Leonard Feldman

Join us in congratulating Dr. Leonard S. Feldman (@DocLennyF) on his recent Master in Hospital Medicine Award! 🏆 Thank you, Dr. Leonard S. Feldman, for your educational leadership and dedication to hospital medicine. 👏 🔗 bit.ly/3wbrkEP

So proud of friend and @Hopkins_GIM colleague @mcbeachmd - winner of the #SGIM23 Excellence in Medical Ethics Award!

@masnOrioles I think you gave Tyler’s ERA instead of WHIP on your graphic. His WHIP was below 1 yesterday. Great job, Tyler.

#JHMChat. Many more TWDFNR in the pipeline. Keep submitting your great ideas and watch Tony B and John S present TWDFNR at Converge.

@jenreadlynn @WrayCharles @LannaFelde @JHospMedicine #jhmchat that’s amazing!!!

@WrayCharles @LannaFelde I've also worked with our IT folks to allow @JHospMedicine links in our notes so I can link a #TWDFNR article in my note and allow others to read if they have questions too. #JHMChat

A3. Much like holding metformin, it's the inertia! It's so reflective and I feel like if I don't fluid restrict I will have to explain to every other person in the hospital. #JHMChat

@Payalia320 @tony_breu #jhmchat we have started ‘financial Fridays’ to review a TWDFNR with all our resident teams weekly.

@tony_breu this 👆 mixed messaging is so detrimental to our profession!! how can we change this culture faster? almost like we need #TWDFNR PSAs (Physician/clinician service announcements)! #jhmchat

And I feel that a culture change is required for this TWDFNR. Patients will lose trust if they hear the mixed messages ("my last team said I could drink when thirsty...") #JHMChat

#JHMChat how much does the avg HFrEF pt drink in the hospital/day?

#JHMChat have you ever restricted to < 1L routinely?

@Arhait @JHospMedicine #jhmchat definitely have used race as a proxy for socioeconomic status. Just as problematic as proxy for genetics. Can’t assume anyone’s experience.

@JHospMedicine A2. During the covid crisis, race in the chart was like a hint of how complicated this encounter will be (implicit bias trap) #JHMChat

Q2: How do you address and/or teach about the use of race in an HPI? How has this #TWDFNR article impacted your practice? #JHMChat

#JHMChat Should OUD, AUD, or tobacco use be in the social history? Aren’t they medical problems, not social problems?

@prabimd #jhmchat. How does it add to the social history?

@YichiZTulane @JHospMedicine @michellebr00ks #JHMchat Social determinants of health are so often overlooked!

@JHospMedicine @michellebr00ks A2: I think the focus here should really be educational programs aimed at recognizing and mitigating #implicitbias. Because whether race is included in HPI or not, some clinicians will still choose different treatments based on race if they are not well-informed. #JHMChat

Topic 2️⃣: Routine Inclusion of Race in the HPI 🔗 Article Link: bit.ly/3CXxsiN 👀 #VisualAbstract by @michellebr00ks #JHMChat

@DavidACohen_MD @NdidiUnaka @ETSshow @JHospMedicine #JHMChat Obs pts are definitely low hanging fruit.

@NdidiUnaka @ETSshow @JHospMedicine Thanks @NdidiUnaka — I’m on our endo consult service right now & it’ll take my 2 hands plus 1 of yours to count the patients we have on metformin. Without contraindications (hypoxia, sepsis, AKI) it is very effective to help lower glucose levels without hypoglycemia. #JHMChat

Q1: What's your approach to the use of metformin in hospitalized patients? How has this #TWDFNR article impacted your practice? #JHMChat

@EileenBarrettNM @JHospMedicine #JHMChat it is a bit like swimming upstream.

@ETSshow @tony_breu #JHMChat hard not to remember the time an attending ripped you. I still recall when I got yelled at for not doing a testicular exam on a pt with a new DVT.

@DocLennyF @tony_breu It’s been a minute but yes #JHMChat

Mark - do you do this because it's the simplest route or because of a fear of LA? #JHMChat

@ETSshow @tony_breu #JHMChat Nausea in pts who regularly take met?

@tony_breu Honestly, I had an attending absolutely blow me out of the water for prescribing it back in the day. I’ve also seen so many patients experience new nausea w/o other clear cause too #JHMChat

@WrayCharles @tony_breu #JHMChat what about in PERIOPERATIVE patients?

@tony_breu Exactly, Tony. I don't mind if held on day 1 and 2 - but once I start to see clinically stability, I'm pushing myself and team to think about getting back on board #JHMChat

For topic 1, I also wonder how quickly people "add it back" if an admitting doctor stopped it. #JHMChat

@elibrilu #JHMChat And we are developing some great peds TWDFNR content!

@DrSamanthaWang @JHospMedicine @Payalia320 @DanielRicottaMD @DavidACohen_MD @ChristleNwora @juliablumcaton #JHMChat Glad you’re here!

@JHospMedicine @Payalia320 @DanielRicottaMD @DavidACohen_MD @ChristleNwora Excited to be part of the #JHMChat tonight with my colleague and co-author @juliablumcaton!

You also may see some of our authors pop in to #JHMChat! We ❤️ highlighting your #TWDFNR work! @DrSamanthaWang @Payalia320 @DanielRicottaMD @DavidACohen_MD @ChristleNwora