No longer here You can find me on bluesky with the same handle
Indianapolis, IN
- Tweets 39,893
- Following 7,472
- Followers 31,017
- Likes 41,207
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Academic decision algorithm v 7.0- a testament to #SocialMedia peer review, as all versions past 1.0 were improved upon by feedback from colleagues on @twitter. This edition improved by @JRandallCurtis1. There is a descriptive publication here somewhere...
#MedEd #MedTwitter
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HOLY CRAP I AM BEGGING PEOPLE AS AN ICU PHYSICIAN TO PLEASE PUT MASKS BACK ON AND STOP ACTING LIKE LIFE IS BACK TO NORMAL THIS IS WORSE THAN DECEMBER AND I DIDN’T THINK THAT WAS POSSIBLE
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“Welcome to the first day of school everyone. Let’s do introductions.”
My name is Dan
“Ooh it says here ‘Daniel’”
I go by Dan
“OK I’ll have to call your parents and let them know”
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"I see a lot of vaccinated people getting COVID so what is the point?"
The point is these people aren't in the hospital.
That is the point.
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You know what is magic?
Parchment paper
It won't burn in the oven
Stuff won't stick to it
It's frickin’ magic and we don’t talk about it enough
Kudos to parchment paper
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Them: I saved the document in Teams
Me: Great just send it to me I don’t have the emotional wherewithal for a scavenger hunt
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WARNING FROM AN ICU PHYSICIAN
Looks like this winter may be the worst surge yet. The only patients I have cared for in the ICU in the past weeks have been unvaccinated.
If you have not been vaccinated, now is the time.
If you are due for a 3rd shot, get it now.
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This letter signed by over 500 Hoosier physicians expresses disappointment with the treatment of Dr. Caitlin Bernard and was published today in the @indystar
This affects the entire house of medicine
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I am an ICU physician who makes life or death decisions but also tied my scrub pants too tight and almost wet myself just now trying to get them untied
I'm complicated is what I am trying to say
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I’ve been a physician now for 20 years
I’ve never seen polio
Not once
This is because of vaccines
And in the 1950s leaders all realized the importance of public health
We can get back to the mindset that we are all in this together
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Thursday I get the pleasure of a peer to peer call with an insurance company to appeal a denial for the ventilator my patient has used for the last 3 years
Yes, reader, you read that right
Their VENTILATOR
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The contrast between life outside of the hospital (looks pretty normal around here) and what is going on inside the hospital (like nothing I have ever seen) is stark.
People have no idea.
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Really? For me the most disturbing image was the husband and wife who died of refractory hypoxemia in the same ICU on the same day but to each their own I guess
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This tweet has gotten a lot more attention than I expected
For those of you not from Indiana, this is the result of House Bill 1608, which passed earlier this year with this (poorly written and poorly intended) language
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The HPV vaccine literally prevents cancer
Get it for your teenagers 100%
Even the boys
Don’t listen to grifters jUsT aSkInG qUeStIoNs
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Today I heard a resident say "Being a good physician is just being a good human with medical knowledge" and this nails my philosophy exactly.
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FMLA doesn't kick in until you have been employed for 1 year because family emergencies don't happen in the first year of employment so it is really good policy
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Come to Indiana.
Happy to show you through one of our ICUs, which are over twice usual maximum capacity.
You’ll see a lot of dying people and families though so just be ready- COVID is the #1 cause of daily death in Indiana.
Tweets like this are leadership malpractice.
Record numbers testing positive for a sore throat isn’t a crisis
And people in the hospital for car accidents testing positive isn’t a surge
The real crisis is the irrational hysteria which has people with no symptoms waiting hours for a test or missing work for 10 days
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Got a denial for a patient’s home ventilator
(They’ve been on it for years)
Called the “fast appeal” phone line
Spent 30 minutes trying to navigate a phone tree with @AnthemBCBS
Finally got a person on the phone just to be told that I had to fax a letter
This shit is broken
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This was a fight between a cardiologist and a nephrologist over the fact that one of them discontinued a medication on a patient.
Anyone in medicine definitely knows what this medication was.
wkbn.com/news/local-news/pol…
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If you are in Medical school or planning on going to Medical school
And you would not provide medical care because someone is gay or trans or whatever
Go into finance
Or anything else
Medicine is not for you
OUTRAGEOUS: A new bill proposed by Florida Republicans, and backed by Ron DeSantis, would give doctors and insurance companies the freedom to deny care to patients who are LGBTQ people or women. The so-called “Protections of Medical Conscience Act” was proposed by the Health & Human Services Committee and Healthcare Regulation Subcommittee of the Florida House of Representatives.
The bill would allow healthcare providers to refuse to treat or pay for the treatment of people based on “conscience-based objections without… threat of adverse actions.”
Under the law, doctors and insurance companies could deny treatment and payment if they feel the patient goes against their religious, moral or ethical beliefs. Critics say this would impact women and LGBTQ people directly, as doctors could claim they have religious, moral or ethical objections to treating LGBTQ patients, or providing medical care such as birth control, abortion referrals or gender-affirming care.
The bill also provides doctors and insurance companies with legal protection for their objections, and doesn’t require them to refer their patients to another doctor.
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Yesterday was the 1-year mark from the last time I had a drink
I'm gonna put a few thoughts down here about why I did this and what it has been like for me to be sober for a year after an adulthood of alcohol being a major part of my life
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I end all of my clinic visits with
"What did I not ask that I should have?"
and then
"OK what did we not talk about that you hoped we would?"
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My kids' school went mask optional yesterday
The report I got at the dinner table was that essentially everyone was still wearing masks
The kids were never the issue here though
They get the importance of living together as a society of humans
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Who else has to speak in code around their dog?
We have to say “has anyone thrown a B to the D today” otherwise Oso starts going bonkers if we use the words
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It is 4:16 am and I am up to head to work the polls because this shit too important to leave to someone else
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HAS ANYONE CONSIDERED THE POSSIBILITY THAT THE ISSUE WITH ELECTING THE SPEAKER OF THE HOUSE COULD BE THE VACCINE
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If you are attending a large New Year celebration with strangers, please know that in many areas of the country you are contributing to the collapse of the health care system.
This applies regardless of your vaccination status.
I know this sounds dramatic- please read on.
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Florida just passed a law to restrict golf cart usage by teens
There are ~430 golf cart injuries in kids per year in FL
Guns are the 2nd leading cause of death in children in FL
Make it make sense
wptv.com/news/state/new-stat…
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Teams
SharePoint
OneDrive
The holy trinity of productivity
One entity in three forms that confuses literally everyone
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I’m a fellowship director who just finished reviewing over 400 applications for 8 fellowship spots.
The following is a #thread on writing a personal statements.
(Spoiler alert: I find 99% of them to be TERRIBLE.)
#meded
#medtwitter
#medstudenttwitter
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(steps up to mic)
AHEM
A TREATMENT LEADING TO A 50% REDUCTION IN HOSPITALIZATION IS GREAT
BUT
WE ALREADY HAVE A TREATMENT THAT HAS A GREATER THAN 90% REDUCTION IN HOSPITALIZATIONS THAT ANYONE CAN TAKE NOW AND LASTS MONTHS (AT LEAST) AND IS FREE
Thx for coming to my TED talk
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I'm not a covid alarmist.
But with the rate of transmission of omicron and the state of Indiana hospitals unless we want to have patients dying in hallways we should probably start shutting things down.
And I’m generally anti shutdown.
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I’M POSTING THIS FOR MY FUTURE SELF BECAUSE EVERYTIME I HAVE TO GIVE LETTERS OVER THE PHONE I WIND UP COMING UP WITH STUPID WORDS LIKE “L AS IN LYMPHOCYTE” AND I FEEL LIKE AN ASS.
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Every couple of months
Take a random day off with your spouse
Grab breakfast
Go to the museum
Then
At the end of the day
Find the next date day and block your calendar
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I take lexapro 10 mg daily because if I don't I wake at 3 am ruminating on stupid stuff
Just thought you might like to know
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Today I was notified that as of July 1, 2023 I will be promoted to Professor of Clinical Medicine
Pretty cool
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Real world example of what we are up against in Indiana
We are going to have major issues recruiting physicians in any medical specialty
Other states take heed if you like having physicians to care for your citizens
#HoosierTwitter
(sent by a friend; shared with permission)
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Families who vax together grow old together
Shot #3 for me
Shot #1 for the newly 12 year old
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Caring for COVID patients in the ICU is hard but honestly when this is all over my PTSD will come from the hateful humans at school board meetings.
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I am able to accomplish full clinic visits with 95% of patients by phone/virtual platform. No show rate is nonexistent. This may change the face of routine chronic care forever.
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I’m at a swim meet and apparently there is no pandemic in this part of Indiana so that’s good
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SEPSIS IS ALWAYS ACUTE
Bill Clinton has been hospitalized after he had a urological infection that developed into sepsis, an aide said on Thursday. The aide said it was not considered to be acute. nyti.ms/2YRdEhA
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It’s a crazy world.
Doctors getting their third shot to avoid even the possibility of ECMO.
While others are trying to get home ECMO in order to avoid getting their first shot.
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REMINDER
If you have symptoms and a positive home test, YOU HAVE COVID
IMO there is NO REASON to go and get a PCR test somewhere
I realize your positive won't be counted in the state totals
But I'd rather you not go out and expose others
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I have to say that getting to chat with @maddow tonight was super cool.
And it’ll be much cooler when I don’t have to do stuff like this because this shitshow is over.
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When you are rounding as a lone wolf in the ICU and someone brings you pizza in a specimen bag you don't ask questions about the mode of delivery you say thank you and then nom
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IU Health Academic Health Center current hospitalization data
Keep in mind Indiana is at about 50% vaccinated at this point. So if vaccines didn’t work, it should be equal numbers of vax and unvax hospitalized.
Vaccines clearly keep people out of the hospital.
Get the shot.
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It’s Doctor’s Day!!!
Wanna thank a doctor?
Get your vaccine. That’s all the thanks we need.
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Pushup challenge
Do one pushup today
Double the number every day
On day 7 you will do 128
On day 14 you will do 16,384
On day 30 you will do 1,073,741,824
Follow me for more fitness tips
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This hotel was Cook County hospital from 1914-2002
It feels… like a hospital
I’m going to lay my head on the pillow and pretend nothing bad happened on this very spot and hope for a good night of sleep
[spooky violin music]
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I stand proudly by Caitlin
If you are a physician and don’t, I’m afraid you misinterpret what this whole thing is about npr.org/2023/05/26/117743527…
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I take lexapro, 10 mg daily
It helps me to not wake up at 3 am thinking about pointless stuff
Just thought someone might need to know we all have our shit and very few of us have it as together as it appears
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PET PEEVE ALERT
Longer notes don’t make you a better doctor
It just wastes everyone’s time
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Today marks 6 months since I’ve had alcohol
That makes me happy
A huge shout out to @Adamhill1212 for scouting the path for me and supporting me as I made this change
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Altruistic empath? Get the vaccine for those around you.
Selfish asshole? Get vaccinated for yourself.
Something for everyone.
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Everyone, 2020: WE NEED GOOD TREATMENTS FOR COVID!!
The entire scientific and medical enterprise, late 2020: HERE YOU GO VACCINES
Some people, 2021: NOT LIKE THAT WHAT ABOUT PARASITE MEDICINES
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2 states, 2 pictures
Almost identical population sizes
Massachusetts has 73% vaccinated
Indiana 53%
Cases nearly identical. Deaths more than twice as high in Indiana.
Get the vaccine.
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Me: Can we give you a flu shot today?
Patient: no I don’t take flu shots
Me: can you say more?
P:
Me:
P: OK I’ll take it
(IMO “Can you say more?” Is the most useful and underrated phrase in medicine)
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I’d like to hear from @SenToddYoung and @SenatorBraun as to why they voted against capping the cost of insulin at $35 per month
Insulin has been around forever and is needed by approximately 260,000 Hoosiers to control their blood sugar every day
What gives?
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Just got a denial for generic Albuterol HFA inhaler because the patient hadn’t tried and failed 2 brand name albuterols
I swear this is what drove Michael Douglas’s character to lose it in Falling Down (1993)
Honestly I can’t even
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THERE IS A PANDEMIC WHAT SHOULD WE DO???
Public health experts: masks for all, contact trace, quarantine exposures, vaccinate everyone
Some states: LET’S MAKE ALL THAT ILLEGAL
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It me
One Indiana doctor expressed his concerns about COVID protocols as 100,000 football fans pack downtown for Monday's title game at Lucas Oil Stadium.
wthr.com/article/news/health…
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If you want ivermectin because of the science that says it works, oh boy pull up a chair and lemme talk about this other thing we have called vaccines.
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Did the pandemic make anyone else an introvert?
I’m now a social media extrovert and an IRL introvert
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At what age do kids realize that if you don’t rinse cream of wheat from the bowl that it transforms into a hardened substance that defies the laws of physics?
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If I had #COVID19 and had the choice between 5 days of Ivermectin or burritos supreme I’d take the burritos because as far as we know at this point the outcome would be the same and I loves me some burritos supreme
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Indiana: $6 billion surplus! You all get $200 refunds!
Also Indiana: Federal government forgiving $10,000 of your loans? That will be $323 please.
Make it make sense please.
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If you want proof that healthcare is broken, here you go
A friend was asked to fax his old records to a new specialist
They don’t use email
Like a regular human was told this
In 2023
Regular humans do not use fax machines
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My teenagers prefer to watch TV with closed captioning on is this a generational thing does this mean I’m irrelevant
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So weird that we evolved with the food tube so close to the air tube
These are the thoughts I have on ICU rounds
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The fact that in Indiana Senate Republicans just voted down an amendment to guarantee access to contraception shows that this discussion is not primarily about reducing abortions
Because guaranteeing access to contraception has been proven to do that
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Over the last about 6 years I have adopted the practice of not checking email AT ALL on vacation.
When I mention this, many scoff and say that would never work for them.
I said the same thing when I started.
Join me for a 🧵 about my journey to vacation email freedom.
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Want to improve physician wellness?
1. eliminate non-compete clauses
2. 12 weeks paid new parent leave
3. get rid of shifts longer than 16 hours for housestaff
4. Long term: train and hire more physicians so that 1 FTE= 1 FTE
What am I missing?
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If there were restaurants in Indiana that required proof of vaccination and all employees were vaccinated I would go to those places exclusively.
Retweet if you agree so business owners will see how many of us there are.
#hoosiertwitter
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Hey
I'm 46 and will be getting my flu and COVID vaccine in the coming weeks
Those of us in the know understand that, even for those previously infected by COVID, the vaccine helps to prime your immune system to make symptomatic disease and hospitalization MUCH less likely
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Bay leaves don’t do jack shit
The bay leaf industry has fooled us all to putting a stale frond in our food that we have to take out before serving
They are geniuses
I won’t be convinced otherwise
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I just walked back to my office from the hospital only to realize that I left my keys
Cursing myself, I schlepped all the way back into the hospital (6 flights) to get them
Could not find said keys
Reader, it was then that I realized the keys were in my hand the whole time
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OK PLEASE GOD LET’S JUST MAKE ALBUTEROL OVER THE COUNTER BECAUSE THIS PRIOR AUTH BULLSHIT IS GOING TO KILL ME
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Cross country has only 1 heat and is generally over in about 20 minutes in case anyone is trying to decide which sport to foist upon your offspring
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A reminder for everyone gearing up to vote for governor in Indiana that @SenatorBraun objected to the results of the 2020 election before the capitol was attacked
He puts party before country
Vote @mccormickforgov
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