#jhmchat Transcript
Healthcare social media transcript of the #jhmchat hashtag.
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See #jhmchat Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | 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 |
 | Journal of 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 |
 | Tony Breu @tony_breu RT @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 |
 | Lakshman Swamy (he/him) @laxswamy RT @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 |
 | Internships from FCA @FCA_Internships RT @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 |
 | Society of Hospital Medicine @SocietyHospMed RT @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 |
 | High Value Alliance @hvpaa RT @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 |
 | Vinny Arora MD MAPP @FutureDocs RT @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 |
 | Vineet Chopra @vineet_chopra RT @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 |
 | Charlie M. Wray, DO, MS @WrayCharles RT @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 |
 | 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, MD @RyanGamlin RT @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 |
| Society of Hospital Medicine @SocietyHospMed @JHospMedicine - get ready, #JHMChat is tonight! Don't forget to claim #CME following the chat: https://t.co/tSW45uEXdW https://t.co/sMItUwIjIW |
 | Society to Improve Diagnosis in Medicine @ImproveDX RT @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 |
| Journal of Hospital Medicine @JHospMedicine RT @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 |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: @JHospMedicine - get ready, #JHMChat is tonight! Don't forget to claim #CME following the chat: @JHospMedicine - get ready, #JHMChat is tonight! Don't forget to claim #CME following the chat: https://t.co/tSW45uEXdW https://t.co/sMItUwIjIW |
| Society of Hospital Medicine @SocietyHospMed Only 2 hours away #JHMChat community! |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: Only 2 hours away #JHMChat community! |
| Vinny Arora MD MAPP @FutureDocs RT @SHMLive: Only 2 hours away #JHMChat community! |
| Journal of Hospital Medicine @JHospMedicine RT @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 |
| Journal of Hospital Medicine @JHospMedicine RT @PSEPUMVA: Tonight at 9pm eastern! #JHMChat #MedEd Come chat about diagnosis! https://t.co/q0fMQ79W2k https://t.co/NKzaVzrBxN |
| Journal of Hospital Medicine @JHospMedicine RT @DrSinhaEsq: #JHMChat is a great journal club; you get #CME, too! cc: #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 tonight at 9PM EST on the diagnostic process w/@vineet_chopra & @sanjaysaint. https://t.co/FhHUZKLek2 https://t.co/8xw2dnJx4i |
| Journal of 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! |
| Patient Safety Enhancement Program (UMVA) @PSEPUMVA RT @JHospMedicine: 1 hour until #JHMChat: 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 tonight at 9PM EST on the diagnostic process w/@vineet_chopra & @sanjaysaint. https://t.co/FhHUZKLek2 https://t.co/8xw2dnJx4i |
| 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 tonight at 9pm ET. #ptsafety #patientsafety #residents https://t.co/sOr9gwZJtE |
| 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 diagnoses on the wards and what barriers they face with author-experts @vineet_chopra @sanjaysaint https://t.co/wUcOxVHoKw https://t.co/4CSgA6v47d |
| 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 diagnoses on the wards and what barriers they face with author-experts @vineet_chopra @sanjaysaint https://t.co/wUcOxVHoKw https://t.co/4CSgA6v47d |
 | Dr. Neha Bhatnagar, MD 🌈✊🏿😷 @nbhatnagar_md RT @FutureDocs: Dear #meded #ptsafety communities, join us Monday for #JHMChat At 9pET for an illuminating look into how residents make diagnoses on the wards and what barriers they face with author-experts @vineet_chopra @sanjaysaint https://t.co/wUcOxVHoKw https://t.co/4CSgA6v47d |
| Journal of 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 |
| Journal of Hospital Medicine @JHospMedicine Welcome to #JHMChat, I am your moderator @FutureDocs please introduce yourself. |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Welcome to #JHMChat, I am your moderator @FutureDocs please introduce yourself. |
| Society of Hospital Medicine @SocietyHospMed 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 diagnosis https://t.co/w84xwIDjqw |
| Journal of Hospital Medicine @JHospMedicine @tony_breu welcome to one of our regulars! thank you for joining. #jhmchat |
 | Benji Mathews, MD MBA @MDbenji @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, DO, MS @WrayCharles Charlie Wray checking in from SF and looking forward to tonights discussion #JHMChat |
 | Michelle Brooks, MD @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 MD MACP medrants@med-mastodon.com @medrants Important topic - happy to participate #JHMChat |
| Journal of Hospital Medicine @JHospMedicine welcome to everyone and just a reminder to use #JHMChat to hashtag all your tweets! |
 | Anika Kumar, MD (she/her) @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 |
| Journal of Hospital Medicine @JHospMedicine @STangGirdwood @FutureDocs welcome to #JHMChat! |
| Tony Breu @tony_breu @gracefarris Don't you mean, Grace in @HuffPost? #JHMChat |
| Journal of 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 #ptsafety discussion on #JHMChat tonight! |
| Vineet Chopra @vineet_chopra RT @JHospMedicine: Welcome to #JHMChat, I am your moderator @FutureDocs please introduce yourself. |
| Journal of 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 (he/him) @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! |
| Journal of Hospital Medicine @JHospMedicine Multitasking on #jhmchat! welcome! |
| Vinny Arora MD MAPP @FutureDocs @tony_breu @gracefarris @HuffPost Our celebrity #jhmchat artist in the house! |
| 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 roles in diagnosis. What are some advantages and disadvantages to these strategies? https://t.co/LHA1IdqFO4 |
| Charlie M. Wray, DO, MS @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 @SocietyHospMed T1 is in! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: T1 is in! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @mahoneyr @FutureDocs welcome to a prior expert discussant to #JHMChat! |
| Robert Centor MD MACP medrants@med-mastodon.com @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 |
 | The Blonde Broker @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 |
| Vineet Chopra @vineet_chopra @JHospMedicine Informal environment, on the other hand, promotes asking questions without fear of retaliation or embarrassment #JHMChat |
 | Sonya Tang Girdwood 鄧 智佳, MD, PhD @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 |
| Journal of Hospital Medicine @JHospMedicine RT @vineet_chopra: @JHospMedicine Informal environment, on the other hand, promotes asking questions without fear of retaliation or embarrassment #JHMChat |
| Charlie M. Wray, DO, MS @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 |
| Journal of 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: @JHospMedicine Advantages to formal rounds: structure, pattern, ability to pose questions in a direct way. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @tony_breu: These conversations are important, but the authors note that hierarchy gets in the way of open dialogue #JHMChat |
| Patient Safety Enhancement Program (UMVA) @PSEPUMVA RT @vineet_chopra: @JHospMedicine Informal environment, on the other hand, promotes asking questions without fear of retaliation or embarrassment #JHMChat |
| Journal of Hospital Medicine @JHospMedicine great point @medrants and thanks for joining us tonight on #JHMChat! |
| Robert Centor MD MACP medrants@med-mastodon.com @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 @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, MD MBA @MDbenji @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 (she/her) @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. |
| Journal of 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, DO, MS @WrayCharles @tony_breu Are there ways to remove this hierarchy during this process...? #jhmchat Asking for a friend... |
| Journal of Hospital Medicine @JHospMedicine RT @michellebr00ks: T1 - disadvantage: 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 |
| Journal of 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 to say, “Hey, what do you think of this lab?” Fresh eyes, fresh perspective. Better #Dx #JHMChat |
| 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 |
| Journal of Hospital Medicine @JHospMedicine RT @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 |
| 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 to say, “Hey, what do you think of this lab?” Fresh eyes, fresh perspective. Better #Dx #JHMChat |
| Anika Kumar, MD (she/her) @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, DO, MS @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 |
| Michelle Brooks, MD @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, MD MBA @MDbenji RT @vineet_chopra: @JHospMedicine Advantages to formal rounds: @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 process... #jhmchat. |
| 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 @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 process... #jhmchat. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @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 |
| Journal of 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 (rhythm) of rounds - esp when learners of various stages present. #JHMChat |
| Tony Breu @tony_breu @vineet_chopra @STangGirdwood @JHospMedicine @laxswamy Being close to nursing is fantastic! #JHMChat |
| Robert Centor MD MACP medrants@med-mastodon.com @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 process... #jhmchat. |
| 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 |
| Journal of 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 process... #jhmchat. |
| Journal of Hospital Medicine @JHospMedicine RT @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, DO, MS @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 @SocietyHospMed 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 |
| Lakshman Swamy (he/him) @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 |
| Journal of Hospital Medicine @JHospMedicine RT @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 |
| 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 鄧 智佳, MD, PhD @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”. What are some tips on how to use the EMR to ensure accurate diagnosis? https://t.co/BaMHyAKhjI |
| 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. It’s my job to make sure that happens. Sets the right tone for the session. #JHMChat |
 | Cornelia Taylor @cornelia_taylor RT @vineet_chopra: @JHospMedicine 1/ keep problem list updated: @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 |
| Michelle Brooks, MD @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 proposed diagnoses. Stressing problem representation and illness scripts daily can help. #JHMChat |
| Anika Kumar, MD (she/her) @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 process... #jhmchat. |
 | 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 MD MACP medrants@med-mastodon.com @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 @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 |
| Journal of 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: @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 |
| 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 micromanagement leaves time for diagnosis. #JHMChat |
| Charlie M. Wray, DO, MS @WrayCharles RT @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 |
| Patient Safety Enhancement Program (UMVA) @PSEPUMVA RT @vineet_chopra: @JHospMedicine The other key issue: @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 |
| Anika Kumar, MD (she/her) @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 disjointed. The EMR doesn't facilitate the patient's story. #jhmchat |
| 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: @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 鄧 智佳, MD, PhD @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 (she/her) @freckledpedidoc RT @vineet_chopra: @JHospMedicine 1/ keep problem list updated: @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 |
| 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 |
| Robert Centor MD MACP medrants@med-mastodon.com @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 |
| 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 #gamechanger #JHMChat |
| 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, MD MBA @MDbenji @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, DO, MS @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 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 |
| 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 |
| 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 鄧 智佳, MD, PhD @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 |
| Journal of Hospital Medicine @JHospMedicine RT @STangGirdwood: @vineet_chopra @tony_breu @JHospMedicine #JHMChat: @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 |
 | 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 |
| Chris Moriates, MD @ChrisMoriates @vineet_chopra @umichmedicine You gotta pick and choose. Choose wisely, @vineet_chopra #JHMChat |
| Charlie M. Wray, DO, MS @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 鄧 智佳, MD, PhD @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. |
| 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 affected by #patients, family members, other physicians and healthcare workers. |
 | Nik Theyyunni @HeyDrNik RT @vineet_chopra: @JHospMedicine 1/ keep problem list updated: @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 |
| Michelle Brooks, MD @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: @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. |
| 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. |
| The Blonde Broker @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 |
| Vineet Chopra @vineet_chopra @mahoneyr @freckledpedidoc And can’t figure out a thing because all the note look the same. #JHMChat |
| Charlie M. Wray, DO, MS @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 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 @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 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 |
| 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 diagnosis. The first few days of hospitalization are critical. Putting a name on something can sometimes be harmful #JHMChat |
| 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 affected by #patients, family members, other physicians and healthcare workers. |
| Chris Moriates, MD @ChrisMoriates RT @STangGirdwood: @vineet_chopra @tony_breu @JHospMedicine #JHMChat: @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 |
| 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 diagnosis. The first few days of hospitalization are critical. Putting a name on something can sometimes be harmful #JHMChat |
 | 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 diagnosis. The first few days of hospitalization are critical. Putting a name on something can sometimes be harmful #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Better late than never welcome to @sanjaysaint author for article discussion in tonight's #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 |
| Journal of Hospital Medicine @JHospMedicine RT @sanjaysaint: T1 #JHMChat: Major advantage of having peers help with #diagnosis: 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. |
| Patient Safety Enhancement Program (UMVA) @PSEPUMVA RT @sanjaysaint: T1 #JHMChat: Major advantage of having peers help with #diagnosis: 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. |
| The Blonde Broker @gracefarris RT @WrayCharles: The Jeckyl & Hyde of modern #EMR from @gracefarris #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Better late than never welcome to @sanjaysaint author for article discussion in tonight's #JHMChat! |
| Benji Mathews, MD MBA @MDbenji @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, DO, MS @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 diagnosis. The first few days of hospitalization are critical. Putting a name on something can sometimes be harmful #JHMChat |
| Society of Hospital Medicine @SocietyHospMed Don't forget to claim CME following tonight's chat! #JHMChat https://t.co/nowiSYYU1F |
| Journal of 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 |
| Journal of Hospital Medicine @JHospMedicine @tony_breu @vineet_chopra @freckledpedidoc @gracefarris thanks for joining even for a bit for #JHMChat! |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @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 @michellebr00ks RT @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 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 diagnosis. The first few days of hospitalization are critical. Putting a name on something can sometimes be harmful #JHMChat |
| 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 (she/her) @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, DO, MS @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 MD MACP medrants@med-mastodon.com @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 |
 | José Silva Figueroa @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 diagnosis. The first few days of hospitalization are critical. Putting a name on something can sometimes be harmful #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 |
| 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 heaadphones on is not the solution. That just creates more social isolation! #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @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 |
| 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 @michellebr00ks T3 - anecdotally, inviting the nurse to bedside rounds with the team and the patient helps to decrease the pages post-rounds. #jhmchat |
| Charlie M. Wray, DO, MS @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 |
| 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 |
| Anika Kumar, MD (she/her) @freckledpedidoc RT @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 |
| 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 |
| 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: 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 |
| Michelle Brooks, MD @michellebr00ks RT @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 |
| 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 |
| 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 study that is aimed at reducing diagnostic #error #MindfulMoment |
| 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 study that is aimed at reducing diagnostic #error #MindfulMoment |
| Journal of Hospital Medicine @JHospMedicine RT @sanjaysaint: T3 #JHMChat: 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 |
| Journal of 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-rounds. #jhmchat |
| Michelle Brooks, MD @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 (she/her) @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 interruptions to promote diagnosis in the clinical setting?https://t.co/zT55tzyBFF |
| 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? |
| 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 |
| Journal of 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 and interrupting me as I am trying to think about what to say next on #JHMChat |
| Journal of 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 鄧 智佳, MD, PhD @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? |
| CORE IM @COREIMpodcast The struggle is real. #JHMchat |
| Journal of 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 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 |
| 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 |
| Journal of 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 heaadphones on is not the solution. That just creates more social isolation! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @freckledpedidoc: Everyone’s favorite topic: Everyone’s favorite topic: alarm/pager fatigue!! #jhmchat |
| Benji Mathews, MD MBA @MDbenji @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 |
| Charlie M. Wray, DO, MS @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) being "interrupting" THEM (usually nurses). Any literature on US interrupting THEM and the effects of that? |
| Michelle Brooks, MD @michellebr00ks RT @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 |
| 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 |
| Anika Kumar, MD (she/her) @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. Tell them you’ll be writing notes between 3-5p. Page emergency only. #JHMChat |
| 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 ensuring that team rounds WITH nursing at the patient's BEDSIDE (not hallway) occur on the majority of the patients. #jhmchat |
| 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 #dxchecklist to see if it can help eliminate distractions. Results will come next year. #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @vineet_chopra: @mahoneyr @JHospMedicine @UofT My advice: @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 |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @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. |
| Michelle Brooks, MD @michellebr00ks RT @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 @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 |
| 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 arrives! #JHMChat |
| Charlie M. Wray, DO, MS @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 |
| 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 |
| 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 |
| Journal of Hospital Medicine @JHospMedicine we are getting very meta tonight on #JHMChat - reminds me of our last #JHMChat on #JHMChat :) |
| 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 |
| Journal of Hospital Medicine @JHospMedicine RT @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 |
| Journal of Hospital Medicine @JHospMedicine RT @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 |
 | MaryroseASP @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 process... #jhmchat. |
| Journal of 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 paradoxically was writing notes. A way to stop, pause. Synthesize and think. On each patient. Every day. #JHMChat |
| 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 era. Since everything is available in the EMR, what more needs to go in there that are examination and our thinking? #JHMchat |
 | Tejas Desai, 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 @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 @SocietyHospMed Last topic for tonight! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @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 |
| Vinny Arora MD MAPP @FutureDocs RT @SHMLive: Last topic for tonight! #JHMChat |
| Charlie M. Wray, DO, MS @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 :) |
| 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 |
 | Chris Childers @cchildersmd RT @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 |
| Anika Kumar, MD (she/her) @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 |
| Patient Safety Enhancement Program (UMVA) @PSEPUMVA RT @sanjaysaint: T4 #JHMChat: 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 |
| Charlie M. Wray, DO, MS @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 |
| 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 created a pathology results page with the Cerner folks at our institution after a safety event like this. #JHMChat |
 | Amy Pearson, MD, FASA @AmyPearsonMD RT @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 |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @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. |
| Journal of Hospital Medicine @JHospMedicine RT @COREIMpodcast: T4. It take a lot of #teamwork to get this 'time to think': 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 |
| 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 |
| Journal of Hospital Medicine @JHospMedicine RT @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 |
 | 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 |
| Journal of 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 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 |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @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 |
| Journal of Hospital Medicine @JHospMedicine RT @sanjaysaint: T4 #JHMChat: 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 |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: Last topic for tonight! #JHMChat |
 | 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 |
| 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 |
| Journal of Hospital Medicine @JHospMedicine RT @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 |
| 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 make the right dx isn't recognized, because it isn't easily measurable. #JHMChat |
| 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 (she/her) @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-rounds. #jhmchat |
| Chris Moriates, MD @ChrisMoriates #jhmchat |
| Vinny Arora MD MAPP @FutureDocs RT @sanjaysaint: T4 #JHMChat: 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. |
 | Ajoy Kumar, MD, MBA, 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 |
| Anika Kumar, MD (she/her) @freckledpedidoc RT @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 |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @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, MD MBA @MDbenji @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 - while they're waiting for the elevator - while they're in the elevator answering a call ("elevator thoughts") #JHMChat |
| 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 鄧 智佳, MD, PhD @STangGirdwood RT @sanjaysaint: T4 #JHMChat: 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 |
| Michelle Brooks, MD @michellebr00ks RT @FutureDocs: @sanjaysaint @VAAnnArbor @nate_houchens We added a medical librarian to a team to promote time for clinical reasoning and promoting asking questions! #JHMChat |
| Journal of 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. |
| José Silva Figueroa @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 ensuring that team rounds WITH nursing at the patient's BEDSIDE (not hallway) occur on the majority of the patients. #jhmchat |
| Michelle Brooks, MD @michellebr00ks RT @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 |
| 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: 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. |
| Tejas Desai, 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 |
| Journal of 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, DO, MS @WrayCharles RT @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." |
| 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. 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 RT @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 |
| Amy Pearson, MD, FASA @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 time to think" #JHMChat @vineet_chopra @sanjaysaint |
| 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: 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 |
 | Dr. Fredo @asonidllnn RT @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 |
| 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: 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 |
| Charlie M. Wray, DO, MS @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 conversation. Final shout out to @FutureDocs for the insightful questions and guidance #JHMChat |
| Anika Kumar, MD (she/her) @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/FhHUZKtDsu |
| 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 conversation. Final shout out to @FutureDocs for the insightful questions and guidance #JHMChat |
| Society of Hospital Medicine @SocietyHospMed #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 tuned! #JHMchat |
| Michelle Brooks, MD @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 |
| Journal of Hospital Medicine @JHospMedicine RT @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 |
 | 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 promoting asking questions! #JHMChat |
| Journal of 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 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 |
 | Carlos Oronce, MD, PhD @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 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 |
| Vineet Chopra @vineet_chopra @SHMLive #JHMchat https://t.co/vUN6rQaF3S |
| Journal of Hospital Medicine @JHospMedicine Thank you to our partners @SHMLive @CostsofCare and @ABIMFoundation for supporting #JHMChat! |
| Journal of Hospital Medicine @JHospMedicine Special thanks to our authors for their expertise on diagnosis in teaching hospitals #JHMChat @sanjaysaint @vineet_chopra |
| Journal of Hospital Medicine @JHospMedicine Dont forget to claim your #CME here after #JHMChat https://t.co/zvbxrFCXY6 |
| Journal of 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 possible diagnosis. Usually have 7-10 people on the team, so 7-10 more potential differentials. They can use Isabel or other tools. #JHMChat |
| 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 |
| Journal of Hospital Medicine @JHospMedicine RT @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." |
| Journal of Hospital Medicine @JHospMedicine RT @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 |
| Michelle Brooks, MD @michellebr00ks Heading to see another admission, but it was great to participate! Hope to see you next month! #jhmchat https://t.co/djcEn89gd3 |
| Journal of 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? Or one where another physician concurs? Or when where no (obvious) harm happens? Moving pieces in a moving target on a moving train. #JHMChat |
| Vineet Chopra @vineet_chopra @michellebr00ks @ChrisMoriates Part “brainstorming” but also part process. Have you personally examined #EKG? #Images? If you have question - ask! #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @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 |
| 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 |
| Tejas Desai, 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 (she/her) @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: 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. |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @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? Or one where another physician concurs? Or when where no (obvious) harm happens? Moving pieces in a moving target on a moving train. #JHMChat |
 | Rod Hayward @ProfHayward RT @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 |
| 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 hospital systems (different inpatient cultures) #JHMChat |
| 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/djcEn89gd3 |
| Benji Mathews, MD MBA @MDbenji @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_chopra |
| CORE IM @COREIMpodcast RT @tony_breu: These conversations are important, but the authors note that hierarchy gets in the way of open dialogue #JHMChat |
| Society of Hospital Medicine @SocietyHospMed 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 fit these discussion in. #JHMChat |
| Hardeep Singh MD @HardeepSinghMD @WrayCharles Yes, humility absolutely essential in #meded and beyond #JHMChat |
| Benji Mathews, MD MBA @MDbenji RT @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 |
| 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 before it closes at 12AM ET! https://t.co/ePby9YbmEN |
| 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 (and think) now! |
| Journal of 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 (and think) now! |
| Journal of Hospital Medicine @JHospMedicine RT @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 |
 | Rebecca Jaffe, MD @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 accurate diagnosis #JHMchat https://t.co/X7rsei4LPX https://t.co/UeUKO3qAiW |
| Sonya Tang Girdwood 鄧 智佳, MD, PhD @STangGirdwood RT @vineet_chopra: @JHospMedicine 1/ keep problem list updated: @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 |
 | 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 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 |
| Anika Kumar, MD (she/her) @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 study that is aimed at reducing diagnostic #error #MindfulMoment |
 | Tammy Luan @tamtammster RT @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 |
| Journal of Hospital Medicine @JHospMedicine @RJmdphilly no worries you can catch the #JHMChat transcript! |
| Journal of Hospital Medicine @JHospMedicine RT @freckledpedidoc: Thanks @SHMLive @JHospMedicine @CostsofCare & @ABIMFoundation for a great #JHMChat! Also special thanks to our moderator @FutureDocs & lead author @vineet_chopra! |
| 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: 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 |
 | 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 about diagnosis, the more I think that the right paradigm to consider is social learning theory.#JHMChat |
| 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 not allow for thinking and diagnosis, we have to change the system. #Evolve #Givemybrainsomespace |
| Anika Kumar, MD (she/her) @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 error in hospital medicine in a Table https://t.co/chdDTEk4LR |
 | Akshay Sharma MD @akshaysharma.bsky.social @AkshaySharmaMD RT @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 |
 | Scott Yen MD @scottsyenmd RT @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 |
 | Mike Tchou @TchouMd RT @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 |
 | 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 affected by #patients, family members, other physicians and healthcare workers. |
| Carlos Oronce, MD, PhD @cioronce RT @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 |
 | Jihoon Baang MD FACP FIDSA @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 |
| Jihoon Baang MD FACP FIDSA @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 answer my guess is A. What is yours?”. This has helped me in creating safe spaces for our learners #meded #jhmchat |
| 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 think the system is depriving our residents of this experience by focusing on efficiency and administrative tasks a little bit too much #jhmchat #MedEd |
 | 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, MD FRCSC @DrDanica RT @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 |
 | Avital Y. O'Glasser, MD FACP SFHM DFPM (she/her) @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 @DrJohnMcP RT @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 |
 | Mary Dixon-Woods @MaryDixonWoods RT @sanjaysaint: Even as we try to improve our diagnostic skills/processes let’s not forget Osler’s (paraphrased) warning: 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 |
 | Matt Young @mbcrumb RT @sanjaysaint: Even as we try to improve our diagnostic skills/processes let’s not forget Osler’s (paraphrased) warning: 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 |
 | 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 process... #jhmchat. |
 | L. Chun @LINDCHUNMD RT @sanjaysaint: Even as we try to improve our diagnostic skills/processes let’s not forget Osler’s (paraphrased) warning: 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 |
 | Kapil Dev Soni @kdsoni111 RT @sanjaysaint: Even as we try to improve our diagnostic skills/processes let’s not forget Osler’s (paraphrased) warning: 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 |
 | Noodlegirl @NoodleGirl2010 RT @STangGirdwood: @JHospMedicine T1, #JHMChat: @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. |
| Samir S. Shah @SamirShahMD RT @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 |
 | 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 created a pathology results page with the Cerner folks at our institution after a safety event like this. #JHMChat |
 | Lonika Sood @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, MS, MBA, FACS 🇺🇸 @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 process... #jhmchat. |
| 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! |
 | 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 and interrupting me as I am trying to think about what to say next on #JHMChat |
#jhmchat content from Twitter.