#JHMChat Transcript
Healthcare social media transcript of the #JHMChat hashtag.
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See #JHMChat Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Journal of Hospital Medicine @JHospMedicine 🔟 MINUTES LEFT UNTIL #JHMChat! Last chance to fill your #myJHMmug! ☕ PC: @freckledpedidoc (P.S. we are jealous of those marshmallows!!) https://t.co/8cSniyqGPR |
 | Society of Hospital Medicine @SocietyHospMed ⏰ 🔟 minutes until this month’s #JHMChat! 🩺 Tonight’s facilitator and guests: @michellebr00ks as @JHospMedicine, @tony_breu, and @DocLennyF Don’t forget to use #JHMChat in all tweets! Need a refresher on how to join? 👀👇 https://t.co/ivHhIPERG8 https://t.co/PJIa2EDoiQ |
| @freckledpedidoc RT @JHospMedicine: 🔟 MINUTES LEFT UNTIL #JHMChat! Last chance to fill your #myJHMmug! ☕ PC: @freckledpedidoc (P.S. we are jealous of th… | |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: 🔟 MINUTES LEFT UNTIL #JHMChat! Last chance to fill your #myJHMmug! ☕ PC: @freckledpedidoc (P.S. we are jealous of th… |
 | Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @SocietyHospMed @michellebr00ks @JHospMedicine @tony_breu @DocLennyF Unfortunately don't have mine with me tonight... https://t.co/1JWDdzmdt0 |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @JHospMedicine @freckledpedidoc Unfortunately don't have mine tonight #myJHMmug #JHMChat https://t.co/JtbbCFmoQk |
| Journal of Hospital Medicine @JHospMedicine RT @TheRealDSrini: @JHospMedicine @freckledpedidoc Unfortunately don't have mine tonight #myJHMmug #JHMChat https://t.co/JtbbCFmoQk |
 | Michelle Brooks, MD, SFHM @michellebr00ks RT @JHospMedicine: 🔟 MINUTES LEFT UNTIL #JHMChat! Last chance to fill your #myJHMmug! ☕ PC: @freckledpedidoc (P.S. we are jealous of th… |
 | Samir S. Shah @SamirShahMD RT @JHospMedicine: 🔟 MINUTES LEFT UNTIL #JHMChat! Last chance to fill your #myJHMmug! ☕ PC: @freckledpedidoc (P.S. we are jealous of th… |
| Society of Hospital Medicine @SocietyHospMed @TheRealDSrini @JHospMedicine @freckledpedidoc Any mug will do, but we love the photo! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @SocietyHospMed: ⏰ 🔟 minutes until this month’s #JHMChat! 🩺 Tonight’s facilitator and guests: @michellebr00ks as @JHospMedicine, @tony… |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini 2 Minutes left! Reminder for those who want to join! @gradydoctor @jenreadlynn #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Hello! I'm @michellebr00ks, your moderator for tonight's #JHMChat, coming at you from San Antonio, TX. 🤠 🤝 Go ahead and introduce yourself while we wait for people to join. |
 | Jen Readlynn, MD, FHM (she/her) @jenreadlynn #JHMChat, #KetanjiBrownJacksonHearing , & #MomMilestones by @gracefarris! Great day! https://t.co/JgejyzpgJs |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @TheRealDSrini @gradydoctor Thanks for being on top of it for me! 😉 |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Hello! I'm @michellebr00ks, your moderator for tonight's #JHMChat, coming at you from San Antonio, TX. 🤠 🤝 Go ahead an… |
| Society of Hospital Medicine @SocietyHospMed 🏥 Welcome to this month’s #JHMChat. We’re excited for a great discussion! 🔥 📢 Use #JHMChat on all replies. 📢 Introduce yourself and where you’re from. 📢 Engage with the prompts and each other. 📢 Refresh the latest tweets with the hashtag to stay up to date. |
| Journal of Hospital Medicine @JHospMedicine We would like to thank our special guests @tony_breu @DocLennyF for joining us tonight for a #JHMChat focused on our #TWDFNR series. This sort of feels like a warm-up for #SHMConverge! BTW, have you registered yet? https://t.co/jpypOF8zJJ https://t.co/QuvS1T1QFh |
| @freckledpedidoc @JHospMedicine @michellebr00ks 👋 Anika Kumar, Pediatric Hospitalist in Cleveland #JHMChat | |
 | Tony Breu @tony_breu I'm excited to be back for #JHMChat. It's been too long. I blame DST for my absence. |
 | One Week Bot (parody) @OneWeekBot 🎶 Gotta get in tune with Sailor Moon 🎶 #oneweek https://t.co/ESgdIGiNCL |
 | Annie Massart @Annie_Massart_ @JHospMedicine @michellebr00ks Hello! I'm Annie Massart, an academic hospitalist in Atlanta. Looking forward to chatting with y'all! #JHMChat |
 | Leonard Feldman @DocLennyF #JHMChat. Lenny Feldman in the house. |
| Journal of Hospital Medicine @JHospMedicine @jenreadlynn @gracefarris So glad you're here! And not jealous at all of your book. #JHMChat https://t.co/upSzVqko2d |
| Society of Hospital Medicine @SocietyHospMed @Annie_Massart_ @JHospMedicine @michellebr00ks Welcome! Glad you made it. #JHMChat |
 | Charlie M. Wray, DO, MS @WrayCharles @JHospMedicine @michellebr00ks Hey there #JHMChat community. I'm @WrayCharles - hospitalist in SF. Looking forward to tonight's chat w/@tony_breu & @DocLennyF - w/moderator @michellebr00ks |
 | Trushar M. Dungarani @DrT_Dungarani #JHMChat Trushar Dungarani, adult hospitalist @HopkinsMedicine |
| Society of Hospital Medicine @SocietyHospMed @tony_breu Welcome! Glad to have you with us. #JHMChat |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @SocietyHospMed I'm Jen Readlynn, academic hospitalist in Rochester, NY and big fan of #TWDFNR! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @Annie_Massart_ @michellebr00ks Welcome! You've had a busy day! #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: We would like to thank our special guests @tony_breu @DocLennyF for joining us tonight for a #JHMChat focused on our #TW… |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @JHospMedicine @michellebr00ks Dhruv Srinivasachar, PGY-1 Med-Peds @WMUMedicine , thinking combined hospitalist. Hoping for good discussion on #TWDFNR #JHMChat |
 | Lanna Felde @LannaFelde Lanna Felde here coming at you from @UTSWHospitalMed. Excited to be here! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine You also may see some of our authors pop in to #JHMChat! We ❤️ highlighting your #TWDFNR work! @DrSamanthaWang @Payalia320 @DanielRicottaMD @DavidACohen_MD @ChristleNwora https://t.co/2rkJ83e1Uu |
 | Ndidi Unaka MD, MEd @NdidiUnaka @JHospMedicine @michellebr00ks Hi! I'm Ndidi, peds hospitalist in Cincinnati :) #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @tony_breu Same. #JHMChat https://t.co/d4JlqNTNMZ |
| Charlie M. Wray, DO, MS @WrayCharles @tony_breu It's nice to see some of the OG #JHMChat crew. Hey @FutureDocs - look who showed up! (Can't wait to catch up in Nashville) |
 | Payal Parikh, MD, FACP @Payalia320 @JHospMedicine @michellebr00ks hi all! Im Payal Parikh, academic hospitalist, Vice Chair of Quality and Safety Robert Wood Johnson Medical School (NJ), also co-author of the #TWDFNR metformin publication! So excited for today! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @freckledpedidoc @michellebr00ks Hi! Still jealous of your marshmallows. #JHMChat |
| Society of Hospital Medicine @SocietyHospMed @jenreadlynn We all love #TWDFNR! This is gonna be a great discussion! #JHMChat |
| @prabimd @JHospMedicine @michellebr00ks Prabi Rajbhandari, pediatric hospitalist , Akron childrens #JHMChat | |
| Journal of Hospital Medicine @JHospMedicine FYI - #JHMChat has 3️⃣ topics tonight, centered around 3️⃣ #TWDFNR articles. A 🔗 link to the article and the #VisualAbstract will be posted just prior to each #JHMChat question. |
| Annie Massart @Annie_Massart_ @JHospMedicine @michellebr00ks Grateful for all the virtual connections happening today! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @LannaFelde @UTSWHospitalMed Hope you're staying safe and away from any severe weather up there! #JHMChat |
| Society of Hospital Medicine @SocietyHospMed @Payalia320 @JHospMedicine @michellebr00ks Yay! Glad you're here! #JHMChat |
 | Samantha Wang @DrSamanthaWang @JHospMedicine @Payalia320 @DanielRicottaMD @DavidACohen_MD @ChristleNwora Excited to be part of the #JHMChat tonight with my colleague and co-author @juliablumcaton! |
| Journal of Hospital Medicine @JHospMedicine @TheRealDSrini @michellebr00ks @WMUMedicine Welcome back! #JHMChat |
| Tony Breu @tony_breu @WrayCharles @FutureDocs I'm excited to catch up too. #JHMChat |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @JHospMedicine @freckledpedidoc @michellebr00ks Same! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @NdidiUnaka @michellebr00ks Thank you for being here! #JHMChat |
| Society of Hospital Medicine @SocietyHospMed @DrSamanthaWang @JHospMedicine @Payalia320 @DanielRicottaMD @DavidACohen_MD @ChristleNwora @juliablumcaton Welcome! Glad you're here for this conversation! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Q1: What's your approach to the use of metformin in hospitalized patients? How has this #TWDFNR article impacted your practice? #JHMChat https://t.co/AcTv8ZcaI0 |
| Journal of Hospital Medicine @JHospMedicine Topic 1️⃣: Holding Metformin in Hospitalized Patients 🔗 Article Link: https://t.co/j86y6Vuclu 👀 Awesome #VisualAbstract by @LannaFelde #JHMChat https://t.co/jbJN76mXro |
| Ndidi Unaka MD, MEd @NdidiUnaka RT @JHospMedicine: We would like to thank our special guests @tony_breu @DocLennyF for joining us tonight for a #JHMChat focused on our #TW… |
 | Mark Shapiro, MD @ETSshow @WrayCharles @JHospMedicine @michellebr00ks @tony_breu @DocLennyF Evening all! Mark Shapiro here, Hospitalist & host of Explore The Space Podcast Delighted to be virtually near to @tony_breu Hopefully you’ll be at SHM Annual Meeting & I can conjure you out of thin air again like in 2019! #JHMChat https://t.co/aDBqXow5NQ |
 | Yichi Zhang (张一弛) @YichiZzzzz @SocietyHospMed Hey everyone, it's Yichi again! High winds today and wifi went down but that's not stopping me from being here! #JHMChat #TWDFNR https://t.co/GYL3K4HTa3 |
| Tony Breu @tony_breu @DrSamanthaWang @JHospMedicine @Payalia320 @DanielRicottaMD @DavidACohen_MD @ChristleNwora @juliablumcaton It's great to have you here Samantha! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @DrSamanthaWang @Payalia320 @DanielRicottaMD @DavidACohen_MD @ChristleNwora @juliablumcaton We're so excited to highlight your #TWDFNR work! #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @ETSshow: @WrayCharles @JHospMedicine @michellebr00ks @tony_breu @DocLennyF Evening all! Mark Shapiro here, Hospitalist & host of Explor… |
 | @KarynDoc @karynbaum @JHospMedicine @michellebr00ks Karyn Baum, hospitalist and evil administrator at Essentia Health! |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @JHospMedicine @michellebr00ks @WMUMedicine Currently on nights but hoping for no admits or calls! 🤞🤞🤞#JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Topic 1️⃣: Holding Metformin in Hospitalized Patients 🔗 Article Link: https://t.co/j86y6Vuclu 👀 Awesome #VisualAbstrac… |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Q1: What's your approach to the use of metformin in hospitalized patients? How has this #TWDFNR article impacted your p… |
| Leonard Feldman @DocLennyF @DrSamanthaWang @JHospMedicine @Payalia320 @DanielRicottaMD @DavidACohen_MD @ChristleNwora @juliablumcaton #JHMChat Glad you’re here! |
| Lanna Felde @LannaFelde Woooo pumped to learn some nuggets of wisdom from the #TWDFNR that @michellebr00ks is about to drop 💣 #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @prabimd @michellebr00ks Thanks for being here! Hope to highlight more pediatric #TWDFNR in the future! #JHMChat |
| Society of Hospital Medicine @SocietyHospMed @YichiZTulane LOVE your perseverence. Welcome! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @Payalia320 @michellebr00ks Thank you for being here! Excited to highlight your work! #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @YichiZTulane @SocietyHospMed Good to see you back, Yichi #JHMChat |
| Payal Parikh, MD, FACP @Payalia320 @JHospMedicine @DrSamanthaWang @DanielRicottaMD @DavidACohen_MD @ChristleNwora excited to join this evening! #JHMChat |
 | Ammar Saati عمار ساعاتي @AmmarSaati RT @JHospMedicine: Topic 1️⃣: Holding Metformin in Hospitalized Patients 🔗 Article Link: https://t.co/j86y6Vuclu 👀 Awesome #VisualAbstrac… |
| Lanna Felde @LannaFelde @TheRealDSrini @JHospMedicine @michellebr00ks @WMUMedicine way to multitask! #jhmchat |
 | Julia Caton @juliablumcaton @DrSamanthaWang @JHospMedicine @Payalia320 @DanielRicottaMD @DavidACohen_MD @ChristleNwora thanks @DrSamanthaWang - excited to be here! #JHMChat |
| Yichi Zhang (张一弛) @YichiZzzzz @JHospMedicine @tony_breu @DocLennyF Done and done! Two abstracts comin' right up to #SHMConverge! |
| @KarynDoc @karynbaum @Payalia320 @JHospMedicine @michellebr00ks Hi Payal!!!! |
| Society of Hospital Medicine @SocietyHospMed [REDACTED USER] Welcome! We love a representation for the tiny humans! #JHMChat |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini [REDACTED USER] Wondering if @esharpmd is going to join us? #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Awwww...we hope y'all can recreate this picture in Nashville! #JHMChat |
| Mark Shapiro, MD @ETSshow @JHospMedicine A1: I do not use metformin in hospitalized patients ever Prepared for your slings & arrows #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @JHospMedicine I've been dancing with the idea of continuing metformin in hospitalized patients for several years. This article really helped me solidify that desire. Funny, how something just needs to be written down to justify my doctoring #JHMChat |
| Lanna Felde @LannaFelde @YichiZTulane @SocietyHospMed Same here - just got done sheltering with my family in the bathroom for a half hour waiting for the tornado sirens to stop🙃. Excited to be here! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine So glad you're on the #TWDFNR team! #JHMChat |
 | Satyendra Dhar, MD SFHM @DharSaty I’m Satyendra Dhar, #Hospitalist at University of Michigan Health system. Always enjoy #JHMChat |
| Tony Breu @tony_breu For topic 1, I also wonder how quickly people "add it back" if an admitting doctor stopped it. #JHMChat |
| @freckledpedidoc [REDACTED USER] Yay for Tiny Humans! #JHMChat https://t.co/1RDgC0tcdR | |
| Trushar M. Dungarani @DrT_Dungarani #JHMChat often our admitters and night time team hold metformin with uncertainty of renal fxn the next day. Day time team forget or not interested in restarting. |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @JHospMedicine This article combined with @COREIMpodcast on oral meds in the hospital have definitely given me the confidence to continue or resume home metformin in hospitalized patients. We're discussing as a division on 3/30 (@UR_HMD) and getting some endo tips as well. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @jenreadlynn: @JHospMedicine This article combined with @COREIMpodcast on oral meds in the hospital have definitely given me the confide… |
| Mark Shapiro, MD @ETSshow RT @JHospMedicine: Awwww...we hope y'all can recreate this picture in Nashville! #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @DrSamanthaWang @JHospMedicine @Payalia320 @DanielRicottaMD @DavidACohen_MD @ChristleNwora @juliablumcaton Good to see you here, Samantha! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @DrT_Dungarani: #JHMChat often our admitters and night time team hold metformin with uncertainty of renal fxn the next day. Day time tea… |
| Leonard Feldman @DocLennyF [REDACTED USER] #JHMChat And we are developing some great peds TWDFNR content! |
| Society of Hospital Medicine @SocietyHospMed @DharSaty Thanks for joining! #JHMChat |
| Yichi Zhang (张一弛) @YichiZzzzz @LannaFelde @SocietyHospMed Oh no! Hope everyone's safe and everything's tied down alright! |
| Tony Breu @tony_breu Mark - do you do this because it's the simplest route or because of a fear of LA? #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @WrayCharles: @JHospMedicine I've been dancing with the idea of continuing metformin in hospitalized patients for several years. This ar… |
| Mark Shapiro, MD @ETSshow RT @JHospMedicine: Topic 1️⃣: Holding Metformin in Hospitalized Patients 🔗 Article Link: https://t.co/j86y6Vuclu 👀 Awesome #VisualAbstrac… |
| Journal of Hospital Medicine @JHospMedicine RT @ETSshow: @JHospMedicine A1: I do not use metformin in hospitalized patients ever Prepared for your slings & arrows #JHMChat |
| Tony Breu @tony_breu @DrT_Dungarani The resonates with me #JHMChat |
 | David A. Cohen @DavidACohen_MD @JHospMedicine @DrSamanthaWang @Payalia320 @DanielRicottaMD @ChristleNwora Hey there, sorry I’m late! David Cohen popping in… https://t.co/d0W3sagJQg |
| Mark Shapiro, MD @ETSshow @JHospMedicine @NdidiUnaka @michellebr00ks Time for my requisite reply to my friend @NdidiUnaka… Go Bruins! #JHMChat https://t.co/TXKup6UFTP |
| @prabimd @freckledpedidoc [REDACTED USER] Peds hospitalists watching the adults hash out metformin debacle #JHMChat https://t.co/EOYkn13XEw | |
| Charlie M. Wray, DO, MS @WrayCharles @tony_breu Exactly, Tony. I don't mind if held on day 1 and 2 - but once I start to see clinically stability, I'm pushing myself and team to think about getting back on board #JHMChat |
| Samantha Wang @DrSamanthaWang @JHospMedicine If patient is admitted without acute renal injury or increased risk for renal injury, I continue metformin! I find it achieves better glucose control than transitioning to basal/sliding scale insulin. #JHMChat |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @tony_breu Definitely try to add it back when approaching discharge. Have started doing earlier if taking good PO. Often makes insulin management much easier and allows us to space BG checks too. #JHMChat |
| @freckledpedidoc @ETSshow @JHospMedicine I have not used Metformin in Hospitalized Patients since I was a medical student and took care of patients older than me. #JHMChat | |
| Journal of Hospital Medicine @JHospMedicine This is an excellent question. Do we develop therapeutic inertia? #JHMChat |
| Satyendra Dhar, MD SFHM @DharSaty @jenreadlynn @JHospMedicine @COREIMpodcast @UR_HMD I agree with u. I do continue unless acute kidney injury, sepsis or recent IV contrast ( hospital policy). |
 | barttels @barttels2 @tony_breu I blame Daylight Stealing/Shifting Time for everything that’s wrong in the universe, tbh. |
| Society of Hospital Medicine @SocietyHospMed RT @DrSamanthaWang: @JHospMedicine If patient is admitted without acute renal injury or increased risk for renal injury, I continue metform… |
| Samantha Wang @DrSamanthaWang @WrayCharles @JHospMedicine @Payalia320 @DanielRicottaMD @DavidACohen_MD @ChristleNwora @juliablumcaton Likewise, Charlie! |
| Leonard Feldman @DocLennyF @WrayCharles @tony_breu #JHMChat what about in PERIOPERATIVE patients? |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: This is an excellent question. Do we develop therapeutic inertia? #JHMChat |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @ETSshow @JHospMedicine But why? #JHMChat |
| Mark Shapiro, MD @ETSshow @tony_breu Honestly, I had an attending absolutely blow me out of the water for prescribing it back in the day. I’ve also seen so many patients experience new nausea w/o other clear cause too #JHMChat |
| Mark Shapiro, MD @ETSshow RT @tony_breu: Mark - do you do this because it's the simplest route or because of a fear of LA? #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles We have a front-runner for tonight's best #JHMChat Tweet |
 | Jeffrey Jaeger, MD @jjaeger3 RT @JHospMedicine: Topic 1️⃣: Holding Metformin in Hospitalized Patients 🔗 Article Link: https://t.co/j86y6Vuclu 👀 Awesome #VisualAbstrac… |
| Ndidi Unaka MD, MEd @NdidiUnaka @ETSshow @JHospMedicine I can count on one hand the number of times I have taken care of a hospitalized peds patient on metformin. So I would love to learn more about what informs your practice #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @freckledpedidoc @ETSshow Appreciate the honesty! #JHMChat https://t.co/6bdI6cGoN0 |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @JHospMedicine A1: on the pediatric side we heavily rely on our endocrine colleagues, but on the adult side, we routinely hold it. Just seems to be a whole bunch of inertia even if it's a #TWDFNR. #JHMChat |
| Payal Parikh, MD, FACP @Payalia320 @ETSshow @JHospMedicine that was my teaching as well, but working on this paper with @DavidACohen_MD and @DanielRicottaMD helped me to really change my own practice, especially in the right patient population that does not have any reason to have significant AKI. now I teach my residents! #JHMChat |
| @MelissaPlesacMD @JHospMedicine @michellebr00ks Melissa Plesac from University of Minnesota joining a few minutes late! #JHMChat | |
| Tony Breu @tony_breu @JHospMedicine I certainly experience this inertia. With complex patients, this is often not item #1 for discussion. #JHMChat |
| Leonard Feldman @DocLennyF @ETSshow @tony_breu #JHMChat Nausea in pts who regularly take met? |
| Journal of Hospital Medicine @JHospMedicine This has to be my favorite part about the #phm folks being in this chat! #JHMChat |
 | Averi Wilson-Raya, MD @AveriWilsonMD RT @JHospMedicine: Topic 1️⃣: Holding Metformin in Hospitalized Patients 🔗 Article Link: https://t.co/j86y6Vuclu 👀 Awesome #VisualAbstrac… |
| Mark Shapiro, MD @ETSshow @NdidiUnaka @JHospMedicine #JHMChat |
| @KarynDoc @karynbaum @JHospMedicine A1 I used to hold it all the time. Now I only hold if the renal function is off, sepsis, decompensated CHF or liver ds. Tell me if I'm an idiot though since all I do now is admitting shifts! #JHMChat |
| Ndidi Unaka MD, MEd @NdidiUnaka RT @JHospMedicine: This is an excellent question. Do we develop therapeutic inertia? #JHMChat |
| Mark Shapiro, MD @ETSshow @jenreadlynn @JHospMedicine #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @WrayCharles Hard co-sign @ETSshow #JHMChat |
| Payal Parikh, MD, FACP @Payalia320 @WrayCharles @JHospMedicine Agreed! working on this paper with @DavidACohen_MD and @DanielRicottaMD helped me to really change my own practice and made me comfortable to continue the metformin, now I teach my residents! #JHMChat |
| Trushar M. Dungarani @DrT_Dungarani Also Irrational fear of diarrhea and subsequent c diff ordering #JHMChat |
| Tony Breu @tony_breu @ETSshow It's remarkable how that attending experience imprinted a sustained practice. #JHMChat |
| Mark Shapiro, MD @ETSshow @DocLennyF @tony_breu It’s been a minute but yes #JHMChat |
| David A. Cohen @DavidACohen_MD @jenreadlynn @tony_breu Last years @AmDiabetesAssn guidelines on management of inpatient hyperglycemia I thought did a good job of stressing the importance of restarting home meds at least 1-2 days prior to discharge. |
| @jbcowartmd @JHospMedicine @michellebr00ks Howdy! Jennifer Cowart, academic hospitalist in Florida, here as longtime #TWDFNR fan! #jhmchat | |
| Journal of Hospital Medicine @JHospMedicine Adds another whole dimension! Surgeons can blame the metformin for the elevated lactate and AKI? @aoglasser #JHMChat |
| Payal Parikh, MD, FACP @Payalia320 @DharSaty @jenreadlynn @JHospMedicine @COREIMpodcast @UR_HMD that is eactly the basis of our paper! throwing in also advance heart failure and any reason to believe a patient will likely go into AKI! #JHMChat |
| Society of Hospital Medicine @SocietyHospMed @jbcowartmd @JHospMedicine @michellebr00ks Welcome to the #JHMChat! Happy you're here! |
| Mark Shapiro, MD @ETSshow @tony_breu My admiration for you grows. I appreciate this #JHMChat |
| Mark Shapiro, MD @ETSshow RT @tony_breu: @ETSshow It's remarkable how that attending experience imprinted a sustained practice. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @DrSamanthaWang: @JHospMedicine If patient is admitted without acute renal injury or increased risk for renal injury, I continue metform… |
| Society of Hospital Medicine @SocietyHospMed 📟 Our #JHMChat is happening NOW with guests @tony_breu and @DocLennyF. We’re talking Things We Do For No Reason™️ 👀 Pros 🆚 Cons. Unnecessary 🆚 Necessary Don’t miss the chance to share your stance! 💪 @JHospMedicine @michellebr00ks |
| Journal of Hospital Medicine @JHospMedicine RT @WrayCharles: @tony_breu Exactly, Tony. I don't mind if held on day 1 and 2 - but once I start to see clinically stability, I'm pushing… |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @prabimd @freckledpedidoc [REDACTED USER] 🤣🤣🤣🤣🤣 Combined resident half laughing and half engaged in the argument...#JHMChat |
| Mark Shapiro, MD @ETSshow RT @Payalia320: @ETSshow @JHospMedicine that was my teaching as well, but working on this paper with @DavidACohen_MD and @DanielRicottaMD h… |
| Charlie M. Wray, DO, MS @WrayCharles The cool thing about #JHMChat is that it brings back a lot of our past JHM Editorial Fellows, like @MelissaPlesacMD & @DrSamanthaWang |
| Mark Shapiro, MD @ETSshow @Payalia320 @JHospMedicine @DavidACohen_MD @DanielRicottaMD I really appreciate this. Thank you! #JHMChat |
| David A. Cohen @DavidACohen_MD @jenreadlynn @tony_breu @AmDiabetesAssn And it’s isn’t a point that is unique to #diabetes — so many home regimens get changed while a patient is admitted and not restarted on discharge. Leads to difficulty with transitions of care and readmissions. #JHMChat |
| Samantha Wang @DrSamanthaWang @Payalia320 @WrayCharles @JHospMedicine @DavidACohen_MD @DanielRicottaMD I once had a patient with solitary kidney and diabetes (on Metformin) who developed oliguric AKI. Nephrologist did ask to trend lactates overnight. He did not develop lactic acidosis (though we did hold his metformin in that case). #JHMChat |
| Payal Parikh, MD, FACP @Payalia320 @DrSamanthaWang @JHospMedicine agreed completely! less fluctuations in blood glucose, and thereby possibly less days in hospital because less hypoglycemic/hyperglycemic events! #JHMChat |
| Ndidi Unaka MD, MEd @NdidiUnaka RT @tony_breu: @ETSshow It's remarkable how that attending experience imprinted a sustained practice. #JHMChat |
| @freckledpedidoc @prabimd [REDACTED USER] I’m just over here enjoying my marshmallows… #JHMChat https://t.co/gktD3NPtPY | |
| @MelissaPlesacMD @jenreadlynn @tony_breu Same! I am driven by my love for having the active med list the day prior to discharge being as close to the discharging med list as possible! #JHMChat | |
| Mark Shapiro, MD @ETSshow RT @JHospMedicine: @WrayCharles Hard co-sign @ETSshow #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @DavidACohen_MD: @jenreadlynn @tony_breu @AmDiabetesAssn And it’s isn’t a point that is unique to #diabetes — so many home regimens get… |
| Journal of Hospital Medicine @JHospMedicine RT @jenreadlynn: @tony_breu Definitely try to add it back when approaching discharge. Have started doing earlier if taking good PO. Often m… |
| @jbcowartmd @JHospMedicine A1: I have started trying to continue the metformin but it is difficult to move against the tide. | |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @DocLennyF @WrayCharles @tony_breu Luckily I have colleagues like @JennyShenMD who deal much more w/ periop. If it hasn't been restarted, I would probably wait until after surgery "just in case" but if they're already on &stable I don't see a reason to stop unless concerned for kidney injury in surgery. #JHMChat |
| Leonard Feldman @DocLennyF @ETSshow @tony_breu #JHMChat hard not to remember the time an attending ripped you. I still recall when I got yelled at for not doing a testicular exam on a pt with a new DVT. |
| Journal of Hospital Medicine @JHospMedicine RT @NdidiUnaka: @ETSshow @JHospMedicine I can count on one hand the number of times I have taken care of a hospitalized peds patient on met… |
| @jbcowartmd RT @JHospMedicine: Topic 1️⃣: Holding Metformin in Hospitalized Patients 🔗 Article Link: https://t.co/j86y6Vuclu 👀 Awesome #VisualAbstrac… | |
| Journal of Hospital Medicine @JHospMedicine RT @Payalia320: @ETSshow @JHospMedicine that was my teaching as well, but working on this paper with @DavidACohen_MD and @DanielRicottaMD h… |
| @freckledpedidoc RT @SocietyHospMed: 📟 Our #JHMChat is happening NOW with guests @tony_breu and @DocLennyF. We’re talking Things We Do For No Reason™️ 👀… | |
| Journal of Hospital Medicine @JHospMedicine @MelissaPlesacMD @michellebr00ks So glad you're here! #JHMChat |
| @KarynDoc @karynbaum @JHospMedicine @aoglasser All the surgeons: https://t.co/ZEDlGWFoG2 |
| David A. Cohen @DavidACohen_MD @MelissaPlesacMD @jenreadlynn @tony_breu Yes!!! So important for transitions of care!! #JHMChat https://t.co/NcSwslNyxD |
| Payal Parikh, MD, FACP @Payalia320 @karynbaum @JHospMedicine agreed! I used to hold it all the time too! working on this #TWDFNR with @DavidACohen_MD and @DanielRicottaMD helped me to really change my own practice and made me comfortable to continue the metformin and really only hold if potential for AKI! #JHMChat |
| @MelissaPlesacMD @WrayCharles @DrSamanthaWang https://t.co/6XMQ1HLjHb | |
| Mark Shapiro, MD @ETSshow @DocLennyF @tony_breu We all have stories sadly I would have enjoyed having you both as attendings #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @DocLennyF @tony_breu Making it more difficult for us now, Lenny! For me, it's held periop. If anticipate quick DC home (ie. pt on a CoM service) will just advise to restart at home (1-2 days later) #JHMChat |
| Lanna Felde @LannaFelde @DocLennyF @ETSshow @tony_breu https://t.co/NmLifLjPHD |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @tony_breu @JHospMedicine For sure. I always tell new hospitalists or even residents that unless they're admitted for a blood sugar issue, we're going to pay more attention to that on day 2 and deal with other acute issues on day 1. We'll have a plan but take a closer look later. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine #JHMChat https://t.co/EozoCFCNJL |
| @KarynDoc @karynbaum @tony_breu #MedRecMess |
| Ndidi Unaka MD, MEd @NdidiUnaka RT @SocietyHospMed: 📟 Our #JHMChat is happening NOW with guests @tony_breu and @DocLennyF. We’re talking Things We Do For No Reason™️ 👀… |
| Journal of Hospital Medicine @JHospMedicine This has been so interesting to hear how practices differ. Topic 2️⃣ is coming up soon... #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @jbcowartmd @michellebr00ks So glad you made it! #JHMChat |
| Trushar M. Dungarani @DrT_Dungarani Hope you did your fecal occult test too! #twdfnr #JHMChat |
| Tony Breu @tony_breu I do want to go on the record as saying that I believe metformin associated lactic acidosis exists. #JHMChat |
| Mark Shapiro, MD @ETSshow @WrayCharles @DocLennyF @tony_breu Our patterns are similar here @WrayCharles #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @SocietyHospMed: 📟 Our #JHMChat is happening NOW with guests @tony_breu and @DocLennyF. We’re talking Things We Do For No Reason™️ 👀… |
| Lanna Felde @LannaFelde @MelissaPlesacMD @jenreadlynn @tony_breu Agree, this is part of good discharge planning 💪#jhmchat |
 | Joe Thomas, MD, FHM @DocWithBowtie @JHospMedicine #JHMChat A1: I’m in the same camp as @ETSshow, I always hold it. Even after the “looser control 120-180” proved less difficult, and seeing through the “people don’t eat as much, so we just hold all the meds”, it’s just ingrained to switch to insulin control. This is a good topic. |
| Society of Hospital Medicine @SocietyHospMed RT @tony_breu: I do want to go on the record as saying that I believe metformin associated lactic acidosis exists. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @Payalia320: @DrSamanthaWang @JHospMedicine agreed completely! less fluctuations in blood glucose, and thereby possibly less days in ho… |
| @jbcowartmd Hidden curriculum strikes again. | |
| Mark Shapiro, MD @ETSshow RT @DocWithBowtie: @JHospMedicine #JHMChat A1: I’m in the same camp as @ETSshow, I always hold it. Even after the “looser control 120-180”… |
 | Chris “The Chiu Man" Chiu, MD @cjchiu @tony_breu 😯 |
| Journal of Hospital Medicine @JHospMedicine @freckledpedidoc @prabimd [REDACTED USER] Is this you? #JHMChat https://t.co/danVzLvQyO |
| @freckledpedidoc @NdidiUnaka @JHospMedicine @ETSshow You have more experience than me Dr. Unaka… learning so much from our Adult Hospitalist colleagues #JHMChat https://t.co/wKVuniaomN | |
| Journal of Hospital Medicine @JHospMedicine Topic 2️⃣: Routine Inclusion of Race in the HPI 🔗 Article Link: https://t.co/2SbJf9IcV1 👀 #VisualAbstract by @michellebr00ks #JHMChat https://t.co/wR7OjiMeiF |
| Charlie M. Wray, DO, MS @WrayCharles @tony_breu Honest question...have you ever (knowingly) seen it? #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Topic 2️⃣: Routine Inclusion of Race in the HPI 🔗 Article Link: https://t.co/2SbJf9IcV1 👀 #VisualAbstract by @michelle… |
| Yichi Zhang (张一弛) @YichiZzzzz @jenreadlynn @JHospMedicine @COREIMpodcast @UR_HMD Speaking of the wonderful @COREIMpodcast and inpatient diabetes mgmt, I'm working to produce a graphic byte about Basal-Bolus > SSI. And a major limitation of previous studies is the discontinuation of oral antidiabetic agents. Future studies should really address this! #JHMChat |
| Tony Breu @tony_breu It's just very rare and requires pretty bad AKI and continuation of metformin. #JHMChat |
| Lanna Felde @LannaFelde @EileenBarrettNM @JHospMedicine So true. Inertia is so powerful. #JHMChat |
| @freckledpedidoc @JHospMedicine @prabimd [REDACTED USER] #JHMChat https://t.co/avWx3I2lA0 | |
| Journal of Hospital Medicine @JHospMedicine Does anyone want to talk about the other biguanide in the article? #JHMChat https://t.co/un4XFZWoYo |
| Leonard Feldman @DocLennyF @EileenBarrettNM @JHospMedicine #JHMChat it is a bit like swimming upstream. https://t.co/PfrCuGjerP |
| Ndidi Unaka MD, MEd @NdidiUnaka RT @JHospMedicine: Topic 2️⃣: Routine Inclusion of Race in the HPI 🔗 Article Link: https://t.co/2SbJf9IcV1 👀 #VisualAbstract by @michelle… |
| Tony Breu @tony_breu @WrayCharles I have. It wasn't subtle. Cr 9. LA >10. #JHMChat |
 | Maha Sulieman @MahaArhait @JHospMedicine Q1 I would say at least continue metformin for observation patients #JHMChat |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @JHospMedicine Since when do people use Phenformin anymore?! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @DrT_Dungarani #JHMChat https://t.co/jBSfwePbLs |
 | Robert A. Montgomery @ramontgo @tony_breu @DanCBelz can breathe a sigh of relief. |
| Samantha Wang @DrSamanthaWang @DocWithBowtie @JHospMedicine @ETSshow Harkens back to one of the first #TWDFNR on why sliding scale insulin monotherapy for glucose control in hospitalized patients is reactive (not proactive) and sub-optimal! |
| David A. Cohen @DavidACohen_MD @NdidiUnaka @ETSshow @JHospMedicine Thanks @NdidiUnaka — I’m on our endo consult service right now & it’ll take my 2 hands plus 1 of yours to count the patients we have on metformin. Without contraindications (hypoxia, sepsis, AKI) it is very effective to help lower glucose levels without hypoglycemia. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @jenreadlynn: @tony_breu @JHospMedicine For sure. I always tell new hospitalists or even residents that unless they're admitted for a bl… |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @EileenBarrettNM @JHospMedicine My colleague (Dr. Meghan Train) and I help run our high value care series for our HMD faculty development. We use these articles as the blueprint and bring in local experts to discuss practices. It's really fun and informative! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @Payalia320: @karynbaum @JHospMedicine agreed! I used to hold it all the time too! working on this #TWDFNR with @DavidACohen_MD and @Da… |
| Journal of Hospital Medicine @JHospMedicine RT @DavidACohen_MD: @MelissaPlesacMD @jenreadlynn @tony_breu Yes!!! So important for transitions of care!! #JHMChat https://t.co/NcSwslNyxD |
| Mark Shapiro, MD @ETSshow RT @jenreadlynn: #JHMChat, #KetanjiBrownJacksonHearing , & #MomMilestones by @gracefarris! Great day! https://t.co/JgejyzpgJs |
| Ndidi Unaka MD, MEd @NdidiUnaka RT @DavidACohen_MD: @NdidiUnaka @ETSshow @JHospMedicine Thanks @NdidiUnaka — I’m on our endo consult service right now & it’ll take my 2 ha… |
| @freckledpedidoc @jenreadlynn @EileenBarrettNM @JHospMedicine That’s a wonderful idea @jenreadlynn!! #JHMChat | |
| Journal of Hospital Medicine @JHospMedicine Is there a zoom link? Asking for our friend @michellebr00ks. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Q2: How do you address and/or teach about the use of race in an HPI? How has this #TWDFNR article impacted your practice? #JHMChat https://t.co/MavwL5QakO |
 | Jenny Y Shen, MD, FHM @JennyShenMD @jenreadlynn @DocLennyF @WrayCharles @tony_breu Metformin periop I tend to hold until clinical stability. Post op AKI no joke and common. I usually hold Metformin on admission since people show up with AKI or need contrast study. #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Q2: How do you address and/or teach about the use of race in an HPI? How has this #TWDFNR article impacted your practic… |
| Payal Parikh, MD, FACP @Payalia320 @tony_breu I did see a case of it as an intern @The_BMC! it does exist!! patient had a glucose of 5! AG 30, corrected in 24 hrs, patient walked out!! #JHMChat |
| Ndidi Unaka MD, MEd @NdidiUnaka RT @JHospMedicine: Q2: How do you address and/or teach about the use of race in an HPI? How has this #TWDFNR article impacted your practic… |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn RT @YichiZTulane: @jenreadlynn @JHospMedicine @COREIMpodcast @UR_HMD Speaking of the wonderful @COREIMpodcast and inpatient diabetes mgmt,… |
| David A. Cohen @DavidACohen_MD @TheRealDSrini @JHospMedicine I use it right in between leaches for bloodletting and eye of newt. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @YichiZTulane: @jenreadlynn @JHospMedicine @COREIMpodcast @UR_HMD Speaking of the wonderful @COREIMpodcast and inpatient diabetes mgmt,… |
| @MelissaPlesacMD @tony_breu Have only seen it when patient with new renal failure gets sent out with it restarted as a home med on accident #obsessedwithmedrecs #JHMChat | |
| Leonard Feldman @DocLennyF @DavidACohen_MD @NdidiUnaka @ETSshow @JHospMedicine #JHMChat Obs pts are definitely low hanging fruit. https://t.co/GhHtv5dGCP |
| @jbcowartmd @JHospMedicine @michellebr00ks A2: I stopped doing this a few years ago. Great articles on the subject. Usually irrelevant to clinical history. Still difficult for me to describe in chart when a patient’s minority status has contributed to discrepancies in care, but race in HPI wouldn’t fix this. | |
| Payal Parikh, MD, FACP @Payalia320 @WrayCharles @tony_breu I did see a case of it as an intern @The_BMC ! it does exist!! patient had a glucose of 5! AG 30, corrected in 24 hrs, patient walked out!! #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @DocLennyF @EileenBarrettNM @JHospMedicine You should come more often, Lenny. You eventually get used to it #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @DavidACohen_MD @TheRealDSrini Only took a few minutes to get to bloodletting! #JHMChat |
| Yichi Zhang (张一弛) @YichiZzzzz @JHospMedicine @michellebr00ks A2: I think the focus here should really be educational programs aimed at recognizing and mitigating #implicitbias. Because whether race is included in HPI or not, some clinicians will still choose different treatments based on race if they are not well-informed. #JHMChat |
 | 𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 @PulmCrit @tony_breu its real, maybe seen more often in tox/icu. have definately seen some unequivocal cases. then some other cases may be more debatable (eg sepsis+metformin). |
| Society of Hospital Medicine @SocietyHospMed RT @YichiZTulane: @JHospMedicine @michellebr00ks A2: I think the focus here should really be educational programs aimed at recognizing and… |
| @EileenBarrettNM @DocLennyF @JHospMedicine Y E S Sometime I will write about the battle to get race out of the HPI... I 💜 JHM for this as a #TWDFNR | |
| Charlie M. Wray, DO, MS @WrayCharles RT @JHospMedicine: Q2: How do you address and/or teach about the use of race in an HPI? How has this #TWDFNR article impacted your practic… |
| Journal of Hospital Medicine @JHospMedicine Really well said @YichiZTulane. #JHMChat |
 | Beatriz Rivera Rodriguez @Bea_riverar RT @JHospMedicine: Topic 2️⃣: Routine Inclusion of Race in the HPI 🔗 Article Link: https://t.co/2SbJf9IcV1 👀 #VisualAbstract by @michelle… |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @DavidACohen_MD @JHospMedicine 🤣🤣🤣🤣🤣 |
| David A. Cohen @DavidACohen_MD @JennyShenMD @jenreadlynn @DocLennyF @WrayCharles @tony_breu Yes about holding with AKI & contrast. But IV contrast with normal renal function + metformin is totally OK! And actually good… #JHMChat |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @JHospMedicine @michellebr00ks I can make it happen as long as @UR_HMD and @ValerieLangMD agree to share! #JHMChat |
| @KarynDoc @karynbaum @JHospMedicine @michellebr00ks A2 Used to include it until a couple of years ago. Don't anymore. Goes in social if anywhere at all. Otherwise, into the EHR so we can measure how we are doing with closing disparity gap (hint: not great). Honestly, how many of us have been trained how to ask anyway? #jhmchat |
| @MelissaPlesacMD @karynbaum @EileenBarrettNM @JHospMedicine Haha makes me think how many times I have had to explain to a Minnesotan patient why I have held their Metformin! I miss you Dr. Baum!!!! #JHMChat | |
| Leonard Feldman @DocLennyF @YichiZTulane @JHospMedicine @michellebr00ks #JHMchat Social determinants of health are so often overlooked! |
| @jbcowartmd @YichiZTulane @JHospMedicine @michellebr00ks Also, we should have language to describe when a patient’s experience of healthcare system is negatively impacted by race and other SDOH. Race in HPI does not fix this—I quit using it—but we should be able to talk about systemic racism and bias. | |
| @prabimd A2: not in HPI but in social history, after one has asked and verified appropriately , often people assume the race based on how they look which is wrong #JHMChat | |
| Tony Breu @tony_breu One of the most interesting quotes from the paper. "In a recent study, clinicians documented race in the HPI for 33% of Black patients compared with 16% of White patients, and White clinicians were twice as likely to document race as Black physicians." #JHMChat |
| David A. Cohen @DavidACohen_MD @JHospMedicine @TheRealDSrini https://t.co/cgYKe6WWkq |
| @MelissaPlesacMD RT @YichiZTulane: @JHospMedicine @michellebr00ks A2: I think the focus here should really be educational programs aimed at recognizing and… | |
| @KarynDoc @karynbaum @MelissaPlesacMD @EileenBarrettNM @JHospMedicine Hey I am only a text away! Miss u too. |
| Society of Hospital Medicine @SocietyHospMed RT @tony_breu: One of the most interesting quotes from the paper. "In a recent study, clinicians documented race in the HPI for 33% of Bla… |
| Ammar Saati عمار ساعاتي @AmmarSaati RT @JHospMedicine: Topic 2️⃣: Routine Inclusion of Race in the HPI 🔗 Article Link: https://t.co/2SbJf9IcV1 👀 #VisualAbstract by @michelle… |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @JHospMedicine A2: I have consciously avoided putting race in the HPI. My question is how do we incorporate SES/effects of systemic racism into the Social Hx (likely the best place)? #JHMChat |
| Leonard Feldman @DocLennyF @prabimd #jhmchat. How does it add to the social history? |
| Joe Thomas, MD, FHM @DocWithBowtie @JHospMedicine #JHMChat A2: YES I LOVE THIS ONE. This is actually something I did all through residency and then becoming active on #MedTwitter and seeing people discuss the exact points of this #TWDFNR made me realize how unnecessary it was as a routine one-liner component. |
| David A. Cohen @DavidACohen_MD RT @Payalia320: @karynbaum @JHospMedicine agreed! I used to hold it all the time too! working on this #TWDFNR with @DavidACohen_MD and @Da… |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @JHospMedicine T2: I'm grateful that I haven't encountered a lot of use of race in HPI as a learner or an educator. However, we have only recently started addressing social determinants of health in the medical record and we could do better w/ actions & resources. #JHMChat |
| Lanna Felde @LannaFelde [REDACTED USER] Agree. But I find it challenging to correct trainees. Do you take time out to explain to your team why they shouldn't include it? #jhmchat |
| Ndidi Unaka MD, MEd @NdidiUnaka @JHospMedicine A1: I honestly never document race in my notes. There is more than enough bias in our system...we do not need to create more. I am so glad that the students and trainees I have worked with share this same approach #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @DocWithBowtie: @JHospMedicine #JHMChat A2: YES I LOVE THIS ONE. This is actually something I did all through residency and then becomin… |
| David A. Cohen @DavidACohen_MD RT @Payalia320: @WrayCharles @JHospMedicine Agreed! working on this paper with @DavidACohen_MD and @DanielRicottaMD helped me to really cha… |
| Annie Massart @Annie_Massart_ @JHospMedicine A2.Someone taught me why this is a TWDFNR a few years back. Since then,I realized most of my learners were ahead of the curve and they don't use race in the HPI. When I see it in notes, it's always written by faculty. Takes us older folks longer to change our ways! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @DocWithBowtie: @JHospMedicine #JHMChat A2: YES I LOVE THIS ONE. This is actually something I did all through residency and then becomin… |
| Joe Thomas, MD, FHM @DocWithBowtie @JHospMedicine #JHMChat A2.2 It’s been difficult to find opportunities to discuss and change this practice among others, outside of directly precepting residents, which I don’t do as regularly. Usually bc the days are busy and I feel like it’s seen as trivial among my mostly White colleagues. |
| Jenny Y Shen, MD, FHM @JennyShenMD @jenreadlynn @DocLennyF @WrayCharles @tony_breu I tried to teach purposeful management of PTA. Also to teach another #TWDFNR point of using short acting insulin as sole glycemic control by making learner to 1. Justify metformin holding and 2. inpatient glycemic control plan. |
| @freckledpedidoc @JHospMedicine A2. The #TWDFNR article didn’t impact my practice of documenting race. In my Pediatrics residency, we were taught not to include it. Since then I’ve always questioned it. The article made it easier to teach trainees not to document race. #JHMChat | |
| Tony Breu @tony_breu @TheRealDSrini @JHospMedicine I do a poor job of assessing for these factors myself which limits my ability to incorporate them. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @tony_breu: One of the most interesting quotes from the paper. "In a recent study, clinicians documented race in the HPI for 33% of Bla… |
| @KarynDoc @karynbaum @JHospMedicine @michellebr00ks Interesting note: fewer responses to this question. Are we still uncomfortable with the topic? |
| @freckledpedidoc RT @YichiZTulane: @JHospMedicine @michellebr00ks A2: I think the focus here should really be educational programs aimed at recognizing and… | |
 | Lonika Sood @sood_lonika Lurking from Spokane… #JHMChat |
| Samantha Wang @DrSamanthaWang A2: I think we've failed in medicine in perpetuating the fallacy that race is biologic and inclusion of it into the PMH is somehow significant in its association with chief compliant, disease, or treatment. Instead, focus should be on structural factors affecting health #JHMChat |
| Joe Thomas, MD, FHM @DocWithBowtie @JHospMedicine #JHMChat A2.3: This is inspiring to include this in one of our upcoming team-wide e-mails, though. |
| Society of Hospital Medicine @SocietyHospMed ⏲️ This #JHMChat is 🔥! ✅ Connect with your hospitalist community ✅ Share advice ✅ Learn tips Use #JHMChat on all replies to be part of the conversation! |
| Society of Hospital Medicine @SocietyHospMed RT @DrSamanthaWang: A2: I think we've failed in medicine in perpetuating the fallacy that race is biologic and inclusion of it into the PMH… |
| Payal Parikh, MD, FACP @Payalia320 @JHospMedicine @michellebr00ks A2: I agree with the authors. Including in the social Hx. #SDOH are 📈important. Also would add, better to ask and not assume! do need a standard way to capture in EMR #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @SocietyHospMed: ⏲️ This #JHMChat is 🔥! ✅ Connect with your hospitalist community ✅ Share advice ✅ Learn tips Use #JHMChat on all rep… |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @MelissaPlesacMD @tony_breu I have to say that I love and appreciate your obsession with med recs! #JHMChat https://t.co/j1LowI5ZHB |
| Lonika Sood @sood_lonika @JHospMedicine T2: learnt in residency to use it… but #MedTwitter has helped to change my approach… I don’t use it anymore #jhmchat |
| Tony Breu @tony_breu @Annie_Massart_ @JHospMedicine Yes, I have noticed this as well. #JHMChat |
 | Christle Nwora, MD @ChristleNwora RT @JHospMedicine: Q2: How do you address and/or teach about the use of race in an HPI? How has this #TWDFNR article impacted your practic… |
 | ex-caregiver ✝️💞🙏 @stevecripe57 @JennyShenMD @JHospMedicine @jenreadlynn @DocLennyF @WrayCharles @tony_breu Our local hospital still does creatine clearance blood work prior to a CT with contrast, they hold Metformin prior to surgery, and they still put patients NPO at midnight even if their surgery isn't until 3-4 pm the next day. Yeah, I don't know why either. |
| Journal of Hospital Medicine @JHospMedicine Another hard co-sign. #JHMChat |
| @freckledpedidoc @prabimd Curious Prabi, why you add it to social history? #JHMChat | |
| Journal of Hospital Medicine @JHospMedicine RT @freckledpedidoc: @JHospMedicine A2. The #TWDFNR article didn’t impact my practice of documenting race. In my Pediatrics residency, we w… |
| Charlie M. Wray, DO, MS @WrayCharles Nailed it! #JHMChat 👇👇👇 |
| Ndidi Unaka MD, MEd @NdidiUnaka The data speaks for itself #JHMCha |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @NdidiUnaka @JHospMedicine Totally agree. Now trying to work on bias associated with mental health disorders and substance use and how that gets discussed in the medical record! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @Annie_Massart_ #JHMChat https://t.co/nujxB3t146 |
 | Vinny Arora MD MAPP @FutureDocs @JHospMedicine @michellebr00ks This is one where I WAS taught to include race as a student so had to honestly learn not to as a practicing physician. Grateful for the grace and time to make this change and a key example of why faculty need to be taught too. #jhmchat |
| Lanna Felde @LannaFelde @sood_lonika Welcome lurker! #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @NdidiUnaka: @JHospMedicine A1: I honestly never document race in my notes. There is more than enough bias in our system...we do not nee… |
| Joe Thomas, MD, FHM @DocWithBowtie RT @DrSamanthaWang: A2: I think we've failed in medicine in perpetuating the fallacy that race is biologic and inclusion of it into the PMH… |
| Leonard Feldman @DocLennyF #JHMChat Should OUD, AUD, or tobacco use be in the social history? Aren’t they medical problems, not social problems? |
| Satyendra Dhar, MD SFHM @DharSaty @JHospMedicine I guess I have to change my practice! I believed the HPI should include every detail with well known diseases common in certain races. Thank you for article #NEJM . #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @sood_lonika #JHMChat https://t.co/wjmca0dAz9 |
| @KarynDoc @karynbaum @Payalia320 @JHospMedicine @michellebr00ks We train registration folks how to ask this often sensitive question. If we are going to document, shouldn't we get the same training? #JHMChat |
| Ndidi Unaka MD, MEd @NdidiUnaka @jenreadlynn @JHospMedicine I could not agree more! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine What do y'all think? #JHMChat |
| Lonika Sood @sood_lonika @jenreadlynn @EileenBarrettNM @JHospMedicine Imma gonna chat with you about that #jhmchat |
 | Inas Abuali, MD @inas_md RT @DrSamanthaWang: A2: I think we've failed in medicine in perpetuating the fallacy that race is biologic and inclusion of it into the PMH… |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: @JHospMedicine @michellebr00ks This is one where I WAS taught to include race as a student so had to honestly learn not to… |
 | Andrew Zimolzak @AndrewZimolzak RT @tony_breu: One of the most interesting quotes from the paper. "In a recent study, clinicians documented race in the HPI for 33% of Bla… |
| Journal of Hospital Medicine @JHospMedicine RT @jenreadlynn: @NdidiUnaka @JHospMedicine Totally agree. Now trying to work on bias associated with mental health disorders and substance… |
| Lanna Felde @LannaFelde @NdidiUnaka @jenreadlynn @JHospMedicine great points! #jhmchat |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @TheRealDSrini @JHospMedicine I find it hard to do an assessment of these areas w/o having resources or solutions. Talking about these things can be traumatizing so I let them initiate. Probably not the best approach &am definitely missing things but want to help where I can & not cause harm. #JHMChat |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @DocLennyF Interesting thought! Especially if patients are on medical treatment for it! #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @JHospMedicine @michellebr00ks And yes I’m that old 😂 #jhmchat |
| Yichi Zhang (张一弛) @YichiZzzzz @tony_breu I wonder what if this trend still holds true at our hospital, which serves a minority-majority community (60% African Americans), and the clinical faculty also tends to be more diverse. #JHMChat |
 | Michelle Ploch, MD @MichellePloch RT @tony_breu: I do want to go on the record as saying that I believe metformin associated lactic acidosis exists. #JHMChat |
 | Ravi Singh @rav7ks @tony_breu Interesting ! I’ve long stopped documenting race and don’t set up expectations to document it amongst others |
 | Doctor Fingerguns @docfingerguns 98% of the time the inclusion of race in the HPI has no clinical relevance. Stop including it unless it is directly pertinent to the disease State going on (which it ALMOST never is) |
| Maha Sulieman @MahaArhait @JHospMedicine A2. During the covid crisis, race in the chart was like a hint of how complicated this encounter will be (implicit bias trap) #JHMChat |
| @prabimd @DocLennyF Not saying it’s the best place but among all available probably the where it fits the most . Social history focuses on social characteristics and structure of which race, ethnicity, religion, language is a part of | |
| Journal of Hospital Medicine @JHospMedicine ⚡ As always...this #JHMChat is going by so quickly! #TWDFNR Topic 3️⃣ is up next.. |
| @KarynDoc @karynbaum @DocLennyF They end up on many problem lists now. But a more standard approach would be helpful. #JHMChat |
| Trushar M. Dungarani @DrT_Dungarani #JHMChat race and gender attempt to paint a human picture of our patients but lacks the consistency that is needed to avoid micro aggressions. We do need a solution to humanize the people we take care of. |
| Payal Parikh, MD, FACP @Payalia320 @karynbaum @JHospMedicine @michellebr00ks yes agreed! need to all be comfortable and use the same approach! so often it is "someone else's job" and tied to chart completion; but really should be everyone's job and tied to health care improvement! #JHMCHAT |
| Vinny Arora MD MAPP @FutureDocs @DocLennyF I actually think no TED is the worst social history. I want to know what does this person live with? What do they do/did? How do they support themselves or how do they need support? What are they motivated or inspired by? #jhmchat |
| Lanna Felde @LannaFelde @DocLennyF #jhmchat https://t.co/zM3mADdn4h |
| Leonard Feldman @DocLennyF @Arhait @JHospMedicine #jhmchat definitely have used race as a proxy for socioeconomic status. Just as problematic as proxy for genetics. Can’t assume anyone’s experience. |
| @MelissaPlesacMD @DocLennyF My biggest worry about this is that these Dx often incorrect, or based on false information/assumptions/bias, and then in the world of copy forward they exist forever. Try only to include if relevant to admission and I confirmed myself #JHMChat | |
| Charlie M. Wray, DO, MS @WrayCharles @Annie_Massart_ @JHospMedicine Totally agree, Annie. Rarely see trainees doing this anymore, usually a vestige of older attendings #JHMCHat |
| Journal of Hospital Medicine @JHospMedicine RT @DocLennyF: @Arhait @JHospMedicine #jhmchat definitely have used race as a proxy for socioeconomic status. Just as problematic as proxy… |
| Journal of Hospital Medicine @JHospMedicine Topic 3️⃣: Fluid Restriction for the Management of Acute Decompensated Heart Failure in Patients with Reduced EF 🔗 Article Link: https://t.co/XMGR3qnqMl 👀 #VisualAbstract by @michellebr00ks #JHMChat https://t.co/KYs8jx37Ne |
| Journal of Hospital Medicine @JHospMedicine RT @MelissaPlesacMD: @DocLennyF My biggest worry about this is that these Dx often incorrect, or based on false information/assumptions/bia… |
| @jbcowartmd @JHospMedicine Also, let’s be honest, in EHR the social hx is useless. All the good clinical info is in HPI. #jhmchat https://t.co/nX4ot8VInc | |
| @prabimd @freckledpedidoc Social history reflects a persons social circumstance which is defined by a lot of factors of which race is 1 #JHMchat | |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: @DocLennyF I actually think no TED is the worst social history. I want to know what does this person live with? What do the… |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Topic 3️⃣: Fluid Restriction for the Management of Acute Decompensated Heart Failure in Patients with Reduced EF 🔗 Arti… |
| Yichi Zhang (张一弛) @YichiZzzzz @tony_breu Hmm... I do recall that several times on surgery rotation, this was left for the #PCP to do after discharge... 😅#JHMChat |
| Journal of Hospital Medicine @JHospMedicine Q3: What's your approach to fluid restriction in patients with heart failure? How has this #TWDFNR article impacted your practice? #JHMChat https://t.co/zyiqzJtUkI |
| Ndidi Unaka MD, MEd @NdidiUnaka @jenreadlynn @TheRealDSrini @JHospMedicine Yep, I totally get this. Asking questions about social risk and not having processes and resources to address patient and family needs negatively impacts our quest to build trust and strong therapeutic alliances #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Q3: What's your approach to fluid restriction in patients with heart failure? How has this #TWDFNR article impacted you… |
| Lonika Sood @sood_lonika @JHospMedicine I almost always stop it…#jhmchat |
| @freckledpedidoc @LannaFelde @NdidiUnaka @jenreadlynn @JHospMedicine They should be entered into the PMH or Problem List like any other diagnosis. Some #SDoH can be entered into the Problem List too I enter food insecurity into my problem list WAY too often #JHMChat | |
| @prabimd #jhmchat | |
| @MelissaPlesacMD RT @FutureDocs: @DocLennyF I actually think no TED is the worst social history. I want to know what does this person live with? What do the… | |
 | Samantha 🆖 @neph_ning @tony_breu @WrayCharles I reckon I have too. Same as above Cr 700(micromols/L) lactate 12 |
| Payal Parikh, MD, FACP @Payalia320 @jenreadlynn @EileenBarrettNM @JHospMedicine that is a great idea! #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @freckledpedidoc: @LannaFelde @NdidiUnaka @jenreadlynn @JHospMedicine They should be entered into the PMH or Problem List like any other… |
| Journal of Hospital Medicine @JHospMedicine I think that @PaulNWilliamz was talking about this earlier...screening without a solution. |
| Vinny Arora MD MAPP @FutureDocs @DocLennyF *who* clearly on a roll here w my rage tweets |
| Joe Thomas, MD, FHM @DocWithBowtie @WrayCharles @Annie_Massart_ @JHospMedicine Some of my NPs and PAs are also still doing it fresh out of school, need to extend this discussion to their schools/training as well, and find the opportunity to discuss at work, too (I work with a lot). #JHMChat |
| Journal of Hospital Medicine @JHospMedicine I think that @PaulNWilliamz was talking about this earlier on Twitter...screening without a solution. #JHMChat |
| Ravi Singh @rav7ks @jenreadlynn @NdidiUnaka @JHospMedicine Absolutely a great point. One of my interests is the removal of labels than can be disparaging and can introduce bias subconsciously during our interactions. Respect is required in both our interactions as well as the medical record. #jhmchat |
| Lonika Sood @sood_lonika @JHospMedicine T3: the older I get the less restrictive I am…except maybe for refractory hyponatremia or chf #jhmchat |
| Annie Massart @Annie_Massart_ @JHospMedicine A3. I'm so glad to change this practice. I've always felt bad restricting fluids, especially in patients with heart failure who so often have dry mouth. Glad to have data tell me it's not necessary! #JHMChat |
| @jbcowartmd @JHospMedicine @michellebr00ks Ooh a juicy one! Definitely struggling to implement this—people look at me like I have horns. Don’t even mention 3% saline infusion. #jhmchat #twdfnr https://t.co/BfVz8o7nnN | |
| Trushar M. Dungarani @DrT_Dungarani RT @JHospMedicine: Topic 3️⃣: Fluid Restriction for the Management of Acute Decompensated Heart Failure in Patients with Reduced EF 🔗 Arti… |
| Leonard Feldman @DocLennyF #JHMChat have you ever restricted to < 1L routinely? |
| @jbcowartmd @JHospMedicine A3: shamefully I have to admit I have not been successful in adopting fluids to thirst. #jhmchat #twdfnr https://t.co/bP4QkVUou4 | |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @JHospMedicine A3: Hate it. Will only do it if really having a hard time diuresing/bad hyponatremia or if cardiology is following and insists on it. I also try not to put people on low Na or diabetic diets unless they want to be. I would be so thirsty. #JHMChat https://t.co/gCr0vO6seG |
| @KarynDoc @karynbaum @JHospMedicine A3 less restrictions than I used to use. Hint: the nurses always knew this was crap. And they have to be the enforcers, which is awful for them. #JHMChat |
| Tony Breu @tony_breu Talk about inertia. The one is harder to reverse than holding metformin #JHMChat |
| Lanna Felde @LannaFelde A3. Much like holding metformin, it's the inertia! It's so reflective and I feel like if I don't fluid restrict I will have to explain to every other person in the hospital. #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @NdidiUnaka @jenreadlynn @TheRealDSrini @JHospMedicine This is good learning for me. I often probe on these issues as it helps me understand my patients and their situations better. I'm often advocating for them with SW/CM, DC planners, etc - that having such data points allows me to be an advocate and "tell their story" #JHMChat |
| Journal of Hospital Medicine @JHospMedicine That just seems mean. #JHMChat https://t.co/90cbU9e2fy |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @JHospMedicine A3: On the adult side, just general 2-3L fluid goal+diuretics as appropriate for net loss. In peds, esp. w/congenital heart disease, w/o GDMT, & w/need for growth (i.e. formula/breastmilk), diuretics w/o fluid goal. But again, cards drives the ship in peds. #JHMChat |
| Payal Parikh, MD, FACP @Payalia320 RT @SocietyHospMed: ⏲️ This #JHMChat is 🔥! ✅ Connect with your hospitalist community ✅ Share advice ✅ Learn tips Use #JHMChat on all rep… |
| Charlie M. Wray, DO, MS @WrayCharles @DocLennyF Ugh, that's just torture, Lenny! #JHMChat |
| Annie Massart @Annie_Massart_ @JHospMedicine Also, I drink so much Coke Zero. Telling someone to back off on fluids is really hypocritical. #JHMChat https://t.co/YIiTni7aXP |
| Leonard Feldman @DocLennyF #JHMChat how much does the avg HFrEF pt drink in the hospital/day? |
 | Kimberly D. Manning, MD, MACP @gradydoctor @TheRealDSrini @jenreadlynn Just seeeeeeeing this!!!😭😭😭 |
| Lonika Sood @sood_lonika #jhmchat tonight is… On fire 🔥 Peds Hospitalists are teaching the Medicine Hospitalists A-LOT 🤯 |
| Journal of Hospital Medicine @JHospMedicine RT @karynbaum: @JHospMedicine A3 less restrictions than I used to use. Hint: the nurses always knew this was crap. And they have to be the… |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @WrayCharles @NdidiUnaka @jenreadlynn @JHospMedicine Agreed. And it also allows us to figure out what is needed, and if not there, advocate for such services #JHMChat. |
| Satyendra Dhar, MD SFHM @DharSaty @JHospMedicine I usually go for 1200-1500 ml fluid restriction, funny that, I have been ignoring previous articles which say 30 ml/kg bw is reasonable. #JHMchat https://t.co/VnfgpF7Xxi |
| Kimberly D. Manning, MD, MACP @gradydoctor 😭😭😭 |
| Tony Breu @tony_breu And I feel that a culture change is required for this TWDFNR. Patients will lose trust if they hear the mixed messages ("my last team said I could drink when thirsty...") #JHMChat |
| @prabimd A3: Phone call to a friendly peds cardiologist #JHMChat https://t.co/ngeGP48anX | |
| Journal of Hospital Medicine @JHospMedicine What's the most you've seen someone drink in a day? Maybe that person should be restricted and everyone else we can just trust to drink to thirst. #JHMChat |
| Ndidi Unaka MD, MEd @NdidiUnaka RT @WrayCharles: @NdidiUnaka @jenreadlynn @TheRealDSrini @JHospMedicine This is good learning for me. I often probe on these issues as it h… |
| Journal of Hospital Medicine @JHospMedicine RT @Annie_Massart_: @JHospMedicine Also, I drink so much Coke Zero. Telling someone to back off on fluids is really hypocritical. #JHMChat… |
| Lonika Sood @sood_lonika @jbcowartmd @JHospMedicine https://t.co/CURm96hxOh |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @DocLennyF No. Have done it rarely but not routinely. It sounds awful. #JHMChat https://t.co/kmwqjtQbz2 |
| @freckledpedidoc [REDACTED USER] @DocLennyF Interesting… I personally do not diagnose a lot of Alcohol, Tobacco or Drug Use Disorders as a Pediatric Hospitalist so I think that’s why I place it in the social history. Perhaps documenting Use in Social History is a #TWDFNR in PHM? 🤔 #JHMChat | |
| Society of Hospital Medicine @SocietyHospMed RT @tony_breu: And I feel that a culture change is required for this TWDFNR. Patients will lose trust if they hear the mixed messages ("my… |
| Lanna Felde @LannaFelde @tony_breu Argh that's such a great point and so disheartening! #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @tony_breu: And I feel that a culture change is required for this TWDFNR. Patients will lose trust if they hear the mixed messages ("my… |
| Charlie M. Wray, DO, MS @WrayCharles @LannaFelde Totally understand this rationale, Lanna. Often when I do something like this, I'll actually print out the #TWDFNR article, bring it on rounds, hand it out then make a big deal about it so that no one asks again. Seems to work - and drill it into learners #JHMChat |
| @EileenBarrettNM @DocLennyF Ooof never. In addition to starting a bowel regimen and stopping nighttime vitals, liberalizing the diet is the best part of being a hospitalist some days :) | |
| Trushar M. Dungarani @DrT_Dungarani Depends how many techs are on the floor #jhmchat |
| Yichi Zhang (张一弛) @YichiZzzzz @JHospMedicine A3: This is why I'm super appreciative of the nursing staff who perform diligent #dailyweights. It would give me more confidence to have patients take sips if weights and lytes were both reassuring! #JHMChat Then, the patients also have more energy to tell me stories! #Winwin |
| Charlie M. Wray, DO, MS @WrayCharles @tony_breu I recall you presenting this topic topic at #SHMConverge 3-4 years ago, Tony #JHMChat |
| Samantha Wang @DrSamanthaWang @JHospMedicine A3: I trained and practice at an institution where fluid restriction is not part of #EminenceBasedMedicine. So we let most of our ADHF patients #QuenchThatThirst #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @WrayCharles @tony_breu I barely made it but I’m trying to secretly be quiet while A is supposedly going to bed although he is talking to me so it’s one of those nights 😭 |
 | Dr. Taison Bell @TaisonBell @tony_breu Definitely real |
| Journal of Hospital Medicine @JHospMedicine @WrayCharles @LannaFelde *actual footage of @WrayCharles on rounds. #JHMChat https://t.co/1AJ87EeRPi |
| Joe Thomas, MD, FHM @DocWithBowtie @JHospMedicine #JHMChat A3: I have definitely loosened restrictions, strengthened by a COREIM (or Curbsiders?) heart failure ep which discussed how terrible anything less than 2L water and 2g sodium was. This is an interesting read! Makes sense to consider in hyponatremia. |
| Vinny Arora MD MAPP @FutureDocs @JHospMedicine @WrayCharles @LannaFelde No one rounds with me anymore. Charlie what’s your secret??? #jhmchat |
| Tony Breu @tony_breu @WrayCharles I sure did. I do think that avoiding sodium restriction is just as important. #jhmchat |
| Journal of Hospital Medicine @JHospMedicine Perhaps another nomination for tweet of the night? #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles [REDACTED USER] @JHospMedicine You all are too smart for us internists with all your equations and conversions #JHMChat |
| Payal Parikh, MD, FACP @Payalia320 @JHospMedicine A3: I have begun to do this recently, probably bc I am now one of the "older attendings" 😂 - fluids to thirst is my motto to train residents, and patients. (assuming not decompensated CHF where I would be chasing my tail when INs>>>Outs !) #jhmchat https://t.co/wgjPEZoFOY |
| Joe Thomas, MD, FHM @DocWithBowtie @JHospMedicine #JHMChat A3.B: It’s also interesting to see how people will judge patients for drinking a lot while hospitalized with heart failure when we ought to be considering how thirsty they are and maybe that our diuresis efforts aren’t enough. |
| @MelissaPlesacMD @WrayCharles @LannaFelde Sooo @WrayCharles when can we do a distance virtual peer observation …. #JHMChat | |
| Ndidi Unaka MD, MEd @NdidiUnaka [REDACTED USER] @JHospMedicine LOL!!! Yes! #JHMChat |
| Maha Sulieman @MahaArhait @tony_breu I bet the like the one who let them drink though 😅 |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn This gets back to questions about social history in T2 of #JHMChat. We have to find out what patients and families can do at home and not assume! Treatments that only work in the hospital are a recipe for readmission! |
| Journal of Hospital Medicine @JHospMedicine But what happens if you *don't* order a low sodium diet? Does the hospital revoke your hospitalist card? #JHMChat |
| Lonika Sood @sood_lonika @JHospMedicine #metricsystemwins #jhmchat |
| Society of Hospital Medicine @SocietyHospMed @gradydoctor We've missed you! Hope you can catch up on the great pearls of wisdom! #JHMChat |
| Yichi Zhang (张一弛) @YichiZzzzz @tony_breu A super cool trick I learned on IM rotation! When we are the primary team, we sometimes leave sticky notes for our dear consultants by the bedside! Sometimes more effective than merely noting it in the progress note in EHR. #JHMChat And always with a smiley face ofc :) |
| @freckledpedidoc @WrayCharles @LannaFelde I did that with the NPO after Midnight before Sedation #TWDFNR article. My trainees loved it and it wasn’t even Pediatric!! #JHMChat https://t.co/SorYdhNu1n | |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @WrayCharles [REDACTED USER] @JHospMedicine So grateful to not use a calculator most days! #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @FutureDocs @JHospMedicine @LannaFelde Ha! This GIF implies that that lead duck knows where it's going. I just start walking the halls until someone tells me to stop. I've become that attending. #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @YichiZTulane: @tony_breu A super cool trick I learned on IM rotation! When we are the primary team, we sometimes leave sticky notes for… |
| Tony Breu @tony_breu The authors (including @DrSamanthaWang) make the point that thirst may be related to elevated ATII. This is not what we want in our heart failure patients. #jhmchat |
| Payal Parikh, MD, FACP @Payalia320 @tony_breu this 👆 mixed messaging is so detrimental to our profession!! how can we change this culture faster? almost like we need #TWDFNR PSAs (Physician/clinician service announcements)! #jhmchat |
| @KarynDoc @karynbaum @JHospMedicine You mean fluids, right? Asking for a friend. |
| Ravi Singh @rav7ks @JHospMedicine It looks good on core measures and discharge paperwork but pretty much accomplishes nothing. Na restriction is also not accomplishing much but possibly preventing adequate caloric intake leading to nutritional deficiencies. #jhmchat |
| Journal of Hospital Medicine @JHospMedicine Did you see the pediatric QI study? #JHMChat #VisualAbstract by @LannaFelde https://t.co/aqfuZnqQ02 |
| Lanna Felde @LannaFelde @Payalia320 @tony_breu this #JHMChat is the PSA 😂 |
| Dhruv Srinivasachar MD (he/el/ele) @TheRealDSrini @jenreadlynn @WrayCharles [REDACTED USER] @JHospMedicine #JHMChat https://t.co/te3g0vDlt0 |
| Society of Hospital Medicine @SocietyHospMed Thank you 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 👂 from you on what you want to see from #JHMChat! 👀 https://t.co/k9nukaNq1d |
| Journal of Hospital Medicine @JHospMedicine 📘 Just enough time for any closing thoughts! Also - if you have any recent JHM articles or topics you want to see discussed for a future #JHMChat, drop them below! |
| Leonard Feldman @DocLennyF @Payalia320 @tony_breu #jhmchat we have started ‘financial Fridays’ to review a TWDFNR with all our resident teams weekly. |
| Journal of Hospital Medicine @JHospMedicine BRB downloading all of these RIGHT NOW! #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles @jenreadlynn Completely agree, Jen. They are a captive audience, then we send back out into the wild to do what they want. Never understood our rationale when it came to these barbaric (yeah, I said it) treatments. PS. I also don't believe in a cardiac diet for this reason #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles RT @JHospMedicine: BRB downloading all of these RIGHT NOW! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine #JHMChat #TWDFNR PSA!! https://t.co/V94furyzNT |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @WrayCharles @LannaFelde I've also worked with our IT folks to allow @JHospMedicine links in our notes so I can link a #TWDFNR article in my note and allow others to read if they have questions too. #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles For those of you in the back who missed this... Great resource put together by former @JHospMedicine Editorial Fellow and now Associate Editor [REDACTED USER] |
| Ndidi Unaka MD, MEd @NdidiUnaka @JHospMedicine @LannaFelde Such a great QI project! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Everyone else is in 2022, and @jenreadlynn is in 3022. #JHMChat |
| Ndidi Unaka MD, MEd @NdidiUnaka RT @SocietyHospMed: Thank you for being a part of this #JHMChat. 🙏 As we wind down, please take some time to fill out our brief feedback f… |
| Leonard Feldman @DocLennyF @jenreadlynn @WrayCharles @LannaFelde @JHospMedicine #jhmchat that’s amazing!!! |
| Samantha Wang @DrSamanthaWang @tony_breu As @juliablumcaton knows, this could drive worsening renal function. But the data is still so sparse on a practice that is so ubiquitous! #JHMChat |
| @freckledpedidoc @jenreadlynn As a patient, I’ve been there. My doctors have asked me to do things to care for myself that they’ve said they wouldn’t be able to do themselves… #JHMChat. https://t.co/pLlYnI3owR | |
| Annie Massart @Annie_Massart_ @jenreadlynn @WrayCharles @LannaFelde @JHospMedicine We couldn't get our IT folks to add a fishbone for labs to notes. Very impressed by your success! #JHMChat |
| Joe Thomas, MD, FHM @DocWithBowtie @JHospMedicine #JHMChat A3C: I also find that some of my patients know these “tricks” but have seen them as punishments because previous docs haven’t partnered with them as well, so when I admit I get the “and don’t put me on that low sodium crap, I hate that.” Mismanaged expectations. |
| @freckledpedidoc @sood_lonika @JHospMedicine We ❤️ the Metric System in Peds #JHMChat | |
| @jbcowartmd @DocWithBowtie @JHospMedicine I agree! I was just thinking we blame a lot of acute CHF on “diet” and “fluids” but honestly, I wonder how much we really know about why some patients decompensate and others don’t. | |
| Payal Parikh, MD, FACP @Payalia320 @LannaFelde @tony_breu true! #jhmchat |
| Andrew Zimolzak @AndrewZimolzak RT @JHospMedicine: BRB downloading all of these RIGHT NOW! #JHMChat |
| @MargotZarinPass @JHospMedicine @PaulNWilliamz I think “screening without a solution” is a bit reductive. By asking respectful questions about someone’s lived experience you are performing an intervention - validating them, building trust. | |
| Payal Parikh, MD, FACP @Payalia320 RT @JHospMedicine: Topic 1️⃣: Holding Metformin in Hospitalized Patients 🔗 Article Link: https://t.co/j86y6Vuclu 👀 Awesome #VisualAbstrac… |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Everyone else is in 2022, and @jenreadlynn is in 3022. #JHMChat |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn [REDACTED USER] @freckledpedidoc @WrayCharles @LannaFelde Did not know this! This will be so helpful! #JHMChat https://t.co/XUdvTHTeYV |
| @jbcowartmd @DocWithBowtie @JHospMedicine If we restrict the diet to unsustainable levels inpatient, we cannot titrate therapy to what the patient’s normal intake is like outpatient. I incorporate education and some restrictions but try to partner on what patients can sustain after dc. #jhmchat | |
| Vinny Arora MD MAPP @FutureDocs @WrayCharles @JHospMedicine @LannaFelde Congratulations you’re ready to get promoted now! #jhmchat |
| Journal of Hospital Medicine @JHospMedicine That's a wrap! We had so much fun with y'all tonight. Can't wait to see you in Nashville! 🤠 Be on the lookout for our #JHMChat recap on The Hospital leader Blog. https://t.co/vEL1hAsLE3 https://t.co/2q56VD8O7P |
| Joe Thomas, MD, FHM @DocWithBowtie [REDACTED USER] @DharSaty @JHospMedicine Yes! Gotta manage expectations and partner with the patient. |
| Leonard Feldman @DocLennyF #JHMChat. Many more TWDFNR in the pipeline. Keep submitting your great ideas and watch Tony B and John S present TWDFNR at Converge. |
| Tony Breu @tony_breu @JHospMedicine Thanks for the great #JHMChat. Hopefully, I'll see everyone in Nashville. |
| Journal of Hospital Medicine @JHospMedicine RT @DocLennyF: #JHMChat. Many more TWDFNR in the pipeline. Keep submitting your great ideas and watch Tony B and John S present TWDFNR at C… |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: That's a wrap! We had so much fun with y'all tonight. Can't wait to see you in Nashville! 🤠 Be on the lookout for o… |
| Society of Hospital Medicine @SocietyHospMed That’s a wrap on March’s #JHMChat with @tony_breu and @DocLennyF. Our hat tips to them for this engaging and lively discussion. 🙌 🎉 Shout out to @michellebr00ks for facilitating as @JHospMedicine. See you all next month! |
| Yichi Zhang (张一弛) @YichiZzzzz @JHospMedicine Would love to see grand rounds based on these decks being given to us MS3 students starting IM rotations! This way we can start doing it the right way from the get-go! #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @DocLennyF: #JHMChat. Many more TWDFNR in the pipeline. Keep submitting your great ideas and watch Tony B and John S present TWDFNR at C… |
| @MargotZarinPass @YichiZTulane @tony_breu I love this! | |
| Journal of Hospital Medicine @JHospMedicine RT @tony_breu: @JHospMedicine Thanks for the great #JHMChat. Hopefully, I'll see everyone in Nashville. |
| Journal of Hospital Medicine @JHospMedicine RT @SocietyHospMed: That’s a wrap on March’s #JHMChat with @tony_breu and @DocLennyF. Our hat tips to them for this engaging and lively dis… |
| @MelissaPlesacMD Well @jenreadlynn this is the coolest and I would like this function immediately! Such an awesome opportunity for learning and teaching! Imagining all the #MedEd possibilities! You all are so cool and smart 👏🏻👏🏻👏🏻 #JHMChat | |
| Payal Parikh, MD, FACP @Payalia320 @JHospMedicine Thank you for a great #Jhmchat! #practice changing! See you all there! |
| Charlie M. Wray, DO, MS @WrayCharles @FutureDocs @JHospMedicine @LannaFelde Is that all it takes? The brass just check in periodically to see how you round? Once you get to "wandering the hall status" you can become Associate? What does it take become Full Professor? #JHMChat |
| Jen Readlynn, MD, FHM (she/her) @jenreadlynn @Annie_Massart_ @WrayCharles @LannaFelde @JHospMedicine Hyperlink tool was available but putting in an external link always ended up blocked. I've started to learn through QI work that if I just ask, we can usually find a way to make it happen. #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles RT @DocLennyF: #JHMChat. Many more TWDFNR in the pipeline. Keep submitting your great ideas and watch Tony B and John S present TWDFNR at C… |
| Journal of Hospital Medicine @JHospMedicine RT @jenreadlynn: This gets back to questions about social history in T2 of #JHMChat. We have to find out what patients and families can do… |
 | Ali Carroll, MD, MPH @alisonrcarroll @JHospMedicine @LannaFelde Thanks for the shoutout! Check out our #QI paper on reducing unnecessary fasting for hospitalized children recently published in @JHospMedicine |
| @EileenBarrettNM @JHospMedicine Great work and thank you for this #JHMChat! | |
 | Logan Lawson, DO, MPH @LoganDLawson RT @DrSamanthaWang: A2: I think we've failed in medicine in perpetuating the fallacy that race is biologic and inclusion of it into the PMH… |
| Charlie M. Wray, DO, MS @WrayCharles @YichiZTulane @JHospMedicine Can't wait for you to become a hospitalist, Yichi #JHMChat |
| Joe Thomas, MD, FHM @DocWithBowtie @jbcowartmd @JHospMedicine Couldn’t agree more. If they can’t/won’t (for whatever reason) do it when they go back to their own life, it’s not an effective discharge med regimen. #JHMChat |
| @freckledpedidoc [REDACTED USER] @DocLennyF I often find these are the best times for me to ask my #medpeds or Adolescent Medicine colleagues for advice. I’m very fortunate to work with a great group. #JHMChat | |
| @ @JHospMedicine During intern year, would include it in presentations on rounds, but not consistently across races(🤨) and then my attending @SybilPentsil asked me why I said it at all and I didn’t have a good reason. Haven’t included it since. | |
| @jbcowartmd @SocietyHospMed @tony_breu @DocLennyF @michellebr00ks @JHospMedicine Thanks everyone! https://t.co/6Y6L7H5klx | |
| Yichi Zhang (张一弛) @YichiZzzzz @SocietyHospMed @tony_breu @DocLennyF @michellebr00ks @JHospMedicine Thank you @michellebr00ks @tony_breu @DocLennyF and everyone who chimed in! Can't wait for the #TWDFNR discussion at #SHMConverge Another inspirational #JHMChat for the books~ |
| Charlie M. Wray, DO, MS @WrayCharles @JHospMedicine Can't end a #JHMChat without a salute to @michellebr00ks for putting this all together and making things happen https://t.co/B6xPMDN2jN |
| @jbcowartmd @JHospMedicine https://t.co/y6EJ34xP03 | |
| Lanna Felde @LannaFelde Strong work by our host @michellebr00ks #JHMChat https://t.co/5i7aQAmrl9 |
| Michelle Brooks, MD, SFHM @michellebr00ks Y’all are the best. #JHMchat always flies by, and now I have to wait for the next one!! 😔 |
| @freckledpedidoc @WrayCharles @FutureDocs @JHospMedicine @LannaFelde Seriously⁉️ I was wondering the halls 2️⃣ years into being an Assistant‼️ 🤔 Maybe I have a poor sense of direction… #JHMChat | |
| Vinny Arora MD MAPP @FutureDocs @WrayCharles @JHospMedicine @LannaFelde Well yes probably takes a little more than that but you’re definitely rounding like a senior faculty! |
| Joe Thomas, MD, FHM @DocWithBowtie @SocietyHospMed @JHospMedicine @tony_breu @DocLennyF @michellebr00ks Terrific discussion, thank you all. See you in Nashville! |
| Michelle Brooks, MD, SFHM @michellebr00ks Are we making our own gif of this at #SHMConverge @LannaFelde? #JHMChat |
| Michelle Brooks, MD, SFHM @michellebr00ks #JHMChat! |
| Yichi Zhang (张一弛) @YichiZzzzz @WrayCharles @JHospMedicine Headed there one small step at a time!😃 Next stop, an "acting" intern coming to a hospital near you very very soon! https://t.co/rvUWBgpIiq |
| @freckledpedidoc @JHospMedicine Thanks #JHMChat Crew & @michellebr00ks for an Awesome #TwitterChat See you in Nashville, IRL‼️ | |
| @ @jenreadlynn Yayyyy!!! Hope you love it!!! 💋💋💋💋💋 | |
| @prabimd @michellebr00ks Appreciation from #phm peds hospitalist @SocietyHospMed https://t.co/mLGlHKfETh | |
 | CORE IM @COREIMpodcast RT @jenreadlynn: @JHospMedicine This article combined with @COREIMpodcast on oral meds in the hospital have definitely given me the confide… |
| @Margaret1473 RT @DrSamanthaWang: A2: I think we've failed in medicine in perpetuating the fallacy that race is biologic and inclusion of it into the PMH… | |
| @ Missed attending the #JHMChat Thank the Twitter Gods for hashtags and the ability to have asynchronous conversations. Following up now .. | |
| Satyendra Dhar, MD SFHM @DharSaty @SocietyHospMed @TheRealDSrini @JHospMedicine @freckledpedidoc I need this mug badly. Ready pay bribe😂 |
#JHMChat content from Twitter.