Had an interesting chat with a patient recently which made me think of “shared decision making”. It’s central to the way we practice, but there are limits.

An elderly patient has very severe coronary artery disease. I said there are 3 options we’ll discuss at MDT

1/8 1 - high risk CABG
2 - high risk PCI
3 - medical management (also high risk) and as I started talking he interrupted and said “look, what I don’t want you to do is to come back and say ‘it’s up to you’, I am not the doctor, it’s your job to tell me what is best”

I'm a consultant interventionalist, but was a trainee just 18mo ago. I am an educational supervisor (to doctors) and have mentored ANPs & pharmacists to expand their skills. I am clinical lead for my department, so all too aware of the pressures on trusts. Here are my thoughts.

https://twitter.com/GHCardiology/status/1668261119356555264

Firstly, this is no way directed at the ANP involved who I have no doubt is hard working and talented. It's clear he has benefitted from some intensive mentoring, mentoring many interventional cardiology trainees are desperate for. Glenfield is an amazing centre.

A few years ago, a friend sent me what I would later learn was a typically bizarre tweet by @njohncamm, asking if I knew who he was. No idea, but something bothered me – he almost shared a name with a very famous cardiologist, Professor John Camm

Coincidence?

No...much stranger He went viral yesterday, but within cardiology circles we've known about him for a while and, while his lack of filter could occasionally be quite entertaining, he is routinely misogynistic, anti LGBTQ, racist & antivax. So I went to look him up.

https://twitter.com/BadMedicalTakes/status/1633468109486018561

I’ve recently realised how enormous a market there is for exogenous ketones

Do you actually produce ketones by carefully choosing the food you eat?! Wow grandpa get with the program, no one produces endogenous ketones these days, just ingest & go! lol of course

I think it's important that responsible healthcare professionals call a spade a spade.

'Integrative', 'holistic', 'functional', 'lifestyle' medicine, or whatever its latest rebranding is, is a gateway to complete and utter quackery. It is not a field of medicine.

https://twitter.com/MedCrisis/status/1630087783594196992

Of course, a statement like that brings out the sea lions who say "why do you have a problem with treating the patient as a whole?" which is to expertly miss the point. I am not defending modern medicine, I am a frequent critic of it & all the problems it has.

If you watch similar kinds of youtube channels to me, you might've noticed quite a lot of people being sponsored by something called 'Established Titles', who have clearly really been splashing the cash on influencers lately. But...is it just a scam? Many of my friends have been approached as well, but been put off by the concept. I wasn't sure a lowly channel like mine would be on their radar, but sure enough I found some emails in the bin.

I missed Aseem Malhotra’s big reveal yesterday. I know you still follow me Aseem so I hope you see this. Please know, what you’re saying isn’t just whipping up your base and putting you on TV, it is having real, awful effects on real people You suffered a terrible loss. My father in law also died very suddenly this year. Same age as your dad. Also had no PMHx except high blood pressure, went to gym daily. I am genuinely at a loss how you can conclude either death was due to the vaccine

I have interrupted my weekend DIY because I am so stunned by how appalling the latest episode of Instant Genius by BBC @sciencefocus is. Truly staggering lack of even the most basic fact-checking, regarding the new cult of blood glucose monitoring. sciencefocus.com/the-human-body… I hope the BBC are aware they've just aired a long advert for Glucose Goddess Jessie Inchauspé's book. She introduces her background - mathematician, biochemist, Silicon Valley entrepreneur. Great to hear ideas, but the host just bought every single unevidenced claim

My friend is attending a Prader-Willi syndrome (a rare genetic disorder) meeting and has found himself sharing event space with people who can lead a horse to water Yes vet homeopaths really are a thing. Sounds hilarious but actually could be really sad, like when parents give their kids homeopathy. For minor stuff nbd but I hate to think animals are getting f*&£ing homeopathy for serious ailments. The website is about what you’d expect

I AM SHOCKED I TELL YOU, SHOCKED

https://twitter.com/adamcifu/status/1506800062600515588

Alan asks a sensible question. How many trials will it take? Surely the hundreds of negative vitamin D trials will convince even the true believers?

https://twitter.com/AlanHeldman/status/1506819167311257600

By far the most common request I'm emailed is to comment on videos by John Campbell, a popular medical educator on YouTube. I haven't done so thus far mostly due to lack of time, but I wanted to respond to his video on heart inflammation after vaccination. But this thread isn't really about the video, it's an analysis of the source material, a poster presentation abstract in Circulation. Vaccines & myocarditis are probably the second most common thing I'm asked about, so this is lazy/efficient threadmaking
ahajournals.org/doi/10.1161/ci…

Food is medicine

1. Nutmeg liver

Venous congestion; heart failure 2. Cauliflower ear

Repeated trauma; combat sports, rugby etc
(that's Khabib)

Here's collab number 2 of the week!

First, @skdh asked me some medical questions (and I said she's weird)

Shot at @Ri_Science, big thanks to them for hosting us! Next up I returned the favour and posed Sabine all the daft physics questions I had knocking around in my head (and talked about my favourite particle)

Have another watch of the video - it is not directed at antivaxxers, ie the people who spread lies online. It is directed at ordinary people. "Shut the f*ck up and take the vaccine". Your passive aggressive "if Dr Francis were pro-vax" is appreciated btw. Patients love that too.

https://twitter.com/UrbaneDoc4Kids/status/1391011894459305987

Yes, we should only be critical of medical public communication from our own country. The vaccine and the Internet famously respect national borders.

A ward patient had a chest drain inserted & quickly went into pulmonary oedema. We know this as re-expansion pulmonary oedema. Solution usually involves clamping the drain to prevent further drainage (if it's an effusion). But why does it happen? It occurred to me during my shift tonight that I don't understand why. It seems I am not alone. Often it's just a radiological finding, but I've seen patients in significant distress from it & it can apparently be be fatal.

But no one really knows why it happens.

Found my to do list from 2013 with this action point in the 'amber' column, ie not super urgent, but try to do soon. Unfortunately it would quite be many years before I finally got round to it 😐 My only regret with YouTube is starting so late.

As you can see I went with 'f'. Leonardo and his sinus did indeed become my first video ever, and remains one of my favourite ever bits of medical trivia. Advice for a newbie is maybe cut your teeth on B grade material, learn how to edit etc and then whip out your pièce de résistance once you've got some skills

You might not be aware there is an 'anti lockdown' protest in Trafalgar Square this Saturday, the 'Unite for Freedom' event. It boasts "Top World Class Doctors & Nurses" which piqued my interest.

So I thought I'd look them up. A theme through many of my twitter threads & youtube videos is that doctors can be just as big morons as anyone else. Some of the 'doctors' saying social distancing & masks are unnecessary are fake, they're chiropractors or naturopaths. But the sad truth is, many are medical docs

Next procedure cancelled so sitting in the staff room with 2 nurses watching day 6 of #BlackLivesMatter protests in the US. Yesterday a huge protest in London & many other cities. The nurses felt protestors shouldn't use violence & were wrong to go near the White House. I said > "what other options do they have?" But as I said it, I knew how tone deaf it is for me to saying that as both of the nurses are black and I'm not. You've heard the difference about non-racism vs anti-racism, I've been thinking about it a lot recently.

Important update from @ICNARC - analysis of the first 775 patients admitted to critical care in the UK with COVID-19

Average age only 60 (remember this will be skewed, but pretty similar to typical admission with non-COVID viral pneumonia - R column)

icnarc.org/About/Latest-N… Compared to typical viral pneumonia admissions to ICU, COVID patients:

Are in previously better shape (90% fully independent)
Have fewer pre-existing co-morbidities
Are *much* more likely to be mechanically ventilated

A little tidbit for non-cardiologists who might not've heard of the Smoker's Paradox. WHY INCOMPLETE DATA CAN MISLEAD!

Yrs ago it was observed that although smokers had more heart attacks (MIs), they actually did *better* after having had one, compared to a non-smoker. wtf? Can you think of any reason why this might be the case?

I thought #BlackHistoryMonth (Europe) would be a great opportunity to make a video about 2 cardiac surgery stories that I love. Behind the blockbusting first Tetralogy operation & the first heart transplant were black men working in deeply racist times. Followers/readers of @FredWuMD & @thomasngmorris will know these well. Hamilton Naki left school at 14 and worked as a gardener in Cape Town but ended up performing heart & liver transplants on dogs and is credited with devising the heterotopic heart transplant