Not too long ago, a student I was working with asked me why patients with iron-deficiency anemia experience ice-craving AKA pagophagia. I had no idea. So I thought I’d look. Spoiler—we’re still not sure. But I did turn up some neat stuff.

A 🧵about 🧊 (1/14) “Pagophagia” derives from the Greek “pagos” (ice) and “phagein” (to eat). It's a type of pica, the eating or chewing of non-food like clay, corn starch, and paper. Pica, delightfully, derives from the Latin word for magpie, for the bird’s indiscriminate eating habits. (2/14)

How to Ask Me to Give a Talk:

A short, extremely niche, probably unpopular thread for chief residents, early faculty, and anyone else whose job includes asking people to give talks for stuff.

🧵(1/10) Despite hating the sound of my own voice and not knowing where to put my hands, I love giving talks and I'm always grateful to have been asked.

I also desperately want to do a good job, and want your thing to be a success, so there's some stuff that's helpful to know.

2/10

I was thinking about nicotine replacement therapy (NRT), as one does. Varenicline works better (and varenicline + NRT works better still), but I think we often reach for NRT first because it seems more intuitive and maybe more accepted by patients. 🧵1/14 A plea to please think about it, no matter what the setting. Tobacco use is a leading, reversible cause of morbidity and mortality, and we have tools to help reduce it. Are they great? Well, they are much better than offering nothing. 2/14

How to not know stuff – a thread for new attendings by someone who doesn’t know stuff.

Let's pretend there's a funny gif here.

1/18 There is a lot of great advice out there for new interns and new upper years, but I haven’t seen much for new attendings.
Being an attending is great—you get your life back in innumerable important ways, and you get paid more commensurate with the stakes of the job.
2/18

I see a lot of ibuprofen 800 mg given with wild abandon. I thought I remembered learning from @02Satz that analgesic efficacy didn't increase much over 400 mg, but bleeding risks did.

So I decided to revisit this.

1/5 So it seems I slept on a nifty little 2019 ER study that randomized a convenience sample of patients presenting with acute pain to a 400 mg, 600 mg, or 800 mg dose of ibuprofen. pubmed.ncbi.nlm.nih.gov/31383385/

Turns out, all 3 doses have similar analgesic efficacy. 2/5

*How to clinic with Paul Williams*

Mostly for internal medicine residents, but also for anyone else who is curious.

Others may do things differently or disagree, and that’s totally fine. (1/22) Before you see the patient, look at the chart. I mean REALLY look. Focus on notes, but also on imaging and unusual labs. Why was it ordered, and does anything need done with it? (2/22)

*How to round with Paul Williams*

Tips for medical students, interns, and the curious - a thread

Just in case this might be helpful. Your mileage may vary with other attendings, who may violently disagree with these. (1/16) Before we start together, it's really helpful for me to know what things you're trying to improve on. This will help me know how to best tailor my feedback for you as we go through the rotation together. (2/16)