Thomas Whiting

Great schema! But beware that *any* time you see a diagram like this, it assumes the patient has one disease process. Our patients are increasingly multimorbid so: ⚠️May have >1 cause of hypoNa ⚠️Fixing one cause may cause dominant physiology to shift (playing wack-a-mol)

What happened is the “art of medicine” is not taught anymore. I hate that phrase because it is not art, it is doctoring. Clinicians have to balance what is known - history, physical exam, and testing. All imperfect. Against what is not known, we do not have anywhere near a perfect understanding of physiology and pathophysiology. Most docs now do it reverse. Look at the tests first and then decide. Being a great clinician requires a deep understanding of human nature and the individuals we treat. Understanding the problem as best we can and working through tremendous uncertainty with confidence. It is not trainable in 4-6 years. It’s takes a long time and a lot of reps with the guidance of great mentors. Getting a black belt in karate is step one toward real learning. It takes about 4-5 years in many instances, but is individuals in most systems to the person on that journey. Getting a black belt in medicine is 4 years undergrad, 4 years med school, 3-5 years residency. And the the real learning starts as an attending. And it’s only possible to become great at that starting point with great colleagues, mentors, and the time needed for continued learning. Our system is broken and tried to break down patient encounters into relative value units. It’s broken. This is nonsense. To be great at this job, the level of introspection is unfathomable to most people. Doctors work in a space that 99% of people do not have high school level competency - science. And we apply an imperfect science and its principles in treating infinitely complex humans. AI is here. And it will augment the skill of those with skill. It will cripple those without foundations in real clinical medicine. Reminder, we need to take back medicine from the government, insurance, and corporate interests. 💊 @DutchRojas @mass_marion @txsportsdoc @realdocspeaks @BrentAWilliams2 @LighthouseDPC @paulsaladinomd @drcraigwax @BrianSuttererMD @Paul_Wischmeyer @doctorwes @DocLibertarian

@cardiojaydoc02 I almost went into afib just reading that sentence.

NOT NONINFERIOR? 😐

I loved it, probably my favorite book of the series. But I am also religious. And feel like his portrayal of man’s interaction with deity to fit inline with how I imagine it to be. It’s one of the neatest wrap ups of a fantasy world/series I have ever read and why I think I love it so much.

@DadDocGamER Oh interesting, from what I've heard people really disliked that last Lightbringer book

If you're limited to one, what's your favorite fantasy/sci-fi work of all time? Can be a single book, a trilogy, a series, etc etc, but you can only pick one

@PatrickHeizer Ohh this would be epic. Yes please!!

I am pleading with the forces of the universe to convince Villeneuve to tackle yet another "unfilmable" sci-fi series.

Peripheral vasopressor administration in critically ill adults was associated with a low incidence of adverse events—major events were rare using short peripheral intravenous catheters, and use avoided central venous catheter placement in 60% of cases. ja.ma/4btNGSr

@GaltMD Literally what my nightmares are made of.

@DadDocGamER Horrible case. Neonate in extremis, with what can only be some kind of undiagnosed inborn metabolic error.

I saw the sickest infant of my career yesterday. Gonna be a while before I can sleep again. Legit record breaking labs, like worst in all of recorded medical literature. Horrifying.

Just-released: Decoder chart incorporating the secret messages in the new PE guidelines

Our ultrarealistic phantom simulating a pericardial effusion. One of the stations in our advanced ultrasound-guided hemodynamic monitoring course (CAMUS in portuguese) held this weekend. Teaching how POCUS always wins.

@drrdemon Second for project Hail Mary

I need a good book rec

Sitting is a medical super power 👇🏻

@Mark__Lawrence Great book!

Reading this - got it for £1 in the hospital charity shop.

Addiction to short-form videos reduces brain activity in the frontal lobe weakening the ability to focus.

me to my work bestie after they code their 3rd patient in 4 hours

LENTZ EQUATION 🔥PEEP = BMI/3🔥 🙅‍♂️Stop under-PEEPing patients with high BMI 🙅‍♂️Stop trying to wean everyone down to a PEEP of 5 Patients with high BMI often need high PEEP as long as they are intubated & can be extubated *directly* off high levels of PEEP 😁

Look forward to reading the new guideline for the evaluation and management of acute pulmonary embolism in adults. No more submassive or massive it seems! jacc.org/doi/10.1016/j.…

Pediatric Anaphylaxis thesgem.com/2026/02/sgem50… @DennisRenMD @TessaRDavis @DFTBubbles

@jointdocShields Trampolines if it’s a peds patient maybe a consideration for your business model as well..

I just left the dentist and she gave me cookies when I was done. Interesting business model Next week all ortho patients are getting roller skates as a gift at the end of the visit