Yale Traditional Medicine Residency Program @TradIMYale Twitter profile

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

Shout out our brilliant #InternalMedicine residents presenting work at national conferences🎉! From cardiology to rheum, from GI to bioethics. Our residents can do it all! 🔬 Students and residents: check the thread for upcoming conferences that still are accepting abstracts!

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

Ever seen a patient's med list grow and grow? Come read a case presented by Justin Dower, PGY-2 resident and CT-ACP awardee. Justin recently presented this case which showed a classic example of a phenomenon called the "prescribing cascade". Read on! 1/n #PrimaryCare #MedEd

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

Coming soon to a hospital near you! 🌟 Big congratulations to all of our incredible Yale residents on this momentous Match Day. From fellowship to chief years, to hospitalist and primary care stars, we couldn't be prouder of our outstanding Internal Medicine crew! 🏥💙 #MatchDay

Mark D. Siegel

@MarkDSiegel1

6 months

So happy for our @TradIMYale residents who matched into fellowship today! Here's our list of Traditional @YaleIMed residents who are entering fellowship and GIM fields. Congratulations to all!

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Yale Traditional Medicine Residency Program

@TradIMYale

7 months

Do you have a conceptual understanding of hematuria? Check out an approach generated by one of our own residents compiled from a series of resources! It covers considerations for emergent hematuria, management differences between gross and microscopic hematuria, and more! 1/10

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Yale Traditional Medicine Residency Program

@TradIMYale

4 months

#Match2024 applicants! Meet one of our star residents Rachel! Why did she choose Yale IM? "The culture! The people...Yale is truly unique in that it is a highly respected academic program with vast amounts of world class research that maintains a welcoming, supportive community."

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Yale Traditional Medicine Residency Program

@TradIMYale

7 months

Hi all! We lost access to the old Twitter account. Please follow us! We are the best resident-run Yale IM traditional residency program account on this entire app

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

🩸Did you know studies show thrombophilias 🔼your DVT risk but not DVT recurrence? PFOs 🔼 stroke but not stroke recurrence? Smokers having a better prognosis post-MI than non-smokers 🤯? These observations can be partly explained by something called INDEX EVENT BIAS!

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Yale Traditional Medicine Residency Program

@TradIMYale

7 months

Some pearls on hyperkalemia: Do you have a framework for figuring out the etiologies? Things to consider: is it real (pseudohyperK), decreased excretion of K, cells breaking open, and things that influence compartmental distribution of K #MedEd

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

#match2024 #MedTwitter #MedEd

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

@kaushik_ramya @AyeshaButtMD @ASanchez_PS @MDVictorJimenez @evivemmou @LAMoreMD @EmilyMossMD @KevinWheelockMD @marywhite_md @YaleIMed @MarkDSiegel1

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Yale Traditional Medicine Residency Program

@TradIMYale

7 months

Share your thoughts on this approach! How do you conceptualize this as an internist? #MedEd #MedTwitter

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

One of the most influential papers on this topic was published in BMJ by Rochon and Gurwitz.

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

As a result, he is thrown on furosemide -- this leads to a decline in his potassium levels and patient is started on a potassium supplementation tablet. This is a classic example of the prescribing cascade!

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

Patient develops symptomatic orthostatic hypotension. In order to make it easier for him to tolerate physical rehabilitation, the primary hospital team starts him on fludricortisone. He then develops scrotal edema and lower extremity swelling...

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

In his presentation, Justin points out that continuity of care and thorough primary care can serve as an additional layer of protection against this phenomenon. This is especially important because patients will often transfer between hospitals, subacute, and outpatient settings!

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

We start with a case: Justin sees a patient in clinic. He recently presented to the hospital with systolic BP in the 220s with signs of stroke concerning for hypertensive emergency. For his chronic BP regimen he is started on carvedilol, and that's where the cascade commences...

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

The prescribing cascade refers to a phenomenon where an adverse drug reaction is misinterpreted as a new medical condition. As a result, prescribers recommend an additional drug to treat the adverse reaction of a previous one.

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

In their paper, they point out three common examples of prescribing cascades.

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

Thanks for reading along and I hope you'll be more wary of considering adverse drug reactions as part of your differential and to think twice before prescribing a new med, especially in our geriatric populations! #Polypharmacy

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

So what ended up happening? The patient was slowly deprescribed antihypertensives to good effect other than losartan (for which he was given a dose increase). At Justin's clinic, there is a remote BP monitoring program that helps faciliate this in conjunction with telehealth!

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

Justin's resident primary care clinic is at the Fair Haven clinic, a FQHC that serves the multilingual communities in the surrounding areas regardless of ability to pay. This is one of multiple clinics that Yale residents can parttake in during their immersion blocks! #match2024

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

So what's the solution? Rochon and Gurwitz point out some potential solutions to mitigate this phemenon.

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Yale Traditional Medicine Residency Program

@TradIMYale

4 months

Read more about Rachel here:

Resident Roundup: Rachel Thompson, MD

Meet Rachel Thompson, from Minneapolis, Minnesota. She attended University of Minnesota Medical School, and is a PGY-2 in the traditional internal medicine

medicine.yale.edu

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Yale Traditional Medicine Residency Program

@TradIMYale

5 months

@AbushoukMD @YaleIMed @MarkDSiegel1 🌟Star🌟

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Yale Traditional Medicine Residency Program

@TradIMYale

7 months

What meds can influence potassium levels in the blood?

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Yale Traditional Medicine Residency Program

@TradIMYale

6 months

So no: we shouldn’t gasp a sigh of relief when our DVT patients actually have an underlying thrombophilia, we shouldn’t encourage people who just had a heart attack to smoke, and we shouldn’t puncture holes into hearts of people who just had a crypotogenic stroke…

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Yale Traditional Medicine Residency Program

@TradIMYale

7 months

10/10

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Yale Traditional Medicine Residency Program

@TradIMYale

7 months

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Yale Traditional Medicine Residency Program

@TradIMYale

7 months

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Yale Traditional Medicine Residency Program

@TradIMYale

7 months

@ASanchez_PS @Mark_Heslin @GlassHealthHQ Appears to be an evolving area! Check out this 2023 JAMA Review. It comes with proposed management algorithms and compiles different treatment approaches based on cases series/expert recommendations