🦋doctor doubt🦋 @reverendofdoubt
Emergency Physician Everywhere All at Once Joined April 2012-
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Consolidation doesn't make care cheaper or better, but does make the health system doing the consolidation richer
Consolidation doesn't make care cheaper or better, but does make the health system doing the consolidation richer
@FutbolistaMedic @reverendofdoubt @jeremyfaust Absolutely love our ED colleagues but I’m so appreciative of attendings like Dr Magidson who are comfortable monitoring geriatric AMS patients off abx when there are no systemic signs, focal findings, or correlating hx for infection.
@FutbolistaMedic @reverendofdoubt Last point before I go to bed is that the lack of good data either way for something that comes up SO often is frustrating. There’s certainly enough equipoise to do clinical trials for a lot of these questions, and I don’t really understand why that hasn’t happened
@FutbolistaMedic @AlanPlotzker Exactly -I give empiric abx every shift 😂 not infrequently for the *ill appearing* delirious patient I can’t get a history or reliable exam from who I’m also getting XR or CTs on too looking for a source
@FutbolistaMedic @jeremyfaust @reverendofdoubt Often times they are just dehydrated. Fluids cure a lot of what ails us.
@reverendofdoubt @AlanPlotzker Also, as you’ve stated, it’s never saying empiric antibiotics aren’t warranted. As with all things, answer often lies somewhere in the middle.
@jeremyfaust @reverendofdoubt You see confused elderly patients with positive UAs “all the damn time”… but if you tested all your non-confused elderly folks, you’d also get a lot of positive UAs “all the damn time”. This is bad medicine. Old folks are colonized chronically, you know that.
@jeremyfaust @reverendofdoubt No, you don’t. You see confused patients with abnormal UA’s, start them on antibiotics, and then don’t see them again. Majority of the time I stop your antibiotics, and the patient still gets better. Shocker.
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@reverendofdoubt @FutbolistaMedic @jeremyfaust Yeah most definitely! 100% agree.
@reverendofdoubt @FutbolistaMedic @jeremyfaust Ok that’s fair. If you are talking about something a bit more subtle cognitively and they have ABS sure…. I think it’s a different picture when you have a truly acute encephalopathy and an UA pointing towards cystitis/pyelonephritis.
@reverendofdoubt @Claude__Cat @FutbolistaMedic @jeremyfaust I maintain that a significant portion of ED visits would be avoided if people (especially those over 60) drank 64oz+ of fluids per day. On almost all my dc instructions I include "maintain adequate hydration (8 cups+ of fluids)"
@reverendofdoubt My mom was so prone to UTI’s & she had dementia. We as family could see it immediately but No the Dr always wanted to do other labs & exams which just kicked off the agitation in mom. And it was hell just to get her to the appointment. Thank you for your continued advocacy!!!!
@reverendofdoubt @jeremyfaust @Brief_19 Does that change if: -WBC 13k Or -left shift Or -Temp 38C Or -They were in your ED last month and their urine was completely clean (so proof of recent non-chronic colonization) And the corollary: If they are septic, do you look for sources OTHER than the urine considering…
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What drives human lifespan: genetics or lifestyle? A new @BMJ_EBM study indicates both, but impact of favorable lifestyle is big ebm.bmj.com/content/early/…
@reverendofdoubt Sometimes what a patient believes is a UTI is really Interstitial Cystitis and that condition has a very different treatment plan. Especially common in older female patients past menopause.
@reverendofdoubt Lost too soon. Christopher Hitchen inspired a lot of my personal interest in ethics and was hugely instrumental in my life. Great sayings :)
The most important "test" in the ER is the bedside MD clinical evaluation of the patient. Sometimes the at end of a shift, some docs like to "cherry pick" but that can backfire. Rather, the priority should be the longest waiting patient and the most sick patient - regardless of…
@reverendofdoubt If you’re lucky you’ll develop Groat’s disease before your next shift.
@reverendofdoubt @AnnalsofEM Nice piece, but no further study is needed, they just don't give shit.
Consolidation doesn't make care cheaper or better, but does make the health system doing the consolidation richer
Hospital systems have justified horizontal mergers for years claiming that larger scale will lower costs and raise quality. We now have the 3rd study showing that merged systems, even if in different markets, materially raise prices & don't improve quality measures. via @statnews
@reverendofdoubt @FutbolistaMedic @jeremyfaust There is so much value to cross-trained physicians that doesn’t translate obviously to publications or salary but makes the hospital and their department a better place.
@AlanPlotzker @reverendofdoubt Won’t disagree with that.
@FutbolistaMedic @reverendofdoubt @jeremyfaust Absolutely love our ED colleagues but I’m so appreciative of attendings like Dr Magidson who are comfortable monitoring geriatric AMS patients off abx when there are no systemic signs, focal findings, or correlating hx for infection.
@FutbolistaMedic @reverendofdoubt Last point before I go to bed is that the lack of good data either way for something that comes up SO often is frustrating. There’s certainly enough equipoise to do clinical trials for a lot of these questions, and I don’t really understand why that hasn’t happened