i was born into the southern baptist church. my grandfather was my pastor for the first decade of my life. i was "born again" when i was 6 after a particularly terrifying sermon about hell. i spent 32 years in white evangelical churches, and it fucked me up in a lot of ways 🧵 i attended bob jones academy, a conservative fundamentalist christian school where interracial dating was banned until the year of their lord 2000. i was taught that the bible is 100% literally true/historically accurate and that the earth is 4-6k years old don't ask questions

during my MS-3 surgery rotation, i got pulled into a cardiothoracic surgery case. the division, and this attending in particular had...a reputation, and most of us would do anything to get out of working with them. but this time, i couldn't get away. it was a laparoscopic case involving one lung. my job was to hold the camera--not a particularly difficult job, but one that's really important, and one that's not easy if you've not done it before.

when i was in residency, i had an idea for a different practice model. one that would allow me to spend more time with patients, and would let me operate outside the bounds of the typical healthcare system, giving my patients the attention they deserved. i spent two years working on a business model that i thought would work. i examined similar practices from across the country, took the best parts of them, and implemented them into a practice model that i thought would be great.

“colic” isn’t a thing. “gripe water” is also not a thing.

except they kind of are. they're multiple things, really.

come with me on this journey. (THREAD) in 1954, dr. morris wessel published a paper called “paroxysmal fussing in infancy, sometimes called 'colic’” it’s about (as you probably surmised) babies who cry a lot.

$25, but here: pediatrics.aappublications.org/content/14/5/4…

The story of teething begins, as all good medical stories begin, with Hippocrates, who wrote in the 4th Century BCE that “teething children suffer from itching of the gums, fever, convulsions, diarrhoea, especially when they cut their eye teeth.”

(a thread) It wasn’t until the late-19th century that a precise mechanism was elucidated. J. W. White explained, “The nervous perturbation occasioned by the eruption of teeth increases the susceptibility and lessens the resistive power of the child.” (There, that sounds science-y enough.)

here's why:

we shouldn't be here. the management of this pandemic has been a complete disaster from the start. efforts to get this pandemic under control have not been only ignored, but undermined by our president. we shut down for weeks, and we have very little to show for it.

https://twitter.com/chadhayesmd/status/1286767153920782336

we still lack adequate ppe. we don't have a coherent testing strategy, and the tests we are doing often take a week or more. we still lack hospital beds and icu beds and staffing required to handle what's here or coming. that's what the shutdown was for.

In the words of Kenny Rogers, "If you're gonna wear a mask, boy, you gotta learn to wear it right." (Thread intended for HCWs, but important for anyone)

Point #1: If you're wearing a mask, its job is not to protect you. The point of the mask is to protect other people from you. Because a significant percentage of people infected with SARS-CoV-2 don’t have any symptoms, and those that do are contagious before symptoms develop, we have to assume everyone has it, including ourselves. Your mask is intended to protect others from you in case you're infected.

Biotech companies distributing rapid IgG/IgM test kits for SARS-CoV-2 🦠that provide results in as little as 10 minutes from a simple finger stick.

What could go wrong?

Well... 😬 These are being produced and released without sufficient testing or FDA approval. We don't have great data on how accurate the results are, and any data that we do have likely comes from the companies that are trying to sell them...

If parents want to co-sleep with their babies, I don't shame them for it. I have a conversation.

Life is full of risks, and we all make decisions every day that aren't the safest options.

So, just like any other situation, I talk about how to be as safe as possible. (1/) With teens who are having sex, I talk about contraception, STI prevention, HPV vaccine, consent, legal implications of nude pictures of people under 18.

With kids who drink, I talk about avoiding situations (driving, swimming, sex, etc.) where this could increase risks. (2/)

I recently drove by a billboard for a health system. It showed a picture of a very happy patient and her very happy doctor, and it read:

"See a doctor who actually sees you."

My thoughts follow, and I'd love to hear yours. I understand that there are patients who have been let down by our system and by doctors within it.

But I'm talking marketing, and I seriously doubt that the doctors at this one tiny little health system are the shit we've all been missing.

I’m excited to offer a line of children's health supplements designed to provide targeted boosts to your child’s immune system, optimize their health, and help them reach their wellness goals. These supplements should be integrated into every holistic wellness routine. (1/v) Developed by leading scientists and backed by research, each of these products works with your child’s natural immune system to support the function of every organ. Best of all, they are typically available at no cost to you at physicians' offices around the world. (2/v)

I'm talking to parents about #CBD a lot recently, so just wanted to throw this out there:

CBD oil *may* turn out to be a safe and effective treatment for ADHD, anxiety, or some other condition.

May.

We don't know that. (1/) We also don't know what negative effects it might have. Because everything that had potential for good effects also has potential for bad ones.

Sure it's "natural." Whatever that means. But that doesn't mean it's safe. (See "uranium," "poison ivy," and "moose.") (2/)

A #homeopathegg #tweetorial:
It’s Easter again, and for reasons that remain unclear to me, millions of people are spending time and money turning eggs different colors. I’m going to dye some eggs, too…but this year, I’m going to try something different--using #homeopathy. 1/X Many people think homeopathy is a synonym for “natural." It’s not. Homeopathy is a system of "medicine," developed in the early 1800’s by Samuel Hahnemann, a German physician who had stopped practicing medicine because he felt that he was often doing more harm than good. 2/X

A lot of patients have had bad experiences with medicine. There are lots of reasons for that. It's really complicated, for one. Our knowledge isn't perfect. Our tests aren't perfect. Our treatments aren't perfect. And the people who do the jobs...well, we're far from perfect (1/) There are other reasons, too. Historically, we've done a really bad job taking care of certain groups of people. Women with "hysteria," for instance. Locking away people with mental health disorders. Treating homosexuality as a disease. Treating addiction as a moral failure. (2/)

I make a lot of kids cry. You might think that it’s the shots or other procedures, but more than that, it’s insecurity. Kids get more upset about being taken from their parents (even if just a few feet away) or being unable to move around freely than they do about the pain. 1/ They cry because they can’t access the source of comfort/security that their parents provide, more than they cry from the pain itself. I do my best to make them comfortable-encourage parents to be as close as the procedure allows, use distraction, and minimize the time apart. 2/

If I won’t prescribe/refill medications on the phone, it’s not because I’m mean. I don’t prescribe antibiotics without seeing a patient because: 1) most kids don’t need them, 2) antibiotics have side effects, and 3) some are sick enough that they need other things as well. (1/x) I don’t refill asthma meds over the phone because if you’re calling, it’s either time for the next visit to see if we need to make changes, or your child is currently having an asthma flare that might need additional treatment. (2/x)

It's a new week. Last week was tragic. Don't forget it. But also don't forget that America is not a nation of two parties; it is a nation of 325 million people of diverse backgrounds, beliefs, and opinions. The majority of those 325 million people lie between two extremes. (1/x) We must find a way to come together in order to create solutions rather than becoming even more polarized. Gun violence in America is not a simple problem; it will not have a simple solution. No solution will please all parties, and none will end gun violence entirely. (2/x)