stuff we foist on you to memorize. You won’t need much of it when you practice medicine, but a fair amount of the content will be on board exams”
#TwitterGIFs
4/“How do you avoid going down a well trodden path in which the patient is related to as “It” rather than “Thou”? Foremost..by remembering that you are more like your patients than otherwise. You are just a motor vehicle accident away from becoming a patient yourself.”
5/For a fresh, inspiring, humane take on the growth we wish to do in becoming a healer (and the many ways that is undermined by our medical schools), read “On Becoming a Healer” by @SaulWeiner and consider our podcast by the same name open.spotify.com/episode/6M4AV3…

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More from @StefanKertesz

Feb 3
1/There is a new “Lancet Commission” report on the North American opioid crisis.

It is led by @KeithNHumphreys and includes @DrSeanMackey & @ChelseaLShover

I will share a few shots of some messages & recs as it is behind paywall

Selectivity is unavoidable. It is 50 pages!
2/These are the key messages of the Commission Image
3/The Commission does see the opioid overdose/poisoning crisis as a result of a multi system regulatory failure Image
Read 11 tweets
Feb 3
1/This is an update 🧵re: our research on suicides after Rx opioid reduction
Clinical context of SuicIde following OPIOID transitionS
(CSI OPIOIDs)
TL;DR: we're progressing. The pilot study is NOW.
A "bigger" study is coming
We are preparing docs for the funder & ethical review
2/Background: CSI OPIOIDs does *not* seek more statistical papers.
There are already *3* papers that find a tendency of higher suicide event frequency in persons who are tapered versus those who are not:
pubmed.ncbi.nlm.nih.gov/33863865/
jamanetwork.com/journals/jama/…
bmj.com/content/368/bm…
3/I'm going to detour one tweet here on ADVOCACY:
In my role as ADVOCATE, not researcher, I have been decrying the imposition of nonconsensual changes to care of disabled patients, changes lacking evidentiary support, since 2017 (here with @AJ_Gordon ) statnews.com/2017/02/24/opi…
Read 14 tweets
Feb 2
One of the most fascinating pieces of evidence in the Washington opioid litigation (against distributors) is this chart

1: I credit anyone's ability to diagram a problem

2: It's crazy to diagram problems of opioid prescription without referring to clinicians or patients
2/It is *harmful* to make clinicians invisible from the chain of accountability in our drug death crisis.

Civil litigators like to portray the medical profession understood as "putty". For people who like cop-outs and shirking responsibility, this is just fine.
3/But there's no drug company that convinced med schools to NOT prioritize training in addiction, in pain, in rehabilitation or in long-term care of complex problems.

And that choice, by OUR profession, is a big part of why many docs were pliant to marketing pushes
Read 5 tweets
Jan 27
The next CDC Opioid Guideline draft is coming:

Be ready to speak LOUDLY to protect patients who were *not protected* by institutions that gave that the 2016 Guideline regulatory force, without regard to the the complexities of scientific evidence
2/My 2016 comment to CDC anticipated such harm:

“As medical boards, insurers and government agencies enforce this guideline, prescribing differently from the topline recommendations is likely to become onerous, leaving many patients in the lurch”

stefankertesz.medium.com/considering-cd…
3/Many of us didn’t fully anticipate that patients would be abandoned,

Or that DEA would use that threshold to investigate doctors,(and to seek criminal convictions)

But I now have observed that is the reality
Read 12 tweets
Jan 20
Hey: 👩🏽‍⚕️👨🏽‍⚕️🧑🏼‍⚕️
I'm sick of stories on health care that erase and dumb down the professional roles & responsibilities of clinicians (doctors, nurses, etc) – whether it’s @NYTimes on genetic screening or @DopesickOnHulu on opioids. /1
The public is flooded with stories about health care that show health professionals as, well,
patsies, victims and cogs.
Health professionals need to ask "why we look that way" to them, and push back /2
That’s what got me talking in our latest podcast from @OnHealer.
We reviewed a @NYTimes story of highly marketed prenatal screening tests.
These tests do traumatize moms if results come in without appropriate clinical counseling.
Listen: pod.link/healer/episode… /3
Read 14 tweets
Jan 19
1/*Hope* Short thread/🧵

Reflections shared with me from Dr. Lachlan Forrow this evening

Eric Cassell - "Hope has *nothing* to do with probabilities"
2/"Everything that is done in the world is done by hope."

Martin Luther and Martin Luther King, Jr.
3/Hope is your superpower. Don’t let anybody or anything make you hopeless. Hope is the enemy of injustice,” Stevenson said. “Hope is what will get you to stand up when people tell you to sit down.”

Bryan Stevenson
Read 4 tweets

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