#UCSF #HospitalMedicine Physician Researcher at #SFGH || Research in outcomes & health services || #EBM advocate, but not in the usual sense
Oct 23, 2023 • 23 tweets • 5 min read
Finished a brief stint on the faculty hospital medicine service in a safety net hospital
Lots of skin/soft tissue infections, addiction, & inability to care for self
Run down of every single patient I saw with a teaching pearl (or two)
I saved the best for last
1| AUD intoxication->fall->inability for self care
system pearl 🦪: there's a real donut hole in the safety net (& many hospitals frankly) for patients who don't have acute rehab needs, but need custodial care in the short term
what I do know is they don't need to see me daily
Oct 18, 2023 • 15 tweets • 6 min read
Wow
Just read perhaps the greatest article about a doctors’ diagnostic skills
Not in the medical literature, but in an economics journal!
If you think about diagnosis, follow along
It won’t disappoint
@RogueRad
1| THE ISSUES
Diagnostic test thresholds have an inherent sensitivity/specificity tradeoff
But if the test involves doctoring (ie history or exam finding) is this tradeoff still true?
Aug 7, 2023 • 16 tweets • 3 min read
5 cases I reflected on after a 5 day stint on service in the hospital
1A. Pt with AUD & freq falls was still orthostatic after 3L IVF & attributed possibly to dysautonomia
But HR change was ~30 beats with much less dramatic BP drop
ΔHR/ΔSBP >>> 0.5 so very c/w low preload (here hypovolemia)
Here are my top 12 studies from 2022 in no particular order that influence Hospital Medicine
I avoided:
-only abstracts (sorry SABATO & TRANSFORM-HF)
-COVID since the disease as we once knew it is uncommon
-Subspecialty or critical care only implications
For agitated delirium it’s safe to treat with haloperidol & probably also saves lives
This upends what I thought I knew about delirium treatment
1| This thread is for other parents who are also deciding about #COVID vax for their toddlers (2-4 yo) who have ALREADY had Omicron
TLDR: Will wait to see: 1) vax effectivness vs BA4/5; 2) whether new vax to O variants available; 3) most importantly, how day care policies evolve
2| Disclaimers:
-I believe COVID mRNA vax for adults is among the most remarkable scientific innovations in our history
-I am vaxxed with pfizer x3 (and my DNA hasn't been altered)
Sep 3, 2021 • 25 tweets • 8 min read
The community masking trial in Bangladesh by @Jabaluck@mushfiq_econ et al is AMAZING & EXCEPTIONALLY well done
Joy to read & I learned a LOT
Encourage all scientists in related disciplines to read, even if not your content
2| Let's start with MI def. Billing codes less accurate than adjudicated MI outcomes, yes? Could be nondiff misclassification which bias to null. But could also be diff w/ ascertainment bias (look harder, anchoring) knowing CCTA result, since 2/3rds normal or nonobstruct.
