Mlbirch1

2.1K posts

Mlbirch1

Mlbirch1

@Mlbirch11

Anesthesiologist and Critical Care Physician

Katılım Haziran 2019
346 Takip Edilen49 Takipçiler
Mlbirch1
Mlbirch1@Mlbirch11·
@purviparwani @DrRyanPDaly Marino is vastly overrated. It’s popular because it’s short and simple. But out of date. My favorite crit care textbook is Critical Care Nephrology, Ed Bellomo, Kellum, and Ronco. It’s long but incredibly well written and must importantly modern. Dialysis sections are useful too
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Dr. Purvi Parwani
Dr. Purvi Parwani@purviparwani·
I wouldn’t necessarily recommend starting all the cardiology reading before fellowship unless you have extra time during your third year of residency. That said, the following preparation was extremely helpful for me: 1. Marino's The ICU Book before the CCU rotation. Cardiac Intensive Care By Dr Brown 
A lot of cardiologists gradually lose touch with the intensive care aspect over time. As a fellow, being strong in ICU medicine can really help. 2. EKG books — read as many as you can.
My favorites were: ◦The ECG Criteria Book Okeefe ◦Rapid Interpretation of EKG's Dubin ◦The Only EKG Book You'll Ever Need Malcom Thaler 3.I loved using a pocket cardiology book during my first year.
I kept adding notes to it, and by third year it had become three times bigger. I did not use it as much later on, but it was invaluable early in training. 4. For echo, buy textbooks by Jae K. Oh, Catherine Otto, and board review by Allan L. Klein.
I started reading them from the beginning of fellowship along with the Mayo echo videos, and it helped tremendously. 5. Finally, going home and reading Braunwald's Heart Disease on weekends and late evenings really helped reinforce everything I learned during the day. It is an excellent resource. @CardioNerds has some excellent resources- wasn’t available when I was a fellow but I hear it’s incredibly useful Pace yourself. Cardiology is a marathon, not a sprint. If you are in your third year of internal medicine residency, I would start with the EKG books first. #Cardiology #FIT #Cardiotwitter #CardioX
Mansunderbir Singh@MBSingh_MD

Starting cardiology fellowship this July and excited (and slightly nervous) for the journey ahead. For current fellows and attendings, what are the BEST resources you’d recommend for an incoming fellow to build a strong foundation early? Looking for: • ECG • Echo basics • Hemodynamics/cath fundamentals • Board prep • HF/EP/interventional learning resources • Podcasts, YouTube channels, apps, textbooks, websites, question banks, etc. Also what do you wish you studied before Day 1 of fellowship? Would really appreciate any advice/resources/learning strategies from #CardioTwitter 🙏 #Cardiology #CardiologyFellowship #MedTwitter #FOAMed #CardioEd #FITTwitter #EchoFirst #EPeeps #HeartFailure #InterventionalCardiology

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Mlbirch1
Mlbirch1@Mlbirch11·
@kiddiewise_ We don’t. But, alternatives have costs. More signouts, loss of information btw drs, loss of longitudinal understanding of disease course, inability of trainees to function on call as staff. No system is perfect. But there is no free lunch. There’s always a cost.
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Dr. Yonni
Dr. Yonni@kiddiewise_·
If chronic sleep deprivation impairs judgment, memory, empathy, and decision making, why do we still believe exhausted doctors produce the best patient outcomes?
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Dr. Yonni
Dr. Yonni@kiddiewise_·
One unpopular truth about residency programs nobody wants to admit? Let’s hear it.
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Aleph
Aleph@woke8yearold·
Trump’s decision to go to war with Iran was stupid, but he has also conducted the war in a pathetic fashion. Just terrible across all dimensions F-
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Mlbirch1
Mlbirch1@Mlbirch11·
@mcuban Independent practice is unbelievably difficult and has little to do with school debt.
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Mark Cuban
Mark Cuban@mcuban·
If you want more doctors doing house calls, not selling their practices and going to work for the big HC conglomerates, make public med school free. A little gov intervention, so that rather than having 100s of thousands in debt guiding their decisions , they can do primary care or be a family physician and spend as much time with patients as they want. They can take cash. They can take chickens. If you had 250k after almost a decade of school, do you think that would impact your decisions ? And if you own a big HC conglomerate, does knowing they are drowning in debt impact your decision and how you compete and contract with them ? Fuck yeah it does. You pressure them till they have to sell out to you in an acquihire. They can’t afford to survive on their own and every huge HC company takes advantage of them About 32k students enter med school and DO school a year. 75k for a grant each. Thats 2.4b annually for each class. That’s it. You want better healthcare for everyone. That’s the place to start.
Mark Cuban@mcuban

@MarkGabriele22 @DrDiGiorgio They can open up their own practice and do whatever they want. No one is stopping them. This is exactly how the direct primary care business has grown so quickly.

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Mlbirch1
Mlbirch1@Mlbirch11·
@PulmCrit @IM_Crit_ I think this is pretty common. Same happened to me. Post-op npo pt not receiving his po methadone. No one gave iv. Came to the icu in frank withdrawal but the reason was hypertensive emergency.
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𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊
once encountered similar situation with a patient who repeatedly presented with "hypertensive emergency" that was actually opioid withdrawal "he's presenting again with another hypertensive emergency... history of multiple ICU admits... so we inserted an A-line and started... "
IMCrit@IM_Crit_

After a frantic 📞 from the floor, I accepted a transfer to the ICU yesterday. Young ♀ with "HTN emergency" (BP 220/120, restlessness) and abd pain (I saw in her chart that she had recurrent pancreatitis). I gave her 0.5 mg dilaudid and 20 mg labetalol and next BP was 150/80...

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Mlbirch1
Mlbirch1@Mlbirch11·
@drterrysimpson Best consult note I’ve ever seen began with “Post hoc ergo propter hoc is a logical fallacy.”
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Dr Terry Simpson
Dr Terry Simpson@drterrysimpson·
No, medicine trains us not to confuse temporal association with proof of causation. People develop strokes after flu shots. Heart attacks after antibiotics. Miscarriages after ultrasounds. Autoimmune disease after viral infections. Cancer after CT scans. The question is never “did event B happen after event A?” The question is whether it happened more often than expected, plausibly, reproducibly, and statistically above background rates. That is not gaslighting. That is literally how we avoid fooling ourselves. And importantly: transverse myelitis is rare, but it also occurs after viral infections — including COVID itself, which carried a far higher inflammatory and neurologic risk than the vaccines designed to reduce severe disease from it.
NovaScotia@akeith941

@molsjames @michaelZorn12 @drterrysimpson Yep we're trained and gaslit out of believing the evidence of our own eyes day one of medical school. Seen transverse myelitis develop 20 mins after the shot. I will not be gaslit out of believing the obvious conclusion

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Skeptic Research Center Team
One of the most persistent false beliefs in American culture is that the Floyd/BLM riots were incredibly peaceful, causing little damage to life and property. In fact, the Floyd/BLM riots were the most destructive riots in American history, leading insurance agencies to designate them as a "catastrophe event." (See first chart below showing that misinformation about the Floyd/BLM riots is positively correlated with trust in journalists.) (See second chart below showing that misinformation about the Floyd/BLM riots is associated with left-leaning political beleifs.)
Skeptic Research Center Team tweet mediaSkeptic Research Center Team tweet media
TheBlaze@theblaze

Sunny Hostin: “There was very limited destruction of property and violence during the BLM uprising.”

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Jim Flood
Jim Flood@Ronin72·
@EsotericCD The only thing I remember thinking was “they dragged Peter O’Toole into this garbage?”
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Jeff Blehar is *BOX OFFICE POISON*
I come in peace. I didn't bring artillery. But I'm pleading with you, with tears in my eyes: If you try to convince me that TROY (2004) was anything except pure garbage I will kill you all Mattis-style.
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Mlbirch1
Mlbirch1@Mlbirch11·
@wil_da_beast630 Too much overlap of groypers and incels to differentiate the 2. They’re basically the same. So them.
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Wilfred Reilly
Wilfred Reilly@wil_da_beast630·
Which Internet-concentrated phenomenon do you dislike the most?
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Daniël Lakens
Daniël Lakens@lakens·
If a scientist uses AI to make strong claims in public about the scientific literature, and some references do not exist, and the generated text does not correcfly reflect the findings, should we inform them privately to fix the text or should we share this information publicly?
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Dr Terry Simpson
Dr Terry Simpson@drterrysimpson·
Any medical student who does not get vaccinated and can cause patients, who are the most vulnerable, to be exposed to that virus, is failing at basics of public health. Maybe in Texas it is against the law to enforce vaccine mandates in hospitals or for medical students - but I would state that such a law is against public interest.
Mary Talley Bowden MD@MaryBowdenMD

There is a medical school in Texas requiring students to have a Covid booster. It’s against the law, but the student doesn’t want make waves. If you need an exemption for the Covid shot, please email frontdesk@breathemd.org. I do not charge for this service.

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Mr Wrestlmania
Mr Wrestlmania@justtheone_1·
Any Addition or Objections?
Mr Wrestlmania tweet media
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Mlbirch1
Mlbirch1@Mlbirch11·
@jimstewartson @Kasparov63 This type of testing isn’t very interesting. It’s like giving students an open book exam. What is interesting is how LLMs have been successful solving complex mathematical problems that have stymied mathematicians. That seems qualitatively different.
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Jim Stewartson, Decelerationist 🇨🇦🇺🇦🇺🇸
I’m getting tired of “experts” like this misunderstanding what they’re looking at. LLMs are giant databases of stuff HUMAN BEINGS have done. They are the EXHAUST of humanity. Prompts are database queries into EXISTING DATA. It’s a fuzzy search engine, not intelligence.
Daniel Lemire@lemire

I am getting tired of reading 'experts' like LeCun repeatedly claiming that our AIs are nowhere near human-level intelligence. Let us look at the evidence. US universities rank students based on standardized tests like the SAT. Current AIs achieve near-perfect SAT scores. They also beat tests like the GRE. A few years ago, it was notable when early ChatGPT scored ~120 on an IQ test, a common measure of human intelligence. An IQ of 120 is well above average. Current AIs reportedly have IQ scores similar to those of leading scientists. It is not just in tests. I can ask an AI to produce a science paper that looks undistinguishable from what a PhD level student could do. I just have to give it the data. Better yet, from a prompt, agents can run the experiments and collect the data, and then write the papers. Those of us who try to get work done with AI know what is possible. You can't possibly just say 'this is nowhere near human-level intelligence'. In software, good AIs show a greater mastery of, say, C++, than your average software engineering professor. You could just build a formal test to prove it. The difficulty is that the professors would refuse to take your tests. At this point point, someone will object 'yeah, but your AI can't do this simple thing that we can all do'. Fine. These AIs do not have *human* intelligence. They are very much not human beings. They are something like alien intelligence. They can code straight in assembly language, but have trouble counting characters in words. But that's the result of trade-offs. A dog or a monkey can solve some problems faster than you can. But let us be fair. As a species, these AIs have definitively 'human-level intelligence'. You can't spend decades setting up cognitive tests for human beings, have these AIs beat us in these tests and then say 'well, that's not real intelligence'. Come on !

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Tyler Stone
Tyler Stone@tylerstoneart·
@FlintDibble This reply floored me. It’s not the worst thing she said, and I understand the broad point she’s trying to make… but wording it this way is incredibly irresponsible in an era of rampant science denial.
Tyler Stone tweet media
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Flint Dibble 🍖🏺
Flint Dibble 🍖🏺@FlintDibble·
It's so stupid how the point of this story is not that she learned from her mistake, but somehow arguing that it's not a mistake because other people also made it? 😔
Lenka Zdeborova@zdeborova

@eiszett Have you read all the sources you ever cited? During my PhD we, along with dozens of other papers, cited a paper that I later found did not contain the result for which it was commonly cited. I should be banned I guess.

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Mlbirch1
Mlbirch1@Mlbirch11·
@zdeborova @eiszett Yes you should. That’s how misinterpretations get o pi propitiated. Don’t know your field but in medicine it’s harmful.
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Lenka Zdeborova
Lenka Zdeborova@zdeborova·
@eiszett Have you read all the sources you ever cited? During my PhD we, along with dozens of other papers, cited a paper that I later found did not contain the result for which it was commonly cited. I should be banned I guess.
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Lenka Zdeborova
Lenka Zdeborova@zdeborova·
Occasional errors and oversights are part of science. If we lost our driver’s license for a year every time we exceeded the speed limit by 10 km/h, daily life would become unworkable. Many countries instead use point systems, where trust can be rebuilt through good behavior.
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Michael McGough
Michael McGough@MichaelMcGough3·
@DavidAFrench In what world do employers ask an Ivy League grad what his or her grades were?
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David French
David French@DavidAFrench·
This is excellent news and reminiscent of the approach of many (most?) law schools, which cap A's as a percentage of the class or have mandatory curves that prevent grade inflation. Some students are mad, but they'll adjust (and for some, law school will be less of a shock).
Steven Pinker@sapinker

Breaking news: Harvard faculty votes to cap the number of A's awarded in course grades, a big step in combatting the grade inflation that has been dumbing down our courses, conveying the wrong message to students, and making universities a national laughingstock.

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Mlbirch1
Mlbirch1@Mlbirch11·
@NegroLibre1 @SJFriedl Clinically it’s difficult. Introducing yourself as Dr do and so means physician to pts (depending on the setting eg a dentist or podiatrist office where understanding should be clear). The amount of politics involved is astronomical.
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Negro Libre
Negro Libre@NegroLibre1·
@Mlbirch11 @SJFriedl There's a lot of politics that I was unaware of that was at play in the response I initially made. That said, I think the mentality is that a PhD "can" call themselves a doctor, as much as them just being one, regardless. x.com/NegroLibre1/st…
Negro Libre@NegroLibre1

It's interesting, (which kind of goes back to my original point in my post) there's apparently a long lasting battle between "Doctors", Nurses and others over who gets to be referred as Dr. in clinical settings (The more you know...): nytimes.com/2011/10/02/hea…

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Negro Libre
Negro Libre@NegroLibre1·
I don't know if this an American thing or not, but the hostility towards Non-MDs using Doctor as a title, is one of the most amusing things I've ever seen. It's not really a partisan thing as well, just this belief that PhD's don't deserve the respect of MDs or even DOs.
Cardio NP@CardioNP

Hospitals and institutions need to address this issue. NPs with doctorate degrees should NOT refer to themselves as doctor in the context of patient care. If you want the doctor in front of your name, go to medical school.

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Mlbirch1
Mlbirch1@Mlbirch11·
@SJFriedl @NegroLibre1 The problems occur clinically. When I introduce myself it’s Dr Birch and pts assume physician. Non physicians using that introduction don’t meet patients’ assumptions.
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Steve Friedl
Steve Friedl@SJFriedl·
@NegroLibre1 @Mlbirch11 Ah: there is a difference between using Doctor as a prefix to a name (Doctor Rothstein) and calling oneself “a Doctor”. The latter is strictly for MDs
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