Father of 5๏ธโฃ | Urologist
@laheyuro
| Associate Professor | MIS robotic oncology | ๐ธ wannabe | Personal finance rants | Building
@wellprept
๐
๐๐๐คฃ
If you need a good laugh today...
Medical academic scams are now the new normal.
You can imagine my delight at the invite to be plenary speaker at the 4th International Conference on Urology and Renal Health.
๐ฟ๐ฟ Grab some popcorn and happy
#DoctorsDay
๐ฟ ๐ฟ
โ โ โ
If your hospital/clinic uses EPIC, and you don't know the command 'Control + E'...
...then you may be missing out on a major productivity hack.
๐งต
Some attendings want a lot of information in the middle of the night.
I'm not one of them.
โ๏ธMy ideal call:
Resident: "Stone. Stent."
Me: "Tonight?"
Resident: "Yes" / "No"
Me: "On my way" / "Goodnight"
Reviewing outside records.
Late career MD.
Likely dictating into a dictaphone -- each visit was 4-5 sentences.
Called pt by first name, described what was going on in their life, w/ pithy summary of clinical picture.
It was such a beautiful thing.
What we have now is worse.
Making room for what's important, rather than what seems urgent.
I blocked off 90 minutes during clinic today and went to be the 'secret reader' at my youngest son's kindergarden class.
This was my last opportunity to be the secret reader.
I'll remember this day as one of theโฆ
DV5 from
@IntuitiveSurg
first case, first impressions.
I have parts of my DNA that force me to be a baseline curmudgeon. Still, it's a clear improvement and overall I'm impressed!
Here are some top level thoughts:
1. I can finally sit up straight: Ok, this is the thing I'mโฆ
I love my job.
Yes I sometimes complain.
#Burnout
looms on occasion and I fend it off. We are overburdened and over-moused and over-clicked.
But we canโt forget who itโs all for: our patients. It is tremendously worthwhile.
#MondayMotivaton
(posted w/permission)
if youโre still describing hematuria in terms of beveragesโฆ
๐ฉธโผ๏ธ๐ท
Consider this grading scale instead which really simplifies communication.
(I have to dig up the reference)
Hereโs neat (minor) modification to help pass a wire from a sheath with no assistance which I borrowed from an IR colleague
Put the sheath on your wrist/forearm like a giant bracelet
@Urology_tips
#urotipsandtricks
๐ Asking ChatGPT to write a Seinfeld bit about Urology is pure gold:
โYou know, Iโve been thinking about urologists lately. These are the doctors who specialize in all things related to yourโฆ โequipment.โ And let me tell you, itโs a fascinating profession.
First of all, youโฆ
The AUA choosing wisely campaign could use a facelift.
Hereโs my proposalโฆ
Know any of these characters? ๐
Retweet your favorite, or the whole ๐งต
#tongueincheek
#littlemissmemes
Urologists!
I created an online IPSS survey that patients can use to see their score.
It doesn't record their score (didn't want to invoke HIPAA) - it's for their own educational purposes.
Feel free to use it! ๐
#urotwitter
๐๐ฝPatient:
Are the lymph nodes being sent for biopsy?
๐๐ฝMe as new Attending:
๐Well, kinda. The whole sample of nodes is being looked at under the microscopeโฆ a biopsy is a piece of a larger thingโฆ ๐
๐๐ฝMe 14 years in:
Yes. They will be sent for biopsy.
@Dr_Oubre
After surgery, when spouses/partners both present
โWhat are my limitations, doc?โ
โNo household chores for 10 years!โ
๐๐คฃ
๐ฅ ๐ฅ
Then go to your note, hit Ctrl+E in blank space, the board pops up, and you can sequentially paste ๐multiple items into your note.
Think of this part as dropping all the breadcrumbs you picked up while reviewing the chart.
Desperately trying to convince a patient today to choose surveillance for low risk prostate cancer.
Showed the joint
@AmerUrological
and ASTRO 2022 guidelines.
This statement did it: "It's like you have a hang nail, and you want me to cut off your arm."
See you in 6m w/PSA.
MRI-based screening reduced the number of both lifetime biopsies and overdiagnosis by approximately 50% and had a high probability of being cost-effective than the traditional PSA screening.
From
@JAMA_current
Remember when you used to say, "Hold this for a quick sec?"
First actual experience with CystoAssist from
@MediflexSurg
Made me wonder where this thing has been all my life.
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One of the most powerful EPIC features occupies <1% of the pixels on the screen.
Nobody taught me about it during training.
That feature is EPIC SEARCH.
Let's dive in.
This is the second installment of
#EpicShortCuts
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What's Control E?
The EPIC Pasteboard.
It's Copy/Paste, but 10 things can fit on the clipboard, which "remembers" all of the copied snippets you chose (even if they contain images).
@AlexStanek
@MittRomney
This is an overly simplistic take. Vast majority of depositors are startups, not tech billionaires. They had their money in a business checking account at a top 20 bank. You want to penalize them for not splitting into many accounts to keep under $250k for a near never eventโฆ
Humbled that
@Dr_Oubre
mentioned me yesterday.
Been kind of a wild ride
My twitter ๐คฏ in the last 24h
Have dozens of EPIC
#EHR
tips in the works for all of you
(In addition to my usual snark, gummy ๐ป mentions, personal finance rants, and cynical urology ๐ takes)
๐
@okusanyamd
Never pay more than 20%% fees.
Index funds > active management.
Pay yourself first.
Time in the market > timing the market.
Term life > whole life
Live and enjoy life > extreme frugality
So, Iโm doing a right robotic partial nephrectomy.
Kocherize the duodenum, expose lateral border of cava,
Onto the psoas, marching up to hilum.
ID the renal vein. Then Iโm about to dissect out the artery and this recaptcha pops up on the console.
I swear Iโm not a robot
When patients allow you to operate on them, they are entrusting you with their lives. It's an incredible privilege.
Don't let the administrative burdens of everyday practice overshadow that reality.
Office consult: 87F with a 5cm Bosniak 1 renal cyst.
It was a lovely visit, and I enjoyed the conversation.
HOWEVER, if we had value-based care, such a visit would never occur.
It's incredible that with the $$$ on EHRs nearly none of it prevents such low value care.
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Back in your feed with another
#EpicShortCuts
for this week
โจ Typing = necessary
โจ Lots of typing = bad
โจ Decreased keystrokes = good.
Enter USER DICTIONARIES. ๐ฎ
(HT
@gorejohn
)
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So as you prepare a note - poke around the chart, highlight all the crumbs you want for your note, and hit Ctrl+E.
For example:
-The date of the CT scan, the scan title, and the impression (highlight just those, Ctrl+E on each)
-Your Op note date, name of procedure
-etc
๐ฅณ๐ฅณ๐ฅณ
The future sure is bright!
Here's a sampling of some of the
#uromatch
#auamatch
photos so far.
Do you see yourself here?
Congratulations to everyone!
๐ฅณ๐ฅณ๐ฅณ
Possibly unpopular opinion:
Healthcare workers don't want videos of celebrities and sports figures saying 'thank you'.
โ They want adequate PPE.
โ They want hazard pay.
โ They want safe working conditions.
โ They want access to testing.
โ What else? ___________ (comment below)
@AndrewHarris_MD
@m_e_nielsen
@AmerUrological
๐ถ Typical response to mitigate burnout (all sincerely well intentioned):
-create a wellness or serenity suite
-free massages
-appoint wellness officers and a committee
-resiliency training
-team building retreats
-stress management workshops
-recognition and reward programsโฆ
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Next up in our
#EpicShortCuts
series tweetorials...
How can you leverage SmartPhrases to practice evidence based medicine?
#EBM
Easy.
Just create this habit: read something you like -> turn it into a SmartPharse and USE IT.
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Has anyone tried
#chatGPT
for journal club?
@anobelodisho
Feed it a dropbox link - it instantly digests the PDF and spits out whatever you want.
A summary? Key points? Discussion questions?
Seeing a single clinic patient:
- prep the chart
- source all relevant information
- see the patient
- establish rapport and trust
- examine the patient
- bring patient up to speed
- develop and communicate the plan
- answer questions and ensure alignment and buy-in
- order allโฆ
My wife gets each kid a completely different brand of underwear and socksโฆwhich makes sorting laundry so much easier.
๐ฉฒ๐ฉฒ๐ฉฒ๐ฉฒ๐ฉฒ๐งฆ๐งฆ๐งฆ๐งฆ๐งฆ
and I think this is genius. ๐
And if you think itโs basic and obvious for big familiesโฆ well, then, I think youโre a genius too.
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In the next edition of
#EpicShortCuts
tweetorials designed to
#HelpFutureYou
This one occupies so few pixels it may easily go unnoticed. It almost looks decorative.
It's BOOKMARKS!! ๐
๐๐๐๐๐๐๐๐๐๐
๐ช
Ok
#AUA23
I like how this list is shaping up.
As you can see there's room for everyone here.
Raise your hand oh you cast-offs, you laggards, you misunderstood, snarky, and politically incorrect.
I'll keep making the font smaller and smaller. The list has no limits.
Theโฆ
โWhat do you do?โ
โIโm a Urologist.โ
โOh, Neurologist, cool.โ
โNo, URologist.โ
๐ถ
โUrinary tract in men and women, reproductive system in men.โ
๐ถ
โPenis doctor.โ
โOH, Urologist, right.โ
"What do you do?"
"I'm a pediatric ER doctor."
"Ooo, that must be so hard. I don't know how you do it."
"I give out a lot of popsicles."
"Can I ask you a question? My grandmother had a stroke..."
"Does she want purple or red?"
We love to bash our EHRs but EPIC has some pretty cool AI integrations in the works.
I got a sneak peek.
Anyone already have this at their institution?
#EPICEHR
#HealthcareAI
Doctor: please renew your fluoroscopy privileges annually, by taking this quiz. Yes this is the same quiz that has not changed in 20 years.
Every year this paper cut happens, and I'm dumfounded.
Why do we stand for this? Isn't there a better way?
#WeAreSheep
๐๐๐๐๐๐๐
๐ทOne hospital location where I work lifted the mask mandate.
Putting aside whether masks are or aren't important now...
It was a huge relief to be able to finally see patients' faces. It seemed so much easier to make a connection, forge a bond, etc.
Anyone else feel this way?
Nothing we do is simple or completely benign. Nothing is risk free, nor predictable.
Recent patient, hydrocelectomy.
Postop pulmonary embolus.
#humbling
โ๏ธ Unless fighting for overhead storage space, why do people rush to get on the plane?
I wanna be last on.
Not interested in sitting there any longer than necessary.
Clearly I am in the minority.
๐ซ
When you do an HEENT exam make sure to say "normocephalic" every time. Because one or twice in the next 40 years you may see microcephaly or macrocephaly. You never know.
#MehTipsForNewDocs
@Robodoc38
Or, record video explanation of the surgery answering (most) of these questionsโฆ put on youtubeโฆ and share with this and every future RSP patient. Will take 15 mins once.
Dear SiHD,
Weโve been through a lot together since โ08.
You never let me down (well, except for that one time... and that other time... and those other times...).
You mostly never let me down.
I will miss you and all your dead pixels, and your adjustable focal length.
xo
D
It's the moment you been waiting for...๐ฅ
Check out the Who to Follow Guide before you head to
#AUA22
in New Orleansโผ๏ธ๐
#UroSoMe
Start planning your trip nowโก๏ธ
@kjdelay1
Except Iโm sending a tsunami of expired EPIC orders into the future.
I make them all โy+50โ
They may not remember me, but that ripple will be felt!
Learned something from the
@LaheyUro
residents today
Duette catheter. Double balloon less traumatic on mucosa for chronic SP tubes with gross hematuria
A milestone worth celebrating! Lahey's
#RoboticSurgery
program has reached 10,000 total robotic operations with the da Vinciยฎ Surgical System since 2006, ranking in the top 10% nationally for volume.
Congratulations to the entire team!
@Dr_Oubre
Yes but only IF they grasp that itโs a profession in which you gain no equity or ownership (for the most part). Work as hard in your 60s as in your 30s if similar income is desired.