3am musings: where have all the pyelonephritis and GI bleed and heart failure admissions gone? Are they going to come in next week sicker? are our primary care heroes managing with telemedicine? Or will we learn something about who really needs admission when COVID is behind us?
That gut-wrenching feeling when you admit a patient to the hospital with COVID in April who has been eligible for vaccination since January. A missed opportunity: for access, for equity, for education.
When admitting a patient with COVID who โdidnโt have a chance to get vaccinated yetโ and feels miserable, turn them into an ambassador. Ask them to call their unvaccinated friends and family from their lonely hospital room and be a vaccine advocate. It works. Sometimes.
@DGlaucomflecken
Placement in acute or subacute rehab centers. If our physicians and physical therapists who are seeing patients daily think a patient is not safe to go home, infuriating that an insurance โpeerโ feels qualified to make a different assessment. just leads to longer LOS which is $$$
When are we going to start holding insurance companies accountable for practicing medicine without a license? PT and MD seeing patient daily know patient needs rehab after discharge but some โpeerโ reads a single line in a note and refuses authorization. Patient in tears.
Just completed 14 days on service in the hospital. Still testing every admission for COVID. For the first time since March 2020, zero patients with positive COVID tests. Also, >1 year since I have cared for a patient with severe COVID (requiring oxygen).
#VaccinesWork
Hospital medicine: spend half of your day convincing patients they need to stay in the hospital and the other half reassuring patients that they are safe to leave...
One of my favorite things to do after a busy night shift is send an unsolicited email to a residency or fellowship program director giving positive feedback about working with one of their trainees. Bonus points for bcc'ing the trainee.
#academicmedicine
#meded
#wellness
@rubin_allergy
โI know youโve told your story to a lot of people already, but Iโm going to ask you a few more questions to confirm all the details so I can try to get you the right diagnosisโ
@JenniferLeahMD
Cannot tell you how many times Iโve had this conversation with colleagues in academia. Is it enough to โjustโ be a really good doctor?
@pgyfun
I didnโt want to do EM because...I am not brave enough to be simultaneously managing multiple traumas, getting STEMIs to the lab, diagnosing and supporting women having miscarriages, deciding which cough needs to be isolated....then after shift planning my next backpacking trip
@gruntdoc
@AlanaKinrich
Often checked inpatient for patients with unexplained eosinophilia from endemic areas, especially prior to starting steroids which would be done routinely for COVID patients. Strongyloides hyperinfection syndrome can be devastating and easily prevented with ivermectin.
Department of Medicine Grand Rounds
@WeillCornell
- standing room only for the first time in over 3 years -
@Dr_AnthonyFauci
back at his Alma mater, in a generous 55mins imparting as much wisdom as possible
@RJS_med
Itโs called clinical intuition. Keep honing it. Itโs great when we can articulate why weโre worried about a patient, but โthis patient just doesnโt look rightโ will get you very far.
@Caulimovirus
Veto. On patients admitted for strokes, non-withdrawal seizures, appendicitis, SBO from adhesions, knee replacements, too easy for medicine to become an H&P/med/rec/discharge secretary service. We have speciality training and are best suited to manage many medical problems.
This year I am thankful for people who take action to right the wrongs they see in the world, so I just donated to
@AnnieAndrewsMD
's campaign for congress. Thank you for giving our children a voice!
@Dr_Oubre
When I tell people I spend nearly as much time in front of a computer as with patients in my typical day as a hospitalist, so often they ask why I donโt have a scribe. But itโs not just about the writing. That is when my thinking and processing and decision-making gets refined.
@txhealthplans
This is an incredibly irresponsible tweet. Prior authorizations are a barrier to patient-centered care. They serve only to contribute to insurance company profits at the expense of patients. They add waste to the system and contribute to physician burnout.
I'll be honest. My 2yo is still adjusting. But he also sometimes gives us a hard time about brushing his teeth, buckling his car seat, and not eating chocolate for breakfast. It's our job as parents to keep our kids safe and healthy.
Here's the thing: my 9 year old doesn't whine about masks. At all. Just as he doesn't whine about wearing a seatbelt. He knows it what he has to do, for now, to stay safe.
But because data is better than anecdote, here's a quick poll from
@RosenthalHealth
:
Hospital medicine goal: Make the discharge med list shorter than the admission med list (especially for patients >65yo). Why is deprescribing so satisfying?
Excited to share our experience designing and implementing an inpatient vaccination program at
@nyphospital
. Thanks to
@nejmcatalyst
for your interest in the piece!
Leaders at
@nyphospital
faced challenges and successes in offering and administering
#Covid19Vaccines
to hospitalized patients, while addressing concerns from both patients and clinicians:
@RebeccaEBerger
@MatthewCappucci
Walked into a lobby to meet a group for an interview dinner; group was splitting to two different restaurants. Coordinator asked โMexican or Chinese?โ I said โWell my great-great grandparents immigrated from the Ukraineโฆโ before I realized she wasnโt asking about my heritage.
You know you are a meant to be a generalist when you flirt with the idea of going back and doing a subspecialty fellowship every few months...but each time a different one. This month, especially grateful for colleagues in Rheum, ID, Endocrine.
#proudtobeGIM
#HowWeHospitalist
Our institution went live on Epic in October 2020, and the floors/units still sort out of order. Multiple optimization requests, so far I'm told not fixable. My list sorts as "ED-5-4-14-11-10." My 2yo can count to 14, why can't a multi-billion dollar EMR?
@thesavvymd
@mowwyjane
Agree re warm layers for overnight, but itโs not the thermostat itโs your hypothalamus. Itโs called the 3am freezies
@EHahnMD
Had a blast discussing a fascinating case of salicylate toxicity with the
@CPSolvers
Virtual Morning Report tonight (it's morning somewhere?). Pearl: in severe cases, salicylate toxicity can be associated with noncardiogenic pulmonary edema!
Excited to (finally) share the results of our
@MGHMedicine
QI project where we found that hiring discharge schedulers increases appointment attendance. Good for patients, good for residents, good for health system!
Is there anything more satisfying than watching hypernatremia melt away, correcting exactly as you expect after calculating a free water deficit and correction rate? No? Just me?
@DrDanRestrepo
?
#medtwitter
@mike_natter
Get married. Donโt get married. Have kids. Donโt have kids. Donโt smoke and donโt drink. Smoke two packs a day and drink bourbon every night. Hard to know which advice to follow.
If you have been vaccinating please post a selfie๐๐ป!
I was in Queens yesterday and the Armory in Washington Heights tomorrow.
It really is the best antidote to the trauma of the past year.
Thanks for sharing
@BenjaminAbella
@nrgruski
Agree with sentiment (interns have so much to learn from nursing expertise) but must disagree with content. PRN anti-HTN rarely indicated inpatient. In rare cases when necessary, avoid IV. In even rarer cases where need IV, avoid hydral. Medicine consult always happy to help!
@NatMulkey
Took me an embarrassingly long time to understand what a fellow was. Also avoid introducing your PGY1s to patients as "interns," sounds like an unpaid college summer student.
@emily_fri
This is 1000% me. What I lack in encyclopedic knowledge of zebra diagnoses I make up for in obnoxious detail-orientedness and unshakable ability to sweat the small stuff.
because of
@COREIMpodcast
, a patient I admitted last week was cardioverted inpatient. Would previously never have thought to consult. I hope
@ShreyaTrivediMD
and her team understand how important their work is in improving care for patients
1/ ๐จ NEW
#5Pearls
episode: Rhythm Control in A Fib ๐ซ
Rhythm control >> rate control alone, but HOW & WHY?
We dive into why sinus is superior!
Review how to achieve sinus w/ this toolkit โคต๏ธ!
๐ง:
๐ฅ๏ธ:
CME:
@MrsPA_C
Moms who mostly/exclusively pump deserve the medal in my book! I find direct feeding much easier and struggle to find motivation to pump unless I absolutely have to! Most importantly weโre all doing whatโs best for ourselves and our babes.
I cannot justify why it took me so long, but I finally read (okโฆlistened to)
@RanaAwdish
โs In Shock. Absolutely will change the way I practice medicine, parent, and live my life. Thank you for your willingness to share your story to help us be better humans.
@courtneywrites
@clhubes
Both proud and embarrassed that my almost 3-yo knows which of his favorite shows are on Amazon prime video vs Netflix vs YouTubeโฆ.
After hundreds of thousands of lives needlessly lost, I am grateful to see a light at the end of this dark tunnel. I am in awe of the scientists who worked tirelessly for the last year to make this possible. Looking forward to a brighter 2021.
#IGotTheShot
#CovidVaccine
@DrGRuralMD
Iโm 100% supportive of breastfeeding and wish moms had more support on the whole process but WHY does this have to be so negative? Frame it as โbenefits of breastfeedingโ and even a section on โbenefits of exclusive breastfeeding/avoiding early bottlesโ but seriously?
@kjdelay1
I work with fantastic PAs and NPs as part of a collaborative team. I see every patient for whom I am the attending of record, every day. This is physician-led, team-based care and itโs what our patients deserve.
Coming up for air after an exceptionally busy 14 days on service with hard-working
@WCMDeptofMed
residents. In between caring for our complex patients, here are some things we read and learned together
@WCM_MedChiefs
(1/X):
@darakass
@ashishkjha
It's so illogical to me that mask mandates and "opening" are linked to each other. If the goal is to re-open schools, stores, movie theaters, gyms, doubling down on mask mandates would allow this to happen safely.
Got the opportunity again to be a discussant on
@CPSolvers
VMR today. I associate rigors and anorexia with bacteremia - turns out it's been studied! In this paper, normal food consumption had neg LR 0.18, while rigors had positive LR 4.78 for bacteremia!
@callie_mt
Mine keeps asking Alexa to set a timer. For 2 minutes. 4 minutes. 1 minute. When asked whatโs going to happen in 2 minutes, replies โthe timer goes off.โ Logical, if nothing else.
Appropriately cloudy skies on the day I say goodbye to the place I have called home for the last 5 years. It has been the greatest privilege to train and work at
@MGHMedicine
. To everyone who has guided me on this journey, especially to the patients, thank you.
@rabihmgeha
To echo
@andrewdunn111
above โIโm just covering.โ Instead โI am caring for this patient tonight, how can I help?โ Also a la
@rabihmgeha
โIโm just going to do a quick exam.โ Patients donโt want quick. Quick = ?cutting corners. They want thorough and comprehensive!
Lesson from this week on service: it takes way longer to explain to a patient why you do NOT want to give them antibiotics.
#stewardship
#hospitalmedicine
Frustrated by the massive missed opportunity by corporations who spent millions creating SuperBowl ads. Why didn't commercials normalize mask-wearing, distancing, celebrating and working remotely, and getting vaccinated? Too much business-as-usual last night.
#SuperSpreaderBowl
Me: I have a lot of flexibility in my schedule this summer, maybe Iโll try to catch up on some health maintenance like seeing a derm for my overdue skin check.
Dermatology: hahahahaha hereโs our next available appointment!
@DxRxEdu
Today on rounds we managed status epilepticus, reviewed a patients colonoscopy images, discussed an acid/base abnormality, and send off a PNH screen. Oh and of course ordered a lot of diuretics.
Beaming with pride to learn that
@ShiraAnneSachs
was honored by the
@WCM_MedChiefs
@WeillCornell
Medicine residents as the Hospital Medicine Attending of the year. Dedication to the residents, her patients, and her kids - what more could you ask for?
@AnnKumfer
You can discontinue docusate and save a patient pill burden for a day, or you can teach a resident to discontinue docusate and save thousands of patients thousands of unnecessary pills for the duration of the residentsโ career.
@kjdelay1
@soumya_goblue
I remember when scheduling medical school interviews there was one school that I spent hours looking at flight options trying to figure out how to spend as little time there as possibleโฆbefore realizing that was a sign and cancelled the interview altogether.
If youโve ever written โAfib s/p PPMโ in a note (weโre all guilty), take a listen to this fantastic breakdown of cardiac devices for the internist by the always on-point โฆ
@COREIMpodcast
โฉ crew. Thanks โฆ
@ShreyaTrivediMD
โฉ and team!
A day in the life of an off-service academic hospitalist mom in NYC: up before dawn for books and legos, made pancakes, QI project meeting, tackled email inbox, taught med student EBM session, saw Lea Michele in Funny Girl on Broadway, zoom QA meeting
#balance
#offservice
The U.S. COVID experience is paradigmatic of our entire "health care" system. Dismal adherence to primary prevention and public health, breathtaking sophistication and speed of biomedical research, uncoordinated and sloppy implementation exacerbating underlying inequities.
#COVID
Flexing my teaching muscles again for the next two weeks on service with
@WeillCornell
@WCM_MedChiefs
residents! Already two days behind, but
#Twearls
coming at you. Apologies if any are repeats, but my twearling skills are rusty. I'll be back in shape in no time.
Inpatient
#Twearl
Day 3/14
@WeillCornell
: How do you interpret/correct QTc in setting of pacer/bundle causing wide QRS? Multiple published formulas: QTLBBB โ (0.86 * QRSLBBB โ 71)? [QT - (0.7 * QRS - 50)] / sqrt RR? Links in subsequent tweets. Help from
#cardiotwitter
!
@NinoNJ
?
Just stumbled upon my resident evals from this year, my first at
@WeillCornell
. Glad to see they identify my love of teaching, attn to detail, dedication to patient care. But we share frustration that I can't finish rounds on time! Any tips on efficiency (w/o missing details?!)
The emotional roller coaster of maternity leave: baby takes an hour to go down for his 35 minute morning nap, and then you find out a paper is accepted for publication.
#mommedtwitter
#academicmedicine
#womeninmmedicine
A busy week last week on the
@WeillCornell
Academic Hospital Medicine Elective, a unique experience for two medical students working directly with a hospitalist. In between rounds, orders, and family meetings, here is what we learned:
@WeillCornell
(1/X)
When Epic automatically identifies a hospitalist as a patient's PCP......time to invest in outpatient care management/readmission reduction/social support/all of the things that might help keep people from coming back to the hospital.