Dr4kujayhawks

@SuburbanDadX @SBakerMD European Golden is exceptional. Smart, sassy, expressive. We’ve had several good and great dogs. One of our favs for sure. Just got a Belgian Malinois and he looks like he’s going to give our golden a run for the championship.

What is the best dog breed?

@rkh_md Amen. I’d even suggest a new pathway for gen Surg, family med &, ED docs into an orthopedic surgical specialty. Plenty out there with aptitude who had no shot at orthopedics in med school. There are small communities desperate for Ortho care.

These numbers are just getting wilder. We need to figure out a way to make becoming an Orthopaedic surgeon something different from a lottery. Lots of deserving people don’t get a spot.

@independentMDs @BrentAWilliams2 What if an AI has abilty to do full body POCUS in a matter of minutes. Can hear interstitial sounds from 10’ away, read body temp changes real time, do lung dynamics by pt blowing into a tube…. Pop a full body xray…

The fact that med students think these skills are protective, and even may serve as a most against replacement by AI....is detached from the reality of American healthcare in so many ways.

@CoffeeBlackMD I knew I wasn’t the smartest and then I went to med school and met some ppl….O MY G. There are levels of intelligence and stratospheric levels. Like the dude in a class above us that the path prof told us, his only goal last year became to try and make David miss ONE question.

Of course they do. Omg. Save me Lord. Of course! They do. 🤣😂

@nullbotto @AbudBakri If delirium involved

@EnhancedMD @AbudBakri Any idea if you can see hospital sleep/circadian disturbance leading to rapid worsening of hydration?

I’ve been ordering so much thiamine by IV and oral for patients hospital. The pharmacists are so confused as they confirm my orders But my patients get discharged earlier than my colleagues :)

@Dr_Red_Gamer Mine is 5 letters. ER DOC 😎

What’s a seven letter word for when you have too many hobbies, but are skilled in all of them?

@AbudBakri I don’t get to see backside successes. In our little hospital, Most are going in due to some infection or CHF, COPD type c/o. Add in elderly, chronic dehydration, and metformin and thiamine seemed to make sense…

@EnhancedMD Amazing. Cognitive recovery is common limiting factor to going home. Thiamine gets you some support there The lactic acidosis angle is interesting as well. Gonna start paying more attention and see if there is a trend

@AbudBakri Avoid lactic acidosis,support energy metabolism, cardiac function, and possibly reduce delirium or neuropathy. I’ve noticed he leaves it about 7/10

@AbudBakri @TakeWeightOffMD I pass on to a Hospitalist and usually put 100mg IV daily thiamine in the tuck in orders. So, they can or may not continue the orders at their whim. He caught me one day and says, dude, what’s up with the thiamine. I’m like, glad you asked.

@CoffeeBlackMD Feel ya brotha’

@CoffeeBlackMD In ED now for aspiration? H/o CVA with dysphasia, From LTC. Did swish and spit nystatin and can’t stop coughing…

When you get a consult on a guy with a stoma for “aspiration” … the Lord will need to help me not write a passive aggressive note.

@DocBottsNY @CoffeeBlackMD @aclong111 For sure! As an old mentor would tell me, “You were not trained to think within the box. Anyone can follow an algorithm” We are trained to be the one a box cannot contain, to be the ones who can float within and without the algorithms and most common causes.

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

I agree that nuance is best. That’s exactly why I’m not convinced an absolute rule like “no recommendation unless there is clear RCT benefit” works. Medicine is full of situations where the evidence is imperfect, evolving, or indirect, and clinicians still have to make decisions. The question is not whether recommendations should ever exist, but how to make them carefully, transparently, and with appropriate restraint when certainty is low.

@noahkaufmanmd And…cattle dogs with attitude?

A lot of people have asked what we treat at KaufCare. Think urgent care — but with ER physicians. • stitches & lacerations • fractures & splints • abscess drainage • IV fluids • infections • joint injections • pain management • hospice care Walk-ins welcome.

@ajmahler Nice work…you Fat F ;). The words that float in our dysmorphic minds. Me. 6’2, 212. Working my fat down slowly and morphing it into muscle…slower than I’d like, but, 30000’ view. Doing well.

This picture makes me think, damn, maybe I am jacked and my body dismorphia is a lie. Still need to lose lbs or convert to muscle, but…not bad for 200lbs natty 61.

@WolverineDavis Oh shit. You are old ;). What if I mention Joe Montana or Dan Griese, Roger Staubach or Lynn Swann, Mean Joe Greene

Dan Fouts, Chuck Muncie, Jon Jefferson, Charlie Joiner, Kellen Winslow, Lionel "Little train" James.

@hjluks @JohnGoldman @anymanfitness Boooyah! Nice one Howard

@JohnGoldman @anymanfitness 50 wives!!! That’s impressive.

Every year my mother in law asks me when we are going to “celebrate” my birthday and every year I tell her I don’t want to. 45 year old men shouldn’t even acknowledge the day, they should just go about their business.

@noahkaufmanmd @KaufCare Man Noah, I wish you all the best & know you ‘guys’ will absolutely kick As$. Lots of ED docs out there praying you find a new path through the forest that has been placed and purposely planted in front of all of us over the past 20yrs+.

The response to yesterday’s post about opening @KaufCare has been incredible. After 20 years in the ER I saw the same thing every shift: Patients waiting forever. Ridiculous bills. Frustrating for patients & docs. Too many middlemen. That’s why we’re trying a different model.

@Anon61152358473 Why did you come to the ER? A finding is just a number. The context is what brought you there.

ER finds my liver enzyme jumps 500+% vs normal 2 weeks ago. ER solution: follow up w/ PCP about healthy lifestyle choices, reduce alcohol. (At check in I'd truthfully noted alcohol/smoking of zero). Medical encounters take a real toll when you have poorly understood conditions.

@andieiamwhoiam FAR from true. Likely some of the busiest people in a hospital system. In fact, they tend to attract those that would rather be busy

@Anon61152358473 ER employees are lazy

@hjluks Strong work here. Making agreements with diagnosis and “welp, I guess that’s how it will be” is a grievous mistake. Motion is lotion as the old docs (now me) say. The smallest start is just movement. Any movement with purpose to rebuild, strengthen and improve.

I’ve been an orthopedic surgeon for nearly 30 years, and a few patterns have become impossible to ignore. One is that many musculoskeletal problems in adults aren’t sudden injuries. They’re the moment when declining capacity and awful metabolic health finally reveals itself. Over the decades your strength fades, muscle mass declines, as your aerobic capacity tanks. Tendons and connective tissues lose substance, stiffness, and resilience. For years the body compensated... quietly. Then one day a knee hurts during a run to get the train, or shoulder aches reaching overhead, or a back tightens lifting something simple. At that point the story usually becomes more about structural damage. An MRI gets ordered. Welcome to high-tech, low-medicine. And the MRI almost always finds something. A meniscus tear. A rotator cuff tear. A disc bulge. Why? Because by midlife these findings are extremely common — even in people with no pain at all. If you have a tear in one shoulder, image the other shoulder... you probably have the same tear there. But I digress. Once the scan appears, the narrative changes. The image becomes the diagnosis. Now the patient believes something is broken, and the focus often shifts to fixing what the MRI shows. What often gets lost in this is the reason the symptoms appeared in the first place. Many so-called “atraumatic” orthopedic complaints are not purely mechanical failures. They are the moment when reduced strength, declining tissue capacity, and sometimes broader metabolic health issues finally reach a tipping point. Our tissues change over the decades... get over it. In other words, the MRI didn’t create the problem. Well... it sort of did in this scenario. But all the MRI showed was something that was already there.... because of your age, lifestyle, health and so on. The real driver of symptoms is often loss of physiologic reserve. Less muscle. Less tendon or aerobic resilience. Less tolerance for load, etc. Once the MRI enters the picture, the risk becomes overtreatment. This is probably the number one reason people have surgery. When in many cases the most powerful intervention was never the scan or the procedure. It was rebuilding capacity. Strong muscles stabilize joints. Aerobic fitness improves metabolic health and tissue perfusion. Gradual loading restores tolerance. But people often don't take PT seriously prior to surgery. They often take PT very seriously afterwards. Therefore, PT is probably the reason you feel better, despite the surgery. The irony is that the treatment many people ultimately need is the same thing that might have prevented the problem in the first place. Staying strong. Staying active. Maintaining the reserve that protects our joints/tendons/muscles/abilities as we age.