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Anand Jagannath

@AnandJag1

May 3

#Medtwitter, last week I posted about a talk I gave on teaching #clinicalreasoning

As promised, the accompanying #tweetorial

Come explore with me!
1/10

https://twitter.com/AnandJag1/status/1519499322236178433?s=20&t=XFdniGzBgA8tQ3tB4LcW6g

I described a gap between DOING and TEACHING reasoning

All of us DO reasoning every day

TEACHING what we DO is hard unless we
✔️have vocabulary to describe it
✔️know how to describe a process
✔️are ok being vulnerable in front of others
2/10

How do we make an invisible process (reasoning), visible?

Step 1: use specific words to describe steps to the cognitive process:

Problem representation
Schema
Illness scripts

Speaking these words signals their importance to your learners - use them!
3/10

Read 10 tweets

Anand Jagannath

@AnandJag1

Jul 1, 2020

@ucsdim

I recently discussed Chalk Talks with our newly minted @ucsdim R2s.

Until now, I’d never been, “meta” about this valuable teaching tool and thought I’d share what I learned from reflecting in a #tweetorial

Come explore with me #medtwitter! 0/14

1/#meded chalk talks typically deliver FOCUSED teaching in a short amount of time. While venues vary, we’ve probably encountered them in conference, rounds, or in the afternoon post-rounds/lunch.

Where have you encountered chalk talks most frequently?

2/First some general thoughts:

-Keep them short: limit yourself to <10 mins. On rounds? <2 minutes
-Tools: a sheet of paper or a dry erase marker in your pocket
-Bite-sized: even 1 or 2 pearls works! More later (s/o #BSTMode)
-Patient-focused: more engaging

Read 14 tweets

Anand Jagannath

@AnandJag1

May 26, 2020

My team recently asked WHY we give Fe to pts with HFrEF+anemia.

First answer: b/c someone told me so
Better answer: let me get back to you on that

Let’s explore and try to understand, #medtwitter #medstudenttwitter 0/14

1/First off, it helps to review a general schema for anemia.

Blood loss, decreased production, increased destruction

So, why are patients with HFrEF anemic?

2/Controlling for other co-morbids or meds that can lead to blood loss and destruction, it turns out that ↓RBC production drives anemia in HFrEF.

Why?

Read 17 tweets

Anand Jagannath

@AnandJag1

Apr 18, 2020

Hey #medtwitter, #medstudenttwitter, let’s re-visit the topic of Polycythemia!

I saw a number of patients with polycythemia recently, so for this #tweetorial, we’ll look at it from a generalist’s perspective and describe a schema algorithmically. Let’s go!

1/First, let’s remind ourselves that polycythemia itself isn’t a diagnosis. Like many things, it is a condition with an underlying cause.

How we define polycythemia:
-Male: Hb>16.5 g/dL, Hct>49%
-Female: Hb>16.0 g/dL, Hct>48%

2/But wait! Remember that a one-off value won’t cut it. Tempo and delta are key to dx.

Look back in the chart. Is this new or a trend? If new, make sure you check at least one additional Hb AND make sure to account for potential hemoconcentration.

Read 13 tweets

Anand Jagannath

@AnandJag1

Feb 19, 2020

@hdx

“Doc, I feel weak all over”

This chief concern came up many times in the past couple weeks on wards and in @hdx case editing.

So I asked, why do people feel weak?

#Medtwitter, join me while I scheme(a) on “generalized” weakness...

@hdx

@hdx 1/
First: does the patient just FEEL weak (subjective), or do they have TRUE weakness (objective)?

Many things can manifest with a subjective feeling of weakness without actually affecting objective muscle strength.

@hdx

@hdx 2/
Subjective weakness, or Asthenia can be generated by a number of conditions.

Ask yourself:
-Do they have chronic CV/lung/kidney disease?
-Anemic?
-Are they infected?
-How is their mood?

Wait, can’t some of these cause true weakness? Yes, more soon...

Read 8 tweets

Anand Jagannath

@AnandJag1

Dec 11, 2019

@ucsdim

Super proud of Dan Corbally, PGY2 @ucsdim. Stellar work writing this @hdx case!

1/
Spoiler alert:
This case forced me to re-think my schema for mesenteric ischemia.

Read on:

@ucsdim

@ucsdim @hdx 2/
I used to think of mesenteric ischemia as a diagnosis, but now think of it as a syndrome resulting from an underlying disease process.

So, what processes can result in occlusion/ischemia of mesenteric vessels?

(Disclaimer: focusing on arterial ischemia)

@ucsdim

@ucsdim @hdx 3/
Schema/disease categories for mesenteric ischemia:

- Thromboembolism (things that block arteries)
- Hypoperfusion (things that reduce blood flow without occlusion)
- Inflammation (things that can result in the above two)

Read 9 tweets

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