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Aditya Ganguly MD I Internist

@AdiG1993

Jul 18

1) Unpopular opinion

Many people think that a degree, especially one in the medical field owes you a cushy job with perks and benefits.

Frankly, those days are over.

2)

Degrees in isolation are becoming redundant.

You need to be knowledgeable and skilled.

Performance will be your only asset.

3) The days of pensions and gratuities sustaining you till the end of days --> they are not coming back.

A huge pension bill (due to medical inflation and long life expectancy) has ensured that from now on, most jobs will be contractualized.

Read 6 tweets

Aditya Ganguly MD I Internist

@AdiG1993

Jul 17

1) Recently I was asked whether there is an alternative to Harrison? --> I really don't think there is.

Why?

Because the book does a really good job of encapsulating gen med within its volumes SUBJECT to certain limitations of course.

2) I am committing heresy here by saying that it may have alternatives --> but its actually a question of which style suits you best.

Some prefer POC resources like UTD, some like YT and some prefer a traditional textbook.

The info is more or less the same.

3) I used this book to look up several topics --> well edited and written. But the approaches seem to be a bit weaker than Harrison. But since you will have to make your own --> that is not a problem. You may try this!

Read 4 tweets

Aditya Ganguly MD I Internist

@AdiG1993

Jul 17

1) The TB issue is huge in India because

1. TB can invade every organ system with a bewildering array of manifestations --> requires great diagnostic skills.

2. Dx methods like microscopy and even PCR often fail in case of paucibacillary disease.

3. Serology = useless

2)

4. The interaction between the TB bacillus and the immune system is complex.

Why some people can contain it within granuloma and why it spreads hematogenously in others --> this is not well known.

Research is less focused here since TB is not a First World problem.

3)
5. ATD is hepatotoxic (among others) and relies on the same 1st line drugs since the 1950s --> HIV appeared in 1981 but we already have more drugs than we can handle. PLHIV are now dying of ASCVD, like the gen popn!

Why?

Because HIV was a 1st world problem.

Read 6 tweets

Aditya Ganguly MD I Internist

@AdiG1993

Jul 16

The best ECG resources for the budding internist

1. Goldberger
2. LITFL
3. Dr Amal Mattu's lectures PRN

I found Schamroth and Marriot pretty tedious unless you are planning on doing cardio.

Your opinions please.

#MedTwitter

Please don't practice 1 ECG a day --> The ECG without clinical context is like Top Gun without fighter jets --> useless!

Sinus tachy by itself --> meh.
Sinus tachy in a patient with ?PE --> get me the CTPA NOW!

Dr Smith and Dr Ken Grauer both run very successful ECG blogs --> but they are NOT for beginners!

Definitely won't recommend for 1st year residency or beyond that unless you wish to become a cardiologist.

In that situation, you wouldn't be taking my advice actually. xD

Read 4 tweets

Aditya Ganguly MD I Internist

@AdiG1993

Jul 15

1) True learning is not about reading a lot of books, checking out many Tweetorials or listening to a lot of podcasts.

If that was so, everybody would have been 'successful' and not creating content about 'success'.

2) True learning is based on something I called the retention percentage --> the percentage of your knowledge that you can actually use in your day to day life.

3) I have applied this retention ratio to medicine since the day I started --> 10 years back in 2022.

Whatever you learn, until and unless you are comfortable with it --> that you can use it in day to day clinical practice --> you have not really learnt it.

Read 9 tweets

Aditya Ganguly MD I Internist

@AdiG1993

Jul 11

1) Unpopular opinion here --> but something you should check out.

If you are planning on doing MD gen med residency, it might be worthwhile to do it somewhere with a relatively smaller subspecialty/gen med ratio.

2) A large and very well equipped subspecialty dept will usually directly admit all the unusual/teaching cases. Gen med can't do much here.

A smaller dept usually does not have enough staff to cover 24×7 on call and is less enthusiastic about situations like this.

3) So you get all the input that you need while managing to take care of patients directly.

This is very important --> you can't fire a rifle after placing it on someone else's shoulder.

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