Robert Teskey

I was up last night with a STEMI until 4:30. For my entire career I’ve gone to work the next day with whatever sleep I could get. Not anymore. Today, I slept in and did chart work from home. You can’t fly an airplane or drive a truck if you’ve been up all night. Why should it be different for docs?

🧵 "Cough into your elbow" has no peer-reviewed origin Researchers traced it to a 2006 hospital video And a 1994 quote from a pediatrician who said she learned it from daycare Neither CDC nor WHO can tell you who invented it It's just folklore that gained a following

#Sharing For Learning Did you notice something? A subtle finding. Easily missed. Yet potentially fatal if overlooked. Miss it… and you may lose the patient. Recognize it early… and you save a life. What next??

@krassenstein Is MAGA math a thing?

OMFG! RFK Jr: "President Trump has a different way of calculating percentages. If you have a $600 drug and you reduce it to $10, that's a 600% reduction." No, you imbecile. That’s a 98.33% drop. No math besides make-believe math makes it 600%.

Imagine your surgeon preparing for your operation. They see you in pre-op, answer your questions, calm your fears, examine you, confirm the plan, and go get ready for the case. They review the imaging and think through the critical parts of the operation. Then a nurse interrupts them: “Doctor, your pre-op documentation isn’t good enough. You can’t just say you discussed the risks and benefits. You need a full H&P.” The surgeon points out that the H&P was already done in clinic. The note is right there in the chart. “No. That note is 31 days old. It has to be within 30 days. But it’s fine if you just copy and paste that old note.” Think about how insane that is. There is no new clinical information. There is no patient benefit. There is no improvement in safety or quality. The only thing being demanded is duplication. A pointless bureaucratic ritual to satisfy the machine. So now you have a frustrated surgeon, a delayed case, a bloated chart, and one more example of modern medicine confusing clerical box-checking with patient care. This is exactly what is wrong with the system. Endless note bloat. Pointless duplication. Administrative nonsense dressed up as professionalism. If there are no changes, there are no changes. Forcing a doctor to re-paste an unchanged H&P adds absolutely nothing for the patient. And the most insulting part is the tone. That smug, condescending “of course you have to do it this way” attitude, as if this is self-evidently necessary instead of obviously stupid. At this point, a lot of doctors would probably take a substantial pay cut to never touch a computer again. Cut the salary and use the savings to hire people to do the computer garbage. Epic. CDI queries. Coding queries. H&P updates. Order entry. Case booking. Inbox nonsense. All of it. Never touch Epic again. Never answer another coding query. Never update another unchanged H&P. Never place another order that a clerk or protocolized team could enter. Never do another ounce of hospital data-entry cosplay. Just let us be goddamn doctors instead of highly trained documentation technicians.

One catastrophic unforeseen complication that can happen during any PCI and how to handle it 👉 WITHOUT MESSING UP #cardiotwitter #PCI #cathlab_nightmare 50 y 👨 AWMI LV 35 CAG Ostial LM mild , patio prod alas 50-60 , mid LAD total block Looks straightforward right?! (1/n)

And that’s before you try to ascertain whether it was simply underpowered to begin with. Difficult when the in-hospital prevalence at any given moment and the R0 of a particular strain are constantly changing.

@JReinerMD Beautiful!

Almost done (finally). Live edge spalted maple slab desk with maple base. No metal fasteners anywhere. Just dowels, wooden nails, and glue. Finish is Odie’s Oil with an added powdered colorant.

Don't Let Your Lives "Narrow"!! I've been an orthopedic surgeon for 30 years. The thing I watch happen to people, more than any injury or surgery, is refer to as the narrowing. Most of my patients have no idea it's happening to them. They think it's just aging. It's not. 🧵

@DaliaHasanMD @UofT Congratulations!

Happy news!! Beyond excited to share I have been accepted in the emergency medicine fellowship program at @UofT One step closer to weaving together my training in family and emergency medicine to care for patients within remote First Nations communities and close to home alike

Why I Train This Way at 62 1/ I’ve been an orthopedic surgeon for nearly 30 years, and over that time, I’ve watched something happen to many of my patients that isn’t dramatic or sudden, but ends up being far more consequential than any single injury or diagnosis.

Always work back to baseline gradually and listen to your own body’s signals…

I hear this every week in my office: "Doc, my heart rate hits 150 during squats — that's cardio, right?" No. And if your cardiologist hasn't explained why, keep reading. 🧵

A good read. Note that we are still in a pandemic. IMHO for public health to adopt the new paradigm will require new leadership. Only then will the toxic culture of «I know best, I’m the expert» be forced to change. lnkd.in/gvBq4D8h

@EricTopol @Hragy It’s a randomized trial of a hydration-encouraging strategy (including financial incentives), not hydration (difficult to do properly). Identical problem to studies that claim that “masks don’t work” for COVID or other respiratory illnesses.

If you've had a kidney stone, you've been advised that the most important thing to prevent another bout is to increase hydration. Now a randomized trial of hydration in over 1600 participants showed no benefit, despite evidence of increase during volume. thelancet.com/journals/lance…

What happens to the heart when people stop GLP-1 drugs? The short answer: nothing good. New from our team: a study of 330,000+ people in @BMJMedicine 🧵

I just gave a closed-book, pen-and-paper midterm exam in my 300-level course at UBC with 100 students. All exams were graded by an experienced graduate-level TA according to a rubric. *** The average was 64/100.*** My class averages at UBC are usually 80-85. Context: • This was the first midterm, covering ONLY 4 weeks of material. • Students had a list of possible questions in advance: no surprise questions. • Questions included (a) 3 concept definitions, (b) 3 paragraph-long questions, and (c) a 1.5-page essay. • I have taught this class multiple times. Nothing in my teaching style changed this semester. • We read entire paragraphs of text in class, so students don't have to do something on their own that wasn't covered during the lecture. • Students take a 10-question multiple-choice quiz at the end of every class (30% of the final grade). • Attendance is 95-99% every class. Attention during lectures and participation in pair-work activities are very high → anticipating the end-of-class quiz. *** But unfortunately, I suspect many students are not reading the material on the syllabus. They are asking LLMs to summarize it instead.*** After the midterm, students reported: • They thought they knew concept definitions but couldn't produce them on paper. • They thought they understood the arguments but struggled to connect them or identify points of agreement and disagreement. My view: It might be “cool” or “innovative” to teach students to summarize readings with ChatGPT or write essays with Claude. But we may be doing them a disservice: reducing their ability to retain material, think creatively, and reason from what they know. If you only read what AI has summarized for you, you don’t truly "know" the material. Moving forward: We have a second midterm coming up. I don't know how to convey to students that the best way to do better on the exam is to rely on and improve their own reading skills.

@lady_valor_07 19. I never actually owned a set of encyclopedias, but certainly used them at school and public libraries.

6 for me!!….I feel confident nobody Has all 20!! How many for you?

@FCademartiri Particularly important when troponins are ordered indiscriminately…

🫀 Is the Universal Definition of Myocardial Infarction flawed? The Universal Definition of Myocardial Infarction (UDMI) was created to standardize how we diagnose heart attacks across the world. It succeeded in many ways. But it also introduced several conceptual problems that clinicians increasingly recognize. The biggest issue? Troponin became the definition. According to UDMI, myocardial infarction is diagnosed when cardiac troponin rises above the 99th percentile with evidence of ischemia. But troponin is a marker of myocardial injury, not necessarily infarction. Troponin rises in many conditions: • Sepsis • Pulmonary embolism • Renal failure • Tachyarrhythmias • Heart failure • Myocarditis So the biomarker that was meant to clarify diagnosis ended up blurring the line between myocardial injury and true infarction. The second problem is the proliferation of MI subtypes. Type 1 MI: plaque rupture Type 2 MI: supply–demand mismatch Type 3 MI: sudden death Type 4–5 MI: procedural infarctions Type 2 MI alone includes everything from anemia to septic shock. That is not one disease. It’s a basket of completely different pathophysiologies. Then there are arbitrary biomarker thresholds for procedural infarction (>3× after PCI, >5× after CABG), explicitly acknowledged as conventions rather than biologically grounded cutoffs. Another paradox: with high-sensitivity troponins we now detect microscopic necrosis, which the definition treats as “MI”. Meanwhile patients with massive coronary plaque burden but no rupture technically have no infarction. So we ended up with a definition where: • tiny procedural injury = MI • severe coronary disease without rupture = no MI Clinically, that makes little sense. Perhaps it’s time to rethink the framework: Myocardial injury Ischemic injury True infarction (plaque rupture/thrombosis) Clearer biology. Clearer medicine. Sometimes definitions meant to simplify reality end up making it more confusing. Or not? Let's Discuss!

4/ Think about this: We filter our water and only drink 2L a day. We inhale 11,000L of air every day. Unfiltered. Loaded with things that make us sick.