I had a great chat with @MyaCubitt this morning and the word excellence in the context of healthcare came up. Since becoming a patient myself, this word has changed in meaning entirely for me. As a doctor I found the word utterly intimidating... 1/ Excellence to me meant big and impressive. It meant straight As. Prizes. Dux of something. Harvard. Perfection. Everyone lauding your perfect knowledge. But that is not what it is at all.

My school kiddo came home from school really worried a couple of weeks back. An older kid with unfettered Youtube access had watched a video that said the government was going to kill all schoolchildren. Some thoughts. 1/ Firstly, I take a harm minimisation approach with devices. I'm internet-savvy, I have a background in it before changing careers to medicine so this comes with a small degree of confidence (and a bit of terror). Outright banning devices does not educate kids.

"I'm a geriatrician - do you know what that is?"
This is the first question I often ask of my patients, and the answer is often no.
"I didn't think geriatricians would have much work during the pandemic...what is it that you do again?"

A thread on what a geriatrician does! 🧵 A geriatrician is a non-GP specialist doctor that looks after multiple diseases, syndromes, and situations that occur more often in older age (usually over 65 around these parts, over 70 in others).

Kindess is not free.

A thread. 🧵 I used to be that person that said kindness costs nothing. And in day-to-day life, it's probably true. It costs you nothing to be kind to the shop assistant, wait staff, post office staff, especially when they are polite too. But as a health care worker?

One comment I will make about the persistent rate of covid deaths, is that a) they are in addition to everything else causing death, and b) death has a ripple effect... 1/ So you don't just have a high load of death, you have a whole cohort of people - family, friends etc, being affected by these deaths. Death of someone close to you is very often a pivotal moment in your life. When everything you hold to be real is challenged...

What healthcare workers really want, more than anything, is for people to be truly free of preventable diseases and poor health, for the disabled to live in and access the world freely, and for chronic diseases to be managed into the background. 1/ (rant incoming) This is a big, and dangerous idea. People being free from disease means addressing all the big names. Big food. Big fossil fuels. Big pharma. It means holding people truly accountable to their actions towards others, to hold them responsible for traumatising others.

Things we could do right now for the health system... @DanielAndrewsMP @VictorianCHO... #auspol

1. Offer all the junior doctors 2 year contracts. Yearly reference begging is bad enough, let alone in the middle of a pandemic, to say nothing of the yearly recruiting costs. 2. Actively offer and promote part time training positions in *addition* to current positions, because what we've found on our service is that part timers become sources of truth, and stopgaps when there's high amounts of sick leave. It's been incredible for that actually.

I have a whole cohort of carers who are in a state of permanent distress because they have made one of two, or both of the following promises their parents have made them make.

1. I want to die at home.
2. You have to promise me you will never put me in a nursing home.

1/ This really grinds my gears because they know not what they are asking of their child. When we reach the end of our lives, most of us are not lucky enough to sail off peacefully and suddenly, overnight in our sleep. That's the expectation, but the reality is very different.

Reading some famous case studies on amnesia this morning, the most famous being Henry Molaison, a man who had his hippocampus removed to cure seizures in his late 20s. He lost the ability to make new memories, although unlike Alzheimer's, it was not a degenerative condition. 1/ Then there was Clive Wearing, a musician who lost his memory following HSV encephalitis (the cold sore virus infecting the brain) and believed he was waking from a coma, every 30 seconds.

In medical school we were taught that the cardinal signs of a heart attack for everyone was chest pain radiating to the arm or jaw, sweating, feeling like there's an elephant on the chest, and a sense of impending doom.

Except that's not what women experience at all. 1/ The majority of studies in heart attacks were done in men so all the textbooks were written accordingly. As a result, women are misdiagnosed, underdiagnosed, and have worse outcomes if they survive. So what are the symptoms of a heart attack in a woman?

The weaponisation of a politicians death by literally everyone with an agenda...politics to push, newspapers to sell, is one of the lowest points of 2022. Instead of the real story being that heart disease in women has higher mortality and goes undetected for longer... Instead we have whodunnits from people who should know better, full front page scare-jobs about bullying, and all from camps who need something. And the shame-culture going on, instead of any real talk about the political culture which in any other workplace would have...

There's this strange conversation happening on Twitter right now about Covid causing dementia but also lockdowns causing dementia. I am not a clever research person so I wont go into the paper battles flying around, but I thought I'd lend some coalface perspective. 1/ First of all, dementia is an umbrella term - there's a ton of different types, with Alzheimers far and away being the most common so when I say dementia from now on, assume it's that. Secondly - we don't *really* know what exactly causes Alzheimers, there's a lot of factors.

I'd like to introduce you to my 21st century version of the "glad game" twitter and invite you to try it out. It's called "snap your fingers". If you're feeling lost and unmotivated, or your having a bad day and just can't figure out what's going on, try this. 1/ Ask yourself, if you could snap your fingers right now and make something happen for yourself, what would it be? There's nothing too big or small, money is no object. The things that come to your mind are your needs that have been hiding.

I've tried to avoid the covid is/is not mild medical handwringing going on on Twitter but it's sufficiently driven me batty enough to step in.

The answer is that it's both mild and not mild. Accepting duality is important. 1/ I say this as someone who had a very non-medical career prior to this, and might have a slightly different perspective.

Yes it's mild. At a population level, most people get better. The numbers are there. This is what I say to my family when they worry.

I see a lot of physicians on here unhappy with messaging on here they feel is anxiety provoking and panic inducing. And subsequently putting out all the facts and figures to allay those concerns, and informing people they shouldn't be concerned. Doesn't work. A thread. 1/ Geriatric medical training is unique in that we do many many sessions with medical actors, roleplaying all the ways in which people play out their emotions. In an ED, in the community, in a family meeting. We do this, in front of an entire classroom, over and over.

Reading with horror about the Great Famine in India (1876-1878) and realising that the demonisation of welfare goes right back to British colonialism...some 'highlights' (Indian colleagues you likely already know, scroll past. ) 1/

*Content warning: distressing content. Widespread crop failures brought upon by extreme drought affected southern and southwestern India, as well as China, South America, and parts of Africa. The British Empire however, did not stop exporting grain out of the country...

One of the hardest parts of managing covid outbreaks in residential aged care, is the en masse pre-emptive discussions you need to have. Covid in people who are already very frail and very sick is often not survivable. A thread. **end of life content** Interventions like intubation and ventilation are highly invasive. What does that mean? When you are intubated, you are put on medicines that keep you unconscious. These medicines can be toxic to people who are already very sick from other diseases *and* covid*.

I keep hearing the antivaccination crowd raise that MRNA vaccines are in violation of the Nuremberg Code. I'm a little embarassed to say that I've never read the Nuremberg Code, so I looked it up tonight and realised it underpins the way we do research. I will break it down. Vaccines have already gone through clinical trials, they are not 'untested. Keep that in mind as we go through this - it does not apply to society, it applies to the experiments or trials *that were already conducted*. Here are the tenets:

I keep hearing this line "we've had 18 months to prepare the hospital system so staying shut to support hospitals is a lie".
1/ The first issue is that our health system, Australia wide, irrespective of politics, runs short at the best of time. Year after year of stopgaps, temporary staffing up, but at it's heart it is always about churning the max no. of patients through with the min safest staff number

Because I love a good Twitter thread, I'm going to delve into why I think people fall for snake oil treatments, doing what I do best, drawing on personal experience. Because I haven't always been a doctor, I have been a really stupid teenager too. 1/ Another lifetime ago, I was an angry and disinterested teenager, with parents who had split up when I was 4. My Dad had moved overseas when I was 12, and then returned when I was 17 because he had metastatic melanoma and he'd used up all his money on American clinical trials.

I'm seeing a lot of leaks from nurses and doctors to the media in NSW. This happened in Vic last year, and while I personally don't believe in leaking (because it leaves you with zero control over your message, to be manipulated at will), I understand why. 1/ Healthcare workers are usually the *last* people to leak to the press. Non-disclosure clause in contracts aside, we all truly believe in what we do, and we understand that the relationship people have with us is one built on trust. It's very easily eroded, so people stay quiet.