Content Warning; death of a child.

I wanted to share about the single most salient experience I had deciding who I was as a physician from directly observing an attending. Tragically, it involved the death of a pediatric patient; a child about 18 months old.

#MedTwitter 2/ I was an intern on the FM medicine service; our hospital didn't have any other residency programs, so we typically went to every Code because we were frequently more readily available than other doctors in the hospital, and often the first to arrive to help.

Happy First Day of Medical School to everyone with orientation today!

#MedTwitter
#Medstudenttwitter Some of your orientations are going to focus so much on how brilliant and accomplished your class is that you might start to feel like an imposter; like you got in by accident and soon everyone will figure that out.

It's not true. You belong there; we need more doctors like you.

I'll never forget the morning in clinic, a couple of years out of Family Medicine residency, when I walked out of a patient's room around 10:30 AM and was told I had "7 Walk-Ins."

#MedTwitter 2/ I was working at a busy FQHC and had a full schedule; 14 patients scheduled that morning, mostly adults who each needed my help with a mix of medical, psychiatric, and social concerns. This work has always involved that of doctor, counselor, and social worker.

"Non-Compliant"
"Difficult Patient"
"Poor Historian"
"Unreliable"
"Drug-Seeking"
"Low Health Literacy"
Or the indefensibly still in use, "Poor Protoplasm"

So many of the labels Medicine uses for patients are just a way of saying, "Not one of Our People."

#MedTwitter 2/ Medical Students and Residents, don't accept this terminology; don't allow it to dehumanize your patient, remove their agency, and undermine their care. Phrases like these can and do kill people. Fight back against this; both subtly and explicitly. #MedStudentTwitter

I don't know who on #MedStudentTwitter needs to hear this, but Step 1 is not the High Jump. A high score doesn't win, and a low score doesn't eliminate you from contention; it doesn't determine how good of a doctor you will be, and it certainly doesn't determine your worth. It's not really a competition at all, but if you need a track and field analogy it's more like that weird water obstacle in the Steeplechase.

You might leap right over it. You might stumble. You might fall face first with an embarrassing splash and get trampled a bit like I did.

"Live like a resident for a few years so you can pay off your debt" appears to be a bit of a controversy right now.

I finished college with $0 in debt and about $1,000 in savings. By the end of residency in 2016, my med school loans had grown to $470,000. 2/ My living like a resident included a lot of awesome factors. I was married; we had 2 children and an awesome dog we had adopted in med school. We had a reliable baby sitter and went on dates semi-regularly. We had a little rent house that was fairly priced. We had two cars.

There's this theory that "capitalism breeds innovation," so our healthcare system must be improved and advanced by the competition of private insurers.

It fails because it doesn't account for the fact that all innovation of insurance companies is directed at increasing profits.

https://twitter.com/pjputh/status/1490119504625553408

2/ Under our current model, there is no incentive- none at all- for insurance companies to innovate in the direction of improving peoples' health; not the health of their clients, and certainly not the health of others in our society.

Thinking about the attending physician that once told me I was taking too long on informed consent with patients. "It's good to be thorough, but sometimes you just need to get the form signed and go."

Miss me with that for a million years.

#MedTwitter #MedEd 2/ A robust informed consent process prior to a treatment or procedure is not a "stretch goal" if we have enough time. It's not even the highest ideal of patient autonomy; it's the barest essential, the last line of defense that keeps medical care from becoming medical violence.

A 🧵 on white privilege, and the way it operates on your behalf without you ever even needing to think about it.

We travelled to a small family gathering for Christmas; it was about a 13 hour drive. On the way home, our youngest, 2, began to feel sick and then to run a fever. 2/ (He's fine, by the way. It wasn't COVID; more likely RSV).

We still had 7 hours left and it was late, so we decided to get a hotel for the night. We looked at the map and booked a hotel room in the next town on our route; a random town in rural Missouri we had never visited.

About 6 years ago a patient told me they picked up their medication after our last visit, even though it cost over $200 and they had to borrow money from family to afford it.

The medicine was extended-release Nifedipine. It should have cost about $14. The patient told me, with some hesitation or reluctance, "I'd like to switch to something less expensive if possible. I know you have to make your money somehow, but I just can't afford this medicine."

@kidney_boy I'm the resident you're talking about here, sir; the very one. The one who stayed late, blew by duty hours, volunteered for the admission or the procedure; the one who covered his peers' shifts.

The thing you are missing is that I didn't make those choices, I had those choices. @kidney_boy My spouse is an RN; we had talked this through together and had decided that's how those 3 years of residency were going to be for us. It was what we wanted, because we knew it was temporary and because I wanted every last ounce of training I could get out of those years.

Thread: How a trip to the Veterinarian strengthened my resolve to train medical students in patient-centered care.

I teach clinical skills, patient communication, and doctoring at a medical school. This is my good boy Chuck. Today I had to bring him to the Vet. 2/ I should mention that most of these pictures are a few years old. We got Chuck (full name: Special Agent Carmichael) during 2nd year of medical school, and at 12 years old he now has a bit of grey around the paws and whiskers, but he's still as cute as ever.

A pre-med student I mentor recently watched Wit, and then sent me this text:

"I kept looking for any shred of evidence to defend the way the doctors were acting, and I couldn't find a thing."

I told him that he's about 10 years ahead of where I was at his age.

#medtwitter 🧵 2/ The play "Wit" by Margaret Edson has a strange but important role in my journey to becoming a physician.

As a college freshman I was pre-law and did #theatre whenever I could for fun. At the end of the year, I was cast in Wit as part of senior directed one-acts.