Denis Stephen

OUTLIER

[Denis Stephen @denimaso]

I thank any of my new or continued followers. I am a humble and small contributor to large well run teams. I value my specific role and I always strive to do the best I can. I feel strongly any personal recognition should instead celebrate the combined efforts of many.
Thanks.

[Denis Stephen @denimaso]

@OscarW151 @ravenunreal which method do you use to learn it or any other language?

[Denis Stephen @denimaso]

@OscarW151 @ravenunreal is German easy to learn, how🤔

[Denis Stephen @denimaso]

@jasonryanmd how specific please someone give an example

[Denis Stephen @denimaso]

@NrsBunminire je parlons❌️
je parle✅️
welcome for more lessons🙂

[Denis Stephen @denimaso]

@DocPriyamMD what about pancreatic cancer?

[Denis Stephen @denimaso]

What makes me brave is knowing that everyone in the world is guessing, and that my guess is just as good.

[Denis Stephen @denimaso]

@ManCity I hope James French will make sound use of all the set pieces obtained in our next campaign.

[Denis Stephen @denimaso]

Which medical management algorithm do you trust when every source says something different?

This is one of the biggest challenges in medical learning. International guidelines, review books, hospital protocols and exam resources often differ in the sequence or timing of interventions.

One guideline recommends one pathway, another textbook suggests a different sequence and local protocols may differ from both. For students and trainees, this can create confusion and uncertainty about the "correct" next step.

Example: A patient presents with upper GI bleeding. One source recommends early risk stratification followed by urgent endoscopy, while another emphasizes initial stabilization before detailing the endoscopic pathway. Both are evidence-based but the emphasis and sequence differ depending on the guideline.

In diabetic ketoacidosis (DKA), some algorithms emphasize fluid resuscitation first, then potassium assessment before insulin while others present fluids and laboratory evaluation simultaneously before introducing insulin.

Although the core principles are the same, the flowcharts look quite different depending on the source and this is what has been my problem ever since I entered the wards and attempted objective structured clinical examinations.

How do you handle conflicting management algorithms when studying or in clinical practice and what is your strategy for staying consistent?

[Denis Stephen @denimaso]

I struggle reading medical guidelines, not because I don’t care, but because they’re often long, dense and hard to translate into real-life decisions.

Medical guidelines are supposed to make care clearer but I often find them hard to read and apply in practice.

The biggest challenges for me are:

-They’re too long and not easy to scan.

-Conflicting recommendations between different guidelines.

-Difficulty distilling a clear “what should be done” answer for example in cases that need the next best step in manageement.

-In practice, you’re often expected to strictly follow a protocol even when a patient situation calls for adapting it, which makes it harder to translate guidance into individualized care.

So, what makes medical guidelines hard to use in real practice and what should actually be done to make it more usable?

[Denis Stephen @denimaso]

@rpsingh1894 @yeankhar Followed you immediately after seeing this answer, I'm looking forward to learning a lot from you in this never-ending journey of medicine. Thank you.

[Denis Stephen @denimaso]

@ub_quitin personally, I just hate its versatility and the fact that it lacks clear cut principles, one consultant likes this and the other likes that, and when you ask them what exactly should we stick on they end up saying "history taking is an art" yet your art is never tolerated😂

[Denis Stephen @denimaso]

@Tha_gurl_jojo "I need an interactive class"

[Denis Stephen @denimaso]

@jasonryanmd "not uncommon" is mostly used in medical books and I'm now used to it to the extent I can't unlearn it😂

[Denis Stephen @denimaso]

@nehakibatein That's very HY concept worthy knowing, I'm ready.

[Denis Stephen @denimaso]

@thisis_drgsp @ShreerajT I hate when someone writes gentamycin instead of gentamicin

[Denis Stephen @denimaso]

@Melo_Malebo I understand it doesn't work like that because of this thing called inflation, but the problem with me is that how can the government estimate and print enough money to cover all production systems without making it more or less?

[Denis Stephen @denimaso]

@nikitabier Clinical Medicine
@ManualOMedicine
@docxusofficial
@nervemed
@modernHealthMe
@Neuromed_

[Denis Stephen @denimaso]

@drsthanus which book is this?

[Denis Stephen @denimaso]

@DrNikhilMD next best step in management

[Denis Stephen @denimaso]

Me adding "prior" whenever they asked for risk factors associated with any obgy case