Dr. Mark

17.9K posts

Dr. Mark

Dr. Mark

@canlungdoc

Respirologist, Canadian, family man, weekend redneck, conservative,recent ex-atheist. ✝️🍁 🇮🇱

Katılım Şubat 2014
2K Takip Edilen1.2K Takipçiler
Dr. Mark
Dr. Mark@canlungdoc·
@fnveenie I thought Buffalo made a lot more mistakes/giveaways vs Boston than Tampa did v Habs, but will be interesting.
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Mike Veenie
Mike Veenie@fnveenie·
Buffalo does not have a shutdown line like the Cirelli line, but their blueline is big and very deep. Their forecheck will be a big challenge for the Habs. No idea what to expect in this series.
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Not a Non
Not a Non@Anon_not_a_non·
@CCantonii @KILLTOPARTY The real advice for her would be to stop fucking talking (yapping), and do the exact opposite of whatever her instincts are for any situation, for life. A complete 180. A never mention travel again, might land some random incel 3/10 if lucky.
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“Bad” Billy Pratt
“Bad” Billy Pratt@KILLTOPARTY·
End product of dating app culture— the apps made it too easy for attractive men to run through average women, leaving a woman desperate and hopeless by middle age
“Bad” Billy Pratt tweet media
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Dr. Mark
Dr. Mark@canlungdoc·
@DrGorfinkel if they did for some rare reason need a gyne exam the FROM A NEUROLOGIST part is the issue. Why you'd even have the supplies? Can safely say that portion of my exam table has been unused for 30 yrs.
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Iris Gorfinkel, M.D.
Iris Gorfinkel, M.D.@DrGorfinkel·
I’ve been a family doctor for decades … and have never met even ONE patient who needed a gyne exam from a neurologist This is egregious.
Reem Alsalem UNSR Violence Against Women and Girls@UNSRVAW

ctvnews.ca/kitchener/arti… Neurologist accused of 48 counts of sexual assaults against 48 of his female patients has been acquitted recently by a male judge. 48! In doing so, the judge dismissed the expert testimony of a female doctor and expert on whether vaginal and breast exams were part of the norm during neurological exams (They are not) We are still a long way from addressing sexism and gender bias in the court systems. This all will serve to further undermine reporting. Victims legitimately ask "what is the point"

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Dr. Mark
Dr. Mark@canlungdoc·
@alandrummond2 They so clearly fixed everything with their prior majority, now we can return to those glorious times.
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alan drummond
alan drummond@alandrummond2·
Great, now the Standing Committee on Health can get to the real problems facing our health care system. It has been an embarrassing gong show courtesy of Conservative members.
Michael Cooper, MP@MichaelCooperMP

BREAKING The Liberals just RAMMED through a motion to seize control of ALL parliamentary committees. Carney is wasting no time abusing his new "majority" that he didn't earn at the ballot box to SHUT DOWN oversight & accountability. A MASSIVE UNDEMOCRATIC POWER GRAB.

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CoffeeBlackMD
CoffeeBlackMD@CoffeeBlackMD·
Every patient now: “Is it the COPD or the heart failure?” “Yes”
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Dr. Mark
Dr. Mark@canlungdoc·
@s7c20 @CarolynGorman_ Wouldn't higher priced housing drive people towards having two incomes to pay for it?
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ea
ea@s7c20·
@CarolynGorman_ Lists often seem to miss off (in context here): - make the fundamental neccessity of housing unaffordable, with financial repercussions across the fabric of daily life, such that the stakes for a relationship not working out are too high, increasing dating anxiety & cynicism.
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Carolyn D. Gorman
Carolyn D. Gorman@CarolynGorman_·
Yes, dating problems is it. Not enough marriageable men. If you wanted to lower the coupling rate, here's how you'd do it: - make people isolate themselves i.e. covid - disfavor men in higher ed, making them less attractive to women who then have higher levels of education - disfavor men in employment, making them less attractive to women based on lower provider potential - tell women obesity is beautiful rather than a health detriment, making them less attractive to men - tell men they're a problem and constantly harassing women, making them afraid to approach women or even look at them in social settings - give men the internet (porn and gambling will lower any man's time/ambition to put effort in with real women) - tell women and men they can/should date around, lowering obligation on men to lock it in while wasting away women's biological clock for kids - downplay the social and economic value of marriage whoops we did all that
Claire Lehmann@clairlemon

Dating problems is the big one. x.com/romanhelmetguy…

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Dr. Mark
Dr. Mark@canlungdoc·
@henryolsenEPPC Serious question - is there a reason if you don't care much about environment you can't pump oil into a lined pit and get it later?
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Henry Olsen
Henry Olsen@henryolsenEPPC·
This is a good analysis but I disagree on two points: 1) If Kharg’s storage is filled, that likely means Iran has to shut down its oil fields: you can’t pump what you can’t store or sell. How long would it take it to reopen those after a deal? The economy will get slammed. 1/x
Niall Ferguson@nfergus

Let me walk you through the events of the war so far: 1. The United States and Israel tried regime change; it didn’t work. Or rather, they got regime change—Iran became an Islamic Revolutionary Guard Corps–led military dictatorship. That was not an improvement. 2. The U.S. won an overwhelming military victory with air and naval power and scarcely a boot on the ground. But it destroyed less of Iran’s missile- and drone-launching capabilities than at first appeared. 3. Then there was a hostage crisis. Iran took both the Gulfies and the Strait of Hormuz hostage. The result was a massive economic shock for the world that required a rapid resolution. 4. The choice was between 1) military escalation (boots on the ground or strikes on Iranian infrastructure), and 2) a diplomatic deal. Trump chose 2. 5. In Islamabad, the U.S proposed big economic concessions in return for some kind of change in the status of Iran’s enriched uranium stockpile, as well as the reopening of the strait. Contrary to the president’s social media feed, the Iranians did not accept. 6. In any case, the devil of any deal will be in the details, not the Truth headline. (When the small print finally comes out, every former Obama and Biden official will be ready to tell The New York Times that it’s worse than the 2015 Joint Comprehensive Plan of Action.) 7. Meanwhile, the Iranians have survived regime change and discovered that closing the strait is just as powerful a lever in economic warfare as they had always hoped. It’s not, despite the Russian quip, an “economic nuke,” because unlike a nuclear weapon you can use it. 8. Where we go from here is fairly predictable. I would be surprised if Trump now deploys ground forces. There will be more negotiation, so Islamabad, here we come. There may have to be more bombing, if the Iranians dust down the North Vietnamese playbook of stringing the U.S. negotiators along. And the final compromise will take longer to be agreed upon than Mr. Market currently believes. The consensus in prediction markets is this will be over by the end of May, but remember: It took Henry Kissinger more than four months to get the 1973–1974 oil embargo lifted.

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Dr. Mark
Dr. Mark@canlungdoc·
@CyborgPeds Agree. People forget that a good portion of the 'high school was harder' way back when was that a great many people never made it there. Even in 1950's Ontario my father was the lone graduate of his high school.
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Dr. Mark
Dr. Mark@canlungdoc·
@CoffeeBlackMD @Shanbonian And in a huge % of diseases it is the equivalent of bad luck. Eg lung cancer, one of the more proven cause illnesses - ie smoking, radon, some genetics - but do we really know why one smoker got it and the next one didn't? Or why this year and not 5 years ago? Nope.
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CoffeeBlackMD
CoffeeBlackMD@CoffeeBlackMD·
@Shanbonian The root causes are largely irrelevant by the time they needs meds.
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CoffeeBlackMD
CoffeeBlackMD@CoffeeBlackMD·
Anyone who has followed me long enough knows I defend normie doctors. I know normie docs. I’m friends with them. These are my people. Hell, I’m a normie doc in my regular day job. It’s tough work. And often getting more and more thankless. There is this disconnect, however, between what do usually and what people say they want and then practical realities around misunderstood unrealistic expectations. You see, we think we are here to go after your acute and chronic diseases. With medication. Pharmaceuticals. This is the training. This is the context. How a physician is approaching the interaction. And for most interactions this is probably satisfactory enough. However based on some of my conversations with people here decent chunk of were the equivalent of being kicked in the testicles, what many people want is to prevent needing to see the physician. And are mad at us that they have to and wanted us to prevent it. And look we try to do a good chunk of preventative medicine and counseling but we are definitely DOWMSTREAM of your root causes and catching strays in the crossfire. We are not coaches. Not trained that way. And our time, based on the current training, isn’t best spent trying to be a coach. Plus the kind of set up where you check in with a coach like once a week isn’t practical for a physician who needs to regularly see a lot of patients. This means physician coaching would need be expensive and if what we’d offer wouldn’t be fundamentally different from a less expensive coaching set up it simply doesn’t make any sense to insist or expect us to coach you on root causes. Root causes will need to be dealt with by the individual at the individual level. If you’re mad at us. Your anger is directed in the wrong direction. We’re here to help. But you need to understand better what we do. And we’re not “bad” for not dealing with every variable that is yours to control.
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Dr. Mark
Dr. Mark@canlungdoc·
@Farmygurl @NightShiftMD The trouble is that screening always seems appealing but if not done in high enough risk settings it is very easy to do more harm than good - eg CT scans for lung cancer will definitely do more net harm if you don't have a high risk (age plus significant years of smoking).
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Molly Sullivan
Molly Sullivan@Farmygurl·
@canlungdoc @NightShiftMD Agree, however I see why patients think it’s a great idea, especially those that had family and friends diagnosed with late stage cancers causing minor or no perceptible symptoms. Or for those with advanced cancer whose concerns were dismissed or misdiagnosed initially 😞
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Dr. Mark
Dr. Mark@canlungdoc·
@DrSuneelDhand Per quick google - not saying isn't happening but those consequences should be apparent already if at a young age.
Dr. Mark tweet media
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Suneel Dhand MD
Suneel Dhand MD@DrSuneelDhand·
@canlungdoc It has gone out of all control in the last 10 years, especially since the pandemic
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Suneel Dhand MD
Suneel Dhand MD@DrSuneelDhand·
If you have two significantly overweight parents who don’t have healthy lifestyles, the chances of having a healthy in shape child is almost zero The scale of the health catastrophe that we face over the next few years is unprecedented when all of these overweight children start becoming very sick in their 20s and 30s Nothing like this has ever happened before If you think that I am exaggerating, I am not. The disaster from widespread cigarette smoking will be nothing compared to this. We literally have tens of millions of overweight and obese young children I cannot believe how more doctors are not losing sleep over this issue. And NO, the answer isn’t to medicate the children We need a complete cultural revival in this country
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Dr Jumby
Dr Jumby@Jumby757·
@kevinmd Don't worry they have the residents do it all, so really it's them doing it to the younger generation of physicians.
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Kevin Pho, M.D.
Kevin Pho, M.D.@kevinmd·
You can't hold hospital privileges without taking call. Call isn't compensated. That's not a calling. That's coercion. Internal medicine physician Corinne Sundar Rao names something physicians have absorbed for decades without ever being able to articulate it cleanly: call is labor. Not a professional obligation. Not a rite of passage. Labor. And it has been either unpaid or minimally compensated for as long as it has existed. The mechanism is worth understanding. To practice what you trained to do, you need hospital privileges. To keep hospital privileges, you take call. There is no opt-out. The work is tethered, undefined, and endless. One day runs into the next. You carry a full patient load after an overnight on call and you are expected to keep going. No other profession works this way. Pilots have mandatory rest periods because fatigue at high stakes is a patient safety issue. The argument applies equally to surgeons making complex decisions after 30 hours without sleep. The hospitalist model is the clearest proof that the old system stopped working. Nobody decided philosophically that hospitalists were a good idea. The system just broke down until it had to adapt. Defined shifts replaced open-ended obligation. The word hospitalist was first coined in a 1996 New England Journal of Medicine article, and the model has been expanding ever since. The laborist model in obstetrics followed the same logic. High-volume hospitals recognized that asking one physician to manage clinic, elective surgeries, GYN, and overnight deliveries was not a sustainable structure. So they separated the labor floor from the rest of the work. Call hasn't made that transition yet across most of medicine. And the cost is becoming visible. Physicians are quietly leaving. Not dramatically. They are going part-time, shifting to direct care or concierge models, or stepping away from clinical medicine entirely. Physician compensation accounts for only 8 to 8.6% of total U.S. healthcare costs. This is not a compensation problem. It is a structural one. Call is not an infinite resource. It is labor. Labor must be compensated, defined, and protected with rest. Corinne Sundar Rao on The Podcast by KevinMD. Listen link in the first comment.
Kevin Pho, M.D. tweet media
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Dr. Mark
Dr. Mark@canlungdoc·
@FeminaStudiosa Shockingly, abusive parents might have that parenting fail too?
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Dr. Mark
Dr. Mark@canlungdoc·
@tylerblack32 @EdgyGookie Always though it was better in my day when you could get in after 2 yrs of university, if you fail at that point course still good to a 4 yr degree and you aren't behind.
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Tyler Black, MD
Tyler Black, MD@tylerblack32·
@EdgyGookie sort of. it also reflects how medical schools absolutely refuse to "fail" clearly insufficient students for competitive and reputational motives
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Dr. Mark
Dr. Mark@canlungdoc·
@RSW3745 @DrSiyabMD Many diagnostic labels are applied casually and stick. I daily see people where they or record says they have COPD when in fact they do not. "Says who" is a fair question, but of course there are good answers to that question eg had the right tests already.
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RSW
RSW@RSW3745·
@DrSiyabMD Why do you not accept it when another doctor has given us a diagnosis though? We have already done the tests.
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Siyab Panhwar, MD
Siyab Panhwar, MD@DrSiyabMD·
hate to wade into the mud with this discourse but there is an important point to make here. I think the idea of "total control and dominance of their patients" is a little silly. I, and I'm sure many of my colleagues, do not believe patients are little helpless babies who cannot think for themselves or make their own decisions. I also don't want to assert control or dominance because why would I. That's not the job and that's just weird. The job is that a you as a patient come to me with a complaint and I do my job as I am trained to as a professional, to diagnose and then provide options for management. You may disagree and have your own self-diagnosis or ideas for treatment, and that's totally fine. Sometimes I might agree with it! I may have overlooked something or it's something more uncommon I don't see often. Happens. But sometimes I may not. If you want a second opinion (as you have the right to), i'll happily place a referral for you. Often it's something totally unrelated to my field and I'll suggest you seek other options. if you feel like you need to go to the local naturopath and try some concoction, that's fine too! your life, your decisions. I don't lose sleep over this. I move on to the next patient who needs my help. Everyone should for sure educate themselves about their health. People come to me with AI summaries and recommendations all the time. That's great! but that doesn't mean I'm putting my license on the line or doing something I don't agree with just to appease someone. And anyway, there are plenty of direct to consumer labs, imaging, etc you can get on your own if you want. and soon enough, if this admin has their way, most meds might become OTC anyway. So you can self treat if you want! and here's a secret. modern medicine is great, but we don't have all the answers, and not uncommonly, I tell people I don't exactly know what the cause of their chest pain/etc is but at least we've made sure it's not some big bad cardiac pathology by doing some basic appropriate testing. Inb4 the replies come in: yes, many doctors are assholes and don't do their jobs right. but that's not the point of this tweet.
Immuno(un)compromising Writer@jacobscheier

Doctors hate self-diagnosis because it gives patients some power and most drs. want total control and dominance of their patients.

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Dr. Mark
Dr. Mark@canlungdoc·
@CyborgPeds The aspects I enjoy compete daily with the ones I don't.
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Cyborg Pediatrician
Cyborg Pediatrician@CyborgPeds·
I was talking to my mom about my medical career. She seemed upset that I’ve never loved it. I tried to explain that I’m grateful. Maybe I didn’t enjoy it that much but it provided an opportunity to do some good and make a decent living. Not everyone can say that.
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Dr. Mark
Dr. Mark@canlungdoc·
@SmartMusclesMD @CyborgPeds LOL probably...but compared to other expenses and our income it's really a pretty trivial difference...just a visible one. Same reason people hate sales tax more than hidden taxes.
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