Chikitshock

@hjluks Amazing Dr Luk!

Yesterday's post prompted a number of practitioner responses expressing frustration that "patients don't listen to them". Well.... that's okay. One of the hardest conversations in this profession is between the patient who wants something done and the surgeon who knows that something isn't the answer. PTs and docs tell me regularly that they feel stuck, that they've explained the evidence, and the patient still wants the procedure. What do you do? My answer is that our job is to educate and inform. Not to convince. We can explain what the research shows, what the risks are, and what rehab is likely to accomplish that surgery won't. We can be honest and direct about our clinical judgment. What we cannot do, and shouldn't try to do, is override a patient's autonomy. Informed patients get to make their own decisions. That's not a failure of communication. That's medicine working correctly. I like to operate. I became a surgeon because I find it meaningful, and I'm decent at it. When surgery is the right answer, I don't hesitate. What I find genuinely puzzling, after all these years, is when a patient tries to convince a knee surgeon with 30 years of experience that they need an operation, and every instinct that surgeon has developed over those 30 years is telling them otherwise. That clinical intuition exists for a reason. It should be trusted, not negotiated away. The harder version of this is the surgeon who says: If I don't do it, someone down the street will. And that's true. It often is. But I can only answer for what I do in my operating room. If I believe surgery might genuinely help, I'll recommend it, and I'll do it. If a patient has moderate arthritis and wants me to clean out a joint that the evidence says won't benefit from cleaning out, I won't do it. Not because I'm judging the patient. Because I can't compromise my principles for RVUs. This isn't self-righteousness. It's the only way I know how to practice medicine and look at myself in the mirror. The patient may find someone else. That's their right. My obligation is to tell them the truth as clearly as I can, and then let them decide.

@Coffeehudigi A different issue altogether madam But one child with polio and the remaining two with muscular dystrophies? Very unusual

Today, I saw a 44 year old lady wheel chair bound, multiple health conditions polio paralysed her long ago. Her sole care giver is her 80 year old father. He also takes care of his 2 other adult children with muscular dystrophies. I cant say how I felt, when the old man took out file after file and explained everything to me, while reassuring the daughter so lovingly. I wasnt prepared to see this. Another spectrum of geriatrics I wasnt ready to see yet. Caring for special child to adulthood isnt even something we talk about. #MedTwitter #opdstories

@drpraneetajain I recommend something a bit more comprehensive CBC with peripheral blood smear and retic count LFT FBS+PPBS, HbA1c Fasting lipid profile TSH, fT4 Serum vitamin B12 and serum folate Urine RE/ME + ACR

6 blood tests worth doing at least once a year if you have skin or hair concerns: 1. CBC (complete blood count) 2. Ferritin (not just haemoglobin) 3. Vitamin D (total) 4. Vitamin B12 5. Thyroid profile (TSH, T3, T4) 6. Fasting blood sugar Most of this panel costs under ₹3000. The information is worth more than months of product spending.

@jasveer10 You don't understand the limbic system.

Full-time jobs won’t exist in the future! Let’s be honest- Nobody wants to work for someone else. People do jobs out of compulsion, not passion. You do it because of EMI, rent, survival, not because you dream of building someone else’s company. A century ago, people stayed in one company for decades. They didn’t have a choice - starting something needed capital, connections, and some secrets. Only a few had access to those. Then the internet killed that arbitrage. Now everyone has information, access, and capital. Venture money replaced old capital. Knowledge became public. Ownership got split. Earlier, one person owned 100%. Today, five people own 20% each and build faster. (called startup) Tomorrow, those five will become fifty freelancers, each owning their slice. The mindset is shifting from ‘salary’ to ‘share’ from ‘working for’ to ‘working with’ from ‘9 to 5’ to on demand’ People already own their time - look at Uber, Swiggy, Upwork. Nobody wants a boss - they want flexibility, freedom, and upside. As AI automates repetitive work and capital becomes abundant, the only thing left with real value will be human time and creativity. And no one will sell that full-time.

@JimAshmoreUS @Alan_Couzens Exactly A lot of people here simply don't understand the metabolic cost of walking

@Alan_Couzens A vigorous walk is intense for most people. I walked 2 miles up a dirt road today with 650 ft of elevation gain then two miles back down. Two trucks stopped and asked if I was OK. No one I work with would make the attempt. I have 20 years on most.

Correction *6* METs... Standard breakpoints are... LPA - 1.5-3 METs (washing dishes) MPA - 3-6 METs (yard work) VPA - 6+ METs (brisk walk) Nowadays, these papers tend to use accelerometer data to approximate METs which leads to greater time in the "vigorous" band. Either way, "vigorous" is not really vigorous to anyone but a couch 🥔

@Paritolkks Very good question

MRI machines from brands like GE, Philips, and Siemens cost anywhere between ₹3–10 crore upfront. Add 7.5% customs duty, 12% GST, and other levies, and the total cost rises by roughly 16–19%, especially with rupee depreciation. On top of that, annual maintenance contracts (CMC) alone can cost around ₹1 crore, with electricity adding another ₹40–50 lakh. So you're looking at ₹1.5 crore in fixed yearly operating costs before even factoring in staff, rent, or financing. Now look at the revenue side. An average MRI scan in India costs about ₹4,000–₹10,000, with many centers operating closer to ₹5,000 per scan. Even at 10 scans a day, annual revenue comes to roughly ₹1.5 crore. That barely covers operating costs, let alone loan repayments or profit margins. how are these centers actually surviving?

@Alan_Couzens @Alan_Couzens changed my life I have accumulated hours of walking after being inspired by him

I'm still seeing a lot of people who don't understand what this paper is saying, so a quick summary... What this paper is not saying: The harder you train, the lower your risk of major disease/death. What this paper is saying: Adding a small amount (~4%) of brisk walking or light jogging to your gardening or vacuuming is better for your health than gardening or vacuuming alone. That's it. In the paper... - The cut-off for "vigorous" activity was a 30s bout of accelerometer data at 400mg. Many will reach this just walking briskly. For some it will take a light jog. - Positive effects for most health problems plateaued at 4-5% of total PA. So it is not saying the more high-intensity intervals you do, the better off you are, it is saying that 10 minutes of brisk walking/d is a good thing to add on top of your gardening. - Importantly, it *might* also be saying that your ability to walk briskly for ~10min/d is protective in itself, as fitness was not measured/controlled for. ####### While the paper certainly doesn't show a link between the intensity of training and health, I've little doubt that there *is* a relationship between the number of idiots that I see on this platform who talk about the paper without understanding the paper and my own health. So, please, if you lack the background to properly understand a paper, don't position yourself as an expert and talk about it as though you do. My health thanks you. academic.oup.com/eurheartj/adva…

@nileshnolkha Fair enough

@zebrahoofbeat You can’t have secondary cause in 30-50 percent of females in a country, it’s mostly due to our nutritional choices and availability I am not attributing individual cases which are a rarity

1 in 2-3 Indian females (or even more) have hair loss issues cyclically. They also end up in rheumatology opds with fatigue and non specific pains. At least 30-40 percent of these patients can improve by improving iron deficiency alone. It’s amazing how even affluent Indian females have accepted hemoglobin of 9-10 as normal. That’s like having 2-3 packets of less blood than what is considered normal. Many get better and understand what they were missing after iron infusion 😅

@thenerdnxtdoor2 Don't read uveitis and start loving the subject

I love ophthalmology as a subject

@mssakshinarula Many marriages in India fail because the man simply fails to respect the woman's autonomy A total shitshow

Yaar koi inn aadmiyon ko 18th century mein phenk aao. Wtf is this..."physical body in exchange for his resources"...you all talk about your wives like they are prostitutes. Please shut up.

@nadig_cardio What starts as frontal behaviour eventually becomes limbic As @aditya_gan3500 says

Cardiology conferences in India are increasingly becoming platforms for self-promotion rather than scientific exchange. Events are often branded around individuals,“Dr X’s conference,” “Dr Y’s meeting”, where visibility seems to matter more than content. When the motives are so clearly ulterior, academics and meaningful content take a back seat , and bcome social spectacle. Attendees take time off from busy schedules to attend these meetings with one primary goal-to learn! But Topics discussed most often following these conferences is about quality of food , hospitality, etc than about the science, or take-home learning. This erodes credibility, not just nationally but globally. This may b the reason why some may have started to stay away from “big” conferences !

@nob12deficiency @nileshnolkha What?

@zebrahoofbeat @nileshnolkha Looks like you are allowing your personal religious and social beliefs to colour the real picture. You people simply don't want to believe that heme iron is present in red meat. You somehow, via magical thinking, want vegetables to be a source of iron. Reservations are good.

@nihar_nayak2 Anything for funding

What is this?

@anujtiwari11 @DRARN93 IHD is a big spectrum From stable angina to ACS You will need painkillers at one point or the other You cannot avoid systemic use of NSAID at all times

@DRARN93 Ideally all NSAIDS to be avoided in IHD patients unless that’s the only option left

Avoid use of Ibuprofen (Combiflam) in patients taking Asprin for cv protection. Thank me later

@iamjunaidkabir This is some next level stuff

Diagnosed hypocalcemia just by looking at QT prolongation in the ECG, broke the age old myth that ortho bros can’t read ECGs 😂 #ortho #residency

@DocPriyamMD @theliverdoc and his opinion is necessary

Seeking input from the medical community: My facility has seen 5 cases of Acute Liver Failure (ALF) in young adults (20-40yr) in the last 14 days. Most recent case: a 24-week pregnant female who succumbed just 3 hours after admission. What are others seeing? HEV outbreak? DILI? AFLP cluster? This mortality rate is staggering. #MedEd #Gastroenterology #Hepatology

@bhavikpanchal87 @drgunjand @eOphtha This is such a long list Do you mean workup for systemic causes?

1. Bilateral acute non granulomatous anterior uveitis 2. Granulomatous anterior uveitis - even unilateral 3. Uveitis in children and elderly - extremes of age 4. Uveitis associated with systemic conditions like joint pains, back pain, oral and genital ulcer 5. Hypopyon uveitis 6. Anterior uveitis with classical iris nodules

When would you investigate a case of acute anterior uveitis presenting for the first time? #MedTwitter #ophthalmology #neetpg Image @eOphtha

@saaiyer Only an animal would find pleasure in an unwilling woman

She was a newly wed, with fever on the night of her marriage. He was drinking and he r@pes her. She said she was scared and wanted to get to know each other before proceeding further. She did not deny intimacy. He r@pes her. She's shrunk and unemotive during the honeymoon. He doesn't read body language. He r@pes her. She fakes a period. He asks her proof, she cuts her vagina to escape the torture. He still wants to know when he can r@pe her at the next opportunity. What about this plot makes men defend this! I am just not able to fathom!

@DrSharadMutalik @Rheumat_Aravind Probably the commonest etiology in India

@Rheumat_Aravind One should also consider purely neuritic leprosy with reaction.

Mononeuritis multiplex is not just neuropathy. It is a red flag. ⚠️ Painful ⚠️ Asymmetric ⚠️ Stepwise nerve involvement Think vasculitis until proven otherwise. This is a neurological emergency—delay can mean irreversible nerve damage. Common culprits: • ANCA-associated vasculitis • Polyarteritis nodosa • SLE • Cryoglobulinemia • Rheumatoid vasculitis Key clinical clue: ➡️ Sudden wrist drop / foot drop in different limbs, at different times What to do: ✔️ Act early ✔️ Confirm with NCS + biopsy (when needed) ✔️ Start immunosuppression promptly Miss it → disability Catch it → salvageable #Rheumatology #Neurology #Vasculitis #MononeuritisMultiplex @docakx @IhabFathiSulima #MedicalEducation #ClinicalPearls #AutoimmuneDisease #EarlyDiagnosis