Bruce Scott

Geriatrics and Palliative Medicine.

[Bruce Scott @BruceScott_MD]

Pride month?
Here's a #hpm video:

https://t.co/YUyIYvSf7c

[Bruce Scott @BruceScott_MD]

@mattbc That's what came to mind when I read that tweet.

[Bruce Scott @BruceScott_MD]

@EtTuCarl Those letters are already spoken for.

[Bruce Scott @BruceScott_MD]

@jdmar3 I'll queer it up a little for a minute.

[Bruce Scott @BruceScott_MD]

@jdmar3 Fine. I already follow you with my sockpuppet account. This one is pretty boring.

[frank diesel @frankkdiesel]

If I ever found Ice Cube passed out in my kitchen, I’d just kick him under the fridge.

[Bruce Scott @BruceScott_MD]

@ScottMyers20 @skipbidder @EtTuCarl Nope. @Skipbidder is *my* sockpuppet account.
@ExcitingMammoth is @skipbidder's sockpuppet account.
@ExcitingMammoth almost got banned after its first tweet, and I'm not sure too many people are even allowed to see it.
@EtTuCarl is a Llama.

[Jon @ArfMeasures]

[Me as a doctor]
ME: I can't find anything wrong with you. I suspect the problem is heavy drinking

PATIENT: Ok I'll come back when you've sobered up

[Tim Johnson @timberwjohnson]

Rep. Ted Lieu: "This is a stupid and ridiculous hearing"

[Bruce Scott @BruceScott_MD]

@neulpt I really feel like I can cover some of the caregiver questions while I talk with the patient.

The patient-first approach tends to slow things down a bit too. Sometimes that helps. #hpm

[Bruce Scott @BruceScott_MD]

#hpm
Is this the point in the chat when we post non-germane closing thoughts videos? I've got a non-germane closing thoughts video right here, in fact:
https://t.co/Gnn0BdOIKV

[Bruce Scott @BruceScott_MD]

@doctatum Sappy
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But true.

[Bruce Scott @BruceScott_MD]

@rfberry They sometimes seem to think I don't know that mom has dementia.

They don't realize that I'm actually talking to them at the same time I'm talking to the patient. #hpm

[Bruce Scott @BruceScott_MD]

Families sometimes get irritated with me when I talk to the patient first (or primarily). I probably overdo it. #hpm https://t.co/GpHtTMj5R4

[SarahScott Dietz @SDietzMD]

@rfberry T2: As a physician, I try to always start with the patient and let them respond first, before I talk to a family member/caregiver.

As a family member, watching people treat my still-brilliant but now aphasic and hemiplegic father like an idiot was intensely painful. #hpm

[Bruce Scott @BruceScott_MD]

@nickasarbata @BethanyKwan ...what they think the patient would say were they able to look at the situation themselves. (i.e. ask them to guide you to what they think the patient would say, not what they themselves want) #hpm

But no easy answers to the tough ones like this.

[Bruce Scott @BruceScott_MD]

I might not be fully understanding the crux of the question...

I make a capacity assessment. I'm actually in favor of a sort of sliding scale capacity designation, but that is VERY controversial. I want people participating in their decisions as much as possible. #hpm https://t.co/hmQP0XOsIO

[renée berry 🌿 @rfberry]

T1 As a healthcare professional, how do you help patients make medical decisions when the person is suffering from a neurological/cognitive condition in which that person is no longer the person “they used to be,” or struggling to make decisions? #hpm

[Bruce Scott @BruceScott_MD]

@nickasarbata @BethanyKwan That's why computers can't do our jobs yet. Consult palliative medicine! #hpm
Restrain temporarily. Talk with HCPOA (or surrogate) emergently.
Try to find out if this is at all consistent with previously expressed thoughts. Gently direct the HCPOA to make decisions based on...

[Bruce Scott @BruceScott_MD]

@nickasarbata Actually, let me add an addendum here. If I think that a patient doesn't have capacity due to depression or delusion, then I'm probably going to ask psych for an opinion, even if I'm really sure about it. #hpm
Part of that is confirmation. Part is potential intervention.

[Bruce Scott @BruceScott_MD]

@nickasarbata I dislike the approach of punting to psychiatry or psychology. As an internist, a geriatrician, or a palliative doc, I think I should be doing my own evals. I only call in psych when there is a disagreement among providers about capacity. #hpm

[Bruce Scott @BruceScott_MD]

@nickasarbata @BethanyKwan Maybe.