J Dylan Hall, MD

@user0ioi @AaronGoodman33 @nihardesai7 @Bloodman Yes! Anemia is a late finding in iron deficiency.

@ParijatSen11 This is why my signature includes VTE ppx, GI ppx, lines, fever plans, diet, and bowel regimen, to name a few things I don’t want to miss.

@ParijatSen11 As a med Peds Hospitalist, I see charting done both ways. I find that my pediatric learners don’t often have as good of a grasp of the problems when systems based charting is used. I was just talking about this with some colleagues.

Unpopular opinion but the systems based approach in the ICU never made sense to me. Problems based approach gives a true overview “CVS: Hypotension, needing pressors GI: massive lower GI bleed” doesn’t mean much “Hemorrhagic shock 2/2 massive lower GI bleed does” 🤷🏽‍♂️

@Jmarksloan I love how 2+ years outside of residency is considered a red flag and yet institutions continue to train and hire midlevels in these specialties!

These are my own but I suspect most program directors would feel the same.

@adnandawood @dvassallo Of oral X-rays, a panorex (one X-ray visualizing the entire mouth) exposes to four times the amount of radiation as four separate bitewing X-rays. Four bitewing X-rays exposes to the same amount of radiation as we are exposed to from natural radiation in a day. Negligible risk

@dvassallo Is it safe for a child to be xrayd every year ? Also I think you did the right think. General anasthesia is an overkill for milk teeth imho as a parent.

Took my 7yr old to his annual pediatric dentist appt last month (near Seattle) and the dentist found 4 cavities in his baby teeth, all needing filling and one needed a cap. The dentist said this had to be done with general anesthesia. Cost $2,750. We found it bizarre to have to put a 7yr old under general anesthesia, outside of a hospital, in a small clinic above a Starbucks, with full intubation and put on a ventilator, just to fill 4 cavities in baby teeth that would fall off on their own anyway. The dentist insisted the intervention was necessary because these teeth won't fall off in 5 years, and one of the cavities was almost guaranteed to become problematic. And that general anesthesia was required because of the length of the intervention. We had a bad feeling about all of this, and declined the procedure after considering the risks of general anesthesia outside of a hospital. The dentist gave my wife a lecture about how this is totally safe and they do it all the time, and that we should take some time to think about it, but we should come again after the summer to talk with them again and reconsider our decision. The dentist insisted this was the only way to proceed and that it would be very imprudent to postpone it. The entire rant made the whole thing feel even more shady to me. It felt like a Hertz rep trying to sell me car insurance at the airport. We're now in Malta, and took the kid to a local dentist for a second opinion. We thought we'd ask the dentist if we could do the fillings one by one, over multiple sessions, in order to avoid any sedation. And guess what? This dentist took a look at the kid's teeth, and couldn't find anything! Zero cavities. Perfectly healthy teeth. Not even a cleaning was required. We paid €15 and were sent home. Now, the Maltese dentist didn't do an x-ray. They said it would be an over-intervention to order an x-ray with no visible signs of decay. The Seattle dentist does an x-ray every year, and found the cavities from the latest x-ray. They never sent us the x-rays though. Is there a chance the Seattle dentist was right, or is this a classic case of violating the Hippocratic Oath for personal gain? The insistence on general anesthesia just didn't sit well with me, and smelled of malpractice in an attempt to do this procedure quickly and more conveniently (plus charge a lot more). What's your interpretation?

@BradSpellberg @sebpoule @TMcCarty2010 @DrToddLee @Josh_S_Davis Wait you mean we shouldn’t be checking urine cultures for test of cure?! 🙄 (sarcasm)

@sebpoule @TMcCarty2010 @DrToddLee @Josh_S_Davis The prostashort study itself proved that asymptomatic bacteriuria was not predictive of relapse. Ironic. Not the first time no relationship has been found, but very compelling in an RCT.

I'm going straight for the summary slide

Proposition: You should never order troponin without an accompanying ECG.

@Zach__Frank 🙋‍♀️

Have kinky sex at Pride with your rich friends who have bellies instead of abs

@IdVilchez Also why are we including anaerobic coverage for CAP without post obstructive PNA, abscess or empyema?

@IdVilchez Are there host factors that make the risk of missing coverage for drug resistant organisms high? I still see a lot of Zosyn for sepsis without acute organ dysfunction for community acquired infections and immediately de-escalate on admission.

#IDtwitter I don't understand why some hospitals prefer Pip-Tazo + Vanco for empiric sepsis treatment. It seems that every patient with fever has sepsis. The Sodium content if this combo is very high, and do we always need anaerobic coverage?

@issarantqueen @drkeithsiau @ShiYunZhao Then get a UDS including one testing for carrots. Patients always lie! Lol #ThisIsAJoke

@drkeithsiau @ShiYunZhao Maybe in recovery phase. Yellowish discoloration will take time to go even after bilirubin is normal?

Patient presents with yellow hands and normal bilirubin. What’s the diagnosis?

1/ #HFpEF treatment algorithm #tweetorial. This is the algorithm I currently use to treat HFpEF based on evidence we have thus far and my anecdotal experience treating patients over the past 16 years in the @NMCardioVasc HFpEF Clinic.

@HarveyGuzman_ There will be other decades to worry about those loans 😂😵‍💫

@HarveyGuzman_ Make your minimum payment during residency for purposes of counting toward PSLF (if on REPAYE you’ll save some interest) and don’t think about it anymore while you’re a resident. Focus on becoming the kind of physician you want to be…

@willyhfrick @rehbies @LianaMoraitou @IdVilchez @okwalding @ABsteward Does that mean pip/tazo is free? 😂

@rehbies @LianaMoraitou @IdVilchez @okwalding @ABsteward Why is amp/sulbactam so much more expensive than pip/tazo?

What’s the mechanism of resistance. Would you trust cephalosporins? @IdVilchez #IDTwitter #MedTwitter @okwalding @ABsteward

@gbosslet @IUMedSchool “One medical expert told Fox News Digital in December that the foothold gained by DEI policies in medical schools posed a serious risk to the quality of care patients could receive in the future.” - Says no actual expert on this subject

This is a truly fascinating piece of reporting on amazingly mundane medical school stuff I look forward to the next expose on the Krebs cycle and how med students are taught about left-handedness Proud to be a faculty member of ⁦@IUMedSchool⁩ foxnews.com/politics/india…

@okwalding Then the corporate medical groups wouldn’t be requiring hospitalists to see unreasonable numbers of patients and could focus more on getting to enjoy the medicine too.

@okwalding But remember that sometimes a silly consult is from an overworked hospitalist who would like to make it home at a reasonable time. The pay structure needs to change so that many of our cognitive tasks can be reimbursed at higher rates.