Preston Lewis

economics major /math minor now trying to survive surgery residency. UA graduate. roll tide

[Preston Lewis @PrestonLewis8]

@CoffeeBlackMD Everywhere is variable

Had an icu step down the other day where they missed ODS

I personally love hyponatremia though

Hate cirrhosis and alcohol withdraw

[Preston Lewis @PrestonLewis8]

@0music6 @RobertHermanMD Gotta be BER.

Based on new ACC criteria you can’t diagnose pericarditis without pleuritic chest pain or something equivalent

[Preston Lewis @PrestonLewis8]

@SpenceLofthouse @omarkandah @CoffeeBlackMD @_Pax_Virtus_ lol are pharmacists everywhere this arrogant ?

I have had pharmacist make some of the dumbest medical suggestions and not even know the interactions of the drugs they are suggesting and not know the osmolality of d5 1/2 NS with 75 meq of bicarb. But tell yourself whatever 😂

[Preston Lewis @PrestonLewis8]

@neoavatara Mass screening with Thyroid US in South Korea as well

[Preston Lewis @PrestonLewis8]

In 2023 estimates suggest 1 in 5 Americans received a ct scan. But hey what we really need to save healthcare is more scans! 😂

[Preston Lewis @PrestonLewis8]

@neoavatara @politicalmath This is the oddest part about this to me. Almost 100 million ct scans are done a year on 62 million individuals in the us alone where does this idea come from that we don’t scan in the us medical system. 😂😂

[Preston Lewis @PrestonLewis8]

@OSHeartDoc @CoffeeBlackMD No one is more insulated and has a more inflated sense of self worth than a tech bro.

“We will fix everything while actually making no actual change”

[Preston Lewis @PrestonLewis8]

@OSHeartDoc @CoffeeBlackMD Side note they don’t know stats. They throw around statistical terms around their inner bubble who also don’t understand them which makes them feel smart.

I’ve heard Bayes theorem applied incorrectly more today than I ever have in a hospital. But they do this in every field

[Preston Lewis @PrestonLewis8]

@nickmmark These are the Same people that think a 60 hour work week is tough lol

[Preston Lewis @PrestonLewis8]

@loquitur_ponte @unapproved_mess I think that’s probably right.

I was much more libertarian before I got into medicine lol

Enjoyed the convo! Have a good one.

[Preston Lewis @PrestonLewis8]

@loquitur_ponte @unapproved_mess And trust me it’s not about hiding anything for me. I want patients to be informed it makes my job a lot easier. It is not easy when someone comes in not knowing their history, a bag full of meds from 10 different docs and 100 vague complaints and goes fix me

[Preston Lewis @PrestonLewis8]

@loquitur_ponte @unapproved_mess And conversely let’s say you sit on it and ignore it and turns out 5 years down the road it was pancreatic cancer but has advanced ….someone is getting sued into oblivion possibly even the company

[Preston Lewis @PrestonLewis8]

@loquitur_ponte @unapproved_mess Or anaphylactic shock.

[Preston Lewis @PrestonLewis8]

@loquitur_ponte @unapproved_mess They do not. Because of the downstream effects that’s what I am saying.

Say you find something that needs further characterization with a triple phase ct because no one can tell you what it is and then you get said ct and then you get contrast induced aki and end up on dialysi

[Preston Lewis @PrestonLewis8]

@loquitur_ponte @unapproved_mess I mean that’s fair. I’m merely looking at it from the perspective of the entire population. If it’s a niche thing then hey fine by all means. Just a population level I think it is an epic disaster waiting to happen.

[Preston Lewis @PrestonLewis8]

@loquitur_ponte @unapproved_mess You are conflating not looking with looking but intentionally ignoring.

If you ignore everything until it changes you will miss tons of things slow growing renal cancer, an indolent thyroid cancer, neuroendocrine tumors, adrenal tumors, etc.

Not growing doesn’t =benign

[Preston Lewis @PrestonLewis8]

@loquitur_ponte @unapproved_mess Is how you get more unnecessary tests and procedures and uncertainty

One person gets an mri
One person gets a biopsy

This argument also ignores the cumulative false positive burden

[Preston Lewis @PrestonLewis8]

@loquitur_ponte @unapproved_mess End up being benign and some of those tests might bring complications themselves.

Also these tests don’t fall into a “looks worse than average” category. That doesn’t exist. You get size, morphology, growth, and then a level of uncertainty after that.

Looks worse than avera