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@SpineNeuro Art of thorough history and exam replaced by "ordering' a scan, like a drive thru menu. Core physician skills like LP replaced by "ordering" a procedure from IR. We thought radiology would be the 1st speciality to dissappear, but we're not the ones making ourselves expendable!

Why did lumbar puncture go from being a med student procedure (bc it is extremely low risk) to a procedure that can only be done by an interventional radiologist?

@CanesDavid Probably should consult urology for any ureteric stone, or at the very least arrange imaging follow-up.

🚨Radiology twitter: STONE(S) in URETER: My view is the word "nonobstructing" should never be used. A ureteral stone may have no associated hydro because: 1. It truly is letting urine by 2. It's intermittently obstructing, and you happened to catch it after the upper tract decompressed 3. The patient is trying to die, septic, in shock, not making urine. 💀☠️ Words matter because the non urology care team sees the word "nonobstructing" as "not a problem" and may not consult urology. Anyone disagree with this? Would love to see alternate perspectives.

@northwoods1980 @sethmhardy If you don't, some bozo might blurt to the patient that the radiologist "missed it".

@sethmhardy I’m not proud of it, but when I get a BS exam, I’ll go full passive aggressive and list out every single incidental finding. Sometimes 15 impressions deep. It’s not right, but it is what it is.

When the ED finds more incidental pathology than what they are requesting scans for, then they are just running a screening service.

@FerozeSidhwa Ironically, your taxes paid for the missile that killed that poor kid, and almost you too.

I'm an American trauma surgeon. One year ago today I was volunteering at Nasser Medical Complex in Gaza when Israel fired a missile into the room of my 16-year-old patient, Ibrahim Barhoum. The missile killed him instantly. If it had hit the room 90 seconds later it would have killed me, too. Today the US and Israel are still blocking medical supplies from entering Gaza, and are repeating the assault on hospitals and healthcare workers across Lebanon. This is nothing but barbarism. It must be stopped.

@1watchaudio @RonWaxman Somebody's getting a great return on their investment though.

@RonWaxman This whole country is held together by fucking threads at this point.

Important note regarding the accident at LaGuardia Airport. United 2384 wanted to return to gate. Odor in back of plane. Pilot couldn’t raise anyone at United to help get him a gate. Air traffic controller tried to help. There were no gates. Pilot asked for fire truck. 1/2

@JamieBonkiewicz Just avoid traveling to Russia, the USA or North Korea and you'll be fine, no need to do this.

Before you head to the airport: Print your boarding pass Turn off Face ID / fingerprint unlock Delete your social media apps Airplane mode Turn your phone off and put it away

@RasmusJarlov What happens the culprits behind the massacre of those poor schoolgirls? The US stops attacking, straits of Hormuz reopen, and those Americans who committed the atrocities all go safely home with cheap gas once more for their pickup trucks, yeah? Tell that plan to the parents.

I have a genius idea: Dont bomb Iran. That will keep the straight of Hormuz open. It was open and no ships were attacked by Iran before that started.

@BernieSanders Your country caused the deaths of every patient in a Cuban ICU over the weekend. So many atrocities all over the globe, it's hard to keep track.

72,000 killed in the genocide in Gaza. 1 million+ displaced in Lebanon. 1,700 settler attacks in the West Bank. And now war in Iran. Sending 20,000+ more bombs to Netanyahu isn’t just immoral—it’s illegal. That’s why I introduced legislation to stop it.

@MichaelKGarrett Your president is a reflection on the people who voted for him. He has run 3 times over a 12 year span, has has progressively increased his share of the popular vote each time. Half of Americans (12 years after his 1st campaign) voted for him. He reflects American values. 👍

The President of the United States learned that Robert Mueller had died. And he picked up his phone and typed: “Good. I’m glad he’s dead.” I need you to stop. Put down whatever you’re doing and feel the full weight of those words. Good. I’m glad he’s dead. Said by the man who holds the most powerful office in the history of human civilization. The office of Washington. Of Lincoln. Of Roosevelt standing in the rubble of Pearl Harbor promising a nation trembling in the dark that we would rise. That office. Those words. Now let me tell you who Robert Mueller was. He did not have to go to Vietnam. He had every reason not to. A Princeton degree. A blown-out knee. A future waiting for him in the comfort of civilian life. He waited a full year for that knee to heal, just so he could serve. Let that sink in. He walked into hell when other men were running from it. He came home with a Bronze Star for heroism and a Purple Heart soaked in the blood of his sacrifice. He spent the next four decades standing in the breach, as a prosecutor, as FBI Director, as the man who held this nation together in the smoldering ash of September 12th, 2001, when we were all afraid and we needed someone steady, someone serious, someone who loved this country more than he loved himself. He was all of those things. He was a Republican. He was, by every honest measure, an American hero. And the President danced on his grave.

@DrNiravPandya You're meant to relay proper history & clinical exam findings to the radiologist reading the scan to guide their interpretation of the images. You did realise that, right? If you delegate your secretary to send a requisition saying "pain", then surprise, the report is garbage.

An MRI of a joint is a static image of the current state of your ligaments, tendons, cartilage, and muscles. The patient and physician then have to determine what is clinically relevant based on your history and physical exam. Not everything seen on an MRI is pathologic.

@paulg Sunk cost fallacy is now the only explanation for why Trump voters still support that ghoul.

Whether the next president is a Republican or a Democrat, can we have someone with at least a little class next time? Because this is embarrassing.

@Promontorium @SketchesbyBoze Thanks.

@FergusCafferty @SketchesbyBoze Nah, your examples suck. The best is people who don't know 've is a contraction of have, so they write/say "would of", "could of", and "should of"

You can be pretty confident that someone doesn’t read when they say “raped over at Kohl’s” rather than “raked over the coals.” As literacy declines, we are seeing new & unparalleled malapropisms.

@AlHendiify Coal and oil emissions don't exist because they float up into the sky and disappear, right David?

Now show us 10,000 years worth of safely stored waste and how you communicate to a society 500 years into the future that no longer speaks the same language that this is an incredibly dangerous material.

@Aidan_Regan Greenpeace was one of the first major groups to highlight and resist global warming in the 1990s. They influence major global summits-Kyoto, Paris, etc. They arose from the Vancouver branch of Campaign for Nuclear Disarmament, so are ideologically opposed to clean nuclear power.

What’s the lesson?

@kev_tbay @labhaoise99 If your account gets emptied by fraudsters, Revolut will refuse to help you and claim it was your fault. Revolut are fine for small petty cash transactions but I wouldn't dare deposit more with them until they stop behaving like the banking equivalent of Ryanair.

@labhaoise99 Why isn't anyone suggesting Revolut??

@HenMazzig It's disgustingly antisemitic of you to equate the murderous actions of the evil Israeli regime with Judaism. Imagine if 1940s Germans whined about "anti-German sentiment" when the horrors of what the nazis did were exposed? That's you right now. Israel murders kids every day.

A perfect example of a genuinely antisemitic comment, and not criticism of the Israeli government or its actions. This is blood libel antisemitism straight out of the Middle Ages. What’s Kneecap’s next tweet: Jews drinking blood for Passover? And coming from a music band who became famous by supporting Hezbollah, the terrorist organization that killed 12 Druze children by launching a rocket directly at a playground, that’s rich.

@luxemiaa Nah, hate the airline that wanted to charge a young family a few hundred bucks extra just to sit together.

This woman on Instagram shared: I’m at the airport and there’s a family of 8 people on my flight with small children, I just overheard the dad say, “All of our seats are all over the place, no one is close to each other because I didn’t want to pay extra for assigned seats. We’ll switch around when we get on the plane.” Suffice it to say, I hate them....

@zanehkoch en.wikipedia.org/wiki/Radium_Ho…

for a while i've had a slight fear that the bluetooth from my airpods could be frying my brain this weekend i pulled the raw data from a $30m government study of 1,679 mice blasted with cell phone radiation and reanalyzed it what i found was...not what I expected? 🧵

@hjluks An MRI should never arrive before a proper history and exam by a suitably trained physician. You've neatly outlined exactly why in your post. Imaging findings always depend on pretest probability, but sadly, comprehension of Bayes' therom is appallingly poor amongst doctors.

The irony I find myself returning to is that MRI technology has not made us better diagnosticians. It has, in many cases, made us worse ones, because the image is so concrete and the language of the report so authoritative that it takes deliberate effort to resist anchoring to it. When the MRI arrives before the history is fully taken, the finding shapes what questions get asked and which ones don't. Bias abounds throughout the encounter. The encounter organizes itself around what the scanner found rather than what the patient experienced, and that is very difficult to undo once it has happened. Don't look at the scans first... the basics matter. Take a history... confirm it with an exam, then see if the MRI findings make sense in the same context.