#JHMChat Transcript
Healthcare social media transcript of the #JHMChat hashtag.
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| Profile | Tweet |
|---|---|
 | 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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