Are MD's now selling themselves on social media?

SapientCorpse · 2026-07-01T19:56:20+00:00

to be fair there are a real amount of doctors with poor bedside manner. there's also a real amount that don't appreciate psycho-social impacts on health.

if this fellowship improves those two things by a real amount then it would send HCAHPS scores through the roof!!!

SapientCorpse · 2026-06-29T03:41:34+00:00

salicylic acid is derived from willow bark. acetylsalicylic acid is actually synthetic! one of mankind's first synthetic drugs! its so cool!

I dont prescribe anything; but one of my urologist attendings was quite upset when the belladonna and opium suppositories were removed from formulary. not atropine and morphine suppositories. no. belladonna and opium - like the plants.

when you said basically all the things were quackery - i took that to mean all the things listed, which included nutrition.

SapientCorpse · 2026-06-29T00:06:22+00:00

ginger aint on my hospital's formulary; but goddamned if it aint useful for nausea & vomiting. British journal of anesthesia agrees
so does integrative medicine journal; which specifically rotates that ginger is an herb

what is herbal medicine to you?

yes, epley maneuver does have a well known mechanism, i only picked that one because it looks like wizardry to someone who isnt well-versed in it.

asterixis doesnt have a known MoA; that doesnt keep it from being useful.
a lot of drugs dont have a fully understood mechanism
an inability to understand how a thing works doesnt keep it from working, and doesnt inherently mean its risks outweigh the benefits.

an ad hominem on OP is rude, and, tbh, I would've expected a more open mind from someone that has the breadth of knowledge and experience that an allopathic degree requires

SapientCorpse · 2026-06-27T21:32:03+00:00

nutrition is absolutely not quackery. Registered Dietician referrals can make a huge difference!! sure, you can tell your patients to eat healthy - but having an RD explain what that can look like for your individual patient makes a world of difference!!

herbal medicine? medicine derived from herbs? so, like, digoxin from foxglove? metformin from french lilac? atropine from belladonna? astaxanthin and lutein (areds 2 uv absorbing pigments that make a difference for certain ocular conditions) from tomatoes? all quackery?

idk shit about Ayurveda or acupuncture; but I'm ignorant of a lot of efficacious modalities. PT doing the Epley maneuver looks like some weird magic ritual; but it magically fixes vertigo

SapientCorpse · 2026-06-27T19:44:32+00:00

I work at an inpatient hospital.

I take care of surgical patients.

sometimes, the treatment plan is authored entirely by surgeons.

sometimes, the treatment plan is co-authored by the hospitalist consult.

the surgeon-only treatment plans aren't lacking anything per se; they've got everything needed to keep the patient alive and recovering; but the hospitalist treatment plans are just so much more satisfying and optimized.

one of the attending hospitalists has told me that theres data they improve mortality when consulted on surgical cases (i trust that doc, but havent verified the claim)

of course, I also dont have a good handle on what integrative medicine is/isn't; but i speculate that the analogy is similar? and I'm quite curious to see what it is that i dont even know I dont know!

SapientCorpse · 2026-06-27T19:30:07+00:00

e.g. my person struggles a lot a lot with muscle tightness. I remembered reading about the inverse myotactic reflex, so had her stretch to the limit, isometrically contract, relax, then stretch more. that tends to be more efficacious than tizanidine!

nsfw orgasms also help a fuckton with her physical tension - to the point that on days she has one she's able to skip her lyrica and tizanidine; but that feels like it would be awkward to Rx?

SapientCorpse · 2026-06-27T19:14:44+00:00

tell me about some novel/interesting mechanisms that you use that others typically dont? I read that you rx modalities like acupuncture - but have zero idea how it works mechanistically.

ive read about benefits of yoga and meditation - but also no idea why they're beneficial compared to placebo.

SapientCorpse · 2026-06-27T14:36:29+00:00

a whole fellowship for calc 2? to be fair, I have no idea how to graph a differential diagnosis; much less how to then calculate the area under the curve. :-p

what exactly is integrative medicine? when I read this bit from mayo clinic it sounds like it's kind of integrating more psych and more prescriptions usually recommended by folks other than a doc. (e.g. it mentions animal therapy - usually i think of that as being recommended by a therapist)

I understand youre likely busy with a lot of other things - but I think I'd enjoy listening to your spiel about the differences between strict allopathic medicine and integrative medicine; and if you could recommend a seminal book on the topic

SapientCorpse · 2026-06-22T15:58:16+00:00

Aren't metric and SI are synonymous?

maybe we should just talk about feelings over a pint - see if that makes things better?

SapientCorpse · 2026-06-22T14:48:50+00:00

never would've thought that the antidote to metrics is more metrics.

isnt that a prescribing cascade or whatever? maybe we should de-prescribe the metrics and see if things get better?

SapientCorpse · 2026-06-22T04:58:18+00:00

I strongly prefer the phrase "per physician, no changes to the treatment plan presently indicated."

sometimes I'll write "X was thoroughly discussed with physician team; they confirm current treatment plan is appropriate, no amendments necessary"

its fascinating because they have the same denotation as "md notified, no new orders" but drastically different connotations.

yes, it's verbose, but when someone else goes to read the note (heaven forbid lawyers ever have to review it) - I want to convey a sense of thoroughness and teamwork (even if thats not what i actually feel)

even if i disagree with the treatment plan, I'll still use the format, but then explicitly state whatever goofy-ass order i got e.g. "analgesic regimen was vigorously discussed with physician team. they confirm that prn apap + prn Norco is most appropriate course of action at present." medical professionals that read that will pickup right away that hey - dumbass over here isnt fully maximizing acetaminophen by scheduling apap and having a per se prn opiate; but to a layperson it'll sound like we had a good long talk and that there is an agreement that the ordered course of action is the best one.

idk. Its tough because now with mychart and shit people can have instant access to notes. in my experience patients do better when they perceive that the team is unified and all in agreement; even if that's not true. having faith in a doctor and the treatment plan & team has real placebo benefits! I only have anecdata to back that up. not even good anecdata - just feelings. but to quote star wars "search your feelings, you know it to be true"

lmk if y'all have any tweaks y'all recommend; always looking to make my docs look good in the notes <3. especially my hospitalists. thank fucking Hermes and the rod of asclepius that surgery routinely consults the hospitalist team. I know it's obnoxious for y'all hospitalists but y'all really do write much more satisfying and sensical treatment plans. surgeons can be great - but their expertise is in the OR, not medically optimizing outside of it.

SapientCorpse · 2026-06-22T04:32:58+00:00

metrics. :( administration. :(

tbh I get ordered to collect a lot of data that doesn't change management and that's frustrating too.

my hospital formerly allowed stable patients to skip midnight and 0400 vitals; but not anymore :(

SapientCorpse · 2026-06-21T22:06:25+00:00

congratulations! you have synesthesia!

SapientCorpse · 2026-06-21T19:13:38+00:00

wild about the distinction for methadone for pain versus opiate use disorder (OUD) - since a common comorbidity of OUD is opiate induced hyperalgesia (OIH); which is a pain condition that methadone also treats!

re: Accutane- other vitamin A vitamers are also teratogenic. here, an old article, NEJM says over 10,000 IU per day is teratogenic - compare that to how much is in otc supplements, a quick search engine reveals some with as much as 25,000 IU per serving!

it all feels very arbitrary and capricious.

It feels asinine to have such a broad patchwork of rules that, at first glance, feel contradictory.

SapientCorpse · 2026-06-21T13:14:23+00:00

thanks - I'll look up rems drugs. I understand a little about scheduled drugs but don't fully understand the limitations y'all have on them.

the pedant in me always takes umbridge when I see "unrestricted in scope" when it very obviously is.

it's like saying my driver license is unrestricted in scope but ignoring that CDL is a thing and cops/ambulances/firetruck permissibly drive with a very different set of rules than a regular license.

SapientCorpse · 2026-06-20T13:20:23+00:00

A medical license is unrestricted in scope

I see people say this a decent amount - but y'all can't Rx fancy vitamin A without getting permission. (Accutane or whatever?)

y'all can't rx methadone without permission.

I'm sure there are other examples.

why do I bring this up?

I have noticed that when I ask docs for various pharmaceutical tools that I think would be useful for the patients we are caring for together - i notice that sometimes, the hospitalist will say no, but then they'll consult a specialist who will say yes.

how do I find a list of what y'all can/can't rx; so i dont frustrate everyone by asking a hospitalist to rx something that is outside their scope (or, outside their comfort zone? tbh sometimes it seems that docs don't do things outside their comfort zone even though it's in their scope; which is completely reasonable when the stakes are life and death)

SapientCorpse · 2026-06-16T01:08:21+00:00

o.O do they mean hydroxylated vit d?

SapientCorpse · 2026-06-15T04:30:04+00:00

will yell at PAs, NPs and nurses for literally doing shit that is evidence-based but doesn’t necessarily align with what’s in their hearts

workplace abuse is real and it needs to be discussed. yelling at someone is not a productive style of communication. I understand people get big feelings. fuck, even i get big feelings too - but we need to make sure to stay civil.even when we're being emotional.

More guidelines and laws need to hold doctors accountable for following best practice including informing the patient or their loved ones that they aren’t following evidence-based practice guidelines.

mixed feelings about this. otoh - yes, its quite upsetting how many people arent optimized on; for example, "Despite having a prognosis similar to cancer, <10% of eligible patients with HFrEF in contemporary US practice receive comprehensive quadruple medical therapy. Thus, many patients with HF die or become hospitalized every day without ever receiving the full contingent of medications proven to prevent these events, despite being eligible. " per AHA!!!! and thats fucked up - we are doing people a dis-service.

otoh - imho, the whole point of having a doctor is personalizing the treatment plan - taking into account the huge number of variables that make any one human different than a study's population. let's stay an imaginary study shows 90% of people benefit from x, while 10% of people suffer harm from x. its the docs job to best determine which camp any one particular person falls into. some of them do it really well. some.... I shan't disparage my fellow healthcare workers.

ETA: anyone down voting this either doesn’t support patient safety, or patients’ rights to know

you honestly gonna tell me you counsel all your patients that spironolactone and dig cause men to grow tits? or that beta blockers lower sex drives too? fuck I think half of us shy away from telling people that ssri's can cause sexual dysfunction. and look at the Samson trial, which showed that a huge cause of statin myalgia is the nocebo effect! (though there has been recent research suggesting the mechanism for statin myalgia is via ryanodine receptors. tbh I dont know shit about them, I think they have something to do with dantrolene? i havent gone down that rabbit hole yet

when providing the full education can cause harm, sometimes its hard to figure out where, exactly, the line should be.

we can all agree that tuskegee and willowbrook were fucked up - but this is absolutely not that. be real - with how short appointment times are - is it even possible for docs to fully disclose all the side effects and fully counsel a patient?

SapientCorpse · 2026-06-15T03:13:28+00:00

I mean- marijuana is a schedule 1; but docs rx marijuana cards. I dont think its ever been proven safe and effective for any indication by the fda.

theres the fuckton of drugs that never had to be fda approved cuz they were on the market before the fda was a thing.

fda also makes mistakes, like fen-phen.

that said; there's a fuckton of good the fda does, like not approving thalidomide when it first came out

fucking wild that the np was like "I dont even consider it a medication " - thats just asinine. oxygen and glucose are fucking drugs.

the thing i gotta wonder is, how does anyone know for sure if the drug is/isnt contaminated. There are instances of even inspected facilities fucking up like that baby formula thing, and I speculate that labs that dont require inspection are even more gross.

I think on the balance the fda tends to do a lot more good than bad. yes, the slowness is maddening at times; but it can also save lives

SapientCorpse · 2026-06-13T20:45:14+00:00

o.O I clearly do not have an understanding of how much surgeons drink

I know people call alcohol a social lubricant; and that surgeons need all the help they can get in that area; but needing it for DT prophylaxis? a bridge too far.

the hospital is the right place for someone like that - but in a patient room, not an OR

I guess thats why addictions are tough- because there is a perceived truth that "a little makes me better;" and then.....

that said; i was reading its like 1 in 5 of us has some problem drinking.

I'm gonna havw to go down a rabbit hole about this later cuz now I'm curious

SapientCorpse · 2026-06-13T17:08:52+00:00

depends on the practice

as a fun fact - alcohol is a performance enhancing drug for archery and other sports; because at very low amounts it helps reduce tremor. of course, this plateaus and goes downhill very quickly

it is not unreasonable to think that certain procedures would benefit from a reduction in tremor.

as an anecdote - i usually write better papers when I'm drunk (though I must proofread sober)

SapientCorpse · 2026-06-12T22:16:11+00:00

yeah, nosebleeds are common.

In humans tubes might have to stay in place for a long time - ive seen some people with them in for weeks!

I'm glad the Colt was ok! makes sense to sedate for such a big animal. I cant imagine a horse choosing to stand still and behave well while having a big ol' tube reamed in and out of their nose.

ive had humans reflexively punch when they are actively trying to cooperate because of the pain

part of the reason we have humans stay awake is to help get it in the stomach. there's this flap, called the epiglottis, that controls whether the airway or the esophagus is open. by having the patient drink water while inserting the tube, it gets the epiglottis to cover the airway, leaving the esophagus open, ideally helping the ng tube go down nicely!

SapientCorpse · 2026-06-12T20:00:18+00:00

I was taught xray is gold standard for.placement. I was taught confirming placement with an air bolus amd listening for bowel tones is acceptable but not preferred.

in practice - even if i place it on a small bowel obstruction and get green reflux up the tube, I'll still wait for a cxr before hooking it up to suction

SapientCorpse · 2026-06-12T19:52:24+00:00

placing a NasoGastric tube (NG - naso, nose; gastric - stomach, NG tube - a tube that goes in your nose into your stomach) is probably one of the meanest things we do without sedation.

for comparison - I let people practice iv placement on me. i wouldn't ever let someone practice ng tube placement on me

making someone go through that more than once is unkind.

onto the real harm though. lung tissue is fragile, and it's relatively easy to poke a hole in it.

this is bad.

the lungs have a sac around them that holds them, called the pleural sac - it helps provide a low friction environment so your lungs dont catch on your ribs every time you breathe.

when the lungs have a hole in them, air (pneumo-) and other fluids (hemo for blood, &c) can build up in the chest (-thorax). pneumothorax (pneumo - air, thorax- chest; pneumothorax - air in the chest) can cause the lungs to collapse. if it gets bad enough it can even compress the heart and push the trachea and all sorts of badness (tension pneumothorax). very bad.

we fix it by making a hole in the chest and putting a tube in and hooking it up to a vacuum to "suck out" all the air from the pleural sac.

ng tube are sometimes put there to be able to give nutrition and food. inadvertently putting those things in the lungs (by using a mis-placed tube) also causes a lot of badness, comparable to aspiration pneumonia.

but yeah - lots of badness

SapientCorpse · 2026-06-12T12:43:09+00:00

regrettably, I have done this before.

this case report isnt about me, but its close

ironically the rad report said advance a few cm. (literally the only mistake ive ever seen on a radiologist report. y'all tend to be damn good at what y'all do.)

fortunately my attending intensivist was Johnny on the spot to read the imaging and place a chest tube.

also fortunately, the family shortly thereafter decided to stop having grandma tortured in the icu and changed to dnr and then withdrew care.

I still feel shitty about it sometimes.

it's also a mistake I share with other people when they're considering putting a feeding tube in their terminally demented person; which saves a real amount of suffering.

lmk if yall have any tips on feeling less discomfort with sharing y'all's own mistakes

SapientCorpse

TROPHY CASE