#JHMChat Transcript

Healthcare social media transcript of the #JHMChat hashtag.
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Charlie M. Wray, DO, MS @WrayCharles
Starting #jhmchat in 30 min. Join us for the discussion and let us know where you stand: Daily Physical Exams are: A) a waste of time B) always valuable
Society of Hospital Medicine @SocietyHospMed
RT @WrayCharles: Starting #jhmchat in 30 min. Join us for the discussion and let us know where you stand: Starting #jhmchat in 30 min. Join us for the discussion and let us know where you stand: Daily Physical Exams are: A) a waste of time B) always valuable
Matt Sakumoto @MattSakumoto
@WrayCharles Team A (no daily exam) all the way! #JHMChat (actual footage of my pre-rounding below) https://t.co/7tVg4Z0498
Rebecca Jaffe, MD @RJmdphilly
Early #jhmchat entry to sadly bow out - having squandered my early exit from the office on a 3 hour wrong train escapade to NJ I now want to have some face time with the family. Will catch up if I can later! Was really looking forward to the topic!
Adam Rodman @AdamRodmanMD
I will see everyone there! @ShaneWarnockMD @mcnamara_lc @zahirkanjee (clearly I'm getting on a bit early)
Shoshana Herzig, MD, MPH @ShaniHerzig
@TimAndersonMD @WrayCharles Welcome, Dr. Anderson! You are an honorary hospitalist, and we are very glad to have you #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@MattSakumoto @WrayCharles Arg you are already making this hard! #jhmchat
Society of Hospital Medicine @SocietyHospMed
@RJmdphilly Hope you can catch up later, but family first! #JHMChat
Adam Rodman @AdamRodmanMD
RT @WrayCharles: Starting #jhmchat in 30 min. Join us for the discussion and let us know where you stand: Starting #jhmchat in 30 min. Join us for the discussion and let us know where you stand: Daily Physical Exams are: A) a waste of time B) always valuable
Shoshana Herzig, MD, MPH @ShaniHerzig
@AdamRodmanMD @TimAndersonMD @WrayCharles I’d never miss this all-star cast #jhmchat
Journal of Hospital Medicine @JHospMedicine
Time to get comfortable. ✔️Snacks🍿 ✔️Drinks🍺 ✔️Comfy chair💺 #JHMChat starts in 15 minutes!
Samir S. Shah @SamirShahMD
RT @JHospMedicine: Time to get comfortable. ✔️Snacks🍿 ✔️Drinks🍺 ✔️Comfy chair💺 #JHMChat starts in 15 minutes!
Samir S. Shah @SamirShahMD
RT @WrayCharles: Starting #jhmchat in 30 min. Join us for the discussion and let us know where you stand: Starting #jhmchat in 30 min. Join us for the discussion and let us know where you stand: Daily Physical Exams are: A) a waste of time B) always valuable
Adam Rodman @AdamRodmanMD
RT @JHospMedicine: Time to get comfortable. ✔️Snacks🍿 ✔️Drinks🍺 ✔️Comfy chair💺 #JHMChat starts in 15 minutes!
Charlie M. Wray, DO, MS @WrayCharles
@RJmdphilly Your family is more important than #jhmchat, Rebecca. So go to them. But them come to us ;)
Society of Hospital Medicine @SocietyHospMed
⏰Join in 🔟 minutes for November’s #JHMChat! 👨‍⚕️ 👩‍⚕️ Tonight’s facilitator and guests: @LannaFelde as @JHospMedicine, @AdamRodmanMD, @ZahirKanjeee, @ShaneWarnockMD, and @mcnamara_lc. (No COI to disclose.) Don’t forget to use #JHMChat in all tweets! https://t.co/JVBVm26jwf
Eric Schultz @ericschul
Let the spicy takes flow
Adam Rodman @AdamRodmanMD
RT @SocietyHospMed: ⏰Join in 🔟 minutes for November’s #JHMChat! 👨‍⚕️ 👩‍⚕️ Tonight’s facilitator and guests: @LannaFelde as @JHospMedicine, @AdamRodmanMD, @ZahirKanjeee, @ShaneWarnockMD, and @mcnamara_lc. (No COI to disclose.) Don’t forget to use #JHMChat in all tweets! https://t.co/JVBVm26jwf
Society of Hospital Medicine @SocietyHospMed
@LannaFelde @JHospMedicine @AdamRodmanMD @ShaneWarnockMD @mcnamara_lc @zahirkanjee Sorry about the typo! #JHMChat
Matt Sakumoto @MattSakumoto
@WrayCharles The Virtualist exam is also basically a doorway exam (visual observation only) #TelemedNow #JHMChat https://t.co/ZZMnQl4l03
Ndidi Unaka MD, MEd @NdidiUnaka
RT @JHospMedicine: Time to get comfortable. ✔️Snacks🍿 ✔️Drinks🍺 ✔️Comfy chair💺 #JHMChat starts in 15 minutes!
Society of Hospital Medicine @SocietyHospMed
People are already sharing their opinions! Where do you fall on daily routine physical exams?🤔 Worthwhile 🆚 Waste of Time #JHMChat
Swabba @swatiwaves
@safelydoingless
Journal of Hospital Medicine @JHospMedicine
Welcome to #JHMChat!🙋🏼 I'm @LannaFelde, JHM Digital Media fellow and moderator for this evening. Go ahead and introduce yourselves while we get started!👋🏼 Question 1️⃣ will be up in a few minutes
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Welcome to #JHMChat!🙋🏼 I'm @LannaFelde, JHM Digital Media fellow and moderator for this evening. Go ahead and introduce yourselves while we get started!👋🏼 Question 1️⃣ will be up in a few minutes
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Tonight is the night! 🎬 Our #JHMChat will begin this evening at 9pm ET / 8pm CT. The Routine Daily Physical Exam: Waste of Time or Value Added? ⭐ Starring authors @AdamRodmanMD @mcnamara_lc @zahirkanjee @ShaneWarnockMD 📣 Read their piece here: https://t.co/hn43rcmy57
Society of Hospital Medicine @SocietyHospMed
🏥 Welcome to November’s #JHMChat! Don’t forget to: 📢 Use #JHMChat on all replies. 📢 Engage with the prompts and each other. 📢 Refresh the latest tweets with the hashtag to remain up to date.
Mark Shapiro, MD @ETSshow
RT @SocietyHospMed: 🏥 Welcome to November’s #JHMChat! Don’t forget to: 🏥 Welcome to November’s #JHMChat! Don’t forget to: 📢 Use #JHMChat on all replies. 📢 Engage with the prompts and each other. 📢 Refresh the latest tweets with the hashtag to remain up to date.
Mark Shapiro, MD @ETSshow
RT @JHospMedicine: Welcome to #JHMChat!🙋🏼 I'm @LannaFelde, JHM Digital Media fellow and moderator for this evening. Go ahead and introduce yourselves while we get started!👋🏼 Question 1️⃣ will be up in a few minutes
Journal of Hospital Medicine @JHospMedicine
@AdamRodmanMD @LannaFelde Thanks for being here, Adam! Excited to have you #JHMChat
Mark Shapiro, MD @ETSshow
@JHospMedicine @LannaFelde Evening! Mark Shapiro here. Hospitalist & host of Explore The Space Podcast! Delighted to join #JHMChat!
Ndidi Unaka MD, MEd @NdidiUnaka
@JHospMedicine @LannaFelde Hi, I'm Ndidi peds hopsitalist in Cincinnati. I'm excited about this #JHMChat
Journal of Hospital Medicine @JHospMedicine
Our topic tonight is the routine daily physical exam. Is it a waste of time? 🤔 We recently published a Point: Counterpoint about this topic Point👍🏼 https://t.co/hn43rcmy57 Counterpoint👎🏼 https://t.co/dtXcL89nbi #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Our topic tonight is the routine daily physical exam. Is it a waste of time? 🤔 We recently published a Point: Our topic tonight is the routine daily physical exam. Is it a waste of time? 🤔 We recently published a Point: Counterpoint about this topic Point👍🏼 https://t.co/hn43rcmy57 Counterpoint👎🏼 https://t.co/dtXcL89nbi #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
RT @JHospMedicine: Our topic tonight is the routine daily physical exam. Is it a waste of time? 🤔 We recently published a Point: Our topic tonight is the routine daily physical exam. Is it a waste of time? 🤔 We recently published a Point: Counterpoint about this topic Point👍🏼 https://t.co/hn43rcmy57 Counterpoint👎🏼 https://t.co/dtXcL89nbi #JHMChat
Samir S. Shah @SamirShahMD
@JHospMedicine @LannaFelde Hello everyone. Samir @JHospMedicine EIC here #JHMchat
Journal of Hospital Medicine @JHospMedicine
@NdidiUnaka @LannaFelde Thanks for joining, Ndidi! Good to have you! #JHMChat
Charlie M. Wray, DO, MS @WrayCharles
@JHospMedicine @LannaFelde Thanks for leading the way tonight @LannaFelde! I'm Charlie, Hospitalist at the San Francisco VA Medical Center checking in for tonights #JHMChat https://t.co/Ju1XNalUFY
Journal of Hospital Medicine @JHospMedicine
We're so excited to welcome the authors as our special guests tonight @AdamRodmanMD @mcnamara_lc @ShaneWarnockMD @zahirkanjee #JHMChat
Adam Rodman @AdamRodmanMD
@ETSshow @JHospMedicine @LannaFelde Hey Mark! Long time no see! #JHMChat
Zahir Kanjee MD, MPH, FACP @zahirkanjee
@JHospMedicine @AdamRodmanMD @LannaFelde Hi all, I'm Zahir Kanjee, also a general internist and hospitalist at BIDMC. @mcnamara_lc and I wrote the pro daily exam counterpoint to Adam/Shane's article. #jhmchat
Shane Warnock @ShaneWarnockMD
Hi all! @ShaneWarnockMD here; currently an internal medicine PGY-3 at BIDMC in Boston. Team A - all about practicing purposefully! #JHMChat
Journal of Hospital Medicine @JHospMedicine
@SamirShahMD @LannaFelde Whoa! Thanks for dropping in, Samir! Excited to have you here. #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
RT @JHospMedicine: We're so excited to welcome the authors as our special guests tonight @AdamRodmanMD @mcnamara_lc @ShaneWarnockMD @zahirkanjee #JHMChat
Society of Hospital Medicine @SocietyHospMed
@JHospMedicine @LannaFelde Great to see everyone here! Excited to see all the different opinions for this #JHMChat
Mark Shapiro, MD @ETSshow
@AdamRodmanMD @JHospMedicine @LannaFelde I like your new profile picture! #JHMChat
Journal of Hospital Medicine @JHospMedicine
@ETSshow @LannaFelde Thanks for joining, Mark! #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
RT @zahirkanjee: @JHospMedicine @AdamRodmanMD @LannaFelde Hi all, I'm Zahir Kanjee, also a general internist and hospitalist at BIDMC. @mcnamara_lc and I wrote the pro daily exam counterpoint to Adam/Shane's article. #jhmchat
Charlie M. Wray, DO, MS @WrayCharles
RT @JHospMedicine: Welcome to #JHMChat!🙋🏼 I'm @LannaFelde, JHM Digital Media fellow and moderator for this evening. Go ahead and introduce yourselves while we get started!👋🏼 Question 1️⃣ will be up in a few minutes
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: We're so excited to welcome the authors as our special guests tonight @AdamRodmanMD @mcnamara_lc @ShaneWarnockMD @zahirkanjee #JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
@JHospMedicine @LannaFelde Hello! Heather, hospitalist @CleClinicMD. Excited for the discussion! #JHMChat
Journal of Hospital Medicine @JHospMedicine
Make sure to include #JHMChat in all of your responses - this will ensure that it shows up on everyone's feed!👍🏼 After the chat is over, don't forget to claim CME!🏅 https://t.co/Wa0bDHayVJ Okay, question #1 coming right up! 🎬
Vinny Arora MD MAPP @FutureDocs
Wow the new version of #LOFD (“looks ok from door”) is LOOP (looks ok on phone 😂) @WeiWeiLeeMD @Alkureishi_L #jhmchat
Erin Shaughnessy MD @ErinShaughness4
@JHospMedicine @LannaFelde Hi I’m Erin Shaughnessy from UAB. #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Make sure to include #JHMChat in all of your responses - this will ensure that it shows up on everyone's feed!👍🏼 After the chat is over, don't forget to claim CME!🏅 https://t.co/Wa0bDHayVJ Okay, question #1 coming right up! 🎬
Mark Shapiro, MD @ETSshow
@JHospMedicine @LannaFelde Wouldn’t miss it! #FriendOfTheJournal #JHMChat
Society of Hospital Medicine @SocietyHospMed
@HeatherNHofmann @JHospMedicine @LannaFelde @CleClinicMD Welcome!! #JHMChat
Adam Rodman @AdamRodmanMD
@SamirShahMD @JHospMedicine @LannaFelde Hi Samir! Excited that you're here!! #JHMChat
Journal of Hospital Medicine @JHospMedicine
@ShaneWarnockMD Thanks for being here Shane! So pumped you joined! #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
@ErinShaughness4 @JHospMedicine @LannaFelde Hi!!! #JHMChat
Yichi Zhang (张一弛) @YichiZTulane
@JHospMedicine @LannaFelde Hi all! This is Yichi, MS3 at @TulaneMedicine interested in all things IM. Ready to see what #JHMChat is all about!
Society of Hospital Medicine @SocietyHospMed
@zahirkanjee @JHospMedicine @AdamRodmanMD @LannaFelde @mcnamara_lc Welcome team Counterpoint! #JHMChat
Journal of Hospital Medicine @JHospMedicine
@WrayCharles @LannaFelde Woo thanks for being here Charlie!! #JHMChat
Journal of Hospital Medicine @JHospMedicine
Q1: Does the patient-doctor relationship benefit from the ritual of the routine daily physical exam? If so, how? #JHMChat https://t.co/8KtlLLHgA6
Adam Rodman @AdamRodmanMD
My co-author, Dr Warnock!
Frances Ue, MD MPH @TheFrancesUe
@JHospMedicine @LannaFelde 👋@LannaFelde! I’m Frances, hospitalist @challiance in Cambridge/ Boston! 1️⃣st #JHMChat!
Society of Hospital Medicine @SocietyHospMed
@YichiZTulane @JHospMedicine @LannaFelde @TulaneMedicine Welcome! We hope you'll love it and the community here #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
@YichiZTulane @JHospMedicine @LannaFelde @TulaneMedicine Welcome! Thanks for joining! #JHMChat
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
@JHospMedicine @LannaFelde Yay! Happy to finally catch a #JHMChat in such a long time! I’m Jen Readlynn, academic hospitalist in Rochester, NY who chose singing “Happy Birthday” to a patient with her team over an unnecessary exam today! 🙃
Mark Shapiro, MD @ETSshow
RT @JHospMedicine: Our topic tonight is the routine daily physical exam. Is it a waste of time? 🤔 We recently published a Point: Our topic tonight is the routine daily physical exam. Is it a waste of time? 🤔 We recently published a Point: Counterpoint about this topic Point👍🏼 https://t.co/hn43rcmy57 Counterpoint👎🏼 https://t.co/dtXcL89nbi #JHMChat
Adam Rodman @AdamRodmanMD
@YichiZTulane @JHospMedicine @LannaFelde @TulaneMedicine Yichi!!! Wonderful to see you here at #JHMChat! Hope all is well!
Society of Hospital Medicine @SocietyHospMed
@TheFrancesUe @JHospMedicine @LannaFelde @challiance 1st and hopefully not the last! Welcome 😎 #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Q1: Q1: Does the patient-doctor relationship benefit from the ritual of the routine daily physical exam? If so, how? #JHMChat https://t.co/8KtlLLHgA6
Charlie M. Wray, DO, MS @WrayCharles
@zahirkanjee @JHospMedicine @AdamRodmanMD @LannaFelde @mcnamara_lc Really enjoyed you all's piece, Zahir. Made me think twice on my initial opinion #JHMChat
Shoshana Herzig, MD, MPH @ShaniHerzig
@JHospMedicine @LannaFelde Shani here; hospitalist, researcher, @JHM SDE, and proud to be a colleague of these 4 amazing discussants/authors #jhmchat
Vinny Arora MD MAPP @FutureDocs
@JHospMedicine A1 I do think patients expect to be examined by a doctor and the act of the exam may boost trust that you’re being thorough (haven’t seen data on this) #jhmchat
Society of Hospital Medicine @SocietyHospMed
@jenreadlynn @JHospMedicine @LannaFelde Welcome back! Happy to have you 🏥 #JHMChat
Journal of Hospital Medicine @JHospMedicine
@YichiZTulane @LannaFelde @TulaneMedicine Welcome Yichi! Excited to have you join! We want to hear your thoughts! #JHMChat
Mark Shapiro, MD @ETSshow
@YichiZTulane @JHospMedicine @LannaFelde @TulaneMedicine Tennis FTW! #JHMChat
Journal of Hospital Medicine @JHospMedicine
📟 Don't miss out! Question 1 is live! #JHMChat
Journal of Hospital Medicine @JHospMedicine
@ErinShaughness4 @LannaFelde Heyyy Erin! Thanks for joining us! #JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
@SocietyHospMed @zahirkanjee @JHospMedicine @AdamRodmanMD @LannaFelde @mcnamara_lc It’s going to be a Twitter #JHMChat throwdown and I’m here for it. https://t.co/ZbB2LQwoqe
Charlie M. Wray, DO, MS @WrayCharles
@ShaniHerzig @JHospMedicine @LannaFelde @jhm Always great to see you here, Shani #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @HeatherNHofmann: @SocietyHospMed @zahirkanjee @JHospMedicine @AdamRodmanMD @LannaFelde @mcnamara_lc It’s going to be a Twitter #JHMChat throwdown and I’m here for it. https://t.co/ZbB2LQwoqe
Erin Shaughnessy MD @ErinShaughness4
@JHospMedicine I think the relationship is enhanced more by dialogue than a repeat exam. Though sometimes the pause when👩‍⚕️ putting stethoscope to chest leads the patient/family to open up and talk more… that exchange may be more valuable than auscultation. #JHMChat
Mark Shapiro, MD @ETSshow
@JHospMedicine A1: yes, but must be nuanced & discussed. The use of “routine” & “daily” is where we can debate. Also, not every patient would agree! #JHMChat
Adam Rodman @AdamRodmanMD
@HeatherNHofmann @SocietyHospMed @zahirkanjee @JHospMedicine @LannaFelde @mcnamara_lc I'm trying to interpret the gif -- who is doing the one arm push up in this scenario?! #JHMChat
Journal of Hospital Medicine @JHospMedicine
@HeatherNHofmann @LannaFelde @CleClinicMD Welcome, Heather! Thanks for joining! #JHMChat
Journal of Hospital Medicine @JHospMedicine
@zahirkanjee @AdamRodmanMD @LannaFelde @mcnamara_lc Thanks so much for being here Zahir! #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Q1: Q1: Does the patient-doctor relationship benefit from the ritual of the routine daily physical exam? If so, how? #JHMChat https://t.co/8KtlLLHgA6
Charlie M. Wray, DO, MS @WrayCharles
@JHospMedicine Yes and no. There are other aspects of our care that I think contribute more to that therapeutic relationship. Sitting down and listening (just as @AdamRodmanMD & @ShaneWarnockMD), IMHO buys more trust #JHMChat
Michelle Brooks, MD @michellebr00ks
@JHospMedicine A1: I find that a lot of patients have ongoing, new, or concerning symptoms while hospitalized, so I do think a routine exam helps me address those concerns. At least the patient feels heard. #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @WrayCharles: @JHospMedicine Yes and no. There are other aspects of our care that I think contribute more to that therapeutic relationship. Sitting down and listening (just as @AdamRodmanMD & @ShaneWarnockMD), IMHO buys more trust #JHMChat
Laura McNamara @mcnamara_lc
@FutureDocs @JHospMedicine I had a patient thank me for doing such a thorough exam overnight when I was admitting them! Anecdotal and not a "daily physical exam" but something I hope to not forget. #jhmchat
Society of Hospital Medicine @SocietyHospMed
RT @ETSshow: @JHospMedicine A1: @JHospMedicine A1: yes, but must be nuanced & discussed. The use of “routine” & “daily” is where we can debate. Also, not every patient would agree! #JHMChat
Andrea Anampa-Guzmán (she/ella) @AndreaAnampaG
@JHospMedicine @LannaFelde I am Andrea, a medical student from Peru and research assistant at Roswell Park #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
@JHospMedicine A1: Performing a physical exam builds trust and credibility with patients and/or their families. We do not always get it right in our histories. Labs do not always tell the whole story. Patients change from day to day - the physical exam helps us identify changes. #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @NdidiUnaka: @JHospMedicine A1: @JHospMedicine A1: Performing a physical exam builds trust and credibility with patients and/or their families. We do not always get it right in our histories. Labs do not always tell the whole story. Patients change from day to day - the physical exam helps us identify changes. #JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
RT @ErinShaughness4: @JHospMedicine I think the relationship is enhanced more by dialogue than a repeat exam. Though sometimes the pause when👩‍⚕️ putting stethoscope to chest leads the patient/family to open up and talk more… that exchange may be more valuable than auscultation. #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @NdidiUnaka: @JHospMedicine A1: @JHospMedicine A1: Performing a physical exam builds trust and credibility with patients and/or their families. We do not always get it right in our histories. Labs do not always tell the whole story. Patients change from day to day - the physical exam helps us identify changes. #JHMChat
Zahir Kanjee MD, MPH, FACP @zahirkanjee
@FutureDocs @JHospMedicine A1 @futuredocs, fully agree. This paper shows (at least in o/p setting) pts expect exams and think higher of their docs who do more of an exam. #jhmchat https://t.co/8rm16Yjh4A
Mark Shapiro, MD @ETSshow
@NdidiUnaka @JHospMedicine This is a compelling argument #JHMChat
Mark Shapiro, MD @ETSshow
RT @NdidiUnaka: @JHospMedicine A1: @JHospMedicine A1: Performing a physical exam builds trust and credibility with patients and/or their families. We do not always get it right in our histories. Labs do not always tell the whole story. Patients change from day to day - the physical exam helps us identify changes. #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @zahirkanjee: @FutureDocs @JHospMedicine A1 @futuredocs, fully agree. This paper shows (at least in o/p setting) pts expect exams and think higher of their docs who do more of an exam. #jhmchat https://t.co/8rm16Yjh4A
Charlie M. Wray, DO, MS @WrayCharles
@ADetsky @JHospMedicine @LannaFelde Just your run-of-the-mill #JHMChat. Glad to see you here, @ADetsky
Vinny Arora MD MAPP @FutureDocs
@zahirkanjee @JHospMedicine Thank you for this ref #jhmchat
Society of Hospital Medicine @SocietyHospMed
RT @zahirkanjee: @FutureDocs @JHospMedicine A1 @futuredocs, fully agree. This paper shows (at least in o/p setting) pts expect exams and think higher of their docs who do more of an exam. #jhmchat https://t.co/8rm16Yjh4A
Shane Warnock @ShaneWarnockMD
@JHospMedicine A1. The patient-doctor relationship is strengthened with a patient-centered approach where every exam is tailored to the patient; each observation/maneuver being purposeful, not just part of a routine #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @ShaneWarnockMD: @JHospMedicine A1. The patient-doctor relationship is strengthened with a patient-centered approach where every exam is tailored to the patient; each observation/maneuver being purposeful, not just part of a routine #JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
A1: I’m on the fence. For diagnostic purposes, not always. But aren’t negative findings reassuring? #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
RT @ETSshow: @JHospMedicine A1: @JHospMedicine A1: yes, but must be nuanced & discussed. The use of “routine” & “daily” is where we can debate. Also, not every patient would agree! #JHMChat
Michelle Brooks, MD @michellebr00ks
RT @zahirkanjee: @FutureDocs @JHospMedicine A1 @futuredocs, fully agree. This paper shows (at least in o/p setting) pts expect exams and think higher of their docs who do more of an exam. #jhmchat https://t.co/8rm16Yjh4A
Shoshana Herzig, MD, MPH @ShaniHerzig
@ShaneWarnockMD @JHospMedicine Agree, Shane! #jhmchat
Matt Sakumoto @MattSakumoto
@JHospMedicine A1. Daily check-ins are a must, but touch is not required to build trust and the therapeutic relationship. #JHMChat
Journal of Hospital Medicine @JHospMedicine
@AndreaAnampaG @LannaFelde Welcome Andrea! Great to have you! #JHMChat
Resa #GetVax Lewiss MD @ResaELewiss
RT @JHospMedicine: Q1: Q1: Does the patient-doctor relationship benefit from the ritual of the routine daily physical exam? If so, how? #JHMChat https://t.co/8KtlLLHgA6
Charlie M. Wray, DO, MS @WrayCharles
@ShaneWarnockMD @JHospMedicine @ShaneWarnockMD said it better than I did #JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
@ShaneWarnockMD @JHospMedicine “Everything with purpose” is a phrase I’ve used often on rounds. #JHMChat #HighValueCare!
Vinny Arora MD MAPP @FutureDocs
@WrayCharles @JHospMedicine @AdamRodmanMD @ShaneWarnockMD My last block I sat a lot more with patients when I wasn’t rounding with residents — it was great for our patients and me too. I feel like I learned a lot more sitting there because it was more like a “visit” of a friend or a family versus a doctor ironically. #jhmchat
Andrea Anampa-Guzmán (she/ella) @AndreaAnampaG
@JHospMedicine A1 I think that it helps to build the relationship if it is done in a respectful way and the patient have their questions answered #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @FutureDocs: @WrayCharles @JHospMedicine @AdamRodmanMD @ShaneWarnockMD My last block I sat a lot more with patients when I wasn’t rounding with residents — it was great for our patients and me too. I feel like I learned a lot more sitting there because it was more like a “visit” of a friend or a family versus a doctor ironically. #jhmchat
Adam Rodman @AdamRodmanMD
@ShaneWarnockMD @JHospMedicine You've said it better than I could! #JHMChat
Matthew Molloy @MMolloyMD
@JHospMedicine @LannaFelde Late to the party. I'm Matt - a peds hospital medicine fellow in Cincinnati and a JHM editorial fellow. Excited for this conversation! #JHMChat
Matt Sakumoto @MattSakumoto
@JHospMedicine @LannaFelde Matt here from SF. Virtualist PCP but I like to hang out with my hospitalist homies #JHMChat
Society of Hospital Medicine @SocietyHospMed
📟 Our #JHMChat is happening NOW with guests @AdamRodmanMD, @ZahirKanjee, @ShaneWarnockMD, and @mcnamara_lc. Tonight’s topic: “Routine Daily Physical Exams: Worthwhile or a Waste of Time?” @JHospMedicine @LannaFelde
Samir S. Shah @SamirShahMD
RT @SocietyHospMed: 📟 Our #JHMChat is happening NOW with guests @AdamRodmanMD, @ZahirKanjee, @ShaneWarnockMD, and @mcnamara_lc. Tonight’s topic: “Routine Daily Physical Exams: Worthwhile or a Waste of Time?” @JHospMedicine @LannaFelde
Laura McNamara @mcnamara_lc
@ShaniHerzig @JHospMedicine @LannaFelde @jhm @ShaniHerzig & @zahirkanjee go firm robinson! grateful to learn from the best #jhmchat
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
@JHospMedicine A1: Firmly in the camp of “it depends.” Patient prior experiences and traumas and reason for admission and ongoing hospitalization all inform whether it helps the relationship. #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @jenreadlynn: @JHospMedicine A1: @JHospMedicine A1: Firmly in the camp of “it depends.” Patient prior experiences and traumas and reason for admission and ongoing hospitalization all inform whether it helps the relationship. #JHMChat
Shoshana Herzig, MD, MPH @ShaniHerzig
@mcnamara_lc @JHospMedicine @LannaFelde @jhm @zahirkanjee Right back at you, @mcnamara_lc #jhmchat #robinsonrules
Ndidi Unaka MD, MEd @NdidiUnaka
@JHospMedicine A1: My personal experience on the other side of the stethoscope, I felt unseen when a physician I trusted to take my concerns seriously did not attempt to do an exam. We have to be mindful of the implicit messages we convey to patients when we choose not to perform exams #JHMChat
Journal of Hospital Medicine @JHospMedicine
@MattSakumoto @LannaFelde Thanks for joining Matt! We love hanging with our PCP frans #JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
@AdamRodmanMD @FutureDocs @WrayCharles @JHospMedicine @ShaneWarnockMD Especially in this pandemic time of months of disconnect. #JHMChat
Charlie M. Wray, DO, MS @WrayCharles
@FutureDocs @JHospMedicine @AdamRodmanMD @ShaneWarnockMD Love it, Vinny! I usually make a big show of "pulling up a chair" (often mildly self-depricating to level the playing field). I've found that patient's like this "conversation" rather than my "performance" of a PE #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @NdidiUnaka: @JHospMedicine A1: @JHospMedicine A1: My personal experience on the other side of the stethoscope, I felt unseen when a physician I trusted to take my concerns seriously did not attempt to do an exam. We have to be mindful of the implicit messages we convey to patients when we choose not to perform exams #JHMChat
Martin Kaminski @martinkaminski
@JHospMedicine A1: One could argue that the traditional exam is more about establishing performative roles than about a relationship as partners. Sitting at the level of the patient and having a longer conversation is usually more fruitful than a rote undirected exam. #JHMChat
Samir S. Shah @SamirShahMD
A1: A full but cursory exam can come across as just "checking boxes" so I do prefer some intent when I am the patient #JHMchat
Journal of Hospital Medicine @JHospMedicine
@FutureDocs @WrayCharles @AdamRodmanMD @ShaneWarnockMD Sitting >>> Standing #JHMChat
Charlie M. Wray, DO, MS @WrayCharles
And then @NdidiUnaka goes and drops a bomb like this #JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
RT @jenreadlynn: @JHospMedicine A1: @JHospMedicine A1: Firmly in the camp of “it depends.” Patient prior experiences and traumas and reason for admission and ongoing hospitalization all inform whether it helps the relationship. #JHMChat
Mark Shapiro, MD @ETSshow
@NdidiUnaka @JHospMedicine This is critically important In parallel, we as Hospitalists can always remember to ask to do an exam. Better yet, ask if anything specific they would like you to have a close look at #JHMChat
Erin Shaughnessy MD @ErinShaughness4
@AdamRodmanMD @HeatherNHofmann @SocietyHospMed @zahirkanjee @JHospMedicine @LannaFelde @mcnamara_lc I think that’s you, since your arms are free while not performing an exam #JHMChat 😂
Rebecca Jaffe, MD @RJmdphilly
@JHospMedicine I think this begs the question why you aren’t doing an exam. If it’s to move faster and spend less time at the bedside no one benefits. The exam is certainly better than nothing at all. #jhmchat
Society of Hospital Medicine @SocietyHospMed
RT @martinkaminski: @JHospMedicine A1: @JHospMedicine A1: One could argue that the traditional exam is more about establishing performative roles than about a relationship as partners. Sitting at the level of the patient and having a longer conversation is usually more fruitful than a rote undirected exam. #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @WrayCharles: And then @NdidiUnaka goes and drops a bomb like this #JHMChat
Noah Rosenberg, MD @nsrosenberg
@JHospMedicine Oops #jhmchat
Reshon Hadmon, MD 🩺 @HadmonReshon
@JHospMedicine This is the framework for the patient to freely share more pertinent information and clues for the right diagnosis.#JHMCHAT
Journal of Hospital Medicine @JHospMedicine
🎤 Great discussion! Q2 coming up in a minute! #JHMChat
Charlie M. Wray, DO, MS @WrayCharles
@ETSshow @NdidiUnaka @JHospMedicine I like this, Mark. Feels like concierge medicine :) #JHMChat
Laura McNamara @mcnamara_lc
@NdidiUnaka @JHospMedicine Thank you for this. I could not agree more wholeheartedly! Doing the routine physical exam is a powerful check to our own biases #jhmchat
Matthew Molloy @MMolloyMD
@JHospMedicine A1: I think the exam can build a strong relationship, but it has to be done right. Waking patients up on pre-rounds for a sub-par exam just disturbs sleep. Examining a scared toddler who you can adequately examine visually is unnecessary trauma. The nuance matters. #JHMChat
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
@AdamRodmanMD @FutureDocs @WrayCharles @JHospMedicine @ShaneWarnockMD Yes, I feel like I can build a better relationship with talking, making eye contact, holding a hand, and really listening. Building the trust so that if I need to do an exam of a painful area, they know it’s with reason and in their beat interest. #JHMChat
Journal of Hospital Medicine @JHospMedicine
Q2: In what ways does the performance of a daily exam impact meaningful conversations with the patient/family? #JHMChat https://t.co/JpV0npdJrt
Noah Rosenberg, MD @nsrosenberg
RT @martinkaminski: @JHospMedicine A1: @JHospMedicine A1: One could argue that the traditional exam is more about establishing performative roles than about a relationship as partners. Sitting at the level of the patient and having a longer conversation is usually more fruitful than a rote undirected exam. #JHMChat
S Galvin, MD, FAAFP @SGalvin2
RT @NdidiUnaka: @JHospMedicine A1: @JHospMedicine A1: Performing a physical exam builds trust and credibility with patients and/or their families. We do not always get it right in our histories. Labs do not always tell the whole story. Patients change from day to day - the physical exam helps us identify changes. #JHMChat
Eileen Barrett MD MPH (she/her) @EileenBarrettNM
@JHospMedicine A1. Always, if done in a patient centered way, ideally trauma informed and with intention and explanation of findings #JHMChat
Frances Ue, MD MPH @TheFrancesUe
@JHospMedicine A1: I think this needs to be tailored to the clinical context/ patient’s concerns, as mentioned by @michellebr00ks! Why do a routine physical exam when there is no true diagnostic/ management purpose? Trust building means being honest with patients. #JHMChat
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
@michellebr00ks @JHospMedicine I’m all about doing a targeted exam to ensure they feel heard but it might look different every day. #JHMChat
Journal of Hospital Medicine @JHospMedicine
@ETSshow @NdidiUnaka Great point Mark! #JHMChat
Vinny Arora MD MAPP @FutureDocs
@WrayCharles @JHospMedicine @AdamRodmanMD @ShaneWarnockMD While we are here an oldie but goodie on sitting during rounds from @JHospMedicine https://t.co/cTojabpLHT #jhmchat
Society of Hospital Medicine @SocietyHospMed
Really great discussion so far on the need for nuance when considering routine daily physical exams over at #JHMChat!
Eileen Barrett MD MPH (she/her) @EileenBarrettNM
RT @NdidiUnaka: @JHospMedicine A1: @JHospMedicine A1: Performing a physical exam builds trust and credibility with patients and/or their families. We do not always get it right in our histories. Labs do not always tell the whole story. Patients change from day to day - the physical exam helps us identify changes. #JHMChat
Charlie M. Wray, DO, MS @WrayCharles
@mcnamara_lc @NdidiUnaka @JHospMedicine @mcnamara_lc, I loved you alls take that "if you don't practice it every day, you'll lose the skill over time" argument. #JHMChat
Shane Warnock @ShaneWarnockMD
@NdidiUnaka @JHospMedicine Great point! I agree; through conversation I try to understand what a patient is concerned about, and take those concerns into consideration if/when examining. Would never ignore a patient concerns! #JHMChat
Zahir Kanjee MD, MPH, FACP @zahirkanjee
A1: The exam is in many ways a "sacred ritual," with deep meaning to the patient even beyond its diagnostic utility. https://t.co/ZEmmlionFq #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Q2: Q2: In what ways does the performance of a daily exam impact meaningful conversations with the patient/family? #JHMChat https://t.co/JpV0npdJrt
Erin Shaughnessy MD @ErinShaughness4
@WrayCharles @NdidiUnaka Agree, @NdidiUnaka makes a very powerful point #JhMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
@HadmonReshon @JHospMedicine Great point. The silence of exams may allow for the patient to think. #JHMChat
Michelle Brooks, MD @michellebr00ks
RT @zahirkanjee: A1: A1: The exam is in many ways a "sacred ritual," with deep meaning to the patient even beyond its diagnostic utility. https://t.co/ZEmmlionFq #JHMChat
Samir S. Shah @SamirShahMD
A2. Not sure it does. I suppose it helps ensure that you're keeping your thinking broad in the event of diagnostic uncertainty but even then... #JHMChat
Charlie M. Wray, DO, MS @WrayCharles
@FutureDocs @JHospMedicine @AdamRodmanMD @ShaneWarnockMD I quote this paper ALL THE TIME #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @zahirkanjee: A1: A1: The exam is in many ways a "sacred ritual," with deep meaning to the patient even beyond its diagnostic utility. https://t.co/ZEmmlionFq #JHMChat
Yichi Zhang (张一弛) @YichiZTulane
@nsrosenberg @JHospMedicine Great point. I feel like for interns/ and us med students, it can be a bad habit to literally be on "autopilot" when doing these routine physicals. If patient is stable and in NAD, much rather spend the 5 minutes chatting about their day instead!! #JHMChat
Mark Shapiro, MD @ETSshow
@JHospMedicine A2: Starts w/ narration Explaining as you examine what you are doing/seeing/feeling. Relate it to day before “Your heart sounds totally normal” “Oh good, your leg looks much less red than yesterday. Good stuff!” Everything goes from there #JHMChat
Eileen Barrett MD MPH (she/her) @EileenBarrettNM
@MMolloyMD @JHospMedicine ⬆️ Yes! Can’t wait until we develop work flows that preserve sleep and prioritize what matters #JHMChat
Michelle Brooks, MD @michellebr00ks
RT @FutureDocs: @WrayCharles @JHospMedicine @AdamRodmanMD @ShaneWarnockMD While we are here an oldie but goodie on sitting during rounds from @JHospMedicine https://t.co/cTojabpLHT #jhmchat
Heather Hofmann, MD, FACP @HeatherNHofmann
RT @FutureDocs: @WrayCharles @JHospMedicine @AdamRodmanMD @ShaneWarnockMD While we are here an oldie but goodie on sitting during rounds from @JHospMedicine https://t.co/cTojabpLHT #jhmchat
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
@ETSshow @NdidiUnaka @JHospMedicine I was taught to not ask for consent to examine because it was part of my role as physician. It never sat well with me, and I think making it patient-centered to guide what is needed and what they are comfortable with builds the relationship better. #JHMChat
Laura McNamara @mcnamara_lc
@WrayCharles @NdidiUnaka @JHospMedicine dont want to be this guy #jhmchat https://t.co/QZPcGYWMPv
Society of Hospital Medicine @SocietyHospMed
RT @ETSshow: @JHospMedicine A2: @JHospMedicine A2: Starts w/ narration Explaining as you examine what you are doing/seeing/feeling. Relate it to day before “Your heart sounds totally normal” “Oh good, your leg looks much less red than yesterday. Good stuff!” Everything goes from there #JHMChat
Samir S. Shah @SamirShahMD
@FutureDocs @WrayCharles @JHospMedicine @AdamRodmanMD @ShaneWarnockMD Q2 Would love to sit during rounds with the patient but with hospital design, I may need to start bringing my own 🪑 I always feel funny using the patient's furniture #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @jenreadlynn: @ETSshow @NdidiUnaka @JHospMedicine I was taught to not ask for consent to examine because it was part of my role as physician. It never sat well with me, and I think making it patient-centered to guide what is needed and what they are comfortable with builds the relationship better. #JHMChat
Resa #GetVax Lewiss MD @ResaELewiss
RT @JHospMedicine: Q2: Q2: In what ways does the performance of a daily exam impact meaningful conversations with the patient/family? #JHMChat https://t.co/JpV0npdJrt
Ndidi Unaka MD, MEd @NdidiUnaka
@JHospMedicine A2: From a pediatric perspective, doing a daily (and targeted) exam can actually offer quite a bit of reassurance for families. Physical exams are a way of providing high value care and absolutely can minimize unnecessary tests/ imaging. #JHMChat
Eileen Barrett MD MPH (she/her) @EileenBarrettNM
@JHospMedicine A2. It can be trust building if we explain what we see and don’t see and why it matters. Especially given power dynamics and how we often speak in ways that aren’t easily understandable to patients #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @NdidiUnaka: @JHospMedicine A2: @JHospMedicine A2: From a pediatric perspective, doing a daily (and targeted) exam can actually offer quite a bit of reassurance for families. Physical exams are a way of providing high value care and absolutely can minimize unnecessary tests/ imaging. #JHMChat
Charlie M. Wray, DO, MS @WrayCharles
@JHospMedicine In some patients (i.e. HF), I use my daily exam to show progress and elicit hope in going home soon. I find that patients often appreciate this #JHMChat
Journal of Hospital Medicine @JHospMedicine
@SamirShahMD @FutureDocs @WrayCharles @AdamRodmanMD @ShaneWarnockMD Someone needs to invent a computer on wheels that has a seat that folds down #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
RT @ETSshow: @JHospMedicine A2: @JHospMedicine A2: Starts w/ narration Explaining as you examine what you are doing/seeing/feeling. Relate it to day before “Your heart sounds totally normal” “Oh good, your leg looks much less red than yesterday. Good stuff!” Everything goes from there #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@SamirShahMD @FutureDocs @WrayCharles @JHospMedicine @AdamRodmanMD @ShaneWarnockMD Plus side is I get to tell jokes about my “old knees” (I still periodically look like I’m 12 so it’s usually good for a laugh) #jhmchat
Andrea Anampa-Guzmán (she/ella) @AndreaAnampaG
@JHospMedicine A2 I think it can give a sense of intimacy and make the patient feel more comfortable #JHMChat
Charlie M. Wray, DO, MS @WrayCharles
@ETSshow @JHospMedicine Spoken like you've done this a few times, you story-teller, you #JHMChat
Samir S. Shah @SamirShahMD
@AdamRodmanMD @FutureDocs @WrayCharles @JHospMedicine @ShaneWarnockMD This one looks like a pogo stick https://t.co/DrxmQBB9Ht #JHMChat
Dhruv Srinivasachar MD (he/el/ele.) @TheRealDSrini
@JHospMedicine @LannaFelde Oh noes! Late again! Dhruv Srinivasachar, PGY-1 @wmumedicine in #MedPeds! #JHMChat
Journal of Hospital Medicine @JHospMedicine
@EileenBarrettNM This! #JHMChat https://t.co/OlIbQ5WaFT
Noah Rosenberg, MD @nsrosenberg
@ETSshow @JHospMedicine @ETSshow I love that! I feel our exam is often just too singular of a data piece without the other context. It's why I think the timing of this exam is important- after having other data back(labs etc), it allows us to make better real time bedside assessments #jhmchat
Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood
@JHospMedicine @LannaFelde Oh no! I forgot about #JHMChat! Good thing I check Twitter regularly. Sonya from @CincyPHM
Michelle Brooks, MD @michellebr00ks
@JHospMedicine @SamirShahMD @FutureDocs @WrayCharles @AdamRodmanMD @ShaneWarnockMD The equivalent of the rollator for hospitalists!! #JHMChat
Journal of Hospital Medicine @JHospMedicine
@TheRealDSrini @LannaFelde @WMUMedicine Thanks for joining Dhruv! Jump right in. The water's fine. #JHMChat
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
@WrayCharles @mcnamara_lc @NdidiUnaka @JHospMedicine It is a good argument and why I tell my students in my physical exam small group to keep practicing! Get to know your “normal” so when there is a change you catch it. However, I’m not convinced every patient on my service needs it every day. #JHMChat
Society of Hospital Medicine @SocietyHospMed
@STangGirdwood @JHospMedicine @LannaFelde @CincyPHM No worries! Conversation is still going strong. #JHMChat
Charlie M. Wray, DO, MS @WrayCharles
@SamirShahMD @FutureDocs @JHospMedicine @AdamRodmanMD @ShaneWarnockMD I had this discussion a few years ago on Twitter. I used to like to sit at the foot of the bed (reminded me of my mom at foot of my bed when I was sick & comforted me). Is the patient's bed off-limits to you? #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
RT @zahirkanjee: A1: A1: The exam is in many ways a "sacred ritual," with deep meaning to the patient even beyond its diagnostic utility. https://t.co/ZEmmlionFq #JHMChat
Matthew Molloy @MMolloyMD
@JHospMedicine A2: Helps me explain what I'm looking for and how that impacts my thinking. "I'm glad it doesn't bother her when I press here. I don't think there's a bone infection." "His breathing is more comfortable and I hear better air movement. The treatments are working." #JHMChat
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
RT @NdidiUnaka: @JHospMedicine A1: @JHospMedicine A1: My personal experience on the other side of the stethoscope, I felt unseen when a physician I trusted to take my concerns seriously did not attempt to do an exam. We have to be mindful of the implicit messages we convey to patients when we choose not to perform exams #JHMChat
Zahir Kanjee MD, MPH, FACP @zahirkanjee
A2: Watch what happens to your relationship to the pt/family when the *the family* finds that new clinical finding before you do! #JHMChat
Journal of Hospital Medicine @JHospMedicine
@STangGirdwood @LannaFelde @CincyPHM No worries Sonya! Glad you're here! #JHMChat
Reshon Hadmon, MD 🩺 @HadmonReshon
@JHospMedicine @SocietyHospMed Communication is key to any relationship. Simply stating to a family what was done, findings and the purpose could pave the way for less resistance and trust to do your job.#JHMCHAT
Tom Varghese Jr. MD, MS, MBA, FACS 🇺🇸 @TomVargheseJr
RT @ETSshow: @JHospMedicine A2: @JHospMedicine A2: Starts w/ narration Explaining as you examine what you are doing/seeing/feeling. Relate it to day before “Your heart sounds totally normal” “Oh good, your leg looks much less red than yesterday. Good stuff!” Everything goes from there #JHMChat
Dhruv Srinivasachar MD (he/el/ele.) @TheRealDSrini
@JHospMedicine #JHMChat...Twitter needs an edit button! Or at least to autopopulate the hashtag!
Society of Hospital Medicine @SocietyHospMed
⏲️ Happening NOW: Join this month’s #JHMChat before it wraps up. Hop in and share your insight on routine daily physical exams! ✅ Build a hospitalist community ✅ Share advice ✅ Learn tips Use #JHMChat on all your replies to be part of the conversation!
Heather Hofmann, MD, FACP @HeatherNHofmann
So much to digest here. #JHMChat https://t.co/YDRHmq5CQi
Charlie M. Wray, DO, MS @WrayCharles
@STangGirdwood @JHospMedicine @LannaFelde @CincyPHM It felt empty without you, Sonya #JHMChat
Zahir Kanjee MD, MPH, FACP @zahirkanjee
A2: obligatory gif bc apparently that's what the kids do on twitter these days. #JHMChat https://t.co/3PB4KL92gm
Charlie M. Wray, DO, MS @WrayCharles
@AdamRodmanMD @SamirShahMD @FutureDocs @JHospMedicine @ShaneWarnockMD Agree, ALWAYS ASK #JHMChat
Samir S. Shah @SamirShahMD
@zahirkanjee A2: Not ideal but happens on occasion. Always great to have a family engaged in that way. I'm comfortable w/ thanking them. I haven't seen this affect the family's confidence in me but I think how one responds probably makes a big difference in the family's perception. #JHMChat
Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood
@JHospMedicine I work on a service where sometimes PE doesn’t change much day-to-day (patients w/medical complexity w/long LOS) but I find that the act of performing exam is a way of connecting - to allow me to talk with the patient in a close space even if they may not understand me. #JHMChat
Shane Warnock @ShaneWarnockMD
@JHospMedicine A2. I'd argue potentially meaningful conversations are lost when taking time to perform unnecessary maneuvers. In your patient with CHF, assess the volume status, but minimize the unnecessary. #JHMChat
Dhruv Srinivasachar MD (he/el/ele.) @TheRealDSrini
@JHospMedicine A2: I know for the past month on our academic wards, my conversation in getting subjective would continue during the physical...asking about specific symptoms while performing exams to elicit signs...helped to recall symptoms that may be missed. #JHMChat
Samir S. Shah @SamirShahMD
@WrayCharles @FutureDocs @JHospMedicine @AdamRodmanMD @ShaneWarnockMD I ask. Kids seem to find that comforting. #JHMChat
Matt Sakumoto @MattSakumoto
@WrayCharles @FutureDocs @JHospMedicine @AdamRodmanMD @ShaneWarnockMD I just imagine @WrayCharles and @FutureDocs minds are just a walking Zotero of refs and pearls #JHMChat https://t.co/pjgaadzMvc
Heather Hofmann, MD, FACP @HeatherNHofmann
@WrayCharles @FutureDocs @JHospMedicine @AdamRodmanMD @ShaneWarnockMD No one: This paper: figure 1 is going be a 🪑. Easily one of my top 5 fave papers and not just because the 🪑 . #JHMChat
Erin Shaughnessy MD @ErinShaughness4
@NdidiUnaka @JHospMedicine A2. I agree, explaining how the exam fits ( or doesn’t) with other findings helps explain the arc of progress (or lack there of). “I can see she is needing less oxygen and her work of breathing is better today too.” #JHMChat
Journal of Hospital Medicine @JHospMedicine
This #JHMChat is 🔥 Just 2️⃣ more minutes until we drop Q3!
Rebecca Jaffe, MD @RJmdphilly
@jenreadlynn @WrayCharles @mcnamara_lc @NdidiUnaka @JHospMedicine Jenn I love how you’re playing the “both and” hand on this issue. I agree. Don’t want to get rusty and I’ve been fooled before (“oh hmm that *is* a sizable knee effusion”) but also I think an exam without purpose is low value. #jhmchat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: This #JHMChat is 🔥 Just 2️⃣ more minutes until we drop Q3!
Charlie M. Wray, DO, MS @WrayCharles
@MattSakumoto @FutureDocs @JHospMedicine @AdamRodmanMD @ShaneWarnockMD Ha! I cannot unsee this gif @MattSakumoto #JHMChat
Laura McNamara @mcnamara_lc
@JHospMedicine A1: sometimes my patients keep me on my toes and will promptly ask "how do my lungs sound doc?" if I forget to say. patients are looking to our exams and communication of our findings to know how they are doing #jhmchat
Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood
@JHospMedicine A2: My answer to A1 was along this line but I think being physically close to patient while doing the exam allows for more personal conversation. It’s when I ask my Peds patients about school, favorite things they like to do, etc while residents may be talking w/family. #JHMChat
Laura McNamara @mcnamara_lc
@JHospMedicine whoops A2 #jhmchat
Ndidi Unaka MD, MEd @NdidiUnaka
RT @mcnamara_lc: @JHospMedicine A1: @JHospMedicine A1: sometimes my patients keep me on my toes and will promptly ask "how do my lungs sound doc?" if I forget to say. patients are looking to our exams and communication of our findings to know how they are doing #jhmchat
Matt Sakumoto @MattSakumoto
@MMolloyMD @JHospMedicine The PE does sometimes help me remember to ask an ROS while I’m examining each part #JHMChat
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
@JHospMedicine A targeted, well-explained exam that allows for discussion of the hospital course is great! Ending or interrupting an encounter with a patient’s family to do an exam that isn’t going to change anything & makes the family leave the room or look away can be awkward. #JHMChat
Michelle Brooks, MD @michellebr00ks
@WrayCharles @MattSakumoto @FutureDocs @JHospMedicine @AdamRodmanMD @ShaneWarnockMD #JHMChat https://t.co/EFrTVZnFZI
Journal of Hospital Medicine @JHospMedicine
Q3: In what ways could the routine daily physical exam be harmful to a patient? #JHMChat https://t.co/MAycFxToIQ
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Q3: Q3: In what ways could the routine daily physical exam be harmful to a patient? #JHMChat https://t.co/MAycFxToIQ
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
RT @EileenBarrettNM: @JHospMedicine A1. Always, if done in a patient centered way, ideally trauma informed and with intention and explanation of findings #JHMChat
Dhruv Srinivasachar MD (he/el/ele.) @TheRealDSrini
@NdidiUnaka @JHospMedicine It also allows for the child to engage in seeing the doctor more than just talking may...I know for anyone over the age of 2.5 they probably can place the stethoscope where it's supposed to go...and have a few laughs along the way...#JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
Is anyone keeping score? So far, we’ve got challenges to defining “routine,” and different ways to empower patients #JHMChat
Samir S. Shah @SamirShahMD
A2: May give false reassurance if that exam replaces time talking with the patient & family, who may provide important info about illness evolution or who may remember other pertinent historical information that influences differential or management #JHMChat
Yichi Zhang (张一弛) @YichiZTulane
@JHospMedicine A3: Unnecessary diagnostic tests! Affects patients' rest and adds to financial burden. Also increases anxiety for everyone (patient and the team!) And domino effect can mean more tests are coming one after another... #JHMChat
Matt Sakumoto @MattSakumoto
@RJmdphilly @jenreadlynn @WrayCharles @mcnamara_lc @NdidiUnaka @JHospMedicine And just to clarify we’re not saying “No exam ever” right? I think the reps you get from a full H&P on admission should be enough to keep attg PE skills up. MedEd exams (esp Med students) to learn normal is a diff story #JHMChat
Dhruv Srinivasachar MD (he/el/ele.) @TheRealDSrini
@JHospMedicine A3: Goes back to my A1, if it becomes performative, and say we're waiting for placement or at a diagnostic crossroads...are we really benefitting the patient by wasting valuable time for...say...sleep? One of my patients may have caused me to ask this...#JHMChat
Michelle Brooks, MD @michellebr00ks
@JHospMedicine A3: someone mentioned the really early prerounds —> decreased rest. I hate that I say “the hospital is a horrible place to rest,” like 16 times a day. #JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
RT @jenreadlynn: @JHospMedicine A targeted, well-explained exam that allows for discussion of the hospital course is great! Ending or interrupting an encounter with a patient’s family to do an exam that isn’t going to change anything & makes the family leave the room or look away can be awkward. #JHMChat
Matthew Molloy @MMolloyMD
@zahirkanjee I think this happens in peds not infrequently. Exams on fussy kids can be limited. Sometimes when there is diagnostic uncertainty I actually tell parents what I want them to look for! #JHMChat
Rebecca Jaffe, MD @RJmdphilly
I think one of the central arguments we are making is that the exam should be done for a purpose. But also that there are many and fairly nuanced purposes #JHMChat
Journal of Hospital Medicine @JHospMedicine
@MattSakumoto @RJmdphilly @jenreadlynn @WrayCharles @mcnamara_lc @NdidiUnaka Good point Matt! We're saying the routine daily exam is a follow up exam on a stable patient #JHMChat
Erin Shaughnessy MD @ErinShaughness4
@JHospMedicine As a pediatrician I choose when I must do an exam and when it’s okay not to. At times aggravating a fearful toddler is not worth the limited info I would get I may decide that building trust is more important so that I can do that exam when truly needed. #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
@JHospMedicine A3: Physical exams are harmful when they are done without intention, when we are robotic and not fully "present", and when we fail to maintain the patient's dignity/ modesty #JHMChat
Dhruv Srinivasachar MD (he/el/ele.) @TheRealDSrini
@MariaMjaleman @JHospMedicine Exactly. My answer more specifically focused on the first exam of the day by the day team but your point is duly noted! #JHMChat
Samir S. Shah @SamirShahMD
@michellebr00ks @JHospMedicine Don't get me started on pre-rounds #JHMChat https://t.co/qdJVOwMwLe
Michelle Brooks, MD @michellebr00ks
A3: also…we are not the only professionals performing exams. How many exams does a patient need? If something hurts, how many people have to touch it? #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @ErinShaughness4: @JHospMedicine As a pediatrician I choose when I must do an exam and when it’s okay not to. At times aggravating a fearful toddler is not worth the limited info I would get I may decide that building trust is more important so that I can do that exam when truly needed. #JHMChat
Mark Shapiro, MD @ETSshow
@JHospMedicine A3: if they don’t want you to, if they’re indisposed, if they don’t understand what you’re doing, if they read your face/body language when you encounter something abnormal & don’t get a subsequent explanation #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @michellebr00ks: @JHospMedicine A3: @JHospMedicine A3: someone mentioned the really early prerounds —> decreased rest. I hate that I say “the hospital is a horrible place to rest,” like 16 times a day. #JHMChat
Andrea Anampa-Guzmán (she/ella) @AndreaAnampaG
@JHospMedicine A3 The patients may not like being wakened up for something they do not understand. It can become a performance routine #JHMChat
Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood
@michellebr00ks @JHospMedicine Or, if we try not to wake patients, it means we didn’t turn on lights so could we really assess erythema in cellulitis, or retractions in bronchiolitis, or hear breath sounds over all the blankets & onesies? And is it possible that assessments are made on suboptimal PEs? #JHMChat
Rebecca Berger @RebeccaEBerger
Rebecca Berger, hospitalist in NYC, joining fashionably late for tonight’s #jhmchat
Samir S. Shah @SamirShahMD
@AdamRodmanMD @michellebr00ks @JHospMedicine I discourage my residents from doing them (but they all still do them), especially since we round as a group at the bedside. However, some residents find it helpful to consolidate their thinking about the patient. #JHMChat
Michelle Brooks, MD @michellebr00ks
Traumatized by how many people banged on my back for CVA tenderness. If it wasn’t tender before…#JHMChat https://t.co/Kxy8vV3LHD
Journal of Hospital Medicine @JHospMedicine
@RebeccaEBerger No worries Rebecca! Thanks for hopping on! #JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
A3: If you are doing an exam that has no diagnostic value, and I would think trust goes down. #JHMChat
Journal of Hospital Medicine @JHospMedicine
So many hot takes! 🥞 Stay tuned for our 4th and final question coming up in two minutes! #JHMChat
Dhruv Srinivasachar MD (he/el/ele.) @TheRealDSrini
@HeatherNHofmann And also cutting into patients' valuable sleep time! #JHMChat
Rebecca Jaffe, MD @RJmdphilly
And also that there are potential harms just like anything else in healthcare. Exams without proper permission and opportunity costs being just two #jhmchat
Laura McNamara @mcnamara_lc
@JHospMedicine A3: as many already mentioned, the repetition can be a burden to patients - lets work with our team & colleagues in nursing, rehab, etc. to optimize exam times for patients (especially for exam maneuvers that can be uncomfortable!) #jhmchat
Frances Ue, MD MPH @TheFrancesUe
@JHospMedicine Forgot the hashtag! #JHMChat
Noah Rosenberg, MD @nsrosenberg
@JHospMedicine We can really dehumanize a patient here. Waking a pt at 645, asking them to undo a gown, and listen to their lungs is not always patient centered approach, when that time could be spent sitting at eye level and allowing them to feel heard and less like a specimen. #jhmchat
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
RT @NdidiUnaka: @JHospMedicine A3: @JHospMedicine A3: Physical exams are harmful when they are done without intention, when we are robotic and not fully "present", and when we fail to maintain the patient's dignity/ modesty #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @nsrosenberg: @JHospMedicine We can really dehumanize a patient here. Waking a pt at 645, asking them to undo a gown, and listen to their lungs is not always patient centered approach, when that time could be spent sitting at eye level and allowing them to feel heard and less like a specimen. #jhmchat
Heather Hofmann, MD, FACP @HeatherNHofmann
RT @RJmdphilly: I think one of the central arguments we are making is that the exam should be done for a purpose. But also that there are many and fairly nuanced purposes #JHMChat
Samir S. Shah @SamirShahMD
A3: Not sure if someone mentioned this but exams can be fairly traumatic for young kids so doing them in full daily may simply make it harder to assess what's most important. Not fun when a child starts crying the moment enter the room #JHMChat
Journal of Hospital Medicine @JHospMedicine
Q4: How might the practice of the routine daily physical exam protect against or contribute to physician burnout? #JHMChat https://t.co/79IG2OquRa
Dmitriy Kedrin MD,PhD @GI_Pearls
RT @JHospMedicine: Q1: Q1: Does the patient-doctor relationship benefit from the ritual of the routine daily physical exam? If so, how? #JHMChat https://t.co/8KtlLLHgA6
Zahir Kanjee MD, MPH, FACP @zahirkanjee
@AdamRodmanMD @ShaneWarnockMD i think strongest arguments you make against routine exam is if it crowds out other stuff--holding a hand, sitting, listening.benefits of expertise/recognizing normal/etc hard to compete with that,but i'd like to think it's not "either/or" #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Q4: Q4: How might the practice of the routine daily physical exam protect against or contribute to physician burnout? #JHMChat https://t.co/79IG2OquRa
Charlie M. Wray, DO, MS @WrayCharles
I just want to take this opportunity to show my appreciation to my Peds colleagues. You all diagnose (many) of your patients while they fight your physical exam. That's pretty damn cool. I'd call that magic! #JHMChat
Reshon Hadmon, MD 🩺 @HadmonReshon
@JHospMedicine @SocietyHospMed Tough one. For me, each patient situation is different and yes PE should be thorough but also a physician should be considerate of the patient’s current health and ability to do maneuvers.#JHMCHAT
Frances Ue, MD MPH @TheFrancesUe
@SamirShahMD @michellebr00ks @JHospMedicine Seriously, great pre-rounds material for a future #JHMChat?! @martinkaminski @SamirShahMD
Michelle Brooks, MD @michellebr00ks
@TheFrancesUe @SamirShahMD @JHospMedicine @martinkaminski Or another point-counterpoint @SamirShahMD? #JHMChat
Journal of Hospital Medicine @JHospMedicine
@WrayCharles Agree! Pediatricians = Magicians! #JHMChat
Dhruv Srinivasachar MD (he/el/ele.) @TheRealDSrini
@WrayCharles #JHMChat...forgot the important hashtag...again...
Frances Ue, MD MPH @TheFrancesUe
@michellebr00ks @SamirShahMD @JHospMedicine @martinkaminski No spoilers... #JHMChat
Vinny Arora MD MAPP @FutureDocs
@AdamRodmanMD @michellebr00ks Reminds me of a patient who used to greet me and say “I’m at UChicago hospital and the President is Obama” as a way to tell me he is oriented #JHMChat
Matthew Molloy @MMolloyMD
@WrayCharles Sometimes I feel like a magician, sometimes a clown, sometimes an alligator wrestler. #JHMChat
Zahir Kanjee MD, MPH, FACP @zahirkanjee
A4: self-efficacy and mastery that comes from practice/excellence/expertise in physical exam and (crucially) physical diagnosis is an inoculation against burnout #JHMChat
Charlie M. Wray, DO, MS @WrayCharles
@MMolloyMD I'm sure that any one of those three are entertaining for your patients, Matt (I'm just saying) #jhmchat
Rebecca Jaffe, MD @RJmdphilly
This! #jhmchat if we really practiced team based care so much could be cut out. Tech helps - capturing media for example could be a big win
Yichi Zhang (张一弛) @YichiZTulane
@JHospMedicine A4: when I'm pre-rounding as a student, by the time I get to the end of my list, I definitely feel drained and want to interact less with patients. So sometimes I reverse the list order so that my patients with last name "Z" don't hate me. #JHMChat https://t.co/5Ss4kepGyG
Adam Rodman @AdamRodmanMD
@JHospMedicine I don't think it has any effect FWIW. #JHMChat
Laura McNamara @mcnamara_lc
@JHospMedicine A4: i am curious about other folks, but for me human touch, even through a stethoscope and through gloves, a gown, a mask, and goggles, was hugely protective for me amidst this ongoing covid pandemic #jhmchat
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
@JHospMedicine A3: Putting too much weight in a normal exam or maneuver without much evidence, extra testing (🙋‍♀️ guilty of ultrasound for AAA when palpating normal aorta), pain, fear. #JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
@JHospMedicine A4: we have to acknowledge that our skills require repetition to reach expert level. If you relate burnout to quality, we’re looking at building confidence, increasing quality + reducing burnout. That’s quite the challenge + at the expense of the patient? #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
@JHospMedicine A4: Unfortunately, so much of medicine is practiced away from the bedside. Being with and assessing patients at the bedside is a foundational part of our profession and highlights what many of us were drawn to! #JHMChat
Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood
@JHospMedicine In high census, I’m a fan of discovery rounds with the residents, where we do the exam together on rounds for stable patients. Means that the intern doesn’t have to run around trying to do a cursory exam on lots of patients and it turns the exam into teaching moments. #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
RT @STangGirdwood: @JHospMedicine In high census, I’m a fan of discovery rounds with the residents, where we do the exam together on rounds for stable patients. Means that the intern doesn’t have to run around trying to do a cursory exam on lots of patients and it turns the exam into teaching moments. #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @NdidiUnaka: @JHospMedicine A4: @JHospMedicine A4: Unfortunately, so much of medicine is practiced away from the bedside. Being with and assessing patients at the bedside is a foundational part of our profession and highlights what many of us were drawn to! #JHMChat
Adam Rodman @AdamRodmanMD
@zahirkanjee Strong disagree! I think this misses the mark on what contributes to burnout (which is largely out working conditions). I am skeptical of every "this inoculates against burnout" argument #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @HeatherNHofmann: @JHospMedicine A4: @JHospMedicine A4: we have to acknowledge that our skills require repetition to reach expert level. If you relate burnout to quality, we’re looking at building confidence, increasing quality + reducing burnout. That’s quite the challenge + at the expense of the patient? #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @STangGirdwood: @JHospMedicine In high census, I’m a fan of discovery rounds with the residents, where we do the exam together on rounds for stable patients. Means that the intern doesn’t have to run around trying to do a cursory exam on lots of patients and it turns the exam into teaching moments. #JHMChat
Dmitriy Kedrin MD,PhD @GI_Pearls
RT @AdamRodmanMD: @zahirkanjee Strong disagree! I think this misses the mark on what contributes to burnout (which is largely out working conditions). I am skeptical of every "this inoculates against burnout" argument #JHMChat
Reshon Hadmon, MD 🩺 @HadmonReshon
@JHospMedicine @SocietyHospMed 👀Is it really the physical exam causing the burnout? It is a skill of the physician. I do think there are more factors to burnout.#JHMCHAT
Shane Warnock @ShaneWarnockMD
@JHospMedicine A4. Being mindful, staying in the moment, and treating each patient interaction uniquely prevents us from falling into routines that can make a day feel less stimulating and more of the same. #JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
Discovery rounds have an important place in #MedEd! #JHMChat
Diana Mahbod, MD, CPE, FASN, FNKF @DiMiRenalMD
Hi, Diana here, nephrologist in Dallas. Have been lurking and enjoying the convo so thanks all and hope to join again #JHMChat
Dhruv Srinivasachar MD (he/el/ele.) @TheRealDSrini
@JHospMedicine A4: I don't know if it makes much of a difference... looking for changes energizes me...only seeing the same thing everyday disappoints...especially if the patient is not getting better...and is looking for interesting physical signs merely a neat party trick? #JHMChat
Erin Shaughnessy MD @ErinShaughness4
@WrayCharles The amount of fight in the child is telling in and of itself! Am I right @NdidiUnaka? #SickOrNotSick #PHMforLife #JHMChat
Society of Hospital Medicine @SocietyHospMed
@DiMiRenalMD Glad you enjoyed and hope to see you next month! #JHMChat
Eric Schultz @ericschul
@JHospMedicine A4: If not done with a particular purpose, can feel like mindless box-checking for documentation/billing purposes which contributes to burnout. Done well, it can strengthen the human connection between clinician and patient which is protective against burnout. #JHMChat
Journal of Hospital Medicine @JHospMedicine
@DiMiRenalMD Thanks for hanging out, Diana! Glad you were here. #JHMChat
Rebecca Berger @RebeccaEBerger
@zahirkanjee This happens a lot, new extremity swelling, rashes in places we don’t uncover every day. Important to stay humble and be thankful. Even more reason to make every exam intentional rather than going through the motions #JHMChat
Journal of Hospital Medicine @JHospMedicine
⏳ Time flies! This #JHMChat has just a few minutes remaining. Any take 🏠 points?
Society of Hospital Medicine @SocietyHospMed
Thank you all for being a part of this #JHMChat. 🙏 As we wind down, please take some time to fill out our brief feedback form. 📝 We want to hear from you to learn how we can continue to improve #JHMChat! 👀 https://t.co/k9nukavP9F
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
@MattSakumoto @RJmdphilly @WrayCharles @mcnamara_lc @NdidiUnaka @JHospMedicine Absolutely! There are many daily exams that are helpful. At admission and even my first time meeting a patient are musts. If I don’t know what’s going on, repeat exam and try other techniques. Physical exam is a valuable tool, but not one every patient needs every day. #JHMChat
Eileen Barrett MD MPH (she/her) @EileenBarrettNM
@JHospMedicine A4. If it used to forge connections & trust w patients or a way to engage our minds/hearts, I’ve found it restorative. Nerd alert 🚨 : I love percussing the chest & belly, listening for evolvong gallops, describing signs of elevated portal pressure. #JHMChat
Rebecca Jaffe, MD @RJmdphilly
A4 this one is difficult in covid times - during the height of things the need to do some sort of perfunctory exam with a crap stethoscope that was going to direct me clinically in little to no meaningful way at great personal risk did add to my feelings of burnout. #JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
RT @ShaneWarnockMD: @JHospMedicine A4. Being mindful, staying in the moment, and treating each patient interaction uniquely prevents us from falling into routines that can make a day feel less stimulating and more of the same. #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
@ErinShaughness4 @WrayCharles YES!!! #JHMChat
Zahir Kanjee MD, MPH, FACP @zahirkanjee
@AdamRodmanMD @HadmonReshon @JHospMedicine @SocietyHospMed A4: I'm not saying it's the only factor (at all!), but part of burnout is a lack of self-efficacy. Feeling like you can make a difference on outcomes with your hands (right there and then!) feels good. improving/excelling at exam makes me feel better/more fulfilled. #JHMChat
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
RT @NdidiUnaka: @JHospMedicine A4: @JHospMedicine A4: Unfortunately, so much of medicine is practiced away from the bedside. Being with and assessing patients at the bedside is a foundational part of our profession and highlights what many of us were drawn to! #JHMChat
Adam Rodman @AdamRodmanMD
@jenreadlynn @MattSakumoto @RJmdphilly @WrayCharles @mcnamara_lc @NdidiUnaka @JHospMedicine I think this is a wonderful summation of mine and Shane's argument! #JHMChat
Ndidi Unaka MD, MEd @NdidiUnaka
@DiMiRenalMD Thanks for joining! #JHMChat
Dhruv Srinivasachar MD (he/el/ele.) @TheRealDSrini
@AdamRodmanMD @zahirkanjee This...all of this...burnout is a product of the broken system we have and honestly has little to do with how we individually practice medicine...#JHMChat
Frances Ue, MD MPH @TheFrancesUe
@JHospMedicine A4: Spending quality time at the bedside with the patient protects against burnout -- a reminder of why we all went into this profession. How that quality time is defined -- usually does not mean a routine exam but findings ways to establish a human connection. #JHMChat
Eileen Barrett MD MPH (she/her) @EileenBarrettNM
@HeatherNHofmann @JHospMedicine So interesting! I talk with my learners about why we confirm the PE findings we expect when we know the diagnosis is so that we know what to look for when we don’t. It’s also SO helpful in resource limited areas #JHMChat
Rebecca Berger @RebeccaEBerger
@RJmdphilly Daily lung exams on stable COVID patients without underlying obstructive lung disease do not change my management, so I don’t do them. Worsening hypoxia or known asthma/COPD absolutely deserves exam. Intentionality matters. #JHMChat
Joseph “Dr. Joe” Thomas, MD @DocWithBowtie
@JHospMedicine A4: Protects against vs. contributing burnout probably depends on our relationship created with the patient. Also depends on our attitude. Sometimes I feel impatient as a patient is telling me something that maybe isn’t immediately relevant, but they want to share.#JHMChat
Erin Shaughnessy MD @ErinShaughness4
@TheRealDSrini @WrayCharles (I see what you did there) #JHMChat
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
@AdamRodmanMD @zahirkanjee Being at the bedside with my patients helps protect against burnout. It doesn’t mean I have to do an exam. #JHMChat
Joseph “Dr. Joe” Thomas, MD @DocWithBowtie
@JHospMedicine Sometimes I need to remember to chill and make that patient feel listened to. (Also, sorry I’m late!) #JHMChat
Dhruv Srinivasachar MD (he/el/ele.) @TheRealDSrini
@AdamRodmanMD @JHospMedicine I saw the Frank sign in a patient during my second week of wards this month...I can 100% tell you it did not contribute to him getting any further workup for CAD...#JHMChat
Journal of Hospital Medicine @JHospMedicine
That'll do it for tonight, folks! 🙏🏼 Thank you for being a part of #JHMChat! Huge thanks to our special guests @AdamRodmanMD @mcnamara_lc @zahirkanjee @ShaneWarnockMD 👏🏼 👏🏼 👏🏼 Don't forget to claim CME here: https://t.co/Wa0bDHayVJ See you next time👋🏼
Heather Hofmann, MD, FACP @HeatherNHofmann
@AdamRodmanMD @zahirkanjee How many times must a hospitalist hear a normal exam to then ID abnormal? Probably not many. What are the risks of missing something you didn’t know you needed to examine? We really must see the importance of strong history taking skills and where the routine PE fits. #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @SocietyHospMed: Thank you all for being a part of this #JHMChat. 🙏 As we wind down, please take some time to fill out our brief feedback form. 📝 We want to hear from you to learn how we can continue to improve #JHMChat! 👀 https://t.co/k9nukavP9F
Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood
@JHospMedicine I just added to my expectations sheet for the residents on my team my expectations about the physical exam on rounds, specifically stating discovery rounds on stable patients is okay! #JHMChat
Shane Warnock @ShaneWarnockMD
RT @jenreadlynn: @AdamRodmanMD @zahirkanjee Being at the bedside with my patients helps protect against burnout. It doesn’t mean I have to do an exam. #JHMChat
Yichi Zhang (张一弛) @YichiZTulane
@AdamRodmanMD @TheRealDSrini @JHospMedicine When we do find these subtle signs though, it will get me amped up for hours 🤓, so I guess physicals can be protective against burnout in this sense? #JHMChat
Journal of Hospital Medicine @JHospMedicine
@DocWithBowtie No worries Joe! Thanks for hopping on! #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@RebeccaEBerger Agreed - just tapping into the May 2020 guilt fear anger cocktail which was different from the Nov 2021 self confidence and thoughtful justification. #jhmchat
Mark Shapiro, MD @ETSshow
@JHospMedicine @AdamRodmanMD @mcnamara_lc @zahirkanjee @ShaneWarnockMD This was great! Fist bump emojis all around! Thanks to all #JHMChat
Andrew @ndyG83
It definitely shouldn’t…and if it is…then you were burnt out before the exam… https://t.co/OaWoBqRhAp
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: That'll do it for tonight, folks! 🙏🏼 Thank you for being a part of #JHMChat! Huge thanks to our special guests @AdamRodmanMD @mcnamara_lc @zahirkanjee @ShaneWarnockMD 👏🏼 👏🏼 👏🏼 Don't forget to claim CME here: https://t.co/Wa0bDHayVJ See you next time👋🏼
Matthew Molloy @MMolloyMD
@JHospMedicine A4: I'm not sure daily exams impact burnout either way, but I do think getting to the bedside and developing relationships with patients remind us of why we became doctors and shields against burnout. One of my exams on Sunday involved toy cars. My job rocks! #JHMChat
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
@HeatherNHofmann I need to use discovery rounds more. The few times I’ve done it, it’s been so great. This has been an excellent motivator! #JHMChat
Hemal N. Sampat, M.D. @SampatMD
@JHospMedicine A4 - Low-hanging fruit: put real stethoscopes in the room of pts on contact precautions. The cheap plastic ones are a symbol of the routine physical exam becoming a daily chore that gives no useful info and leads to burnout, rather than a vital clinical skill and tool. #JHMChat
Laura McNamara @mcnamara_lc
@JHospMedicine @AdamRodmanMD @zahirkanjee @ShaneWarnockMD Thanks for hosting this great #JHMChat https://t.co/Wfm0dkdVMw
Heather Hofmann, MD, FACP @HeatherNHofmann
#JHMChat https://t.co/4Zp1dltd3l
Society of Hospital Medicine @SocietyHospMed
That’s a wrap on tonight’s #JHMChat with @AdamRodmanMD, @ZahirKanjee, @ShaneWarnockMD, and @mcnamara_lc! Thanks to all for this spirited and interesting conversation. 🙌 🎉 Also, shoutout to @LannaFelde for leading the discussion as @JHospMedicine.
Rebecca Berger @RebeccaEBerger
@RJmdphilly Absolutely agree. Those fisher price toys in the room definitely contribute to the feeling that you’re just going through the motions. #JHMChat
Charlie M. Wray, DO, MS @WrayCharles
@JHospMedicine @AdamRodmanMD @mcnamara_lc @zahirkanjee @ShaneWarnockMD This was such a fun conversation and really enjoyed hearing everyone's take. Special shout out to @LannaFelde for organizing tonight's #JHMChat https://t.co/8KYByNxsgy
Rebecca Jaffe, MD @RJmdphilly
@RebeccaEBerger The worst They are a hidden curriculum telling you that your time and exam are low value m #jhmchat
Shane Warnock @ShaneWarnockMD
Thank you all; great conversation! Thank you @LannaFelde for hosting #JHMChat
Frances Ue, MD MPH @TheFrancesUe
@JHospMedicine @AdamRodmanMD @mcnamara_lc @zahirkanjee @ShaneWarnockMD Nice to hear from everyone! #JHMChat https://t.co/wWZiywkQxv
Journal of Hospital Medicine @JHospMedicine
@ShaneWarnockMD @LannaFelde My pleasure! Thanks for being here Shane! #JHMChat
Dhruv Srinivasachar MD (he/el/ele.) @TheRealDSrini
@RJmdphilly @RebeccaEBerger Why they can't just have actual good stethoscopes that get a good cleaning (which would be cheaper and probably more environmentally friendly btw) is beyond me and my lowly pay grade...#JHMChat
Zahir Kanjee MD, MPH, FACP @zahirkanjee
@SocietyHospMed @AdamRodmanMD @ShaneWarnockMD @mcnamara_lc @LannaFelde @JHospMedicine This was wonderful! So great to hear everyone’s takes on really important questions. I learned a lot! Thanks @SocietyHospMed and @LannaFelde for inviting us and hosting! #JHMChat
Journal of Hospital Medicine @JHospMedicine
@WrayCharles @AdamRodmanMD @mcnamara_lc @zahirkanjee @ShaneWarnockMD @LannaFelde My pleasure! Thanks to everyone for the excellent conversation! #JHMChat
Dhruv Srinivasachar MD (he/el/ele.) @TheRealDSrini
@JHospMedicine @AdamRodmanMD @mcnamara_lc @zahirkanjee @ShaneWarnockMD Thanks for having us! And again...sorry for my tardiness...as usual... #JHMChat
Journal of Hospital Medicine @JHospMedicine
@zahirkanjee @SocietyHospMed @AdamRodmanMD @ShaneWarnockMD @mcnamara_lc @LannaFelde Agree! This was excellent! So glad you joined in the conversation Zahir! #JHMChat
Heather Hofmann, MD, FACP @HeatherNHofmann
Today’s #JHMChat is for you, @HumeralO
Jen Readlynn, MD, FHM (she/her) @jenreadlynn
@RJmdphilly @HeatherNHofmann Ugh! The struggle is real! I often start service with a lot of ideas on how this time is going to be different and better and end up doing the same old. #JHMChat https://t.co/8Z8jAMka0n
Andrea Anampa-Guzmán (she/ella) @AndreaAnampaG
RT @NdidiUnaka: @JHospMedicine A3: @JHospMedicine A3: Physical exams are harmful when they are done without intention, when we are robotic and not fully "present", and when we fail to maintain the patient's dignity/ modesty #JHMChat
Tom Varghese Jr. MD, MS, MBA, FACS 🇺🇸 @TomVargheseJr
RT @FutureDocs: Wow the new version of #LOFD (“looks ok from door”) is LOOP (looks ok on phone 😂) @WeiWeiLeeMD @Alkureishi_L #jhmchat
Resa #GetVax Lewiss MD @ResaELewiss
RT @MattSakumoto: @WrayCharles The Virtualist exam is also basically a doorway exam (visual observation only) #TelemedNow #JHMChat https://t.co/ZZMnQl4l03
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