Nicholas Capaci

MD, OSU Neurology Resident
Annoyingly passionate about the brain. All opinions are my own

[Nicholas Capaci @CapaciNicholas]

@gone_mae86 @randomdisciple @Gigi54374 @goddek He's a quack. He's a naturopathic doctor which is very different from a physician (MD or DO). Folic acid is basically the same thing as folate. They're the acid/base forms of the same compound - so when you ingest folate into stomach acid it becomes folic acid.

[Nicholas Capaci @CapaciNicholas]

@dereknoll14 @shycollie @FateDecided @UHC Why doesn't United Healthcare actually approve guideline-directed medical care for patients with advanced cancer? Doctors see multiple patients a day, prior auths adds on hours of completely unnecessary work just so united healthcare can maximize their own profits.

[Ohio State Internal Medicine Residency @OhioStateIMRes]

Merry Christmas from our residency family to yours!!! 🎄🎊🎉☺️

@BalinskiMD @CapaciNicholas @victoriakreyden @ShilpaSridharMD @daboul_judy @Kathryn54286251 @OSUMedPedsRes

[Nicholas Capaci @CapaciNicholas]

@SidraAkram_ So true and reflects one of the hardest realities of medicine in my opinion. It's so difficult to find to terms with, but I like the phrasing of one of my attendings: I cannot care about a patient's health more than they do.

[Nicholas Capaci @CapaciNicholas]

@DrKentris This may be my favorite medical tweet I've ever seen, especially as I'm only a few months into my career. Thank you Dr K

[Michael Kentris, DO @DrKentris]

Errors are inevitable in medicine

When I think back, I would attribute most of the ones I've encountered to a lack of information

This is usually in the form of some crucial piece of information

That 'last known normal' time wasn't correct

The patient with 'new right facial weakness' actually had a stroke with residual weakness 2 years ago

The patient who is 'hearing voices' actually has very poor sleep quality and increased caregiver related stress who's hearing her husband's voice as she falls asleep. She also has a history of sleep walking/talking

So much of what we need to know to care for our patients comes from talking with them and those who care for them

I contrast that with some days at work where there will be a census of 30+ follow up patients to see and 10-25 new consults

I have a team, it's not just me

But it is a lot of info to juggle all the same

As we see shortages of all physicians looming, not just neurologists, these longer conversations that lead us to the root cause of someone's problem are becoming more and more dear

My suspicion is this will lead to more unnecessary tests, wasted money, and, ultimately, wasted time

One of the things that drew me to neurology is that so much of the information needed to make the diagnosis is right there in the room with you and your patient

Hearing their story

Observing them, examining them

One of my favorite, perhaps apocryphal, quotes of Osler is “Listen to the patient; he is telling you the diagnosis."

While he may not have actually said it the sentiment resonates with me and I've found it has proven true time after time in my own practice

I don't have any answers

These are just musings that I have as I review my list and drink my coffee in the morning

I do believe that education remains an essential part of addressing these issues

And when something doesn't make sense, go back to your history

Take the time now

It will save you, and your patient, time in the future

#medsocial30

[Tirtha Sawant, M.D @tirthasawant10]

🎉Big News! We're thrilled to announce the launch of our brand-new website!🌐 Our mission is to make clinical neurology education accessible to all.

Check out our debut blog article! https://t.co/GgyyxMVc2n  

@DrKentris
@neuro_podcast
@DrVivancortex
@ridafarhan

[Michael Kentris, DO @DrKentris]

Thank you for the plug, and to the great team at @ContinuumAAN as always!

And thank you to our awesome volunteers for this issue!

@aish2197, @tirthasawant10, @CapaciNicholas, Michael Grasso, Mohammed Razi, Chris Economus, and Ehab Hassouna

[Nicholas Capaci @CapaciNicholas]

@garvs_72 @jasonryanmd I say this because I have worked with fantastic NPs and PAs and while I disagree with them practicing independently, I hold a lot of respect for their contribution to the medical team and the training they have also underwent.

[Nicholas Capaci @CapaciNicholas]

@garvs_72 @jasonryanmd The main reason I argue this is not to say that our training is equal, as I believe residency is paramount to create independent practitioners in their respective fields and we learn the philosophy of medicine as well as its application.

[Nicholas Capaci @CapaciNicholas]

@garvs_72 @jasonryanmd Yes, I think residency contributes the main difference between a board certified physician and a PA. But PA school was designed to only learn the applicable aspects of medicine and cut schooling down to 2 years (1 preclinical and 1 clinical like you outlined).

[Nicholas Capaci @CapaciNicholas]

@garvs_72 @jasonryanmd I think this is the objective of PA school honestly.

[Nicholas Capaci @CapaciNicholas]

@DrKentris How about being the "stroke-like symptoms" doctor?

[Nicholas Capaci @CapaciNicholas]

@cjcarrubbaMD @MBurt34 I also disliked the prevalence of rare diseases, it seemed that every question bank would include 2-5 questions on diseases a general practitioner would never see in their lives. In my opinion, this should be closer to 1 question every 50-75. However, this is true on STEP exams.

[Nicholas Capaci @CapaciNicholas]

@cjcarrubbaMD @MBurt34 Uworld definitely prepares students well for the STEP exams but it also fosters anchoring bias and prejudices. E.g. If they mention a patient is an immigrant they're likely unvaccinated, a young black female with cough = sarcoid. The morality questions are a joke

[OSU Department of Neurology and Residency Program @OhioStateNeuro]

Happy Match Day! We are incredibly excited to welcome The OSU Neurology Residency class of 2027!! #MatchDay2023 #neurologymatch2023

[Nicholas Capaci @CapaciNicholas]

@debbie_fadoju @OhioStateMed Dr. Grieco is truly incredible. I wasn't even an OSUMC student but had many questions and high stress during soap week (for a friend). My school couldn't answer my questions, but Dr. Grieco answered all my questions in such a supportive, helpful manner. Truly inspirational.

[Nicholas Capaci @CapaciNicholas]

@BrownAnddBoujee @jasonryanmd I think he means completing the less relevant new/due anki cards instead of attending to the lecture.