WesElyMD Profile picture
Jul 18 8 tweets 4 min read
1/🧵 Training Young Docs & Nurses💥

#JULY is a big time of year for medical trainees who move to the next level of their careers.

Question: How do I best serve them as a teacher & help them succeed?

Tip: this helps me be a better dad & husband, too.

#NurseTwitter
#MedTwitter
2/ As a “coach” of younger doctors (or my kids or athletes, etc), there are certain truths I have learned:

Ultimately, students’, athletes’ and children’s successes and failures are their own. Not mine.

I shouldn’t take credit for their successes nor blame for their failures.
3/ I must, of course, protect patients from misdiagnoses & treatment errors.

While overseeing younger physicians’ progress to independence, I have to prioritize patient safety.
4/ My job is to coach others diligently, lifting them up and helping them see the immense possibilities of using their talents in service of others.

There is a line I must never cross: to want any specific outcome for another person more than s/he wants it for her/himself.
5/ If I cross that line, the next mistake I’ll inevitably make is doing something for another person that they must do for themselves.

This creates entitlement and prolongs their journey to independence.

My goal as a teacher is to become unneeded.
6/ I might trick myself into thinking I’m doing them a favor by fixing or preventing inefficiencies, but I’m not.

Over-support and micromanaging others is the opposite of empowering them.

It robs them of learning from their own choices.
7/ The hardest thing for me is watching people not live up to their potential.

I’m not the judge of her success. I don’t know what’s best for her.

A mistake or a missed opportunity might help them more in the long run (as long as I keep patients safe).

Growth via challenge.
8/fin
As I watch new interns present complicated medical scenarios, I’m so impressed by their poise & maturity.

As an attending, I want to construct the best learning atmosphere & make sure they ask lots of questions without feeling judged.

Please share tips & insights!

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More from @WesElyMD

Jun 27
1/🧵 Hacked on Twitter - what did I learn⁉️

I & other physicians’ @verified @Twitter accts were hacked last week…
 
This “micro-dose” of being silenced reminds me to do all I can to amplify the voice of others.
 
And it made me want to share a few thoughts about this platform…
2/ How did it make me feel?

📍Vulnerable
📍Silenced
📍At the mercy of others
📍Out of control
📍Small

Of course, it’s just social media

But how we handle ourselves here prepares us to fight #Testimonial #Injustice

No one wins if we stifle the voice & truth of another person.
3/ Detachment

I’ve been working on detachment from the lure of worldly things.

When the hackers stole control of my account, my 1st thought was that this was a perfect opportunity for me to practice detachment.

If I’m truly detached, my pulse should remain a calm 46 bpm 😎
Read 11 tweets
Jun 15
1/🧵 Long COVID Brain Science: 🧠

For ~100M suffering 🌎, let’s use data to combat myths & #Misinformation

COVID is biologically dangerous long after virus is gone

#LongCOVID affects our….

📍Olfactory & Limbic Systems
📍 Interferon Autoimmunity
📍PET scans
📍Astrocytes

How? Image
2/ First, Epidemiological comparisons…

FLU vs. COVID

Survivors of viral infxns like #Flu don’t complain of 200 long-term symptoms & ~90% ongoing mood disorders.

#LongCOVID pts do.

Flu kills 0.5M/year vs COVID has killed 10X that (5M) in just 2 years.

bit.ly/3mJTBK4
3/ Consider this:

A study of 150k COVID survivors, hospitalized & not.

COVID survivors had 10-15X ‼️higher risk of considering #suicide at 1 year than 11M control patients.

This is horrifying, yet people still deny #LongCOVID’s importance.

WHY?

bit.ly/3HnHZpB ImageImageImage
Read 27 tweets
Jun 13
1/🧵 95% COVID Immunity⁉️

@JAMA_current data show that in Dec 2021, 95% of US Blood Donors had Immunity from infection or vaccination.🧐
 
Then why do we have record high rates of #Omicron?
 
Does that mean we should have herd immunity?
 
Not so fast…
 
bit.ly/3n2o5HD
2/ First, we make estimates using a combination of the COVID spike Ab & nucleocapsid Ab to determine what proportion of our population is protected at a given time.

ie, either previous infection (nucleocapsid) or vaccination (spike Ab) or combined Infection & vaccination.
3/ But if there was 95% immunity in 2021, how did #Omicron go bonkers infecting so many in 2022?
 
The infection rates reflect #Evolution. The I ntense contagiousness of this variant & enhanced immune escape mutations plus waning protection from previous vaccination & infection.
Read 5 tweets
Jun 8
1/🧵Is Paxlovid Rebound real?👇

Short answer: I say Yes @JAMA_current

It’s when you go from COVID ++ to - to ++ after Treatment.
 
Prior to #Omicron & Pax, rebound seemed rare.
 
We need more data.
 
This article has pearls I want to share…
 
bit.ly/3NZsSEY
2/ 1st “If you’re ++, you must assume you’re infectious to others,” he explained.

“PCR test confirmed his positive rapid Ag test & it was back to jail for Dr. Ho.”
 
Recently, similar cases have been reported & @CDCgov issued a health advisory May 24:
bit.ly/3aDw8Yf
3/ There are just way too many anecdotal cases to ignore.

In recent weeks, prominent physicians in the US including @tmprowell @Bob_Wachter @PeterHotez have all discussed the reality of #PaxlovidRebound.

Yet, @pfizer downplays this & the early papers don’t mention it.
Read 12 tweets
May 25
1/🧵 An exacerbating factor in #LongCOVID is the “Quality of Life (QOL) Gap”🧵👇

…when a person’s expectations about QOL are at odds w their reality.
 
“Covid was over & Long COVID hit my brain, heart & GI.”
 
Let me unpack a study of ICU survivors…
bit.ly/3vp0AMl
2/ Read the thread I attached to the first tweet.

From the cancer literature, we learned about the QOL Gap.

If people appropriately prepare for their “ACTUAL” QOL, there’s a narrow gap and all is well.

If not, #Depression & #Despair too often set in.
3/ This study from Johns Hopkins by @vitaincerta & team adds to our understanding in a way that will apply so well to #COVID ICU survivors.

These are ARDS patients, which is almost always what lands COVID pts in the ICU and later with #PICS.
 
@ChestCritCare
Read 8 tweets
May 2
🧵1/ Here’s your “Big Picture” of COVID & Long COVID for 2022

See my new Figure👇 summarizing #COVID19 Management & Outcomes

Two years in & we have splendid choices.

Stay in peaceful waters of prevention (green) or risk treacherous cliffs of #LongCOVID & Death (red & black)…
2/ Knowledge is Power, and our knowledge has grown dramatically.

Let’s take a look at where we were just 2 years ago - even though it seems like 20 yrs ago.

April 2020: our approach & understanding of COVID looked like this👇.

We didn’t even know about #LongCOVID yet 🤯
3/ Remember, with #LongCOVID, your brain & heart are at stake.

@JohnsHopkinsSPH reports on emerging data: “COVID doesn’t discriminate when it comes to heart problems.”

Anyone affected may develop clots, arrhythmias & strokes >1 yr later.

Link &🧵below
bit.ly/3KzYcbp
Read 23 tweets

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