#jhmchat Transcript

Healthcare social media transcript of the #jhmchat hashtag.
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Patient Safety Enhancement Program (UMVA) @PSEPUMVA
Tonight at 9pm eastern! #JHMChat #MedEd Come chat about diagnosis! https://t.co/q0fMQ79W2k https://t.co/NKzaVzrBxN
MedEdBot @MedEdBot
RT @PSEPUMVA: Tonight at 9pm eastern! #JHMChat #MedEd Come chat about diagnosis! https://t.co/q0fMQ79W2k https://t.co/NKzaVzrBxN
U-M IHPI @UM_IHPI
RT @PSEPUMVA: Tonight at 9pm eastern! #JHMChat #MedEd Come chat about diagnosis! https://t.co/q0fMQ79W2k https://t.co/NKzaVzrBxN
J Hospital Medicine @JHospMedicine
Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat tonight at 9PM EST on the diagnostic process w/@vineet_chopra & @sanjaysaint. https://t.co/FhHUZKLek2 https://t.co/8xw2dnJx4i
Benjamin P. Geisler @ben_geisler
RT @JHospMedicine: Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat
Tony Breu @tony_breu
RT @JHospMedicine: Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat
Lakshman Swamy @laxswamy
RT @JHospMedicine: Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat
Internships from FCA @FCA_Internships
RT @JHospMedicine: Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat
Society of Hospital Medicine @SHMLive
RT @JHospMedicine: Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat
High Value Alliance @hvpaa
RT @JHospMedicine: Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat
Vineet Chopra @vineet_chopra
RT @JHospMedicine: Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat
Charlie M. Wray @WrayCharles
RT @JHospMedicine: Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat
APSF @APSForg
To all #anesthesia trainees and those who teach them, please consider joining #JHMChat on resident diagnoses in the wards tonight at 9pm ET. #ptsafety #patientsafety #residents https://t.co/sOr9gwZJtE
Ryan Gamlin @RyanGamlin
RT @APSForg: To all #anesthesia trainees and those who teach them, please consider joining #JHMChat on resident diagnoses in the wards toni…
Society of Hospital Medicine @SHMLive
@JHospMedicine - get ready, #JHMChat is tonight! Don't forget to claim #CME following the chat: https://t.co/tSW45uEXdW https://t.co/sMItUwIjIW
Improve Diagnosis @ImproveDX
RT @JHospMedicine: Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat
J Hospital Medicine @JHospMedicine
RT @JHospMedicine: Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat
J Hospital Medicine @JHospMedicine
RT @SHMLive: @JHospMedicine - get ready, #JHMChat is tonight! Don't forget to claim #CME following the chat: https://t.co/tSW45uEXdW https:…
Society of Hospital Medicine @SHMLive
Only 2 hours away #JHMChat community!
J Hospital Medicine @JHospMedicine
RT @SHMLive: Only 2 hours away #JHMChat community! https://t.co/VIRA8TsSLN
Vinny Arora MD MAPP @FutureDocs
RT @SHMLive: Only 2 hours away #JHMChat community! https://t.co/VIRA8TsSLN
J Hospital Medicine @JHospMedicine
RT @APSForg: To all #anesthesia trainees and those who teach them, please consider joining #JHMChat on resident diagnoses in the wards toni…
J Hospital Medicine @JHospMedicine
RT @PSEPUMVA: Tonight at 9pm eastern! #JHMChat #MedEd Come chat about diagnosis! https://t.co/q0fMQ79W2k https://t.co/NKzaVzrBxN
J Hospital Medicine @JHospMedicine
RT @DrSinhaEsq: #JHMChat is a great journal club; you get #CME, too! cc: @FutureDocs @JHospMedicine
Kristina Dzara, PhD, MMSc @kristinadzara
RT @JHospMedicine: Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat
J Hospital Medicine @JHospMedicine
1 hour until #JHMChat: diagnosis in teaching hospitals - what do we know with @vineet_chopra https://t.co/w84xwIDjqw
Samir S. Shah @SamirShahMD
RT @SHMLive: Only 2 hours away #JHMChat community! https://t.co/VIRA8TsSLN
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @JHospMedicine: 1 hour until #JHMChat: diagnosis in teaching hospitals - what do we know with @vineet_chopra https://t.co/w84xwIDjqw
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @JHospMedicine: Calling all #MedEd gurus and diagnosticians--including #medicalstudents, #interns, & residents! We have a great #JHMChat
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @APSForg: To all #anesthesia trainees and those who teach them, please consider joining #JHMChat on resident diagnoses in the wards toni…
Vinny Arora MD MAPP @FutureDocs
RT @FutureDocs: Dear #meded #ptsafety communities, join us Monday for #JHMChat At 9pET for an illuminating look into how residents make dia…
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @FutureDocs: Dear #meded #ptsafety communities, join us Monday for #JHMChat At 9pET for an illuminating look into how residents make dia…
Neha Bhatnagar @nbhatnagar_md
RT @FutureDocs: Dear #meded #ptsafety communities, join us Monday for #JHMChat At 9pET for an illuminating look into how residents make dia…
J Hospital Medicine @JHospMedicine
Welcome to #JHMChat, I am your moderator @FutureDocs please introduce yourself.
J Hospital Medicine @JHospMedicine
tonight on #JHMChat we are pleased to welcome @vineet_chopra author of this paper on barriers and facilitators to diagnosis https://t.co/w84xwIDjqw
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Welcome to #JHMChat, I am your moderator @FutureDocs please introduce yourself.
Society of Hospital Medicine @SHMLive
RT @JHospMedicine: Welcome to #JHMChat, I am your moderator @FutureDocs please introduce yourself.
Tony Breu @tony_breu
Excited for this discussion. Joining from (always rainy) Boston. #JHMChat
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @JHospMedicine: tonight on #JHMChat we are pleased to welcome @vineet_chopra author of this paper on barriers and facilitators to diagno…
J Hospital Medicine @JHospMedicine
@tony_breu welcome to one of our regulars! thank you for joining. #jhmchat
Benji Mathews @benjikmathews
@JHospMedicine @FutureDocs Looking forward to this chat on @ImproveDX ! Benji Mathews, hospitalist from @_HealthPartners & work with UMN medical school residents & students. #JHMChat
Charlie M. Wray @WrayCharles
Charlie Wray checking in from SF and looking forward to tonights discussion #JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
Michelle Brooks, academic hospitalist at VCU Health in Richmond -- might be peripherally following as I'm working evening shift currently -- excited about the topic though! #JHMChat https://t.co/JNZRUZ7SKc
Robert Centor @medrants
Important topic - happy to participate #JHMChat
J Hospital Medicine @JHospMedicine
welcome to everyone and just a reminder to use #JHMChat to hashtag all your tweets!
Grace Farris MD @gracefarris
Grace in NYC excited to make this #JHMChat
Anika Kumar, MD @freckledpedidoc
Hi #JHMChat! Anika Kumar, Peds Hospitalist here from Cleveland, OH
Chris Moriates, MD @ChrisMoriates
@JHospMedicine @FutureDocs Hi everyone. Checking in to #JHMChat from bedtime story time. #ResidencyTaughtMeHowToMultiTask https://t.co/EwZ5QwF0QH
J Hospital Medicine @JHospMedicine
@STangGirdwood @FutureDocs welcome to #JHMChat!
Tony Breu @tony_breu
@gracefarris Don't you mean, Grace in @HuffPost? #JHMChat
Grace Farris MD @gracefarris
RT @michellebr00ks: Michelle Brooks, academic hospitalist at VCU Health in Richmond -- might be peripherally following as I'm working eveni…
J Hospital Medicine @JHospMedicine
@benjikmathews @FutureDocs @ImproveDX @_HealthPartners Welcome and glad you are joining us for an exciting #Meded and #ptsafety discussion on #JHMChat tonight!
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: @benjikmathews @FutureDocs @ImproveDX @_HealthPartners Welcome and glad you are joining us for an exciting #Meded and #p
Vineet Chopra @vineet_chopra
RT @JHospMedicine: Welcome to #JHMChat, I am your moderator @FutureDocs please introduce yourself.
J Hospital Medicine @JHospMedicine
T1 #JHMChat In the article, formal rounds and the informal conversation in the work room with peers played important roles in diagnosis. What are some advantages and disadvantages to these strategies? https://t.co/LHA1IdqFO4
Lakshman Swamy @laxswamy
@tony_breu In Boston and lurking on Tony as usual #JHMChat https://t.co/ZlBehIvspK
Vineet Chopra @vineet_chopra
RT @JHospMedicine: welcome to everyone and just a reminder to use #JHMChat to hashtag all your tweets! https://t.co/QEwUE1MeeH
J Hospital Medicine @JHospMedicine
Multitasking on #jhmchat! welcome!
Vinny Arora MD MAPP @FutureDocs
@tony_breu @gracefarris @HuffPost Our celebrity #jhmchat artist in the house!
Grace Farris MD @gracefarris
@tony_breu @HuffPost Exactly! #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: T1 #JHMChat In the article, formal rounds and the informal conversation in the work room with peers played important rol…
Charlie M. Wray @WrayCharles
This, folks, is work-life "balance"... #jhmchat
Vinny Arora MD MAPP @FutureDocs
@ChrisMoriates @JHospMedicine I know those times and books too well #jhmchat
Robert J. Mahoney, MD @mahoneyr
@JHospMedicine @FutureDocs Joining #JHMChat from autumnal St. Louis, Missouri
Society of Hospital Medicine @SHMLive
T1 is in! #JHMChat
J Hospital Medicine @JHospMedicine
RT @SHMLive: T1 is in! #JHMChat https://t.co/ZEyytyoCG2
J Hospital Medicine @JHospMedicine
@mahoneyr @FutureDocs welcome to a prior expert discussant to #JHMChat!
Robert Centor @medrants
First, you should not necessarily separate “formal rounds” from informal conversations. But the attending physician has a responsibility to challenge the team to consider the possibility of incorrect diagnoses. #JHMChat
Tony Breu @tony_breu
These conversations are important, but the authors note that hierarchy gets in the way of open dialogue #JHMChat
Grace Farris MD @gracefarris
@michellebr00ks Lol! #JHMChat
Vineet Chopra @vineet_chopra
@JHospMedicine Advantages to formal rounds: structure, pattern, ability to pose questions in a direct way. #JHMChat
Chris Moriates, MD @ChrisMoriates
RT @WrayCharles: This, folks, is work-life "balance"... #jhmchat https://t.co/SLlDIkH3Ve
Vineet Chopra @vineet_chopra
@JHospMedicine Informal environment, on the other hand, promotes asking questions without fear of retaliation or embarrassment #JHMChat
Sonya Tang Girdwood @STangGirdwood
@JHospMedicine T1, #JHMChat: I never appreciated the value of informal conversation when it came to diagnoses until I was a fellow/attending. I constantly discussed dx dilemmas w/ my co-chiefs or others in the workroom. As a resident, I always felt I had to be right and know the right answer.
Tony Breu @tony_breu
@vineet_chopra @JHospMedicine But, does that formality (and time constraint) also limit conform with thinking outside the box? #JHMChat
J Hospital Medicine @JHospMedicine
RT @vineet_chopra: @JHospMedicine Informal environment, on the other hand, promotes asking questions without fear of retaliation or embarra…
Charlie M. Wray @WrayCharles
The freedom to openly discuss your differential & thoughts with peers and not feel "under pressure" (through attending presence) is an invaluable part of the process for learners #jhmchat
J Hospital Medicine @JHospMedicine
From our expert author on #JHMChat for T1
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @vineet_chopra: @JHospMedicine Advantages to formal rounds: structure, pattern, ability to pose questions in a direct way. #JHMChat
J Hospital Medicine @JHospMedicine
RT @tony_breu: These conversations are important, but the authors note that hierarchy gets in the way of open dialogue #JHMChat https://t.c…
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @vineet_chopra: @JHospMedicine Informal environment, on the other hand, promotes asking questions without fear of retaliation or embarra…
J Hospital Medicine @JHospMedicine
great point @medrants and thanks for joining us tonight on #JHMChat!
Robert Centor @medrants
I would argue that ideal rounds overlap with informal discussions. Minimize the hierarchy of rounds, as an attending invite and encourage asking questions. If the team is intimidated then the attending is not doing the job properly. #JHMChat
Vineet Chopra @vineet_chopra
@STangGirdwood @JHospMedicine There is great value - and we saw this in our study - of the informal lean across the room to say, “Hey, what do you think of this lab?” Fresh eyes, fresh perspective. Better #Dx #JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
T1 - disadvantage: even though there is a process to diagnosis (data gathering, hypothesis formation, etc.) - an informal peer conversation doesn't make this clear that diagnosing is a process. @andrewolsonmd #jhmchat
Benji Mathews @benjikmathews
@JHospMedicine A1: Advantages to informal conversation flattens the hierarchy and allows for asking questions for discovery sake. Interns and students, students and residents, interns and residents... #jhmchat
Anika Kumar, MD @freckledpedidoc
T1. Advantage to formal rounds, group can question diagnoses, biases. Disadvantages: may not have all the data for diagnosis #JHMChat (1/2)
Elizabeth Gundersen @Top_Gundersen
@JHospMedicine @FutureDocs Hi All! It’s Liz from south Florida. I can’t join #JHMChat tonight but wanted to check in in support! I look forward to catching up later.
J Hospital Medicine @JHospMedicine
@laxswamy @tony_breu kind of spooky for Halloween edition of #JHMChat?
Vineet Chopra @vineet_chopra
@tony_breu @JHospMedicine Absolutely does. Hidden agenda in rounds is management and treatment. Less focus on “Are you treating the right condition?” #JHMChat
Charlie M. Wray @WrayCharles
@tony_breu Are there ways to remove this hierarchy during this process...? #jhmchat Asking for a friend...
J Hospital Medicine @JHospMedicine
RT @michellebr00ks: T1 - disadvantage: even though there is a process to diagnosis (data gathering, hypothesis formation, etc.) - an infor…
J Hospital Medicine @JHospMedicine
RT @vineet_chopra: @STangGirdwood @JHospMedicine There is great value - and we saw this in our study - of the informal lean across the room…
Tony Breu @tony_breu
@vineet_chopra @STangGirdwood @JHospMedicine Do both of the study sites have dedicated space for IM teams to congregate? This is an issue at some hospitals. @laxswamy #JHMChat
Vineet Chopra @vineet_chopra
@medrants Agree. But in practice this is hard to do. We see some exemplary attendings do it. But not common. See prior tweet re hidden agenda as well. #JHMChat
J Hospital Medicine @JHospMedicine
RT @medrants: I would argue that ideal rounds overlap with informal discussions. Minimize the hierarchy of rounds, as an attending invite…
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @vineet_chopra: @STangGirdwood @JHospMedicine There is great value - and we saw this in our study - of the informal lean across the room…
Anika Kumar, MD @freckledpedidoc
T1. Advantage to informal discussions, may lead to unanticipated questions. May have access to all the data. Disadvantages: may not be questioning biases #JHMChat (2/2)
Charlie M. Wray @WrayCharles
IMO, this is a major problem with #meded. Need to create the safe space to be wrong. If not, we impede the diagnostic process... #jhmchat.
Tony Breu @tony_breu
@WrayCharles Not sure this is the right answer, but attending-on-first-name-basis? #JHMChat
Grace Farris MD @gracefarris
Sometimesformal rounds seem too formal... #JHMChat https://t.co/9TFWpc80n0
Michelle Brooks, MD, FACP, FHM @michellebr00ks
@WrayCharles @tony_breu You could just be awkward and bring snacks like I do? #JHMChat
Vineet Chopra @vineet_chopra
@tony_breu @STangGirdwood @JHospMedicine @laxswamy Absolutely. The space is also shared by nurses at times for shift changes. #JHMChat
Benji Mathews @benjikmathews
RT @vineet_chopra: @JHospMedicine Advantages to formal rounds: structure, pattern, ability to pose questions in a direct way. #JHMChat
Vineet Chopra @vineet_chopra
RT @WrayCharles: IMO, this is a major problem with #meded. Need to create the safe space to be wrong. If not, we impede the diagnostic proc…
Vinny Arora MD MAPP @FutureDocs
T1 #jhmchat discussion of informal discussions reminds me of the “hierarchy of assistance” @jeannemfarnan studied when describing how residents handle uncertainty — start w peers but hierarchy could lead to delays reaching attending
Tony Breu @tony_breu
@gracefarris My worst nightmare! #JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @WrayCharles: IMO, this is a major problem with #meded. Need to create the safe space to be wrong. If not, we impede the diagnostic proc…
Grace Farris MD @gracefarris
RT @FutureDocs: T1 #jhmchat discussion of informal discussions reminds me of the “hierarchy of assistance” @jeannemfarnan studied when des…
Sonya Tang Girdwood @STangGirdwood
@vineet_chopra @tony_breu @JHospMedicine #JHMChat: One thing that has stuck with me from med school was an IM attending who told us that when presenting the assessment, make it clear if we're dealing with a diagnostic dilemma or a management issue. By acknowledging it as a dx dilemma, it opens discussion on rounds.
Vineet Chopra @vineet_chopra
@WrayCharles Agree. But safe space competes with time and efficiency. Need to also think about flow and structure (rhythm) of rounds - esp when learners of various stages present. #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @gracefarris: Sometimesformal rounds seem too formal... #JHMChat https://t.co/9TFWpc80n0
J Hospital Medicine @JHospMedicine
T2 #JHMChat In the article, the way data is stored or presented in the EMR was described as “frustrating” and “unsafe”. What are some tips on how to use the EMR to ensure accurate diagnosis? https://t.co/BaMHyAKhjI
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @vineet_chopra: @WrayCharles Agree. But safe space competes with time and efficiency. Need to also think about flow and structure (rhyt…
Tony Breu @tony_breu
@vineet_chopra @STangGirdwood @JHospMedicine @laxswamy Being close to nursing is fantastic! #JHMChat
Robert Centor @medrants
It is the attending’s responsibility to have the team question everything. He/she should challenge the team to not accept proposed diagnoses. Stressing problem representation and illness scripts daily can help. #JHMChat
MedEdBot @MedEdBot
RT @WrayCharles: IMO, this is a major problem with #meded. Need to create the safe space to be wrong. If not, we impede the diagnostic proc…
J Hospital Medicine @JHospMedicine
RT @gracefarris: Sometimesformal rounds seem too formal... #JHMChat https://t.co/9TFWpc80n0
Vineet Chopra @vineet_chopra
@tony_breu @WrayCharles Don’t think it’s the name. I have a rule on rounds. Every day, we must all laugh. At least once. It’s my job to make sure that happens. Sets the right tone for the session. #JHMChat
J Hospital Medicine @JHospMedicine
RT @WrayCharles: IMO, this is a major problem with #meded. Need to create the safe space to be wrong. If not, we impede the diagnostic proc…
J Hospital Medicine @JHospMedicine
RT @freckledpedidoc: T1. Advantage to informal discussions, may lead to unanticipated questions. May have access to all the data. Disadvant…
Society of Hospital Medicine @SHMLive
RT @gracefarris: Sometimesformal rounds seem too formal... #JHMChat https://t.co/9TFWpc80n0
Charlie M. Wray @WrayCharles
@tony_breu at the SFVA most operate on this level (which was a first for me). Odd at first, but has grown on me and I now think it definitely flattens hierarchy #JHMChat
Society of Hospital Medicine @SHMLive
Here goes T2. #JHMChat
Vineet Chopra @vineet_chopra
@STangGirdwood @tony_breu @JHospMedicine Yesss!! Ask “What else could this be?” Not, “It’s this, so...l #JHMChat
Grace Farris MD @gracefarris
@JHospMedicine T2 The info asymmetry this creates worries me about dx- for example, I can see vitals but it’s harder to see fingerstick BG #JHMChat
Lakshman Swamy @laxswamy
@vineet_chopra @JHospMedicine one of the best learning experiences I had @BMCimRES @BostonChiefs was on a 'twilight' solo admitting shift. Admit a few pts totally alone. Have people to call around hospital but not in workroom w you-- you realize how much of a crutch having peers around can be! #jhmchat
Vinny Arora MD MAPP @FutureDocs
@vineet_chopra @tony_breu @STangGirdwood @JHospMedicine @laxswamy Agree does this promote convo between residents and nurses re diagnosis? It should! #jhmchat
J Hospital Medicine @JHospMedicine
RT @laxswamy: @vineet_chopra @JHospMedicine one of the best learning experiences I had @BMCimRES @BostonChiefs was on a 'twilight' solo adm…
Vineet Chopra @vineet_chopra
@JHospMedicine 1/ keep problem list updated: 2/ avoid the copy and paste function (period - less is more on notes); 3/ eliminate note bloat (dot phrases in epic)! #JHMChat
Sonya Tang Girdwood @STangGirdwood
@vineet_chopra @tony_breu @JHospMedicine #JHMChat: During s/o, I often point out if a patient is a dx dilemma, just so others recognize I may not be managing the pts optimally, because I'm not even sure what they have. Our division is making lots of efforts in this area, calling certain pts #uncertaindiagnosis @spatelDO
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: T2 #JHMChat In the article, the way data is stored or presented in the EMR was described as “frustrating” and “unsafe”.…
Vinny Arora MD MAPP @FutureDocs
RT @vineet_chopra: @STangGirdwood @tony_breu @JHospMedicine Yesss!! Ask “What else could this be?” Not, “It’s this, so...l #JHMChat
Vineet Chopra @vineet_chopra
@STangGirdwood @tony_breu @JHospMedicine @spatelDO Great idea! Glad uncertain dx like we flag #codestatus could be a #gamechanger #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @vineet_chopra: @tony_breu @WrayCharles Don’t think it’s the name. I have a rule on rounds. Every day, we must all laugh. At least once.…
Grace Farris MD @gracefarris
@vineet_chopra @JHospMedicine I have had probs fall off list (like AC w Coumadin) when avoiding copy paste #JHMChat
Cornelia Taylor @cornelia_taylor
RT @vineet_chopra: @JHospMedicine 1/ keep problem list updated: 2/ avoid the copy and paste function (period - less is more on notes); 3/ e…
Michelle Brooks, MD, FACP, FHM @michellebr00ks
T2 - I think this may be why students struggle sometimes with synthesis to an illness script -- the information is so disjointed. The EMR doesn't facilitate the patient's story. #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @medrants: It is the attending’s responsibility to have the team question everything. He/she should challenge the team to not accept pr…
Anika Kumar, MD @freckledpedidoc
T2. I think having a consistent system to review data in the EHR (like reading a CXR) leads to less frustration and thorough. The consistency allows the user to have some control. With that being said, I learn a new Epic trick every week. #JHMChat
Robert J. Mahoney, MD @mahoneyr
@JHospMedicine T2 #JHMChat When the EMR doesn't work, it is often because it presents data without appropriate context (trends, normal values, etc.)
Vinny Arora MD MAPP @FutureDocs
RT @WrayCharles: IMO, this is a major problem with #meded. Need to create the safe space to be wrong. If not, we impede the diagnostic proc…
Ben Kinnear @Midwest_MedPeds
T2 #JHMChat Documenting uncertain diagnoses in the EHR can help help everyone keep re-examining a pt's diagnosis when multiple handoffs are occuring
Robert Centor @medrants
You have more time to focus on proper diagnosis when you delegate to the resident the more routine problems. Avoiding micromanagement leaves time for diagnosis. #JHMChat
Chris Moriates, MD @ChrisMoriates
We usually bedside round, but when we have a diagnostic dilemma (or interesting case), I like to gather in room w a whiteboard and treat it almost like "morning report," where intern presents and we put up findings and noodle together about DDx, objective findings etc. #JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
@FutureDocs @vineet_chopra @tony_breu @STangGirdwood @JHospMedicine @laxswamy I definitely miss hanging out at the nursing station when we did handwritten notes! Luckily my new role has me partnering with nursing leadership on the units, so I've woven this back into my career! #JHMChat
J Hospital Medicine @JHospMedicine
Wisdom from our expert author tonight on #EHR #ptsafety #JHMChat
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @vineet_chopra: @JHospMedicine 1/ keep problem list updated: 2/ avoid the copy and paste function (period - less is more on notes); 3/ e…
Vineet Chopra @vineet_chopra
@JHospMedicine The other key issue: figure out where your data lies. #EMRs customizable many which ways. Learn yours well. If you don’t know. #ask. #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @medrants: You have more time to focus on proper diagnosis when you delegate to the resident the more routine problems. Avoiding microm…
Charlie M. Wray @WrayCharles
RT @michellebr00ks: T2 - I think this may be why students struggle sometimes with synthesis to an illness script -- the information is so d…
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @vineet_chopra: @JHospMedicine The other key issue: figure out where your data lies. #EMRs customizable many which ways. Learn yours wel…
Anika Kumar, MD @freckledpedidoc
Yes @vineet_chopra! AVOID THE COPY AND PASTE FUNCTION!! #JHMChat
Tony Breu @tony_breu
@ChrisMoriates When do you do this? After rounds are done? In the afternoon? I love the idea, but often find it difficult to fit these discussion in. #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @michellebr00ks: T2 - I think this may be why students struggle sometimes with synthesis to an illness script -- the information is so d…
Chris Moriates, MD @ChrisMoriates
Can only do this sparingly (maybe one patient a couple times per week) but when I have my whole team seems to find it valuable #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @vineet_chopra: @JHospMedicine 1/ keep problem list updated: 2/ avoid the copy and paste function (period - less is more on notes); 3/ e…
Sonya Tang Girdwood @STangGirdwood
@vineet_chopra @tony_breu @JHospMedicine @spatelDO Yes, we now have "UD" flag, thanks to work by @spatelDO and @Hagedorn_MD. @TMarshall_MD and @patrickwbrady are currently characterizing those patients who have received the flag. #JHMChat
Anika Kumar, MD @freckledpedidoc
RT @vineet_chopra: @JHospMedicine 1/ keep problem list updated: 2/ avoid the copy and paste function (period - less is more on notes); 3/ e…
Robert Centor @medrants
If we could define problems rather than being “forced” to provide a diagnosis, then we could signal uncertainty. Example - CAP admission - now we have a “diagnosis” but 1/4-1/3 of such “diagnoses” are incorrect. #JHMChat
Vineet Chopra @vineet_chopra
@Midwest_MedPeds True Ben. I would also wonder about #dx certainty. On a scale of 1-10, how certain are you re the #dx? We’ve found this helps a great deal - esp if longitudinally updated over time. #JHMChat
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @vineet_chopra: @STangGirdwood @tony_breu @JHospMedicine @spatelDO Great idea! Glad uncertain dx like we flag #codestatus could be a #ga
Robert J. Mahoney, MD @mahoneyr
@freckledpedidoc @vineet_chopra There is a lot of copy/paste that is not explicit (e.g., "carry-forward") and this, too, is bad. People read your notes to find out what happened today, and what you're doing about it. #JHMChat
Ben Kinnear @Midwest_MedPeds
@vineet_chopra @JHospMedicine T2 #JHMChat So true. We need 1 - better tools to assess the quality of documentation and 2 - better curricula to train learners how best to convey info in the EHR. Many of us were never taught so it's the blind leading the blind!
Benji Mathews @benjikmathews
@WrayCharles @tony_breu Set the stage early Acknowledge all are prone to mistakes All journeying together in learning Medicine is a #teamsport. Deliberately try to say "I don't know" at least a couple times the first day of wards rounding. (Pretty easy for me, I've got much to learn!) #jhmchat
Vinny Arora MD MAPP @FutureDocs
T2 I remember once working with a new intern and we realized the TH was back , it was abnormal and it requires scrolling to see it so it was almost missed #JHMChat
Charlie M. Wray @WrayCharles
I might take a step back and state that the immediate need for a diagnosis may also act as an impediment to make a correct diagnosis. The first few days of hospitalization are critical. Putting a name on something can sometimes be harmful #JHMChat
Vineet Chopra @vineet_chopra
@ChrisMoriates I would love to do that! But I worry that @umichmedicine , we would need a #whiteboard session for every patient! #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @benjikmathews: @WrayCharles @tony_breu Set the stage early Acknowledge all are prone to mistakes All journeying together in learning M…
Chris Moriates, MD @ChrisMoriates
@tony_breu Usually first thing, as long as nobody crashing. Meet team in room, check in and present the case while everyone is there. Spend no more than 20 mins or so on presentation and discussion then hit the wards. Revisit later during afternoon teaching rounds if necessary. #JHMChat
Grace Farris MD @gracefarris
T2 copy paste existential ennui #JHMChat https://t.co/ZZoEdDqnzz
Robert J. Mahoney, MD @mahoneyr
@tony_breu @ChrisMoriates I tend to do this during rounds while it's "fresh" - but my rounds have been known occasionally to drag on a bit. #JHMChat
Sonya Tang Girdwood @STangGirdwood
@vineet_chopra @tony_breu @JHospMedicine @spatelDO @Hagedorn_MD @TMarshall_MD @patrickwbrady #JHMChat: And the "UD" flag is a mutual decision between physicians and nurses so that everyone is on the same page.
Vineet Chopra @vineet_chopra
RT @freckledpedidoc: Yes @vineet_chopra! AVOID THE COPY AND PASTE FUNCTION!! #JHMChat https://t.co/TM38a6efCY
J Hospital Medicine @JHospMedicine
RT @STangGirdwood: @vineet_chopra @tony_breu @JHospMedicine #JHMChat: During s/o, I often point out if a patient is a dx dilemma, just so o…
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @gracefarris: T2 copy paste existential ennui #JHMChat https://t.co/ZZoEdDqnzz
Grace Farris MD @gracefarris
RT @vineet_chopra: @JHospMedicine The other key issue: figure out where your data lies. #EMRs customizable many which ways. Learn yours wel…
Sanjay Saint @sanjaysaint
T1 #JHMChat (sorry to be late-plane just landed). #Diagnosis is a social phenomenon rarely occurring in a vacuum. It is affected by #patients, family members, other physicians and healthcare workers.
Vinny Arora MD MAPP @FutureDocs
@STangGirdwood @vineet_chopra @tony_breu @JHospMedicine @spatelDO @Hagedorn_MD @TMarshall_MD @patrickwbrady I love this. Really using handoffs as a learning opportunity for “fresh eyes” #JHMChat
Vineet Chopra @vineet_chopra
@tony_breu @ChrisMoriates I’m getting older I guess but I remember a time not that long ago where the entire team would get together every afternoon to #runthelist together. On the table. Talking about cases and consult reccs. #JHMChat
Grace Farris MD @gracefarris
RT @medrants: If we could define problems rather than being “forced” to provide a diagnosis, then we could signal uncertainty. Example - C…
Chris Moriates, MD @ChrisMoriates
@vineet_chopra @umichmedicine You gotta pick and choose. Choose wisely, @vineet_chopra #JHMChat
Charlie M. Wray @WrayCharles
The Jeckyl & Hyde of modern #EMR from @gracefarris #JHMChat
Robert J. Mahoney, MD @mahoneyr
@medrants If your system is implemented well, you should still be able to document symptoms. When I see "dyspnea" I'm aware that folks don't necessarily know what's going on, or maybe it's multifactorial. The pressure to document diagnoses is often the problem. #JHMChat
Sonya Tang Girdwood @STangGirdwood
@FutureDocs #JHMChat: Yes, happens all the time. When the EMR says I have a new result, and I have no idea what it is because it's from days before.
Grace Farris MD @gracefarris
RT @FutureDocs: T2 I remember once working with a new intern and we realized the TH was back , it was abnormal and it requires scrolling to…
Vinny Arora MD MAPP @FutureDocs
RT @sanjaysaint: T1 #JHMChat (sorry to be late-plane just landed). #Diagnosis is a social phenomenon rarely occurring in a vacuum. It is af…
Nik Theyyunni @HeyDrNik
RT @vineet_chopra: @JHospMedicine 1/ keep problem list updated: 2/ avoid the copy and paste function (period - less is more on notes); 3/ e…
Michelle Brooks, MD, FACP, FHM @michellebr00ks
@FutureDocs Human factors engineering -- the more you have to scroll, the more likely you are to miss something! I created a pathology results page with the Cerner folks at our institution after a safety event like this. #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @STangGirdwood: @FutureDocs #JHMChat: Yes, happens all the time. When the EMR says I have a new result, and I have no idea what it is b…
Sanjay Saint @sanjaysaint
T1 #JHMChat: Major advantage of having peers help with #diagnosis: the more brains in the game the better! Also allows for pressure testing of ideas and possible diagnoses. Helpful in both adding & subtracting diagnoses.
Grace Farris MD @gracefarris
@FutureDocs Were you on my rounds last week? #JHMChat
Vineet Chopra @vineet_chopra
@medrants What’s more helpful is: “SOB with cough and sputum. Suspect CAP. bronchitis, cough variant asthma, AECOPD remain in dx” Nes’t pa? #JHMChat
Grace Farris MD @gracefarris
RT @WrayCharles: I might take a step back and state that the immediate need for a diagnosis may also act as an impediment to make a correct…
Vineet Chopra @vineet_chopra
@mahoneyr @freckledpedidoc And can’t figure out a thing because all the note look the same. #JHMChat
Charlie M. Wray @WrayCharles
@ChrisMoriates @vineet_chopra @umichmedicine I see what you did there...#JHMChat
Vineet Chopra @vineet_chopra
RT @benjikmathews: @WrayCharles @tony_breu Set the stage early Acknowledge all are prone to mistakes All journeying together in learning M…
Vinny Arora MD MAPP @FutureDocs
@michellebr00ks Scrolling is 💀 deadly #JHMChat
Ben Kinnear @Midwest_MedPeds
RT @mahoneyr: @medrants If your system is implemented well, you should still be able to document symptoms. When I see "dyspnea" I'm aware t…
Grace Farris MD @gracefarris
RT @sanjaysaint: T1 #JHMChat (sorry to be late-plane just landed). #Diagnosis is a social phenomenon rarely occurring in a vacuum. It is af…
Tony Breu @tony_breu
Gotta run. I can tell already I'll be missing some great stuff from @vineet_chopra, new follow @freckledpedidoc, and our host @JHospMedicine. @gracefarris - I'll look for the graphic representation. #JHMChat
Vineet Chopra @vineet_chopra
RT @WrayCharles: I might take a step back and state that the immediate need for a diagnosis may also act as an impediment to make a correct…
Vineet Chopra @vineet_chopra
@WrayCharles Totally agree. #JHMChat
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @sanjaysaint: T1 #JHMChat (sorry to be late-plane just landed). #Diagnosis is a social phenomenon rarely occurring in a vacuum. It is af…
Chris Moriates, MD @ChrisMoriates
RT @STangGirdwood: @vineet_chopra @tony_breu @JHospMedicine #JHMChat: During s/o, I often point out if a patient is a dx dilemma, just so o…
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @WrayCharles: I might take a step back and state that the immediate need for a diagnosis may also act as an impediment to make a correct…
Elad Sharon @EladSharonMD
RT @WrayCharles: I might take a step back and state that the immediate need for a diagnosis may also act as an impediment to make a correct…
J Hospital Medicine @JHospMedicine
Better late than never welcome to @sanjaysaint author for article discussion in tonight's #JHMChat!
Grace Farris MD @gracefarris
@sanjaysaint Love this- I’m a Sherlock Holmes fan, but diagnosis as a social exercise seems more 2018 #jhmchat
Robert J. Mahoney, MD @mahoneyr
@vineet_chopra @freckledpedidoc Let's say, hypothetically, an insurance company denies your patient's 30-day stay. And 20 of those 30 days have exactly the same progress note. Even that is a problem. #JHMChat
J Hospital Medicine @JHospMedicine
RT @sanjaysaint: T1 #JHMChat: Major advantage of having peers help with #diagnosis: the more brains in the game the better! Also allows for…
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @sanjaysaint: T1 #JHMChat: Major advantage of having peers help with #diagnosis: the more brains in the game the better! Also allows for…
Grace Farris MD @gracefarris
RT @WrayCharles: The Jeckyl & Hyde of modern #EMR from @gracefarris #JHMChat https://t.co/c6JQZaJyMw
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Better late than never welcome to @sanjaysaint author for article discussion in tonight's #JHMChat! https://t.co/aGVsKat…
Benji Mathews @benjikmathews
@vineet_chopra @JHospMedicine What do you think is the role of a trigger to consider alternative diagnoses? EMR's that have a workflow integration to consider alternative diagnoses ideally should help right? Some literature as this is key in @ImproveDX, reducing #dxerror #jhmchat
Charlie M. Wray @WrayCharles
@sumantranji @tony_breu I like this, Sumant. Devil is in the details #jhmchat
Chris Moriates, MD @ChrisMoriates
RT @WrayCharles: I might take a step back and state that the immediate need for a diagnosis may also act as an impediment to make a correct…
Society of Hospital Medicine @SHMLive
Don't forget to claim CME following tonight's chat! #JHMChat https://t.co/nowiSYYU1F
J Hospital Medicine @JHospMedicine
T3 #JHMChat Noise and pages were cited as major distractions to diagnosis. What are some ways we can reduce these interruptions to promote diagnosis in the clinical setting?https://t.co/zT55tzyBFF
J Hospital Medicine @JHospMedicine
@tony_breu @vineet_chopra @freckledpedidoc @gracefarris thanks for joining even for a bit for #JHMChat!
Grace Farris MD @gracefarris
@tony_breu @vineet_chopra @freckledpedidoc @JHospMedicine We’ll miss ya @tony_breu #JHMChat
Sonya Tang Girdwood @STangGirdwood
@freckledpedidoc @FutureDocs @vineet_chopra @tony_breu @JHospMedicine @spatelDO @Hagedorn_MD @TMarshall_MD @patrickwbrady #JHMChat: Great ? Our definition of UD has undergone several revisions over the lyear. It isn't just about whether or not you know the dx, but if the hospital course could signficiantly change. @spatelDO, @Hagedorn_MD or @TMarshall_MD, can you chime in on our latest definition?
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @sanjaysaint: T1 #JHMChat (sorry to be late-plane just landed). #Diagnosis is a social phenomenon rarely occurring in a vacuum. It is af…
Grace Farris MD @gracefarris
RT @JHospMedicine: Better late than never welcome to @sanjaysaint author for article discussion in tonight's #JHMChat! https://t.co/aGVsKat…
Vinny Arora MD MAPP @FutureDocs
RT @WrayCharles: I might take a step back and state that the immediate need for a diagnosis may also act as an impediment to make a correct…
Robert J. Mahoney, MD @mahoneyr
@JHospMedicine T3 Asynchronous communication. So much in healthcare needs to happen right now that we need to start distinguishing the things that don't need to happen right now. #JHMChat
Anika Kumar, MD @freckledpedidoc
Everyone’s favorite topic: alarm/pager fatigue!! #jhmchat
Vineet Chopra @vineet_chopra
@JHospMedicine The million dollar question! I think this is tough to do, but necessary. Oh, and seeing residents with heaadphones on is not the solution. That just creates more social isolation! #JHMChat
Charlie M. Wray @WrayCharles
It's like writing a paper...Not impossible to come from a single individual, but a better product will come about if others are brought into the process #jhmchat
Robert Centor @medrants
Noise is one reason that I start rounds in the team room. We run the list with a quick discussion of what has happened in the last 24 hours and what are plan is. In the team room we have quiet. We then go see each patient. We minimize hall conversations. #JHMChat
Jose Silva @josesilvaf
RT @WrayCharles: I might take a step back and state that the immediate need for a diagnosis may also act as an impediment to make a correct…
Grace Farris MD @gracefarris
@JHospMedicine But are they real impediments? #JHMChat
Vineet Chopra @vineet_chopra
@mahoneyr @JHospMedicine But isn’t there the fear of over communication? Many pages aren’t necessary, distracting. Async allows a break in some sense! #JHMChat
Grace Farris MD @gracefarris
RT @freckledpedidoc: Everyone’s favorite topic: alarm/pager fatigue!! #jhmchat https://t.co/3zJOD78JwZ
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @vineet_chopra: @JHospMedicine The million dollar question! I think this is tough to do, but necessary. Oh, and seeing residents with he…
Grace Farris MD @gracefarris
RT @WrayCharles: It's like writing a paper...Not impossible to come from a single individual, but a better product will come about if other…
Society of Hospital Medicine @SHMLive
RT @JHospMedicine: T3 #JHMChat Noise and pages were cited as major distractions to diagnosis. What are some ways we can reduce these interr…
Ben Kinnear @Midwest_MedPeds
@mahoneyr @JHospMedicine T3 #JHMChat Agreed. Start with multidisciplinary input on what types of information need to be viewed NOW vs LATER. Will take lots of time up front to build shared mental model but save time and mental energy down the road.
Vineet Chopra @vineet_chopra
@freckledpedidoc Reminds me of our paper in @JAMA_current “Alarmed and Dangerous” https://t.co/Lw61j09IY3 #JHMChat
Chris Moriates, MD @ChrisMoriates
This question is feeling a little meta to me right now as all of the tweets and notifications are constantly popping up and interrupting me as I am trying to think about what to say next on #JHMChat
Robert J. Mahoney, MD @mahoneyr
@vineet_chopra @JHospMedicine I would accept any short-term solution whose main downside was that it led to too much communication - as long as there was a way to prioritize it. #JHMChat
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @vineet_chopra: @freckledpedidoc Reminds me of our paper in @JAMA_current “Alarmed and Dangerous” https://t.co/Lw61j09IY3 #JHMChat
Andrew Olson, MD @andrewolsonmd
@sanjaysaint Hi all - just got kids to bed So I’m joining late as well. @sanjaysaint Nails it here. The more I think about diagnosis, the more I think that the right paradigm to consider is social learning theory.#JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
T3 - anecdotally, inviting the nurse to bedside rounds with the team and the patient helps to decrease the pages post-rounds. #jhmchat
Sanjay Saint @sanjaysaint
T3 #JHMChat: An important recent study in #BMJ Quality&Safety found that emergency medicine doctors in Australia were interrupted on average ~8 times per hour. Being interrupted was associated with more prescribing errors. @kgshojania
Charlie M. Wray @WrayCharles
@JHospMedicine In my (nihilistic) opinion, these aren't ever going to go away (it's just the nature of our business). Learners and culture are going to have to adapt. [ducking now] #jhmchat
Anika Kumar, MD @freckledpedidoc
RT @mahoneyr: @JHospMedicine T3 Asynchronous communication. So much in healthcare needs to happen right now that we need to start distingu…
Vineet Chopra @vineet_chopra
@mahoneyr @JHospMedicine I remember a paper from folks @UofT a while ago. Non urgent messages went to email. Only urgent messages paged out. Result: drop in pages by 50%. #JHMChat
Ben Kinnear @Midwest_MedPeds
@JHospMedicine T3 #JHMChat One simple step might be to educate learners about the cognitive cost of task switching. The ability to multitask cost-free is a pervasive myth. #metacognition
Sri Lekha Tummalapalli, MD, MBA @LTummalapalli
Precision of the diagnosis also important - diagnosis is not a binary object of you have it or you don’t. “CVA” or “heart failure” can be a huge range of things. #JHMChat
Chris Moriates, MD @ChrisMoriates
Agreed! And if the nurses know you are going to round with them, they just might hold on to that page until the team arrives! #JHMChat
Robert J. Mahoney, MD @mahoneyr
@michellebr00ks Knowing that all members of the team will get together at some point avoids a lot of those "by the way" communications. #JHMChat
Vineet Chopra @vineet_chopra
RT @sanjaysaint: T3 #JHMChat: An important recent study in #BMJ Quality&Safety found that emergency medicine doctors in Australia were inte…
Sanjay Saint @sanjaysaint
T3 #JHMChat - @vineet_chopra is testing out a #mindfulness-based intervention on hospitalists as part of an #AHRQ-funded study that is aimed at reducing diagnostic #error #MindfulMoment
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @Midwest_MedPeds: @JHospMedicine T3 #JHMChat One simple step might be to educate learners about the cognitive cost of task switching. T…
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @sanjaysaint: T3 #JHMChat - @vineet_chopra is testing out a #mindfulness-based intervention on hospitalists as part of an #AHRQ-funded s…
Robert J. Mahoney, MD @mahoneyr
@Midwest_MedPeds @JHospMedicine A lot of the calls/pages/etc. we get are sent by people who already know full-well they're not emergent but there is no pre-built way to label them as "less urgent". #JHMChat
Vineet Chopra @vineet_chopra
@mahoneyr @JHospMedicine @UofT My advice: find a quiet place to write notes (maybe even after clinical work ends). One resident told us they would sign out and go to the library to think through patients and notes. #JHMChat
Vineet Chopra @vineet_chopra
RT @sanjaysaint: T3 #JHMChat - @vineet_chopra is testing out a #mindfulness-based intervention on hospitalists as part of an #AHRQ-funded s…
J Hospital Medicine @JHospMedicine
RT @sanjaysaint: T3 #JHMChat: An important recent study in #BMJ Quality&Safety found that emergency medicine doctors in Australia were inte…
J Hospital Medicine @JHospMedicine
RT @michellebr00ks: T3 - anecdotally, inviting the nurse to bedside rounds with the team and the patient helps to decrease the pages post-r…
Michelle Brooks, MD, FACP, FHM @michellebr00ks
Most of the problems I've dealt with in my role as medical director for the housestaff units so far are solved by ensuring that team rounds WITH nursing at the patient's BEDSIDE (not hallway) occur on the majority of the patients. #jhmchat
Anika Kumar, MD @freckledpedidoc
T3. In some ways noise & pages can be distracting to diagnosis but they can also be helpful if the page is from a consultant or the lab. However the RTL method at the beginning or end of rounds is a way to overcome the pager disruptions #JHMChat
CORE IM @COREIMpodcast
iIf the intern/resident comes back from returning their pages, sometimes I'll have another team member summarize - 1) allows for pause/summarizing 2) allows a team member do a problem representation #JHMchat
Andrew Olson, MD @andrewolsonmd
@michellebr00ks If diagnosis is truly a social activity, then we must bring all social points of view into the conversation. If the most important diagnostic test is response to treatment, that the people monitoring the response to treatment should be part of the diagnostic activity #JHMChat
APSF @APSForg
RT @JHospMedicine: T3 #JHMChat Noise and pages were cited as major distractions to diagnosis. What are some ways we can reduce these interr…
Grace Farris MD @gracefarris
T3 ok sounds like they are true impediments #JHMChat https://t.co/nmZv9LjpyC
Ben Kinnear @Midwest_MedPeds
T3 I'm sure there's something out there on this (help me out #JHMChat folks), but I only see this as US (physicians) being "interrupting" THEM (usually nurses). Any literature on US interrupting THEM and the effects of that?
Grace Farris MD @gracefarris
RT @WrayCharles: @JHospMedicine In my (nihilistic) opinion, these aren't ever going to go away (it's just the nature of our business). Lear…
Vineet Chopra @vineet_chopra
@mahoneyr @JHospMedicine @UofT Also - constant contact with nursing is key. Head off any major questions or concerns. Tell them you’ll be writing notes between 3-5p. Page emergency only. #JHMChat
Grace Farris MD @gracefarris
RT @sanjaysaint: T3 #JHMChat: An important recent study in #BMJ Quality&Safety found that emergency medicine doctors in Australia were inte…
J Hospital Medicine @JHospMedicine
RT @ChrisMoriates: This question is feeling a little meta to me right now as all of the tweets and notifications are constantly popping up…
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @gracefarris: T3 ok sounds like they are true impediments #JHMChat https://t.co/nmZv9LjpyC
J Hospital Medicine @JHospMedicine
RT @vineet_chopra: @freckledpedidoc Reminds me of our paper in @JAMA_current “Alarmed and Dangerous” https://t.co/Lw61j09IY3 #JHMChat
Sonya Tang Girdwood @STangGirdwood
@ChrisMoriates #JHMChat: @AStatile: in your QI AIM study, were you able to collect any data on whether pages and Voalte messages decreased when we had more nurses present on rounds?
J Hospital Medicine @JHospMedicine
RT @medrants: Noise is one reason that I start rounds in the team room. We run the list with a quick discussion of what has happened in th…
CORE IM @COREIMpodcast
The struggle is real. #JHMchat
Robert J. Mahoney, MD @mahoneyr
@vineet_chopra @JHospMedicine @UofT I might recommend the opposite. I tend to write my notes on the divisions where I have the most patients. You would think that would lead to more interruptions - but it's much faster when folks see whether you're busy and tap you on the shoulder with questions. #JHMChat
Grace Farris MD @gracefarris
RT @ChrisMoriates: Agreed! And if the nurses know you are going to round with them, they just might hold on to that page until the team arr…
J Hospital Medicine @JHospMedicine
RT @vineet_chopra: @JHospMedicine The million dollar question! I think this is tough to do, but necessary. Oh, and seeing residents with he…
J Hospital Medicine @JHospMedicine
RT @freckledpedidoc: Everyone’s favorite topic: alarm/pager fatigue!! #jhmchat https://t.co/3zJOD78JwZ
Grace Farris MD @gracefarris
RT @sanjaysaint: T3 #JHMChat - @vineet_chopra is testing out a #mindfulness-based intervention on hospitalists as part of an #AHRQ-funded s…
Benji Mathews @benjikmathews
@JHospMedicine Provider-nurse rounding is key! At least a brief check-in, a systematic checklist even better. Partner with & engage the larger diagnostic team on rounds. Has not removed distractions but has decreased pager burden & interruptions for our group. #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @gracefarris: T3 ok sounds like they are true impediments #JHMChat https://t.co/nmZv9LjpyC
Charlie M. Wray @WrayCharles
RT @Midwest_MedPeds: T3 I'm sure there's something out there on this (help me out #JHMChat folks), but I only see this as US (physicians)…
Jenna Koliani Pace MD @JKolianiPaceMD
RT @gracefarris: T3 ok sounds like they are true impediments #JHMChat https://t.co/nmZv9LjpyC
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @andrewolsonmd: @michellebr00ks If diagnosis is truly a social activity, then we must bring all social points of view into the conversat…
Vineet Chopra @vineet_chopra
@mahoneyr @JHospMedicine @UofT We are testing out a quiet space concept (mobile screen/pod) with #mindfulness and a #dxchecklist to see if it can help eliminate distractions. Results will come next year. #JHMChat
Grace Farris MD @gracefarris
RT @COREIMpodcast: iIf the intern/resident comes back from returning their pages, sometimes I'll have another team member summarize - 1) a…
Anika Kumar, MD @freckledpedidoc
T3. @STangGirdwood someone should teach these internists about Family Centered Rounds! I don’t round without my nurse or a parent/guardian. #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @vineet_chopra: @mahoneyr @JHospMedicine @UofT Also - constant contact with nursing is key. Head off any major questions or concerns. Te…
Grace Farris MD @gracefarris
RT @andrewolsonmd: @michellebr00ks If diagnosis is truly a social activity, then we must bring all social points of view into the conversat…
CORE IM @COREIMpodcast
@vineet_chopra @mahoneyr @JHospMedicine @UofT This cant be emphasized enough. A certain percentage can be curtailed by communicating a head up of time #JHMchat
Robert J. Mahoney, MD @mahoneyr
@vineet_chopra @JHospMedicine @UofT Plus when we survey nurses, the #1 source of dissatisfaction with physicians is "she/he is never around". Physician presence on the nursing station provides substantial benefits. #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @michellebr00ks: Most of the problems I've dealt with in my role as medical director for the housestaff units so far are solved by ensur…
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @vineet_chopra: @mahoneyr @JHospMedicine @UofT We are testing out a quiet space concept (mobile screen/pod) with #mindfulness and a #dxc
Vinny Arora MD MAPP @FutureDocs
RT @vineet_chopra: @mahoneyr @JHospMedicine @UofT My advice: find a quiet place to write notes (maybe even after clinical work ends). One r…
Vinny Arora MD MAPP @FutureDocs
RT @sanjaysaint: T3 #JHMChat - @vineet_chopra is testing out a #mindfulness-based intervention on hospitalists as part of an #AHRQ-funded s…
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @benjikmathews: @JHospMedicine Provider-nurse rounding is key! At least a brief check-in, a systematic checklist even better. Partner wi…
Sonya Tang Girdwood @STangGirdwood
@vineet_chopra @mahoneyr @JHospMedicine @UofT #JHMChat: I find that writing my note is when I am able to think most about my patient, and being able to do it in a quiet place is most helpful. But sometimes, I want to do it before clinical work ends, in case I make some sort of revelation that requires clinical action.
Vinny Arora MD MAPP @FutureDocs
RT @ChrisMoriates: Agreed! And if the nurses know you are going to round with them, they just might hold on to that page until the team arr…
Charlie M. Wray @WrayCharles
I love how there is an active lit search going on in the middle of #jhmchat. But the search is querying the authors of the study...@JHospMedicine
Vinny Arora MD MAPP @FutureDocs
RT @gracefarris: T2 copy paste existential ennui #JHMChat https://t.co/ZZoEdDqnzz
Grace Farris MD @gracefarris
@vineet_chopra @mahoneyr @JHospMedicine @UofT What do you mean by mindfulness here? A body scan? #JHMChat
Andrew Olson, MD @andrewolsonmd
@vineet_chopra @FutureDocs @mahoneyr @JHospMedicine @UofT I’m curious how we may able to reimagine notes in the modern era. Since everything is available in the EMR, what more needs to go in there that are examination and our thinking? #JHMchat
Sri Lekha Tummalapalli, MD, MBA @LTummalapalli
Pages are all “push” notifications regardless of urgency. Maybe there could be a repository for nonurgent requests like pended orders in the EHR. #JHMChat
Robert J. Mahoney, MD @mahoneyr
@Midwest_MedPeds @JHospMedicine Clearly there is an experience factor, too. Experienced nurses can likely prioritize more effectively than less experienced nurses. #JHMChat
Vineet Chopra @vineet_chopra
@mahoneyr @JHospMedicine @UofT The other component here is #regionalization of care. In our #Obs unit, pages hardly ever used. Nurses and providers share space and share respect of #cognitive process. Not so on #wards. #JHMChat
J Hospital Medicine @JHospMedicine
we are getting very meta tonight on #JHMChat - reminds me of our last #JHMChat on #JHMChat :)
J Hospital Medicine @JHospMedicine
RT @vineet_chopra: @mahoneyr @JHospMedicine @UofT We are testing out a quiet space concept (mobile screen/pod) with #mindfulness and a #dxc
Vineet Chopra @vineet_chopra
@STangGirdwood @mahoneyr @JHospMedicine @UofT Residents told us that what they missed the most about internship paradoxically was writing notes. A way to stop, pause. Synthesize and think. On each patient. Every day. #JHMChat
J Hospital Medicine @JHospMedicine
RT @benjikmathews: @JHospMedicine Provider-nurse rounding is key! At least a brief check-in, a systematic checklist even better. Partner wi…
J Hospital Medicine @JHospMedicine
RT @gracefarris: T3 ok sounds like they are true impediments #JHMChat https://t.co/nmZv9LjpyC
M_LaguioVila @M_LaguioVila
RT @WrayCharles: IMO, this is a major problem with #meded. Need to create the safe space to be wrong. If not, we impede the diagnostic proc…
J Hospital Medicine @JHospMedicine
T4 #JHMChat Time pressures were a major barrier to diagnosis. Residents described choosing between skipping conference “learning” and having time to think about their case to diagnose. How can we reconcile this tension to create time to think? https://t.co/fjfbg6KczS
Vineet Chopra @vineet_chopra
@gracefarris @mahoneyr @JHospMedicine @UofT Nope. A brief pause and a guided breathing exercise using an app and a biofeedback tool! #JHMchat
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @vineet_chopra: @STangGirdwood @mahoneyr @JHospMedicine @UofT Residents told us that what they missed the most about internship paradoxi…
Vinny Arora MD MAPP @FutureDocs
RT @andrewolsonmd: @vineet_chopra @FutureDocs @mahoneyr @JHospMedicine @UofT I’m curious how we may able to reimagine notes in the modern e…
Tᴇᴊᴀs Dᴇsᴀɪ, MD 🇺🇸 @nephondemand
@LTummalapalli Agree. Text-paging software engineers can include a system for the person making the page to designate the message urgency. New pager hardware could color code the urgency...but the pager itself is an antiquated piece of hardware so not sure such upgrades would happen #JHMChat
Robert J. Mahoney, MD @mahoneyr
@vineet_chopra @JHospMedicine @UofT This has to be true. When I am on the unit, people can tell if I'm on the phone, or in a patient room, or embroiled in a complex conversation, and they don't interrupt unless it's important. If they see me staring into space, they know the timing might be better. #JHMChat
Chris Moriates, MD @ChrisMoriates
Seems being present is important on many levels. Medicine is not a video game! (Then again, I see tension between wanting to find a quiet place to write notes/think, and working on the wards). #JHMChat
Michelle Brooks, MD, FACP, FHM @michellebr00ks
@freckledpedidoc @STangGirdwood I am an early adopter! I've been doing it this way for about 3-4 years now and convincing other attendings to do this too! #JHMChat https://t.co/Wlnwa9yry0
Society of Hospital Medicine @SHMLive
Last topic for tonight! #JHMChat
J Hospital Medicine @JHospMedicine
RT @vineet_chopra: @STangGirdwood @mahoneyr @JHospMedicine @UofT Residents told us that what they missed the most about internship paradoxi…
Vinny Arora MD MAPP @FutureDocs
RT @SHMLive: Last topic for tonight! #JHMChat https://t.co/JX4JywyLzx
Charlie M. Wray @WrayCharles
As John Melencamp once said "It hurts so good..." #jhmchat
Sanjay Saint @sanjaysaint
T4 #JHMChat: One approach is to create time to think during work rounds (or attending rounds). A 1-minute ‘pause’ - for the ENTIRE team - when confronted with a diagnostic dilemma. No talking allowed during this pause. 🤫 #DiagnosticTimeOut
Vinny Arora MD MAPP @FutureDocs
This is a major finding #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: we are getting very meta tonight on #JHMChat - reminds me of our last #JHMChat on #JHMChat :) https://t.co/iWmvPzmfzX
Vineet Chopra @vineet_chopra
@JHospMedicine This finding made me sad, but was fairly consistent across our observations. #Dx for MDs is akin to surgeons operating in the OR. No one interrupts surgeons when they are scrubbed into cases. So why don’t we have a dedicated time slot for #dx? #scrubbing in for #dx? #JHMchat
Vineet Chopra @vineet_chopra
@nephondemand @LTummalapalli We have this. Few use it. Everyone thinks their message is urgent. #JHMChat
Robert J. Mahoney, MD @mahoneyr
@ChrisMoriates Part of it is that when you spend time with people, they get to know how you work, and they naturally try to integrate with your workflow. Just like how we don't stop nurses when we see that they're carrying 30 pounds of linens or lifting a patient. #JHMChat
Vinny Arora MD MAPP @FutureDocs
I wrote my questions for #jhmchat this weekend but seeing the tweets fly by realizing how critical the built environment is to facilitate diagnosis #JHMChat
Vineet Chopra @vineet_chopra
RT @FutureDocs: This is a major finding #JHMChat https://t.co/Dx4hjpcuBC
Chris Childers, MD @cchildersmd
RT @vineet_chopra: @STangGirdwood @mahoneyr @JHospMedicine @UofT Residents told us that what they missed the most about internship paradoxi…
Anika Kumar, MD @freckledpedidoc
@vineet_chopra @mahoneyr @JHospMedicine @UofT I think it depends on the type of practice & culture of the hospital too. My Gen Peds nurses know that we do family centered rounds with nursing staff, so they only page my team if there are urgent Qs. #JHMchat
CORE IM @COREIMpodcast
T4. It take a lot of #teamwork to get this 'time to think': often the attending pitching in w/ some tasks or dividing the team up and rounding 1 intern at a time #JHMchat
Grace Farris MD @gracefarris
How I feel when we talk abt #Mindfulness in medicine #JHMChat https://t.co/3985qwwnkM
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @sanjaysaint: T4 #JHMChat: One approach is to create time to think during work rounds (or attending rounds). A 1-minute ‘pause’ - for th…
Charlie M. Wray @WrayCharles
Maybe its attendings' jobs not just to "get residents to noon conference on time", but on a deeper level... "give them time to think" #JHMChat @vineet_chopra @sanjaysaint
Grace Farris MD @gracefarris
RT @vineet_chopra: @gracefarris @mahoneyr @JHospMedicine @UofT Nope. A brief pause and a guided breathing exercise using an app and a biofe…
Vinny Arora MD MAPP @FutureDocs
RT @michellebr00ks: @FutureDocs Human factors engineering -- the more you have to scroll, the more likely you are to miss something! I cre…
Amy Pearson, MD @AmyPearsonMD
RT @vineet_chopra: @JHospMedicine This finding made me sad, but was fairly consistent across our observations. #Dx for MDs is akin to surge…
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @gracefarris: How I feel when we talk abt #Mindfulness in medicine #JHMChat https://t.co/3985qwwnkM
Sonya Tang Girdwood @STangGirdwood
@ChrisMoriates #JHMChat: When I was a chief resident, I told my residents on #hemeonc that if there was a patient that a nurse was concerned about, go assess them. And then just sit at the computer workstation outside the room, so you can be present on the floor but also get your work done.
J Hospital Medicine @JHospMedicine
RT @COREIMpodcast: T4. It take a lot of #teamwork to get this 'time to think': often the attending pitching in w/ some tasks or dividing th…
Ben Kinnear @Midwest_MedPeds
T4 #JHMChat "Every system is perfectly designed to get the results it gets". If our current system of rounding does not allow for thinking and diagnosis, we have to change the system. #Evolve #Givemybrainsomespace
J Hospital Medicine @JHospMedicine
RT @freckledpedidoc: @vineet_chopra @mahoneyr @JHospMedicine @UofT I think it depends on the type of practice & culture of the hospital too…
Sumant Ranji @sumantranji
@JHospMedicine This is why diagnostic error needs to be on hospital leadership's agenda. The value of time to think and make the right dx isn't recognized, because it isn't easily measurable. #JHMChat
Grace Farris MD @gracefarris
RT @FutureDocs: This is a major finding #JHMChat https://t.co/Dx4hjpcuBC
J Hospital Medicine @JHospMedicine
RT @mahoneyr: @ChrisMoriates Part of it is that when you spend time with people, they get to know how you work, and they naturally try to i…
Sonya Tang Girdwood @STangGirdwood
RT @vineet_chopra: @JHospMedicine This finding made me sad, but was fairly consistent across our observations. #Dx for MDs is akin to surge…
Grace Farris MD @gracefarris
RT @FutureDocs: I wrote my questions for #jhmchat this weekend but seeing the tweets fly by realizing how critical the built environment i…
J Hospital Medicine @JHospMedicine
RT @sanjaysaint: T4 #JHMChat: One approach is to create time to think during work rounds (or attending rounds). A 1-minute ‘pause’ - for th…
Grace Farris MD @gracefarris
RT @COREIMpodcast: T4. It take a lot of #teamwork to get this 'time to think': often the attending pitching in w/ some tasks or dividing th…
J Hospital Medicine @JHospMedicine
RT @SHMLive: Last topic for tonight! #JHMChat https://t.co/JX4JywyLzx
Hardeep Singh MD @HardeepSinghMD
@vineet_chopra @JHospMedicine Good points. Two classic additional reads for making current/future EHRs work for accurate diagnosis #JHMchat https://t.co/X7rsei4LPX https://t.co/UeUKO3qAiW
Grace Farris MD @gracefarris
RT @WrayCharles: Maybe its attendings' jobs not just to "get residents to noon conference on time", but on a deeper level... "give them tim…
Grace Farris MD @gracefarris
RT @STangGirdwood: @ChrisMoriates #JHMChat: When I was a chief resident, I told my residents on #hemeonc that if there was a patient that a…
Robert J. Mahoney, MD @mahoneyr
@JHospMedicine T4 There is a learned component here - we must teach trainees to think - while they're talking to the patient - while they're waiting for the elevator - while they're in the elevator answering a call ("elevator thoughts") #JHMChat
CORE IM @COREIMpodcast
RT @gracefarris: How I feel when we talk abt #Mindfulness in medicine #JHMChat https://t.co/3985qwwnkM
J Hospital Medicine @JHospMedicine
RT @vineet_chopra: @mahoneyr @JHospMedicine @UofT The other component here is #regionalization of care. In our #Obs unit, pages hardly ever…
Chris Moriates, MD @ChrisMoriates
RT @sumantranji: @JHospMedicine This is why diagnostic error needs to be on hospital leadership's agenda. The value of time to think and ma…
Vineet Chopra @vineet_chopra
@sumantranji @JHospMedicine As well, defining the right dx is key. What is right? One that doesn’t bring a patient back? Or one where another physician concurs? Or when where no (obvious) harm happens? Moving pieces in a moving target on a moving train. #JHMChat
Sanjay Saint @sanjaysaint
T4 #JHMChat: Another approach (more resource intensive) is hiring care coordinators (like we have at @VAAnnArbor & overseen by @nate_houchens) to offload administrative tasks - eg, bird dogging MRIs, ensuring f/u appointments - so residents have time to read & think.
Anika Kumar, MD @freckledpedidoc
@vineet_chopra @STangGirdwood @mahoneyr @JHospMedicine @UofT This is why I insist on including my own medical decision making when I co-sign notes! It gives me an extra 2-3 min to think about the patient & check my biases and reevaluate my own differential/plan. #JHMchat
Vinny Arora MD MAPP @FutureDocs
RT @michellebr00ks: T3 - anecdotally, inviting the nurse to bedside rounds with the team and the patient helps to decrease the pages post-r…
Chris Moriates, MD @ChrisMoriates
#jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @sanjaysaint: T4 #JHMChat: Another approach (more resource intensive) is hiring care coordinators (like we have at @VAAnnArbor & oversee…
Ajoy Kumar, MD, FAAFP @ajoykumarmd
@mahoneyr @vineet_chopra @JHospMedicine @UofT Ok, it does to a point, however what is going on that you need to have a physician standing at the ready at all times? I think nursing leadership and education has a role in beefing up their critical thinking and management skills. #JHMChat
Grace Farris MD @gracefarris
RT @sanjaysaint: T4 #JHMChat: Another approach (more resource intensive) is hiring care coordinators (like we have at @VAAnnArbor & oversee…
Anika Kumar, MD @freckledpedidoc
RT @vineet_chopra: @STangGirdwood @mahoneyr @JHospMedicine @UofT Residents told us that what they missed the most about internship paradoxi…
Sonya Tang Girdwood @STangGirdwood
@JHospMedicine #JHMChat: Perhaps conferences (like morning reports) should be dedicated to the diagnostic dilemmas that come in overnight, so they don't have to choose. We've tried that, but residents often presented patients that came in several nights/weeks ago.
Benji Mathews @benjikmathews
@JHospMedicine Learners are constantly tasked to do more, early discharges. Systems level changes should also be in play. Ex: census caps & consideration of unit/floor based admissions - both can help with more efficient communication, decrease tension to allow for more time to think. #jhmchat
Vinny Arora MD MAPP @FutureDocs
@sanjaysaint @VAAnnArbor @nate_houchens We added a medical librarian to a team to promote time for clinical reasoning and promoting asking questions! #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @mahoneyr: @JHospMedicine T4 There is a learned component here - we must teach trainees to think - while they're talking to the patient…
Vineet Chopra @vineet_chopra
@freckledpedidoc @STangGirdwood @mahoneyr @JHospMedicine @UofT I find addending notes with my own daily summary helps. Putting pen to paper (metaphorically) focuses the mind. #JHMChat
Sonya Tang Girdwood @STangGirdwood
RT @sanjaysaint: T4 #JHMChat: One approach is to create time to think during work rounds (or attending rounds). A 1-minute ‘pause’ - for th…
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @FutureDocs: @sanjaysaint @VAAnnArbor @nate_houchens We added a medical librarian to a team to promote time for clinical reasoning and p…
Grace Farris MD @gracefarris
@sanjaysaint @VAAnnArbor @nate_houchens This is huge (& the opposite of the NYC culture where residents draw blood cultures and place IVs...) #JHMchat
J Hospital Medicine @JHospMedicine
Welcome to @HardeepSinghMD an expert in #dxerror and another author of the paper we are discussing on #JHMChat tonight !
Kristina Dzara, PhD, MMSc @kristinadzara
RT @JHospMedicine: Welcome to #JHMChat, I am your moderator @FutureDocs please introduce yourself.
Jose Silva @josesilvaf
RT @michellebr00ks: Most of the problems I've dealt with in my role as medical director for the housestaff units so far are solved by ensur…
Michelle Brooks, MD, FACP, FHM @michellebr00ks
RT @benjikmathews: @JHospMedicine Learners are constantly tasked to do more, early discharges. Systems level changes should also be in play…
CORE IM @COREIMpodcast
Love the idea of #elevatorthoughts! Some of our best ideas for podcasts have come from elevator thoughts ! #JHMChat But I think this is what trainees find taxing too; they have to constantly be "on."
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @sanjaysaint: T4 #JHMChat: Another approach (more resource intensive) is hiring care coordinators (like we have at @VAAnnArbor & oversee…
Tᴇᴊᴀs Dᴇsᴀɪ, MD 🇺🇸 @nephondemand
@vineet_chopra @LTummalapalli can u show us screen shots of the web interface? is it mandatory to select an urgency level before sending the page? This would be a good study to correlate the user's sense of urgency with the receiver's assessment of urgency. #JHMchat
J Hospital Medicine @JHospMedicine
CT #JHMChat Please add closing thoughts on Focused Ethnography of Diagnosis in Academic Medical Centers https://t.co/FhHUZKtDsu
Charlie M. Wray @WrayCharles
RT @COREIMpodcast: Love the idea of #elevatorthoughts! Some of our best ideas for podcasts have come from elevator thoughts ! #JHMChat But…
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Welcome to @HardeepSinghMD an expert in #dxerror and another author of the paper we are discussing on #JHMChat tonight !…
Robert J. Mahoney, MD @mahoneyr
@ajoykumarmd @vineet_chopra @JHospMedicine @UofT Not as much about standing ready - but I answer questions about my patients that I likely would have otherwise, as well as providing broader education. And, for the most part, the nursing staff know when it's a good time for "broader education", and when it isn't. #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @benjikmathews: @JHospMedicine Learners are constantly tasked to do more, early discharges. Systems level changes should also be in play…
Vinny Arora MD MAPP @FutureDocs
RT @sumantranji: @JHospMedicine This is why diagnostic error needs to be on hospital leadership's agenda. The value of time to think and ma…
Amy Pearson, MD @AmyPearsonMD
@JHospMedicine T4- Reduce all non-physician-level tasks: cut down on # of clicks, hire scribes, automate protocols (PCA, K+, DKA), delegate paperwork, schedule breaks, standardize attending practice patterns. #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @WrayCharles: Maybe its attendings' jobs not just to "get residents to noon conference on time", but on a deeper level... "give them tim…
Vinny Arora MD MAPP @FutureDocs
RT @gracefarris: How I feel when we talk abt #Mindfulness in medicine #JHMChat https://t.co/3985qwwnkM
Chris Moriates, MD @ChrisMoriates
I am interested in the "scheduled diagnostic time-outs" mentioned in the article -- how does that actually work? Has anybody else tried this? #JHMChat
Sanjay Saint @sanjaysaint
Even as we try to improve our diagnostic skills/processes let’s not forget Osler’s (paraphrased) warning: Error is inevitable in a field premised on the art of balancing probabilities. #JHMChat @AHRQNews @FutureDocs
Robert J. Mahoney, MD @mahoneyr
@FutureDocs @sanjaysaint @VAAnnArbor @nate_houchens We've done the same. It teaches folks to think beyond UTDOL and to formulate questions that are answered by the literature. #JHMChat
Vinny Arora MD MAPP @FutureDocs
@freckledpedidoc @vineet_chopra @mahoneyr @JHospMedicine @UofT I feel like Peds has it together on rounding #jhmchat
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @sanjaysaint: Even as we try to improve our diagnostic skills/processes let’s not forget Osler’s (paraphrased) warning: Error is inevit…
Alfredo Soní D. @asonidllnn
RT @WrayCharles: Maybe its attendings' jobs not just to "get residents to noon conference on time", but on a deeper level... "give them tim…
Vinny Arora MD MAPP @FutureDocs
RT @sanjaysaint: Even as we try to improve our diagnostic skills/processes let’s not forget Osler’s (paraphrased) warning: Error is inevit…
Charlie M. Wray @WrayCharles
What a great discussion! Lots of appreciation to @vineet_chopra & @sanjaysaint and everyone who contributed to the conversation. Final shout out to @FutureDocs for the insightful questions and guidance #JHMChat
Robert J. Mahoney, MD @mahoneyr
@COREIMpodcast The need to be "on" is hard to avoid - and is part of the reason that "off" is "off". #JHMChat
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @WrayCharles: What a great discussion! Lots of appreciation to @vineet_chopra & @sanjaysaint and everyone who contributed to the convers…
Anika Kumar, MD @freckledpedidoc
@JHospMedicine T4. Then we are failing our learners if we are making them choose and letting them believe patient-care isn’t learning. Developing a DDx & a plan is learning. In fact it’s probably more active learning than sitting in a didactic session #JHMchat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: CT #JHMChat Please add closing thoughts on Focused Ethnography of Diagnosis in Academic Medical Centers https://t.co/Fh…
Vineet Chopra @vineet_chopra
@ChrisMoriates We are piloting this now with #Hospitalist faculty. We have a cool #dxchecklist to help facilitate. Stay tuned! #JHMchat
Vineet Chopra @vineet_chopra
RT @WrayCharles: What a great discussion! Lots of appreciation to @vineet_chopra & @sanjaysaint and everyone who contributed to the convers…
Society of Hospital Medicine @SHMLive
#JHMChat
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @vineet_chopra: @ChrisMoriates We are piloting this now with #Hospitalist faculty. We have a cool #dxchecklist to help facilitate. Stay…
Grace Farris MD @gracefarris
RT @WrayCharles: What a great discussion! Lots of appreciation to @vineet_chopra & @sanjaysaint and everyone who contributed to the convers…
J Hospital Medicine @JHospMedicine
RT @WrayCharles: What a great discussion! Lots of appreciation to @vineet_chopra & @sanjaysaint and everyone who contributed to the convers…
Michelle Brooks, MD, FACP, FHM @michellebr00ks
@ChrisMoriates Is it a "what else could this be?" time out? I do that with my team. I make us all come up with a possible diagnosis. Usually have 7-10 people on the team, so 7-10 more potential differentials. They can use Isabel or other tools. #JHMChat
Laurel Fick, MD, FACP @laurelfick
RT @FutureDocs: @sanjaysaint @VAAnnArbor @nate_houchens We added a medical librarian to a team to promote time for clinical reasoning and p…
J Hospital Medicine @JHospMedicine
RT @freckledpedidoc: @JHospMedicine T4. Then we are failing our learners if we are making them choose and letting them believe patient-care…
Carlos Oronce @cioronce
RT @ChrisMoriates: We usually bedside round, but when we have a diagnostic dilemma (or interesting case), I like to gather in room w a whit…
Vineet Chopra @vineet_chopra
@SHMLive #JHMchat https://t.co/vUN6rQaF3S
J Hospital Medicine @JHospMedicine
Thank you to our partners @SHMLive @CostsofCare and @ABIMFoundation for supporting #JHMChat!
J Hospital Medicine @JHospMedicine
Special thanks to our authors for their expertise on diagnosis in teaching hospitals #JHMChat @sanjaysaint @vineet_chopra
J Hospital Medicine @JHospMedicine
Dont forget to claim your #CME here after #JHMChat https://t.co/zvbxrFCXY6
J Hospital Medicine @JHospMedicine
RT @michellebr00ks: @ChrisMoriates Is it a "what else could this be?" time out? I do that with my team. I make us all come up with a poss…
Ben Kinnear @Midwest_MedPeds
@FutureDocs @freckledpedidoc @vineet_chopra @mahoneyr @JHospMedicine @UofT @cincyim has changed our IM side to FCR. Made us #MedPeds feel right at home #JHMchat
Hardeep Singh MD @HardeepSinghMD
@JHospMedicine Great conversations on diagnostic accuracy #JHMChat Here's a quick summary of tips to reduce diagnostic error in hospital medicine in a Table https://t.co/chdDTEk4LR
J Hospital Medicine @JHospMedicine
RT @COREIMpodcast: Love the idea of #elevatorthoughts! Some of our best ideas for podcasts have come from elevator thoughts ! #JHMChat But…
J Hospital Medicine @JHospMedicine
RT @benjikmathews: @JHospMedicine Learners are constantly tasked to do more, early discharges. Systems level changes should also be in play…
Michelle Brooks, MD, FACP, FHM @michellebr00ks
Heading to see another admission, but it was great to participate! Hope to see you next month! #jhmchat https://t.co/djcEn89gd3
J Hospital Medicine @JHospMedicine
RT @vineet_chopra: @sumantranji @JHospMedicine As well, defining the right dx is key. What is right? One that doesn’t bring a patient back?…
J Hospital Medicine @JHospMedicine
RT @HardeepSinghMD: @JHospMedicine Great conversations on diagnostic accuracy #JHMChat Here's a quick summary of tips to reduce diagnostic…
Vineet Chopra @vineet_chopra
@michellebr00ks @ChrisMoriates Part “brainstorming” but also part process. Have you personally examined #EKG? #Images? If you have question - ask! #JHMchat
Robert J. Mahoney, MD @mahoneyr
@JHospMedicine T4 Some of my best diagnoses I made while taking a shower before work. Maybe that's just me. #JHMChat
Tᴇᴊᴀs Dᴇsᴀɪ, MD 🇺🇸 @nephondemand
@vineet_chopra @LTummalapalli this is really interesting. thanks for sharing the screenshot...i'm glad the urgency selection is mandatory and defaults to "routine". Are there any clinical units that are more accurate in their urgency assessments than others? #JHMchat
Anika Kumar, MD @freckledpedidoc
CT would love to see this replicated with other inpatient teams (Peds, Family Medicine, General Surgery) or different hospital systems (different inpatient cultures) #JHMChat
Hardeep Singh MD @HardeepSinghMD
RT @sanjaysaint: T4 #JHMChat: Another approach (more resource intensive) is hiring care coordinators (like we have at @VAAnnArbor & oversee…
Sonya Tang Girdwood @STangGirdwood
RT @vineet_chopra: @sumantranji @JHospMedicine As well, defining the right dx is key. What is right? One that doesn’t bring a patient back?…
Rod Hayward @ProfHayward
RT @sanjaysaint: T3 #JHMChat - @vineet_chopra is testing out a #mindfulness-based intervention on hospitalists as part of an #AHRQ-funded s…
Vinny Arora MD MAPP @FutureDocs
RT @freckledpedidoc: CT would love to see this replicated with other inpatient teams (Peds, Family Medicine, General Surgery) or different…
CORE IM @COREIMpodcast
@ajoykumarmd Like a lot of things in medicine, it has its pros and cons. To give trainees some support and help them grow is imp too just as much as the harsh "real world" experience. #JHMchat
Vineet Chopra @vineet_chopra
@freckledpedidoc #JHMchat https://t.co/SX41gBWOSy
Vinny Arora MD MAPP @FutureDocs
RT @michellebr00ks: Heading to see another admission, but it was great to participate! Hope to see you next month! #jhmchat https://t.co/d…
Benji Mathews @benjikmathews
@JHospMedicine Interesting ER study that suggested diagnostic accuracy was not affected by interruptions or time pressure but was related to experience level - https://t.co/Vdv4bqgj7f @vineet_chopra, @HardeepSinghMD thoughts on if this would be true in hospital medicine? #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Dont forget to claim your #CME here after #JHMChat https://t.co/zvbxrFCXY6
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Special thanks to our authors for their expertise on diagnosis in teaching hospitals #JHMChat @sanjaysaint @vineet_chop
CORE IM @COREIMpodcast
RT @tony_breu: These conversations are important, but the authors note that hierarchy gets in the way of open dialogue #JHMChat https://t.c…
Society of Hospital Medicine @SHMLive
Awesome chat tonight #JHMChat community. Stay tuned for details about the next #JHMChat, and remember to claim CME tonight before it closes at 12AM ET! https://t.co/ePby9YbmEN
sudarsan @sudarsanvk
RT @tony_breu: @ChrisMoriates When do you do this? After rounds are done? In the afternoon? I love the idea, but often find it difficult to…
Hardeep Singh MD @HardeepSinghMD
@WrayCharles Yes, humility absolutely essential in #meded and beyond #JHMChat
Benji Mathews @benjikmathews
RT @JHospMedicine: T4 #JHMChat Time pressures were a major barrier to diagnosis. Residents described choosing between skipping conference…
Vinny Arora MD MAPP @FutureDocs
RT @SHMLive: Awesome chat tonight #JHMChat community. Stay tuned for details about the next #JHMChat, and remember to claim CME tonight bef…
Vinny Arora MD MAPP @FutureDocs
So many pearls on diagnosis in one #JHMChat - i feel like i need to study the transcript. thank you! off to write notes (and think) now!
Patient Safety Enhancement Program (UMVA) @PSEPUMVA
RT @FutureDocs: So many pearls on diagnosis in one #JHMChat - i feel like i need to study the transcript. thank you! off to write notes (an…
J Hospital Medicine @JHospMedicine
RT @FutureDocs: So many pearls on diagnosis in one #JHMChat - i feel like i need to study the transcript. thank you! off to write notes (an…
J Hospital Medicine @JHospMedicine
RT @SHMLive: Awesome chat tonight #JHMChat community. Stay tuned for details about the next #JHMChat, and remember to claim CME tonight bef…
Rebecca Jaffe @RJmdphilly
Dang sorry I missed it tonight!!! Lame but I have a jack-in-the-box for a 3 year old and super mom status was just beyond me tonight. Looks like a great convo! Next time!!! #JHMChat
Jeffrey Braithwaite @JBraithwaite1
RT @HardeepSinghMD: @vineet_chopra @JHospMedicine Good points. Two classic additional reads for making current/future EHRs work for accurat…
Sonya Tang Girdwood @STangGirdwood
RT @vineet_chopra: @JHospMedicine 1/ keep problem list updated: 2/ avoid the copy and paste function (period - less is more on notes); 3/ e…
Dr. Heather Tubbs Cooley @htubbscooley_RN
@benjikmathews @JHospMedicine Time pressure creates interrelated challenges for physicians & nurses. What I’m appreciating more is just how common the causes, consequences, and possible solutions are. We should team up more to create workable solutions -strength in numbers & ideas. #jhmchat
J Hospital Medicine @JHospMedicine
RT @htubbscooley_RN: @benjikmathews @JHospMedicine Time pressure creates interrelated challenges for physicians & nurses. What I’m apprecia…
Shreya P. Trivedi MD @ShreyaTrivediMD
RT @benjikmathews: @WrayCharles @tony_breu Set the stage early Acknowledge all are prone to mistakes All journeying together in learning M…
Anika Kumar, MD @freckledpedidoc
Thanks @SHMLive @JHospMedicine @CostsofCare & @ABIMFoundation for a great #JHMChat! Also special thanks to our moderator @FutureDocs & lead author @vineet_chopra!
healing.ly @livehealingly
RT @sanjaysaint: T3 #JHMChat - @vineet_chopra is testing out a #mindfulness-based intervention on hospitalists as part of an #AHRQ-funded s…
Tammy @tammyluan
RT @HardeepSinghMD: @vineet_chopra @JHospMedicine Good points. Two classic additional reads for making current/future EHRs work for accurat…
J Hospital Medicine @JHospMedicine
@RJmdphilly no worries you can catch the #JHMChat transcript!
J Hospital Medicine @JHospMedicine
RT @freckledpedidoc: Thanks @SHMLive @JHospMedicine @CostsofCare & @ABIMFoundation for a great #JHMChat! Also special thanks to our moder…
Vineet Chopra @vineet_chopra
Always great to be on #JHMChat
Robert J. Mahoney, MD @mahoneyr
Thanks @JHospMedicine and @vineet_chopra for an engaging #JHMChat tonight! See you next time
Doctivist @jbcowartmd
RT @sanjaysaint: T4 #JHMChat: One approach is to create time to think during work rounds (or attending rounds). A 1-minute ‘pause’ - for th…
Eric Holmboe @boedudley
RT @andrewolsonmd: @sanjaysaint Hi all - just got kids to bed So I’m joining late as well. @sanjaysaint Nails it here. The more I think ab…
Eric Holmboe @boedudley
RT @Midwest_MedPeds: T4 #JHMChat "Every system is perfectly designed to get the results it gets". If our current system of rounding does n…
Anika Kumar, MD @freckledpedidoc
@vineet_chopra Wolverines + #JHMchat = great Monday evening #GoBlue
Eric Holmboe @boedudley
RT @HardeepSinghMD: @JHospMedicine Great conversations on diagnostic accuracy #JHMChat Here's a quick summary of tips to reduce diagnostic…
Akshay Sharma @AkshaySharmaMD
RT @vineet_chopra: @STangGirdwood @mahoneyr @JHospMedicine @UofT Residents told us that what they missed the most about internship paradoxi…
Scott Yen MD @scottsyenmd
RT @JHospMedicine: T4 #JHMChat Time pressures were a major barrier to diagnosis. Residents described choosing between skipping conference…
Mike Tchou @TchouMd
RT @WrayCharles: What a great discussion! Lots of appreciation to @vineet_chopra & @sanjaysaint and everyone who contributed to the convers…
Rita Hurd @rita_hurd
intern med friends, if you (like me) need a reminder that life gets better and we have teachers (attendings) out there who care about making our learning experience better, read the #JHMChat thread tonight
kathy kastner @KathyKastner
RT @sanjaysaint: T1 #JHMChat (sorry to be late-plane just landed). #Diagnosis is a social phenomenon rarely occurring in a vacuum. It is af…
The Experiential Dr @Experiential_Dr
RT @vineet_chopra: @JHospMedicine 1/ keep problem list updated: 2/ avoid the copy and paste function (period - less is more on notes); 3/ e…
The Experiential Dr @Experiential_Dr
RT @HardeepSinghMD: @vineet_chopra @JHospMedicine Good points. Two classic additional reads for making current/future EHRs work for accurat…
The Experiential Dr @Experiential_Dr
RT @Midwest_MedPeds: @vineet_chopra @JHospMedicine T2 #JHMChat So true. We need 1 - better tools to assess the quality of documentation an…
Carlos Oronce @cioronce
RT @vineet_chopra: @JHospMedicine This finding made me sad, but was fairly consistent across our observations. #Dx for MDs is akin to surge…
Ji Baang @jbaang
A lot of medicine is a guessing game based on the data at hand. I like to ask my learners “What is your guess? I don’t know the answer my guess is A. What is yours?”. This has helped me in creating safe spaces for our learners #meded #jhmchat
The Experiential Dr @Experiential_Dr
RT @JHospMedicine: T4 #JHMChat Time pressures were a major barrier to diagnosis. Residents described choosing between skipping conference…
The Experiential Dr @Experiential_Dr
RT @vineet_chopra: @JHospMedicine This finding made me sad, but was fairly consistent across our observations. #Dx for MDs is akin to surge…
Ji Baang @jbaang
Maybe I am old school but having a master teacher and sick patients have always been the best learning experience for me. I think the system is depriving our residents of this experience by focusing on efficiency and administrative tasks a little bit too much #jhmchat #MedEd
kirk murphy @kirkmurphy
Burn electronic medical records time sink, try every #HealthIT exec profiting from this scam that sacrifices 50% of all primary care MD face-to-face time with patients for #EMR profits, and put @ASlavitt on trial for accessory to murder the pts who perished from his con. #jhmchat
kirk murphy @kirkmurphy
@JHospMedicine Burn electronic medical records time sink, try every #HealthIT exec profiting from this scam that sacrifices 50% of all primary care MD face-to-face time with patients for #EMR profits, and put @ASlavitt on trial for accessory to murder the pts who perished from his con. #jhmchat
MedEdBot @MedEdBot
RT @jbaang: A lot of medicine is a guessing game based on the data at hand. I like to ask my learners “What is your guess? I don’t know the…
MedEdBot @MedEdBot
RT @jbaang: Maybe I am old school but having a master teacher and sick patients have always been the best learning experience for me. I thi…
The Curbsiders @thecurbsiders
Catching up on the conversation from #JHMchat tonight-- and getting excited to release our upcoming #ClinicalReasoning episodes with @human_dx!
Danica Kindrachuk @DrDanica
RT @medrants: I would argue that ideal rounds overlap with informal discussions. Minimize the hierarchy of rounds, as an attending invite…
Avital O'Glasser, MD FACP FHM @aoglasser
@RJmdphilly Not lame not lame! I missed tonight, too—just finished 14 days straight and really didn’t want to miss dinner time with the family. The joy of asynchronous catch up on #medtwitter #JHMchat!
John McPherson MD @johnmcph
RT @medrants: I would argue that ideal rounds overlap with informal discussions. Minimize the hierarchy of rounds, as an attending invite…
Ji Baang @jbaang
RT @gracefarris: Sometimesformal rounds seem too formal... #JHMChat https://t.co/9TFWpc80n0
Mary Dixon-Woods @MaryDixonWoods
RT @sanjaysaint: Even as we try to improve our diagnostic skills/processes let’s not forget Osler’s (paraphrased) warning: Error is inevit…
mbc @mbcrumb
RT @sanjaysaint: Even as we try to improve our diagnostic skills/processes let’s not forget Osler’s (paraphrased) warning: Error is inevit…
Henry Ajzenberg @ajz_henry
RT @WrayCharles: IMO, this is a major problem with #meded. Need to create the safe space to be wrong. If not, we impede the diagnostic proc…
L. Chun @LINDCHUN
RT @sanjaysaint: Even as we try to improve our diagnostic skills/processes let’s not forget Osler’s (paraphrased) warning: Error is inevit…
Kapil Dev Soni @kdsoni111
RT @sanjaysaint: Even as we try to improve our diagnostic skills/processes let’s not forget Osler’s (paraphrased) warning: Error is inevit…
Noodlegirl @NoodleGirl2010
RT @STangGirdwood: @JHospMedicine T1, #JHMChat: I never appreciated the value of informal conversation when it came to diagnoses until I wa…
Samir S. Shah @SamirShahMD
RT @WrayCharles: What a great discussion! Lots of appreciation to @vineet_chopra & @sanjaysaint and everyone who contributed to the convers…
Pablo Moreno Franco @pmorenofranco
RT @michellebr00ks: @FutureDocs Human factors engineering -- the more you have to scroll, the more likely you are to miss something! I cre…
Lonika Sood, MD, MHPE @sood_lonika
Hey #JHMChat ... for some reason this chat never showed up on days leading to it!!!
Marjorie Stiegler, MD ☤ @DrMStiegler
@JHospMedicine T4 Time pressure and cognitive overload are well-established threats to #ptsafety via #dxerror. #hcldr #meded must protect time, encourage asking 'could this be something else?' no matter how classic or 'obvious' - for trainees AND faculty #JHMChat @MarkGraber
Tom Varghese Jr. MD @TomVargheseJr
RT @WrayCharles: IMO, this is a major problem with #meded. Need to create the safe space to be wrong. If not, we impede the diagnostic proc…
U-M IHPI @UM_IHPI
If you missed this, just check out tweets that include #JHMChat from last night!
Pub Health Monitor @monitor_PH
RT @UM_IHPI: If you missed this, just check out tweets that include #JHMChat from last night! https://t.co/jVZkDM32M5
Mansoor @ManKhalid7
RT @ChrisMoriates: This question is feeling a little meta to me right now as all of the tweets and notifications are constantly popping up…
#jhmchat content from Twitter.