Discover and read the best of Twitter Threads about #medtwitter

Most recents (24)

It's time for #TwitterReport! Get out your illness scripts and problem representations.

Case: A 65yoM with metastatic melanoma goes to the ER with RLE edema: doppler shows a femoral DVT. He also says he's been getting more tired over the last 4wk.

What else do you want to know?
PMH: HTN, HL, T2DM (now diet controlled), metastatic melanoma
PSH: none
Meds: HCTZ, metoprolol, atorvastatin, pembrolizumab/ipilimumab (last cycle 2 weeks ago)
Social: lives with wife and dog at home. From a local rural area. Never smoker/alcohol. Former construction worker.
ER Triage Vitals:
-Temp 37*C
-HR 60
-BP 90/54
-RR 12
-SpO2 98% on room air

What else do you want to know?
Read 17 tweets
Alright, I have some thoughts on this op-ed, esp how tradition + legacy are often used as a distraction tactic from diversity/inclusion.

Buckle up for A THREAD.

#MedTwitter #SoMeDocs #DoubleDocs #DiverseDoubleDocs #MedStudentTwitter #WomenInMedicine #DiversityInMedicine
As always I start my thread by recognizing my own position in this conversation: I am a (proud) Latina woman training to be a physician-scientist. I hold a lot of privilege having attended an Ivy League institution for undergrad and currently training as a #DoubleDocs at another.
My own alma mater #PrincetonU has been recently grappling with its own (problematic) history by taking active steps to diversify iconography + naming around campus. I am proud to say that this is in part due to a meeting I co-hosted as co-president of PLA in combo with other orgs
Read 36 tweets
1/#Medtwitter friends, we are thrilled to share a #tweetorial courtesy of @StephenieLe11 and inspired by @DrDanRestrepo's episode on intrarenal AKI #FOAMed
clinicalproblemsolving.com/2019/03/21/epi…
2/30M presented with MSSA native tricuspid valve endocarditis and lower extremity edema was found to have AKI. What are the renal manifestations of endocarditis?
3/There are numerous causes of AKI in patients with endocarditis. Let us know if you think of others!
Read 11 tweets
1. This is a very useful thread #MedTwitter because it tracks common reasoning errors that lead doctors to readily accept psychosomatic dx for #MEcfs and other contested conditions like #EhlersDanlos, #mito, #dysautonomia, #LymeDisease, etc.
2. Start with the duty that defines your profession @strauss_matt - to ensure that every patient with a need for med care (medical testing, treatment, or support) receives it when she seeks it from you. Mistaken psychosomatic dx violates that duty in every case where it occurs.
3. No doctor should have to be told to err on the side of medical caution. Your job requires (a) humility about the limits of dx science and (b) historical awareness of immense suffering caused by psychological explanations for #MS #epilepsy #PepticUlcer #Parkinsons #lupus etc.
Read 8 tweets
1/ Toxicologists are familiar with loperamide toxicity, but this hasn’t spread as much to other specialities. Thus, my 1st attempt at #tweetorial for #medtwitter . H/T to @jmmarraffa & @DavidJuurlink & @Pete_Wu for their earlier writings. Thxs to @officialdrk12 for the idea
2/ First a poll: Loperamide is/can be:
3/ Loperamide is a mu-opioid agonist with poor oral bioavailability with primary use as an anti-diarrheal. CNS effects are limited when p-glycoprotein (P-GP) is functioning normally at the blood-brain barrier.
Read 13 tweets
10 things IMG (and USMG) applicants should know for the 2020 residency MATCH: I can’t help but recall how stressful the application journey was one year ago. I hope this thread helps out (instead of adding stress)! @ERAS @AAMC
Build your CV: it helps as you are requesting letters from mentors, or basically any email you're sending. Have a clear CV that speaks of your accomplishments. Do not miss a certificate or work in progress. Here is a link to how to do a cover letter.
Before programs see your application & statement letter, look at it yourself. Know your goals, or at least outlines of your goals. Know your weaknesses and SHOW that you are working on them. Practice your ONE LINER. This will improve your statement letter and application.
Read 12 tweets
Well it’s only Tuesday but we have this piece in @statnews saying doctors should stay silent on social media and also, as an aside, show no emotions. So I’m going to do everything the article says not to do and talk about it! #medtwitter statnews.com/2019/06/10/doc…
The piece opens up by talking about how Osler referred to doctors as a “quiet army”. This was a century ago. There were no prior auths. There was more time to spend with patients. No EMR.
A century ago, doctors were not talking about systemic racism or misogyny in medicine. Doctors were not talking about the disparities in LGBTQ health. A century ago, medicine was more paternalistic. Is that really our standard?
Read 10 tweets
So excited for this @OHSUIMRes #ChiefResident #GrandRounds! “What is the purpose of rounds?”
This has been a fascinating discussion to participate in via #medtwitter over the last year or so
@AdamRodmanMD @medpedshosp @ETSshow @PaulNWilliamz @cjchiu @tony_breu @michellebr00ks
Fascinating @JHospMedicine article which was the subject of a #JHMchat gets an early discussion @FutureDocs @WrayCharles
(I think this is also the chat I really “met” a lot of my #medtwitter peeps)
@OHSUIMRes alumnus @AdamRodmanMD gets a shout out!! What was the origin of “rounds”??
Read 13 tweets
Lots coming out around @danielleofri ‘s latest NYT piece. Everything she says here is gold and points to the ways in which the altruism of physicians has been taken advantage of. As a psychiatrist, I always like to take it a little deeper.... (A THREAD 1/10)
Last week in #mdedgechats abt physician suicide, I brought up how strange it is that the most highly educated professionals in the US somehow ended up not being in control of their own profession? Lawyers CEO's, politicians make the decisions about medicine not doctors. 2/10
What @danielleofri writes touches on this too. People who go into medicine are do gooders & givers at their core. Do gooders have bad boundaries. (Most of us) will choose taking care of the patient over taking care of ourselves. If not, we don’t survive training. #MedTwitter 3/
Read 14 tweets
I spent this past year working with kiddos who needed some extra help breathing 🌬. Trachs & vents are incredible interventions for those who want them, and also have hidden medical costs at 🏠.

[Thread on one hidden medical cost for #pulm families, and how to try and help] /1
During my time with families, I learned about the increase in electricity bills when they get discharged. 💡

Families reported monthly power bills ⬆️ by $400-500 once they got home. This might be after a week, 3 months, or 2 years of living in the hospital. /2
Few people think about their electricity bill as a medical expense, but if you use a ventilator, it is.

It became clear that I needed to investigate 🕵🏻‍♂️ how this bill was wracking up, and how to better prepare families for what was ahead when getting ready for 🏠. /3
Read 14 tweets
1/ #medtwitter #twitternists #proudtobeGIM

I've been sitting on a @SocietyGIM #sgim19 debrief #medthread since the meeting, and thought I might finally take a swing at it - here goes ..

I am considering whether I can do more division/systems leadership in coming years .. ->
2/ Theme of the conference was 'Courage to Lead', and single best workshop for me was :

Leading Change: Tools/Tips for Change Management

Crediting Alfred Burger, Emily Fondahn, Brent Petty, Nathan Spell, Dan Steinberg - can't find them on Twitter, so giving proper 🗣🗣.
3/ would like to share key concepts for all of us trying to lead in academic medicine or in #advocacy spaces.

First key Slide/thoughts:

The hard stuff - barriers to change .. ->
Read 16 tweets
Ok. There are a ton of great articles on WHY scholars should join Twitter, but most don’t offer an in-depth HOW-to.

This leads to hesitation and timidness.

So, I present a thread “You’ve joined Twitter. Now what?” #AcademicTwitter #scicomm #SoMe
First, choose a handle you’ll be happy with 5 years from now. I’d regret creating @SarahNEU2013 now that I’ve long since graduated.

#academictwitter #scitwitter #medtwitter
Next, pick a good bio photo. A professional headshot you’ve used in other places (e.g., university directory) is smart.

Because Twitter has paused verification, I see consistent photos across multiple channels as an unofficial way to confirm you are who you say you are.
Read 31 tweets
Thread: Tell me about the good times (#residency)
1/Obviously, so many threads about the tough times in training. Neg experiences, disrespect, fatigue, depression. I began to wonder if I had imagined having a great residency experience. How could mine have been so different?
2/I wouldn't put it past me to have amnesia about the whole thing. So I texted some of my co-residents? Was I seeing things thru rose-colored goggles? Nope-they all said "Great time and Hard Work." Which is what I recall. With so many new interns preparing to start....
3/ Can you share with me some of the good times you remember? Because we surely don't want them all to start a new experience expecting doom and gloom. #MedTwitter #Twitternist #ProudToBeGIM #TipsForNewDocs
Read 8 tweets
Time for a #tweetorial/#medthread on:

#CALCIPHYLAXIS!

This is a devastating diagnosis often seen in inpatients, so this goes to all the @DermHospitalist & #hospitalists out there!

#FOAMed #MedEd #dermatology #dermatologia #dermtwitter #medtwitter @SHMlive @DermHospitalist
1/
First of all, what is it? The exact mechanism is unknown. What we do know is that there is calcium in the arterioles of the skin, with arterial thrombosis. This interruption of blood flow causes painful ulcers and retiform purpura. Remember this?



2/
That interruption of blood flow causes the clinical picture of calciphylaxis - retiform purpura with a predilection for fatty areas, violaceous borders, necrosis with ulceration, and TERRIBLE PAIN. Without the pain, I really think one needs to reconsider the diagnosis!

3/
Read 17 tweets
UTI-Club #3: lesión pulmonar inducida por la ventilación mecánica: VILI #tweetorial

interconsulta.online/uti-club-3-les…

#TuitMédico #MedTwitter #FOAMed #FOAMcc #MedEd #UTI #ICU #MechanicalVentilation #VIL

1/
👩‍🦱 55a
⌨️POP hemicolectomía (CA Colon). 3 hs de cirugía, sin complicaciones
2/
Ingresa a UTI extubada, sin requerimientos de vasopresores.

Al poco tiempo desarrolla hipoxemia e infiltrados pulmonares 🖥️

EAB: (con máscara de O2 al 50%): 7,42/50,4/36,5/-1/23/85,9% 💉

Ecocardiograma normal ❤️

AngioTC negativa para TEP ❎
3/
Requiere intubación orotraqueal y conexión a asistencia respiratoria mecánica.

Cuando se procede a setear al respirador, llama la atención que la paciente tiene baja estatura (1,55 m) y sobrepeso (en la historia clínica de ingreso figura peso previo a la cirugía de 68 kg) ⚖️
Read 16 tweets
1/
Why did Beethoven, possibly the greatest composer of all time, go deaf at the age of 28? Read on in this short Tweetorial to learn about a theory...

#medtwitter #FOAMed #MedEd #medicalhumanities
(theory co-described with Sunil Nair and Joseph Tremaglio)
2/
First, let's get Beethoven's review of symptoms, as documented in his letters and conversations 🤔:

+ Progressive hearing loss/tinnitus ➡️ total deafness
+ Chronic unilateral eye pain
+ Polyarthritis
+ Fatigue
+ Chronic abdominal pain and diarrhea
3/
Many theories try to explain Beethoven's deafness. Perhaps most popularly:

▪️Lead poisoning (supported by high lead levels found in the composer's hair)
▪️Paget's disease (auditory nerve compression from skull changes)
▪️Lupus
▪️Sarcoidosis
▪️Typhus

sciencedirect.com/science/articl…
Read 10 tweets
I stayed for hours after my shift yesterday to be with a little girl whose daddy was dying. We coloured and sang and wandered the secret passageways of the hospital. She confided in me that she is in fact Hermione Granger, a good wizard. I made her a special wand...
She said she only uses her magic for good. She cast spells that all the sick people would get better. She cast a best friend spell on us. She stole my heart & everyone who met her.

I have never met such a special little girl & I started to believe she did hold magical powers
The whole purpose in spending that time with her was to shield her, even if only for those moments, the grief of watching daddy pass away, and allow mommy private time to be with him.
But also to keep her close by for the frequent hugs Mom would come and collect...
Read 7 tweets
1/21 “Is there a nurse or doctor on board?”

Clinicians—have you ever responded to one of these?

Last week I left the hospital and boarded a flight for my vacation. I then responded to the mother of all in-flight emergencies…
2/ This was a flight with hundreds of people from Boston, so I estimated there would be at least 15 doctors. Turns out I was the only adult medicine doctor, BUT there was a cardiac nurse with me.
3/ The patient was middle-aged and experiencing crushing chest pain. We asked for the medical kit, took vital signs and performed an exam. By the way, you cannot hear sh*t through a stethoscope in the air. I could hear bilateral breath sounds, but that’s about it.
Read 24 tweets
1/ Why tuberculosis has a preferential apical localization?
Is it the host? Is it the pathogen?
To answer this question, let’s review some cool stuff
#MedTwitter #IDTwitter #IDMedEd #IDDailyPearl

Follow the thread
2/ Arnold Rich stated: “There is no more puzzling circumstance in the pathogenesis of pulmonary tuberculosis […] than the peculiar fact that in the adult the disease begins almost invariably in the upper portion of the upper lobe“
ncbi.nlm.nih.gov/pubmed/6839825
3/ M. tuberculosis is an obligate aerobe (they have an absolute requirement of O2 to grow).
*Tubercle bacilli respire maximally in vitro at O2 concentrations of 20-40%
*Experimental infections in animals are inhibited by very low O2 concentrations
Am Rev Tuberc 1939; 40:157-68
Read 9 tweets
Today I gave divisional rounds @UofA_ID on the power of #SoMe and #IDTwitter for ID physicians and microbiologists.

I have gained loads in this space, and here I compile some of the takeaways 🥡 for those who remain unconvinced of the benefits of #MedTwitter

A thread 1/
Whether we like it or not, #SoMe has changed our world. It has changed the way leaders are chosen, the way we communicate & interact with one another, the empowerment & mobilization of societies, & giving us unprecedented access to people and spaces otherwise unimaginable. 2/
#SoMe has also changed the way academic physicians and scientists practice and how we conduct and communicate science. 3/
Read 35 tweets
I want to put a 🙌 out to #MedTwitter

I may not tweet a lot but I do follow and gain quite a bit so I want to share how it has changed the way I carry myself and provide care.

It’s a thread.
2/
Patient asks the case manager when the doctor is going to see him

I spent 30 minutes updating him earlier that day 🤔

Pre-twitter: ok
Post-twitter: Sir, I’m in charge of your care, tell me a bit more about why you didn’t think I was your doctor.
#WomenInMedicine @AMarshallMD
3/
Overhear the nurses talking about a patient who made a veiled but serious threat to them during the course of care.

Pre-twitter: I’m sorry.
Post-twitter: 😠 that’s not OK. How can I support you?

#MedTwitter #NurseTwitter
@BrowofJustice
Read 11 tweets
OK #medtwitter #scitwitter #doubledocs #radonc and #newpi tweeps: I have been charged with discussing "Recruitment and Retention of Physician Scientists" in #radonc at a panel for @ASTRO_org #ASTRO20. What are we doing right? What could we improve?
DMs or public tweets welcomed! Would love to get a diverse cache of perspectives! Please spread the word! Apologies in advance if I missed some folks. I'm still getting the hang of this twitter thing.
Read 4 tweets
A Thursday #MedThread #Tweetorial. Consider this an “ode to uncertainty and curiosity” meshed with my clinical practice passion #periopmedicine inspired by many recent #medtwitter, podcast, & IRL role models and conversations about… 1/X
* Stepping into the tension of clinical uncertainty
* Self-reflecting & identifying when we’re on
the edge of uncertainty
* Being able to say “I don’t know”
* Seeing what’s on the margin of our knowledge
* What it means to be “curious”
@ETSshow @CPSolvers @DxRxEdu
2/X
Also drawing from @Gurpreet2015 OHSU #GrandRounds week—as adult learners & clinicians, we must create micro-learning challenges for ourselves:
* What’s the next step
* What else
* What if
* What’s the next logical question to ask the patient, myself, a colleague?
3/X
Read 22 tweets
ALERT: Based on popular demand, #NAFLD #tweetorial for primary care starts here. I guess it's a risk of calling yourself the "hepatoMD".

Topics: What is #NAFLD? How to diagnose it? Who to worry about? Who to refer? How to monitor?

#medtwitter #FOAMed
#NAFLD is an umbrella term. On one end of the spectrum there is 'simple steatosis', and on the other end there is 'NASH'. NASH is the clinical entity liver folks worry about because it causes liver disease.
So what causes NAFLD?
Best way to think of it is as a metabolic disease caused by insulin resistance, that is caused by genetic/environmental/lifestyle factors leading to adiposity.
Read 22 tweets

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