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Richard Dunbar-Yaffe
290 posts
Richard Dunbar-Yaffe
@dunbar37
General Internist, Staff Physician in GIM, University Health Network, University of Toronto
Toronto, Ontario Katılım Haziran 2009
222 Takip Edilen433 Takipçiler
Morning report today given by Dr Ryan Luther @UHN @GIMtoronto - cool case of chest heaviness that wasn't what it seemed - great review of acute coronary syndrome (👋) - impressive trainees knew all the answers! Does he always speak with his hands? @UofT_DoM
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@raghu_venugopal Our discharge rate for GIM consults from ED ranges from 10-12%. Not all consults need admission and even some who do end up staying much longer than would be dictated by their medical issues (eg home care and social supports).
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I get asked all the time on the phone "does this patient really have to stay or they can they follow-up with their family doctor" only for the patient to be admitted for 8-10 days.
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@JesskelleherLiu @LizLeeNP @LiverToronto @UHN @UofTGastroHep Totally agree and I think there’s lots of room for collaboration here!
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Not having dragon on a SMR call is just mean. Having to actually type notes is hard enough combined with my typing skills being equal to a toddler at 3am.
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should there really be a "reply all" option on emails?
asking on behalf of "all"
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@RicharLisa Also depending on your network you can use “Wi-Fi Calling” to make and answer calls with your phone number. iPhones supported I think on most Canadian carriers!
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I guess I am a bit behind in the tech sphere but I just learned that I can make phone calls on WhatsApp in areas where I have wifi but no cell coverage--which is common for me these days. Game changer for me so thought I'd share in case it helps others.
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@Pete_Wu @kobyjane @maximebillick @LapointeShaw @ryanaluther @moirakapral @JesskelleherLiu @BogochIsaac @DrMAB43 @RicharLisa @robcwu @UHN Congrats @kobyjane you’ll be missed! My little guy was so upset you’re leaving I couldn’t settle him :)
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Congrats @kobyjane on a wildly successful TGH CMR year! Thank you for all you did for our students, residents, patients, hospital & program! Up next @maximebillick!
@LapointeShaw @dunbar37 @ryanaluther @moirakapral @JesskelleherLiu @BogochIsaac @DrMAB43 @RicharLisa @robcwu @UHN
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@DrToddLee @AmolAVerma @SurainBRoberts @AutoImmuneLiver @hepatoMD @Dr_ChrisSimpson @davidkaplanmd @DrFahadRazak @ebtapper All GIM at TGH unless listed. There was a liver unit?
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@AmolAVerma @SurainBRoberts @AutoImmuneLiver @hepatoMD @Dr_ChrisSimpson @davidkaplanmd @DrFahadRazak @ebtapper Interesting and I feel it's the same here.
Do you see any effect at TGH by virtue of the liver unit? (Is it still there?)
Do pre transplant patients get admitted to medicine there? Or to another unit?
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GEMINI study led by @SurainBRoberts:
Patients hospitalized with liver disease have 8X greater age-standardized mortality than other cardio-resp conditions. We must urgently improve liver care. @AutoImmuneLiver @hepatoMD @Dr_ChrisSimpson @davidkaplanmd @DrFahadRazak @ebtapper
Surain Roberts@SurainBRoberts
Pleased to share our new article highlighting dramatic premature mortality of liver disease patients admitted to internal medicine in 7 GTA hospitals. Time to re-evaluate approaches to caring for these inpatients. @AmolAVerma @AutoImmuneLiver @APandT onlinelibrary.wiley.com/doi/10.1111/ap…
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@DrDaveRod What I wouldn’t give for a button that just said “log me out there and log me in here”
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@DrToddLee @Ahmed92031359 @PMCram Huge range in those practices too - from billing consult in the AM (as most community partners do) to billing nothing if admission by nocturnist was after midnight.
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@dunbar37 @Ahmed92031359 @PMCram Thanks. So ohip billings for assessments? Or will they also bill consults? Any idea what the cost to ohip was per week?
Hospital meaning the hospital's operating budget or the physicians practice plan?
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What does it take to implement a nocturnist model in a Canadian teaching hospital? @dunbar37 shows the way cmajopen.ca/content/9/2/E6…
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@DrToddLee @Ahmed92031359 @PMCram They billed consults for new patients and assessments for existing. Huge variability though in billing practices so difficult to know how much was billed (we didn’t ask each nocturnist). I’m not sure re: operating budget but it was not the PP that funded it
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@DrToddLee @Ahmed92031359 @PMCram Fee for service mostly, with supplemental on-call stipend from the hospital.
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@AlonVaisman @SonsofAnarchy Yes! Love the oral vanco for generalized sepsis SOA!
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After a 35 minute chart review for a patient with fever NYD in the ICU
(thanks for the tip, @SonsofAnarchy)
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@JesskelleherLiu @ryanaluther @RicharLisa @LapointeShaw @MikeRandazzoMD @Pete_Wu @moirakapral @BDHodges1 @umtincka @paulo_alto @md_frost @BrittneyKucz I couldn't agree more - have worked with @ryanaluther since he was a clerk and couldn't be happier to have him as a colleague!
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👏@ryanaluther is a fantastic colleague! @RicharLisa @LapointeShaw @dunbar37 @MikeRandazzoMD @Pete_Wu @moirakapral @BDHodges1 @umtincka @paulo_alto @@md_frost @BrittneyKucz
UHN Foundation@uhnfoundation
Most of @UHN’s #COVID19 patients are treated in the General Internal Medicine (GIM) unit – it’s also Dr. Luther’s second home. Learn more about the GIM unit and their enormous impact in UHN's battle against COVID-19 ➜ bit.ly/3f9Q2dn
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@RicharLisa We have been actively trying to find a safe solution but so far unsuccessful!
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I am the nocturnist tonight which means I am covering/caring for 3 teams of patients with covid and 2 teams of patients with medical conditions other than covid. I am trying to figure out how to keep track of all of these devices (plus my own iPhone)!
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@DrToddLee @shanxonline @LapointeShaw Almost sounds like some unofficial triaging is already taking place!
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@shanxonline @LapointeShaw "not an icu candidate"
"Goals of care to be reassessed"
"No beds in icu"
These phrases are heard in regular practice but probably much more frequently under crunch circumstances.
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Cases declining were the final sandbag in rising waters.
ICU patients cared for in non-ICU spaces
Urgent surgeries delayed
Complex discussions re prognosis after ICU
Transfers 50, 100, and 500 km away
The worst-case triage scenario was avoided by the hidden triage scenarios.
Kelly Grant@kellygrant1
It's still a bad scene out there in Ontario hospitals, but with cases declining, the province now thinks it can avoid the worst-case triage scenario. Scoop from @jeffreybgray theglobeandmail.com/canada/article…
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@emhendren @ayeletkuper @am_mckenna @Royal_College I don’t think the call stipend was ever enough and certainly think that residents among others should qualify for “pandemic pay”
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@ayeletkuper @dunbar37 @am_mckenna @Royal_College I think the key here is that EVERYONE is working hard taking care of COVID patients. Staff and residents included. Staff have fortunately been compensated for their time on the wards while residents are doing so within their usual call stipend of ~$100 for 26 hours of service.
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#internalmedicine residents are the unsung heroes of the pandemic - staffing all of the academic GTA covid wards (without pandemic pay from day 1)... I am glad that the @Royal_College recognizes their competency and has cancelled the oral exam in these unprecedented times!
Hanna Faghfoury@HannanehF
The @Royal_College Internal Medicine oral exam has been cancelled for this year. This is the correct decision given the current state of the pandemic. My hope is that this can be extended to other training programs as well.
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@Derek_Leong_RPh This guy nails it every time! Disturbingly close to accurate!
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@Derek_Leong_RPh @JWong_PedsID @BogochIsaac @TorontoIDDoc @moirakapral @DavidJuurlink @Pete_Wu @JesskelleherLiu @Rene_Wong Thanks Derek! I think one ‘thank-you’ from our hospital admin is more than enough IMO
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