I was misdiagnosed with brain damage at birth & put up for adoption. My mother climbed over the walls of the facility & stole me out. “Your only child will be stupid.” They said when they caught her. She signed the papers. My mother gave me life twice. I give her everything I am.
During a skin exam, the patient told me they had HIV. I acknowledged it and kept inspecting the skin, some areas with my bare hand. Patient teared up and thanked me for not “jumping away” as soon as I learned they were HIV positive. It’s 2022. HIV+ people are not dirty.
"One more thing," the patient says, right when I'm about to exit the exam room.
I used to be annoyed by it. Until one day, a patient's "one more thing" was actually "the" thing she wanted to say. But she needed to feel me out and make sure I was a safe person first. So, I sat
A patient told me he was using the medications as directed,but later told my attending he wasn’t using it because he couldn’t afford it.With tears in his eyes,he said to me:“I’m sorry I lied to you.”🥹Standard of care is irrelevant if the patient has no access to it.End of story.
When I was 10,I gave my school lunch to a kid who couldn’t afford food for a month.Just 1 month.20 years later,I got into meds school & couldn’t afford tuition.He reached out to offer lending me his savings.“Because you helped the trash collector’s son.”Happy
#Thanksgiving2022
.
36 years ago, I was misdiagnosed with brain damage at birth & put up for adoption. My mother climbed the hospital walls & stole me out. “Your only child will be stupid.” They said when they got her. She signed the papers. My mother gave me life twice. I give her everything I am.
“Where’s home?” People ask me.
10 years ago, serendipitously, me, a girl from Beijing, came to live in a small town in New Hampshire. My landlords are an old couple, who didn’t just take me into their home, but made this little place in the mountains home FOR me.
Medical
97 years ago, my great grandmother walked by a new mother’s open window in a cold winter morning and saw that she was trying to freeze her baby to death.
Turned out, the pregnant woman came to Beijing from far away to look for her husband. But he was already sent to war, and
Note: I do NOT think people with brain damage are “stupid”. The quote does not reflect my view (I was a baby) and this happened 30+ years ago in China, during the One Child Policy generation. 🥹❤️ Also I turned out ok. Thank you. 🥹🥰 Happy
#MotherDay
!
Note: "The patient is noncompliant with her insulin."
Reality: The patient is staying at a shelter. She has no control over her food. Insurance won't pay for more insulin for it's too soon for a refill. Her current insulin supply is at her abuser's, from where she just escaped.
Almost 10 years ago, I did my pediatrics rotation on the Navajo Nation. Years prior, I had read about fry bread in Reservation Blues, and what it meant to the indigenous people in AZ/NM. But I had never tasted it, until I came to Window Rock, in this little shop called “Grilled
A patient told me that each time she had major surgery, during the recovery period, her domestic abuse got worse in many ways.
This is a good lesson for all of us in medicine. One of the pre-op exam questions should be: do you have a safe place to recover after surgery? ❤️🩹
Disclaimer: before I touch a lesion without gloves (non-ulcerated, non-bleeding, non-purulent, non-draining, of course), I always ask the patient if I could.
Things I was taught throughout my medical training that I've stopped believing:
-patients lie to get what they want
-patients are unreliable
-10 out of 10 pain is rare
-patients who don't get better are non-compliant
-patients who don't get better have psychiatric problems
-the
“Why don’t ants get sick?” My patient with dementia asks me proudly each visit.
“Mmm. Why?” I show great curiosity every time.
She pinches her fingers together & says: “Cuz they have these — teenee — tiiiiiny — antibodies!”
And we laugh wholeheartedly. It never gets old.🥹🥰
A patient brought in “bugs and larvae” from her hair. Even though she was found to have delusions, the experience & pain are real. Outside the room, I heard mockery of her. “Folks, it’s just another condition we treat.” I stopped it. Patient mockery is harmful. It has to stop.
Today’s lesson for everyone: don’t get a Chinese tattoo before you consult your trustworthy Chinese friend.
Today’s lesson for me: don’t interpret people’s Chinese tattoos for them, even if they insist. 🫠🫠
Today was an emotional day in clinic. And here are how people amazed me, taught me, and humbled me.
1. A young women with a gang-related tattoo said today she’s an advocate for children with broken homes. “Just because you come from brokenness, doesn’t mean you have to stay
It took me an entire year to get a patient's Hidradenitis Suppurativa under control. We both cried when she finally got better. When I graduated, she ran across the parking lot to hug and thank me. Yesterday, I learned the nationwide Medicaid disenrollment dropped her insurance
I’m a professional woman in my mid 30s and I just got laughed at by a woman in first class on a plane for wearing a mask. I’ve worn a mask intermittently since I was 12, depending on the weather and my health status. This was a first for me. 👀🦭🤯
Recently I interviewed for a job in rural Oregon,after I said Hi,the recruiter said“I’m so sorry,this position was meant for a male provider!”
Why exactly is a practice looking for only male docs?And can I have this in writing to document this illegal & massive waste of my time?
A few years back I declined to take on an extra duty at work on a voluntary basis, and a colleague told people “she won’t help people unless she got paid.” I confronted that person for attacking my character and accepted their nonapology (reluctantly).
Recently, I was asked to
I don’t care what you think of family medicine,the amount of work we do alone demands respect. On day “off”,I spent all day catching babies & rounding on patients.We only stepped up during pandemic. So yes,us country doctors will take a round of applause.Thank you.
#FMRevolution
In my gym right now, a family is forcing a young girl to strip to underwear & weigh herself, then put on sweats to run & jump, rinse, repeat.
I’m shocked. I want to tell the parents to back off & leave the poor girl alone. Her body isn’t damaging her. Your hate is.
Should I?
My patient was crying when I walked into the exam room. She went to schedule an urgent test for cancer. The staff was rude to her & sent her away. We called on her behalf and got her in on the same day. People come to us in healthcare already broken. Enough with the rudeness.
Sent a patient to the ER, called the hospital, called the consultant, & wrote a detailed note. Still I’m worried she might be dismissed and sent home. So I called her to “coach” her what to say. “I’m sorry you have to advocate for yourself while in pain.”🥺I hope she’s believed.
I’m a family doc,in a small rural town.Last night,the ER asked me to help see patients because they were overwhelmed with stabs and gunshot wounds.I came in,only to have the hospital lock down due to active gunman.I salute to my ER colleagues.And I ask:where can we feel safe?
Haha guys I’m happy to report! My mama loved it! (She promised me she can make this at home for me too so we will see if we should enter a fry bread contest 🥹🤣).
Disclaimer: this post refers to a systemic issue regarding the culture of medicine all around the world, and is not an assessment of the specific training programs I personally attended. Any attempt to veer the discussion toward the latter misses the point.
In a country with 330 million people, at least 7.8 million Medicaid enrollees have been disenrolled as of October 2. That is 2% of the population. Is "what a dick move" professional language?
Wow this tweet has received so much love. 🥹 I’m going to share with my mom (when she wakes up, she lives in China🤣🥰). I think I will include the full version of this story in my first newsletter. You can join here (if you want🤓):
“How would they know what symptoms they have?” A colleague scoffed.
Let me say this louder for those sitting in the back.
👏Patients know their bodies. 👏Patients know their symptoms. 👏Patients know how they feel. 👏More importantly, patient know how you make them feel.👏
Can’t disclose what happened to the patient for confidentiality but let me make everyone feel more satisfied with this story:
Friend of mine thought he tattooed 混沌 which means Chaos. Ended up getting 馄炖 which says wontons…🫠🫠🫠🫠
MONTHs ago, I saw a young patient who lost all her hair one day. And as someone who developed alopecia areata ophiasis and lost all her eyebrows and hairlines, I KNOW I needed to act fast.
So far, this is the despicable game we have been asked to play with coordinated care:
-
#MedTwitter
&
#FMRevolution
community,I’m a rural fam doc. Today I had my 1st emergency breech delivery. It was scary.After resuscitation,I went to wash meconium off my arms,shaken,wondering if I’m cut out for this.Then I saw mom holding baby & dad gave me a hug. ♥️Take heart.♥️
Twitter had me take down my last post about Hidradenitis Suppurativa because it was too gory.
If the image of the patient's skin with HS is too gory, how do we describe the insurance company that denied her gore-preventing Humira?
Here is the original tweet without the image:
@BassoonYsu
Wow 🥹🥹 thank you for sharing your story. Also we must stop defining people’s fate in medicine. “You will never get pregnant”, “you only have 3 months to live”, “she will not be smart”…this isn’t a 1980s TV show 😣😣😣😣
In my opinion, it’s unethical for insurance companies to:
- decide what medications are best for patients against medical advice
- require the patient to only fill their medications in certain pharmacies they can make more money from
- automatically reject prior authorizations
If you received this bribe from your friendly Chinese neighbor, would you let your dog come and play with their dog in their yard? Asking for a friend. 👀
When coming on board a new job, I was asked to explain why there is a "gap" between fellowship and the planned start date. It's a period of 3 months.
Since 11 years ago, when I started medical school, I've never had a prolonged period of break from medicine. The pandemic
Got a text from an old friend. 🤬
F: When will you start a family?
Me: I’m intentionally child-free.
F: What kind of legacy do you plan to leave?
🤬A woman’s value is once again reduced to her baby-carrying capacity. Is this 2024?🤬
How should I say? Savage answers only. 😅
When I was 10,I gave my school lunch to a kid who couldn’t afford food for a month. Just 1 month. 20 years later, I got into meds school & couldn’t afford tuition. He called to offer lending me his savings. “Because you helped the trash collector’s son.” Happy
#thanksgiving2023
When I was a kid, my mother would buy me McDonald’s each weekend after swimming lessons. It was the highlight of my week. (McDonald’s was considered luxury in the 90s in China.) Today, after taking my mother swimming at the Y, I got her…a large order of fries! 🥰🥹
Mother of 4 asked me to write her a note to excuse her from doing any housework after our “major surgery”. And I’m here for it.
(I took out a little cyst.)
🤣🤣🥰
In the face of suffering and resentment toward the medical community, how do I earn trust?
Yesterday I stayed in clinic an hour late with my last patient. I was fairly certain I knew what they had but because they have been “kicked around by different doctors,” they didn’t trust
@_FlawlessPage
Not always explicitly, and not always in the form of a lecture. But these are some common, insidious, day-to-day beliefs many hold. And everyone in medicine teaches.
Insurance companies, how about you DON’T tell me this little kid, whose skin is falling off with severe eczema and miserable day and night, needs to try some small tube of cream first before you’d pay for a life changing injection medication?
On this 🧵, here is my calligraphy from 2016, gifted to my nephrology attending that said: “acute kidney failure”. Please don’t use this as a tattoo but at least it’s good penmanship. 😊
A medical student I mentored before, who is now a resident, texed me: "The student cried when a patient died. I was the only one who debriefed with him. Sometimes, I don't understand medicine."
Me, proudly: "I think, this time, you are the only one who understands medicine."
My note: Drug A made patient’s condition much worse and is contraindicated in this condition. We will give Drug B which is first line treatment.
Insurance company: Denied. Must try Drug A.
🫠🫠🫠🫠🫠🫠🫠🫠🫠🫠🤬
Fellowship threw my parents and I a big party and I am🥹.
Attendings to my parents: “Zed is one of the best fellows we’ve ever had!”
My mom: “Ok at least she isn’t the stupidest.”
Attendings: “She is so hard working!”
My dad: “Ok good so she made herself useful.” 🤣😅
Today I turned 36! That’s three whole Chinese zodiac cycles! In my younger years, I wanted perfection. Surprise! Nothing about me has turned out to be that. But somehow, I’m perfectly ok with these imperfections. I think, in a way, that’s exactly where one wants to be at 36. 🥹
That patient whose appointment was delayed because my day was so hectic with multiple emergencies, who not only didn’t get mad, instead had a great time reading their book while waiting, but also was excited to see me and asked about my day: you are my MVP. ❤️😭🫰
#MedTwitter
THIS is my mom’s fry bread!! (A common breakfast item for Beijing folks.🥹🥹🥹) THIS is what home tastes like. Im forever thankful for fry bread everywhere. 🥰🥹
Brought in a male student to show him a rash, and the patient immediately started only looking to him for answers. This isn’t rare.
Women doctors are 2x more likely to be called by first names by patients, yet often they produce better patient outcomes.
See women physicians.
I wear rainbow often both professionally & leisurely. Many of my patients feel much safer without having to voice it. Once at a restaurant in Texas, a young kid came to us in tears, asking if we could help them find LGBTQIA+ friendly community. We listened, talked, and hugged.🏳️🌈
@WilliamMoore175
@Mickolas9
@parden04
@GuyLambertUK
The pride flag, on a lanyard, for instance, is experienced as a political declaration by patients. It does not belong in a professional, ethical doctor-patient relationship. The patients, who are often hurting, terrified and anxious, should not have to deal also with our
The elitism and disrespect in this tweet is embarrassing.
How about we admit we aren’t the only healers out there, and STOP throwing shade?
Without pharmacists, “real doctors” would harm many patients. Chiropractors do the hard work we don’t know how to do. The list goes on…
IT guy came over to ask what his baby can take for constipation.
“Have you tried turning the baby off then back on?” I asked.
🤣🤣🤣🤣
(He deserves that one.)
The delivery guy came in at the right time for my mother to feed him lunch. (No one escapes my household without food.) He said he would try to make our route around noon each time. I think that’s very wise. 🤣🤣🤣
A male colleague (who is younger than me) called me a “young girl” in front of a bunch of staff.
It’s cuz you look young — they say. No, I look as old as my age. The universal perspective has just been dominated by non-Asian standard.
It’s cuz you are so nice — they say.
This month, I’m starting a new job where I am a physician leader. So I set some goals for myself and my team:
1. Believe the patient. Every time.
2. Cultivate a team culture that NEVER blames the patients.
3. Treat everyone with equal respect and call ourselves out when we
Found out that a previous colleague was spreading false rumors about me at work and I couldn’t figure out why. But after dwelling on it for a while, I decided to not let it bother me any more.😠 It’s prolly because we too fab, anyway. 🤣❤️
Sometimes people are surprised when I curse. So, here is one:
If insurance companies can go eat shit, that would be great.
Thank you for attending my curse of the day.
Before this tweet goes further “viral”, it’s worth pointing out that this incident happened a while back, and does not reflect my current work environment. My current position is where I learned how to approach patients with this disorder with respect and dignity.
After learning my return to New England, my old landlord sent me a photo of my studio, inviting me back. Med school was hard. This little haven in the white mountains by the river gave me comfort. “If you prefer, we can find your old bed for you.” I am there in a heartbeat.🥹❤️
I am honored to announce that I have been selected for the NERFC Fellowship offered by the prestigious Massachusetts Historical Society
@MHS1791
! I will be in the historic libraries at Harvard, Brown, & Smith College to work on my book project this fall. Feels like a dream!🥹❤️
I was walking down the street when a man made a loud noise and sudden movement toward me to scare me. When I was startled (as one would be), he laughed and walked off.
This type of toxic masculinity behavior is profoundly misogynistic and perpetuates the societal rape culture.
I do miss being a country doctor. I took pride in NOT sending people to the ER (still do). I admitted, rounded, discharged, and followed up on patients myself, all in addition to running a clinic and delivering babies. Now I feel somewhat powerless in a larger system. 💔
"Your constant light reminds me of my sister (who passed away), so I trust you." A patient wrote me. And I am in tears.
A severe skin condition has left a patient of mine in constant struggle. To his requests to be seen on the same day, I've never said no. How can I? We either
Our flight was delayed today and lots of people were late for their connection. The attendant suggested everyone stay put and let those who had connections go first. When the time came, NO ONE got up except for those who needed to run. Wow, well done, good humans!🫶🫶🥹🥹
My note: "The patient has severe refractory HS. Humira is FDA-approved for such HS cases. The patient is a good candidate for Humira."
Insurance: "Denied. Prescribed doses are too high for psoriasis."
Is HS too gory to be believed? Or is my note with images too gory to be read?
Couldn’t find Moshi Moshi this morning. Turned out, after coming in from the snow, I didn’t wipe her precious paws clean enough. So she had been waiting by the three lab bench on the towel, aka paw cleaning station, this whole time. 🤣🤣🫠 My bad.
After a LONG battle with the insurance company, I finally got a patient’s biologics medication APPROVED! 🥹 The patient and I are so happy. We needed some good news today. 🥹🥹❤️ Here are all the steps we took:
-tried and failed multiple medications including IV med
-had