Mental, physical & behavioral health are inseparable.
The pandemic has laid bare our vast vulnerabilities.
#Primarycare is where ppl can be fully seen & heard, where trust is born & where we apply broad public health advice to pts' unique medical issues & lived experience ...2x
Approx 80M Americans don't have a primary care provider.
We must scale up/increase access to needed #primarycare services, as a hub for problem-solving for medical conditions like obesity, diabetes & depression, in order to heal from trauma & prepare for the next pandemic...3x
On the erosion of trust in public health institutions & the critical important of truth, transparency & trust in medicine - in addition to access to #primarycare 👇 4x
Moving forward, we must recognize the broad & diverse array of health risks. Health is abt more than the absence of COVID19..5x
Proposal: school-based #primarycare & mental/behavioral health services.
Let's meet people where they are. 👇 6x
On the need for a more diverse range of experts at the table during a global pandemic.
The more voices, the better - during & after a collective trauma. ..7x
Trust is the commodity in patient care. We must incentivize doctors graduating from medical school to go into #primarycare. We also need more NPs & PAs!
We must recognize that *time* & the *relationship* with a primary care medical provider is the public health ground game...8x
Two big public health failures:
1) Prolonged school closures, and 2) Failure to protect our frail nursing home population in 2020
In the future, we must tailor our mitigation efforts to degree of risk & recognize the potential harms of any/all interventions 👇 9x
More on the harms of school closures. 👇 10x
On the absence of compelling real-world data (to date!) that masks *mandates* in schools meaningfully reduce the risk of SARSCoV2 transmission within schools ...11x👇. .
Link to today's full hearing 👇👇👇 .... 12x
On infection-acquired immunity versus vaccine-induced immunity.
The human immune system is *not* a political body; it’s an immune system. 👇 13x
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The physical, emotional & behavioral *symptoms* of anxiety can often be more debilitating than the thing(s) we’re anxious about.
Of course, anxiety is part of the human condition. Some degree of anxiety is required for survival. Anxiety isn’t always “bad.”
A short 🧵 …
2. Anxiety can even be helpful if managed appropriately & channeled in a healthy direction.
But anxiety is a medical problem if & when it interferes with thoughts, behaviors, relationships and/or mental & physical health.
The question I ask patients isn’t “Are you anxious?”
3. Instead, I ask patients:
✅ To what extent is anxiety interfering with your health & quality of life?
✅ How much brain space is occupied by excess worry, fear, ruminations?
✅ To what extent is your anxiety out of proportion to the degree of real life & internal stressors?
As we dig out from the last two years & transition to endemicity, we must invest in the unmet physical, behavioral & #mentalhealth needs of millions of Americans.
Last week, a federal judge overturned the Biden administration’s mask mandate for public transportation. When a reporter asked whether ppl should wear masks on flights, President Biden responded, “That’s up to them,” signaling another step toward the “new normal” ... 2x
... and a shift from government-issued mandates to individual decision-making.
Lifting mask mandates at this moment makes sense. COVID isn’t going away, yet vaccines, therapeutics and tests are widely available. Deaths and hospitalizations are low. 3x
Over the past few months, I’ve had the pleasure of being a guest on podcasts of friends, colleagues, & people I admire ...
A 🧵 ...
... For example, I spoke with my friend & colleague @VPrasadMDMPH about the relevance of mental health to our physical health, the harms of moralizing human behavior, & how to approach & appreciate varying/diverse POVs during a global health crisis. 1x
My dear friend and ICU doctor @kwadwo777 & I discussed navigating risk during COVID, getting teens & kids back to normal life, & the mental health impacts of the pandemic.... 2x
... getting COVID?
... sickening my unvax'd child/immunosuppressed son/elderly parent?
These are excellent questions but demonstrate how woefully we've messaged the vaccine.
A 🧵 ...
Sure, some patients are anxious. That's normal.
Sure, some patients get told by Google/a neighbor/TV pundit to get a 4th shot regardless of age & health. That's our world.
Sure, some patients truly *need* a 4th shot to reduce the risk for severe COVID. That's my job.
2x
But when so many of my patients call w the very same question, I want to know why. 🙋♀️
After all, my pts are smart, well-intended, & paying attn. I've been writing a free weekly C19 newsletter x 2 yrs trying to help ppl understand nuance & contextualize data.
I was honored to speak in front of @HouseScience committee yesterday abt the importance of trusted messengers in a crisis— & what we need to do for the next phase of #Covid_19.
As we inevitably face more C19 waves & variants, I worry abt the ongoing devastation from the virus *and* abt the collateral damage from the mitigations themselves. Mostly I worry abt ppls’ confusion & resulting anxiety abt not knowing who to trust in a global health crisis.2x
I’m here to share with you what I’ve learned firsthand caring for patients almost every day during COVID—real people on the receiving end of often confusing public health guidance & the unfortunate politicization of science. 3x