Cory Rohlfsen Profile picture
May 9, 2023 12 tweets 7 min read Read on X
As I wrap up my 5th year of #primarycare practice, I can't help but reflect on the TEN "sparks" trainees may miss out on during residency that make this work so rewarding.

A 🧵of #gratitude...

@CLOSLER @primarycarechat @InduPartha @adamcifu @gabrieldane @GIMaPreceptor

0/11
1) Spending the majority of time in an office visit talking about kids, grandkids, sports, golf league, and fears for the future.

Very few people get to be a sounding board in the lives of others. Image
2) Knowing your patients without having to look anything up. What would take another provider 45 minutes to orient to, you can address in 2 minutes or less.

#knowyourworth Image
3) Getting a thank you card or baked good just for showing up and caring. Image
4) Partnering with a patient through uncertainty (e.g. a new diagnosis).

Diagnostic evals in the outpatient setting are some of the BEST diagnostic reasoning cases!

#investigate #problemsolve Image
5) Coaching or calling out a harmful reality in love.

“Can I tell you something I’ve noticed after taking care of you all of these years…?” Image
6) Getting a phone call from a subspecialist or hospitalist in another city or state because a patient asked that the admitting team reach out to you.

#respect Image
7) Granting “permission” to a subspecialist to add a med because your patient wants to run it by you as the PCP first.

#trust
8) Providing palliative care to a patient as they consider hospice.

Eliminate pain and suffering.

#bepresent Image
9) Setting mutual limits to avoid frustration or harm at the end of life.

Supporting the family and securing closure when “tune ups” or “additional evaluation” in the hospital no longer align with your patient's goals of care. Image
10) Calling the family after the arc of life is complete to offer condolences and validate the tough choice they made in transitioning care to focus on comfort after your patient passes away.

#careisinthename Image
If you're brave enough to follow the highs and lows of someone's life as a trusted source for "good" in all circumstances, then primary care may be for you!

It's only the hardest and most rewarding thing you could do.

11/11

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More from @CoryRohlfsen

Feb 3
What is the one skillset that matters more than any as a #doctor, #leader, or #teacher?

A 🧵on #AdaptiveExpertise for anyone who seeks to master their craft

Hint: it's more than adaptability

@johnbeshears @YihanYangMD @MarenGube @Midwest_MedPeds @mpusic @erhall1 @LRinMD

1/
In Oct 2022, a new home run (HR) king was crowned.

Aaron Judge made history with 62 HRs in a single season.

But what can we possibly learn from this future hall of famer in other domains of expertise?

2/

()mlb.com
Most people talk about Aaron Judge’s power & distance b/c he’s a 6’7’’ powerhouse who "causes the most damage” any time he connects at bat - a real stat in ⚾️!

Few, though, talk about a key ingredient to his success – #AdaptiveExpertise.

3/
Read 25 tweets
Nov 9, 2023
The science of learning is the science of neuroplasticity.

After years of evolution, humans broke through.

Follow this 🧵 to learn how to optimize performance & learning…

#MedEd #Learning #Whitematter

@ShreyaTrivediMD @SatyaPatelMD @mendesthiagob @DxRxEdu @rabihmgeha

1/
Ever wonder why horses are born with the ability to walk while human babies can’t do anything but eat and poop for months?

The answer is horses (like most mammals) come pre-myelinated.

Their motor and sensory circuits are hard-wired in the womb.

2/ Image
Humans on the other hand have very little myelin at birth.

As a result, we have a slower start but also much more potential to build neural networks as we experience new things throughout life.

A baby who explores is a baby who is learning.

#neuroplasticity

3/ Image
Read 18 tweets
Aug 2, 2023
#MedTwitter

We glorify hypothesis-driven reasoning & #problemsolving.

But in doing so, we neglect our biggest contribution to medicine.

After nearly despairing over how #AI will soon replace us, I realized it just ain’t so.

Here’s why.. a 🧵on “situated cognition”

@hdx

1/ Image
AI will outperform average docs in info RICH environments.

It will process higher volumes of data with greater speed & superior (tireless) aptitude.

But only a fraction of diagnoses come to light in this domain.

Most diagnoses spring forth from information DESERTS.

2/
Recall that ~90% of dx are captured during the hx.

And this is where “humanity” prevails.

Yes, docs will always have the upper hand w/ our physical, healing presence. 🙏

But that’s not what this thread is about...

3/
Read 28 tweets
Jul 18, 2023
To err is human.

Our judgments are flawed.
Our decision making is under constant assault.

But there is something we can do about it.

Read this 🧵to learn how “Decision Hygiene” can improve your judgment

@SatyaPatelMD @PrathitKulkarni @DxRxEdu @rabihmgeha @goodmra1 #IDTwitter Image
Did you know judges are more likely to give out lenient sentences the Monday after their favorite football team wins?

Docs are more likely to prescribe opiates at 4pm appts, especially if scheduled on a Friday.

Surgeons have worse outcomes on their bday!

Why is this?

1/15
It’s simple.

The same reason you didn’t ask your parents for the car keys until they were in a REALLY good mood - "occasion noise" was in your favor.

We all suffer from “noisy” judgments.

We all make flawed decisions, so what do we do about it?

2/15
Read 17 tweets
Jul 1, 2023
“They want more autonomy”

Timeless feedback given to every clinician educator in the first 5-10 years of their career.

Why is it so hard? Any solutions?

Read this 🧵 to learn how to let go without putting patients at risk.

#MedEd #ClinicianEducator #Autonomy #Kolbs #ZPD

1/ Image
I was confident going into my driver’s ed test as a teenager.

After all, I'd been driving thru busy intersections, merging on highways, & parallel parking for 6+ mos.

But as I stepped on the gas to skirt across oncoming traffic, the car STALLED.

2/22
I panicked and pushed harder on the gas pedal when I realized my instructor had his foot on the brake.

“I could’ve made it” I said.

“No you wouldn’t” he replied as he pointed to a sheet of ice immediately in front of us.

3/22 Image
Read 22 tweets
Jun 20, 2023
Heya #MedEd,

What do these 3 things have in common?

- Intern presentations (e.g. med student day off)
- Inverted SOAP – “APSO”
- Inheriting a pt w/ organ-based documentation

Answer: an opportunity to INVEST in your interns and here’s why...

@medrants @rabihmgeha

🧵
1/8
All 3 of the above scenarios encourage interns to leave their comfort zone to do more than simply “explain the data” or “propose a plan.”

This opportunity adds the DESIRABLE difficulty of letting them “say what they think is going on” & most importantly, explain “why?”

2/8
I find interns who inherit a pt & present in an inverted manner have ⬆️latitude to think out loud, particularly if not "performing" in front of med studs.

Best of all, when previous notes were organized by organ system, interns are also free from documentation inertia.

3/8
Read 9 tweets

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