I just finished my first night float block of intern year, and here are some unfiltered reflections. 🧵 ⬇️

The word physician is essentially not used in the hospital anymore. Not even 'clinician.' We're 'providers.' Yes, not everyone making care decisions is a physician, and APPs are important too! But the word provider is so devoid of any relation to medicine that we might as well just be called doers.

The word physician is essentially not used in the hospital anymore. Not even 'clinician.' We're 'providers.' Yes, not everyone making care decisions is a physician, and APPs are important too! But the word provider is so devoid of any relation to medicine that we might as well just be called doers.

Me hyping myself up to try, again, to place an ultrasound–guided IV

This is intern year except every 2 weeks you go back to rolling a wooden box filled with patients you know nothing about, subspecialty services you have no experience in, new attending and senior resident preferences, and bathrooms you don’t know the codes for 😀

This is intern year except every 2 weeks you go back to rolling a wooden box filled with patients you know nothing about, subspecialty services you have no experience in, new attending and senior resident preferences, and bathrooms you don’t know the codes for 😀

1/ Last October, 85 people ages 1-91 developed dizziness, drowsiness, anxiety, and/or memory distortion. Some went to the ED. They'd all recently eaten at a Wisconsin pizzeria. Local public health officials investigated. As reported in last week's CDC MMWR, they found

Case-control study in @jamanetworkopen.com suggests living in close proximity to a golf course substantially increases the risk of developing Parkinson's Disease, likely related to pesticide use.

It's that wonderful time of year when new residents are joining the ICU team! Here are a few of my favorite @criticalcaretime.bsky.social infographics to help you understand key concepts: ⚡️Undifferentiated shock 💉 Vasopressors 😮‍💨 The physiologically difficult airway & 🧪 Metabolic acidosis

First week of residency down.

ZODIAC trial: For ischemic stroke patients who are awaiting thrombectomy, flat positioning reduced the risk of neuroworsening or death Premature termination but seems reasonable Statistically robust results Best available evidence; should change practice pubmed.ncbi.nlm.nih.gov/40465238/ #EMIMCC

when perfusion falls, the most vulnerable tissue suffers first. so for someone with a chronic carotid artery stenosis, urosepsis can manifest with focal neuro symptoms.

My palliative care elective in med school was my most impactful rotation. I’m eager to rotate on PC as a resident. It felt like another world of medicine. A reprieve from the cog-in-the-wheel, task-rabbit medicine we practice. A version that prioritizes patients, dialogue, and bedside care #medsky

Could it be that simple? Hanging a folding chair on the wall in patient rooms increased the patient-reported likelihood that physicians sat at the bedside, spent enough time, and checked for understanding. shmpublications.onlinelibrary.wiley.com/doi/10.1002/... @jhospmedicine.bsky.social #medsky

A 25% reduction in research funding in the US would lower GDP by 3.8%— a decline similar in magnitude to that in the Great Recession. A 75% reduction in research funding would lower GDP 11% — a larger decline than in any recession since the Great Depression. www.nytimes.com/2025/04/30/b...

Takeaways from @nejm.org acute abdomen review: ➡️ Don’t withhold analgesia ➡️ CT angio abd/pelv w/ IV contrast is usually ideal image; ultrasound for others but high performance variability ➡️ Consult surgery ASAP ➡️ Beware of cognitive bias www.nejm.org/doi/full/10.... #medsky

Diuresis and fluid status comes up on almost every single ICU patient (especially in a cardiac ICU🫀) It’s very important to understand how each diuretic works, how they can be combined to augment urine output & their limitations Check out my starter guide for diuresis in the ICU #MedSky #Nephsky

Takeaways from @nejm.org acute abdomen review: ➡️ Don’t withhold analgesia ➡️ CT angio abd/pelv w/ IV contrast is usually ideal image; ultrasound for others but high performance variability ➡️ Consult surgery ASAP ➡️ Beware of cognitive bias www.nejm.org/doi/full/10.... #medsky

Wellness will be when I don't have to do a module on how to use hand sanitizer

Ah, yes. Just a little mistake.

What could go wrong? www.nbcnews.com/health/healt...

I'm thrilled to have matched in internal medicine at Penn! @pennmedicine.bsky.social Endlessly grateful for my family, friends, and mentors on whose shoulders I stand. #Match2025

Onward to Friday! #medsky #Match2025

When the recipe calls for 2 cloves of garlic #docswhocook

Cigna and Jefferson Health failed to reach a coverage agreement, meaning Cigna is now out-of-network for Jefferson patients. Was shocked to see that Cigna's reimbursement rates have only increased by 3% since 2020 vs. an inflation rate of 21% www.jeffersonhealth.org/about-us/new...

Little Prayer by Danez Smith As seen on the subway, illuminated by rays of sunset

UpToDate, feeling pressure to remain relevant in the face of popular new generative AI tools like OpenEvidence, leans into AI-powered search, but stops short of rolling out any gen AI tools of its own.

Something I didn't appreciate until the residency process: It's wrong to assume the institution where someone trained was the "best" they could do There are so many other factors––proximity to loved ones, teaching quality, schedule, culture––that can outweigh prestige when deciding where to train

It's out of my hands now! #medsky

Listen to Cher

Do you decompress after leaving the hospital before you get home?

I’ve been wearing a mask to see every patient these days, since it seems like half of them knowingly or unknowingly have flu A. But before I walk into the room, I always pull my mask down for a second to show my face and flash a smile. I find this makes a big difference. #medsky

@uchicagomedicine.bsky.social we wear masks for all patient care when community respiratory virus prevalence is high bc we know hcw can spread before they even feel sick.

I’ve had 4 patients in just the last week who caught influenza during their hospital stay. Maybe we should be going back to universal masking in the hospital…

My neighbor, Lee Aaron Adler, was a father and computer engineer at Cantor Fitzgerald on the 103rd floor of One World Trade. He was also a member of the board of trustees of our synagogue. He died. Knock it off. www.nj.com/lives_rememb...

1/ Cautionary tale about the blindly-accepted "you can't give contrast to a patient with an AKI" dogma still permeating medicine Consensus guidelines from ACR & NKF clearly state risk of contrast-induced kidney injury in pts w/ impaired renal fxn has been overstated d/t confounding #medsky #emimcc

One of the biggest things I’ve learned about academic writing (and writing in general, really) It’s better to write a shitty first draft than to write nothing at all #medsky

Over on Elon Musk's Twitter, people are being banned for criticizing the openly racist 20-somethings working for DOGE, but Kanye West is on another unfettered and unchecked antisemitic rant

1/ Cautionary tale about the blindly-accepted "you can't give contrast to a patient with an AKI" dogma still permeating medicine Consensus guidelines from ACR & NKF clearly state risk of contrast-induced kidney injury in pts w/ impaired renal fxn has been overstated d/t confounding #medsky #emimcc

One of the biggest things I’ve learned about academic writing (and writing in general, really) It’s better to write a shitty first draft than to write nothing at all #medsky

Our first episode covering the GINA Asthma Guidelines is out now! Rupali Sood and Tom Di Vitantonio have joined are team and are leading these high yield discussions! First up is Asthma diagnosis and evaluation www.pulmpeeps.com/2025/02/04/9... #EMIMCC #medsky #pulmsky @pulmtoilet.bsky.social

Exciting to see #Match2025 officially underway. Congrats to everyone who matched in urology today! Now how can we get more med students (and residents) to join us over here #medsky?

Could say the same about why even in Epic we don't have better OSH records (CareEverywhere is basically a giant text file), or implementation of GenAI to summarize progress notes from lengthy hospitalizations. Lack of competition & massive cost to switch EHR = minimal pressure to innovate

Tired of the inane situations that result when rigid adherence to hospital policy conflicts with patients' unique circumstances, LA General Medical Center created a Policy to Override Policies –– guidance empowering staff to override hospital policies when in the best interest of patients. #medsky

I LOVE this! Premise is brilliant. We should all seek to incorporate in our institutions. #medsky

Tired of the inane situations that result when rigid adherence to hospital policy conflicts with patients' unique circumstances, LA General Medical Center created a Policy to Override Policies –– guidance empowering staff to override hospital policies when in the best interest of patients. #medsky

Any outpatient physician knows time spent responding to patient messages–often uncompensated–has grown exponentially Since 2022, Cleveland Clinic has had a transparent policy governing MyChart messaging under which patients are billed for msgs requiring more than a quick answer Thoughts? #medsky

To the ship!

ICU Stories: 70 yo pt w history of A. fib presented to the ED 4 d earlier w slurred speech/diplopia/weakness. CT brain: no stroke. TTE: normal LV/RV, severely dilated LA. Brain MRI: "small multifocal acute infarcts from central embolic source". Admitted & started on heparin drip

"Culture-negative sepsis" is associated with higher rates of pulmonary infection & respiratory failure Why? In a Critical Care letter, I share two hypotheses: 1) Limited ability to detect bugs localized to the lungs 2) Lack of infection (ergo, lack of sepsis) to begin with #medsky #idsky #emimcc