Basim Ali MD

¿Es momento de reemplazar al FIB-4 en el tamizaje poblacional de EHMet? 📉 Un reciente estudio en Hepatology comparó 10 pruebas no invasivas (NITs) en 11.404 pacientes con disfunción metabólica y los resultados cambian nuestro paradigma clínico. 🧵👇 DOI: 10.1097/HEP.0000000000001356 @SAHEpatologia @AEEHLiver @Diabetes_SEMI @feralcivarmd @sepdigestiva @drshafikuchay

- In pts ≥ 75 w prior adenoma, 10y risk of CRC was 1.1% (vs 0.7% w/o adenoma) and risk of CRC-related death was 0.5% (vs 0.4% w/o adenoma). For context: - Recent CGH paper: 30 day complication (GI bleed > Stroke/MI > Perf) from cscopy in age 75-85 is ~0.8%

Very important paper by @drfolamay's group! CRC is rising at alarming rates in certain groups but: Patients ≥ 75y with prior cscope are still much more likely to die WITH rather than OF CRC - almost a 100x more likely.

“I have waited many years, decades, to write these words and the time has finally come. Today, I feel proud to be a Pakistani. Today, my country stands out among the comity of nations as a peacemaker of historic proportions” خرم حسین نے آج قلم توڑ دیا ہے dawn.com/news/1990101

If you keep your eyes open in medicine, you’ll notice lots of patients with symptoms we can’t explain through western medicine. Their tests are normal but they still have headaches, palpitations, chest pain, dizziness etc. It’s important not to dismiss these patients. Their symptoms are real, and blowing them off drives people away from medical care. It’s also important to remain humble. There is so much we don’t understand about the human body. I tell patients this and do not object if they want to explore options outside of western medicine. I’ve seen people improve with acupuncture, cupping, meditation, physical therapy, and even chiropractors in one case of chronic chest pain. I don’t recommend these as first line treatments, and they should be used cautiously because they can lack rigorous evidence. But when patients are suffering and I can’t help them, I support anything that improves their quality of life.

@usamasyedMD Plug for JAMA Rational Clinical Exam series, McGee’s Evidence Based Physical Diagnosis and Salvatore Mangione’s Physical Diagnosis Secrets.

@usamasyedMD Sorry friend, you’re wrong. Diagnostic tests don’t replace physical exam and vice versa. Both have their place and limitations. I will say though, your view is shared by many others which is a testament to declining quality of the skill being taught in schools/training.

This triggered a fair number of doctors on my feed. Some people are reading this as me saying "it's great and I hate physical exams". I'm stating here what is ACTUALLY the lived reality on the ground in U.S. healthcare. WHY the physical exam has been relegated to this new performative role mainly for billing is due to: - More availability of diagnostics: fair, that's evolution. We don't NEED to rely on the reverberations felt by the side of our hand at any given moment during an exam and operator error etc. which is progress). Doctors who are triggered here seem to be only imagining themselves and how good they feel like THEY are at physical exams. But what if your family member was getting examined by the worst doctor you trained with during residency... do you STILL trust that physical exam? Or would you rather they send a diagnostic and get more objective data? - Malpractice risk: If a patient gives you a history that is classic for X condition, but your physical exam during that snapshot does not support X, and you refuse to treat empirically or order confirmatory diagnostics, your chances of getting sued are much higher by 'taking a stand' based on your physical exam. And in a non-zero set of cases, you'll be surprised yourself when diagnostics throw up surprising results that didn't fit your exam. In the majority of cases, it will be 'wasted' treatment/spend on diagnostics, which no patient cares about on an 'N of Me' basis. - Patient expectations: if a patient has convinced themselves they have a specific condition, and you reject it based on your physical exam alone and don't order follow-up tests, they're likely to slaughter you in online reviews. They're not in a position to understand the screening capabilities of physical examinations, and they'll assume you 'didn't take them seriously'. Doctors learn this the hard way earlier on in their careers, and they decide this isn't a fight worth fighting. *Also to be clear, I don't consider just LOOKING at a patient to be the same as a 'physical exam'. Visual cues give a lot of information even now and dramatically change management/ severity triaging. I'm talking about hands-on physical exams.

Prucalopride added to 2-L PEG improves bowel preparation quality and increases polyp detection compared with 2-L PEG alone. @JGHofficial doi.org/10.1111/jgh.70… #JGH #Colonoscopy

👑 Very nice man and contributed so much, including this terrific RCT x.com/ebtapper/statu…

Witnessed the end of an era today. Dr David Graham, past president of @AmCollegeGastro (1990-91), attended the inpatient gastroenterology consult service one final time at @VAHouston. An institution - physician, teacher and mentor to so many. Truly a privilege! @bcm_gihep

@Elhawary_MD Only in medicine do we find these predatory behaviors. Any opinions to the contrary are classist and assume al. physicians come from generational wealth (which is often but not universally true).

@Elhawary_MD Unpaid ‘research’ jobs are predatory. Even without a background in research, a physician brings a wealth of knowledge to the table and should be compensated. Being taught a skill (which is often learning yourself) on the job does not obviate the need for compensation.

I was in this boat before but I'm looking to it by a different way. First, you are getting trained on how to do research, so you should appreciate the opportunity you have. Second, if you put yourself in comparison with the AMGs, they pay around $300K to get into the residency training while you are paying nothing to be there. As an IMG, I feel like we are in far more better situation from financial point of view if I compare myself with an AMG! Just be grateful for the opportunity you have and try to show your good work to your professor so they can pay you faster!!

We're saddened by the loss of James Van Der Beek due to colorectal cancer. 💔 We encourage everyone to get screened starting at age 45, or earlier depending on family history. Don't ignore unusual symptoms — talk to your doctor. More resources ➡️ patient.gastro.org/colorectal-can….

Important! This is what we are up against, friends journals.lww.com/hepcomm/fullte…

Fantastic fellows course by the @ANMSociety in Minneapolis lead by the national leaders in motility! Highly recommended for all GI fellows. @ReenaChokshiMD

The faces of GI dedication and commitment...... THANK YOU to our course directors and faculty for giving up their weekends to guide first-year fellows in didactic sessions and incredible hands-on training at ASGE's headquarters.! Always grateful!❤️❤️❤️❤️

Had a blast teaching at the First Year Fellows Course by @ASGEendoscopy in Chicago! Props for organizing a fantastic and memorable course to the course directors @shifaumarMD and Dr Shivakumar Vignesh. @bcm_gihep with strong representation!

Had a blast teaching at the First Year Fellows Course by @ASGEendoscopy in Chicago! Props for organizing a fantastic and memorable course to the course directors @shifaumarMD and Dr Shivakumar Vignesh. @bcm_gihep with strong representation!

This week features #WorldHepatitisDay. 📽️Our own @BCMDeptMedicine faculty, Dr. Monisha Arya, produced this campaign with her marketing team for #HepatitisB screening in Texas. #MedEd #ContinuingEducation @bcm_gihep @TexasGastros @AmCollegeGastro @JasonHouMD @HowardTLeeMD @hearts_ut @swang8 @HarrysTorres01 @AASLDPresident @Hep_Alliance @SeragHashem @aetcnasc

@JFBirnbaum @UTHimres @BCM_InternalMed @UW_DGIM @UWMedicine So sad to see you go Chief!! Good luck!!

It has been an amazing few years as an APD at @UTHimres and before that at @BCM_InternalMed. I’ve grateful to have worked with amazing residents and educators, and am sad to leave Houston, but excited for new adventures in Seattle at @UW_DGIM and @UWMedicine Residency!