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

As promised, the accompanying #tweetorial

Come explore with me!
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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
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Yesterday, I discussed a pt who had subacute chest pain and dyspnea w/a group of learners

A pivot point in the case gave me some insight into the process of teaching reasoning

I'd love to share my experience #medtwitter #teachdx 1/ The patient's pain was pleuritic. Dyspnea, exertional. Symptoms worsening. Other history, sparse. The exam yielded signal:

Tachycardic, tachypneic, hypoxic, speaking short sentences, quiet lung bases

A dx and rx path was forming 2/

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?

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?

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%

“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 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.

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 @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)