Joe England

@patrickppatten @nycsouthpaw @EM_RESUS It's chest wall gas tracking along pectoralis major.

@nycsouthpaw @EM_RESUS 1 tube in adequate position along the fissure so says fenestration. Looks like intravascular air to me.

Here’s a Chest X-Ray taken in the ER of a 30-year-old man after being shot in the chest What’s going on here?

@WendeNGibbs @drtintin99 @e1v1m1 @BASStrainees @neuro_at_ic @neil_rane Agree. I see missed early spondylodiscitis from time to time, but not (at least not yet) by neuro or MSK trained.

@drtintin99 @e1v1m1 @BASStrainees @neuro_at_ic @neil_rane I think this partly depends upon who is reading the MRI- if specialized neurorad or muskrats, likely MRI much higher (many cases aren't easy ;)

This systematic review of 20 articles showed, for vertebral osteomyelitis, MRI has sensitivity and specificity of 90% & 72% whilst CT PET was 93-95% & 80-92% respectively. #MorningPaper @e1v1m1 @BASStrainees @neuro_at_ic @neil_rane @WendeNGibbs thespinejournalonline.com/article/S1529-…

@northwoods1980 Yes. Usually in the last 1 or 2 shifts of 7. I think it's a mix of calorie deficit from missing meals at the beginning of the week due to changing sleep schedule and sleep deprivation related insulin resistance/poor decision making. I give myself one freebie night per 7.

Does anyone else who works the night shift occasionally, feel like just eating all night long?

@HistoryWaste @triadaxiom @fncmullin @MarkRPellegrino Doesn't the amount that constitutes a living wage depend on how many dependents one has? Does choice play a role in the morality of wages or job number? If a couple chooses to have 6 kids instead of 2, should they take some responsibility for earning the extra money they need?

@triadaxiom @fncmullin @MarkRPellegrino That’s an incredible strawman. Fast food workers should have a living wage, kids or no.

People say you shouldn’t have to work two jobs to make ends meet. Why? I shouldn’t have to limit my food and exercise a lot to stay in shape. I shouldn’t have to get old. But that’s reality. If your skills are replaceable isn’t that on YOU? (Non d*ck answers only)

@HistoryWaste @MarkRPellegrino Why assume there is family to support? Only a minority of workers are primary breadwinners for a family. You can't think of a single good reason why a young, unattached person might choose to work 2 jobs? I often worked 2-3 different jobs when I was young.

@MarkRPellegrino Two jobs? That’s insane. One job is enough. Everyone should be able to support their family on one job alone

@texasrunnerDFW It seems like causality could run either way on this one. Also seems like 1st time buyers would be better to sample since just a cultural trend of moving more often could lead to high median age for all homebuyers.

“WHY AREN’T YOUNG PEOPLE GETTING MARRIED AND HAVING KIDS?” Hint:

@northwoods1980 I have heard that a thick neck is the new abs. Isn't that all you need to know?

I would love a solid on neck exercises athletes, non-athletes, all of us might consider doing on a regular basis along with our workout regimen’s. Does it matter much? A neglected Blindspot in most strength training regimens? Thanks in advance!

@thats_bone @olsonplanner I think if you are RVU incentivized and can read higher RVU studies more quickly and more confidently, fellowship training can add to income. Obviously a willingness to go fast even without the added training would yield the same income, but I think on average it would help.

@olsonplanner Radiology fellowships come with approximately $0 extra income, the outlying exception being neurointerventional training.

Can we talk about the ways to make more money by subspecializing? (with a hat tip to the specialties that pay LESS when you drill down??) The most financially “worth it” fellowships on the top of my head are in radiology and orthopedics, right? Any others that stand out?

@EmmaradMD I feel the same when CXR shows severe CHF and next order is CTPA. William of Ockham is getting dizzy from all the rolling at this point.

@docskalski Totally agree with this. I do nights so I can work way fewer hours at only 10-20% pay cut (relative to local pay in SoCal). Also, that is an awesome bathroom movie set up.

If you're a physician in your 30's with kids, you should be .5 FTE now! or whatever it takes to have health benefits. When you're 50 and your kids are in college/life is when you should be 1 FTE. Let's get our priorities straight. Your days are numbered, spend them wisely.

@docskalski How far back does "current GOP" go? Do you mean MAGA? I don't know many doctors who buy completely into party platform. Most people identify with one party based on a few issues. For some it is more a matter of past affiliation (e.g. Clinton democrat or Reagan republican).

@Joe_R_England Skilled yes, but committed to all patients equally? Certainly not. That's the entire basis of the republican party: it's your fault where you are... health, finances, and otherwise, etc. Understanding and compassion are antithetical to the current GOP.

The current GOP is morally bankrupt, so no, you can't be US Republican and be a good doctor.

@olsonplanner I don't feel like I delayed anything important. I got married in med school and had kids in residency. Income lags behind some non-medical friends, but the difference isn't drastic. Maybe you make 60K as a PGY3 and they make 150K? It's not like they're cruising around on yachts.

When I hear people say how much they love medicine but that the delay in living a life is so much more of a substantial cost, I ask myself: How can pre-meds best make this determination for themselves? Is there no realistic way to understand the life costs before committing?

@ladiologist Yeah if it matches a similar or slightly less distinct opacity on the other side or if it is indistinct on one margin to confirm it is chest-wall location, I will just say nipple or not mention it at all.

@ladiologist I have said "probable nipple shadow, consider repeat exam with metallic marker." Then CT pops up on the list an hour later. So saying it is probably a nipple doesn't always make a difference.

@northwoods1980 @louisanicola_ I have been looking for good literature on creatine as a neutropic and sleep aid but haven't been able to find anything. I've noticed that switching from days to nights feels easier when I'm on it, but it doesn't seem like it's been studied.

@louisanicola_ Can you link the studies showing the utility in young healthy populations? Thanks

Normalise taking creatine for brain health.

@northwoods1980 I really do not see the point of a separate impression section when the findings section is 14 words long.

@northwoods1980 Undesirable in several ways. Depending on tumor histology, mets might not even be the end of the world.

@becker_rad I think this is tricky since many ordering physicians *do* think our job is to exclude things. Recently read non-con CT chest for "exclude esophageal perf." I added the disclaimer "CT is not sensitive for detection of esophageal pathology and cannot exclude small perforation."

Radiology reporting tip for #Radres Do not use the term "cannot be excluded". You can never exclude anything. That is not the radiologists' job. Our job is to describe the findings and assign a likelihood for something to be present or absent, based on history and imaging.

@becker_rad @EmmaradMD Chart dig is definitely part of the job, and I even enjoy occasionally digging on an interesting or difficult case. But we really should not have to chart dig to find a reasonable indication for the study we are already reading.

@EmmaradMD LOL 😄 To be fair, chart dig IS part of our job and included in the professional fee. (That is not to say that this system is sh-t and whoever came up with it clearly has never heard of game theory)