Sumon Das

Father of 2, husband of 1, #PedsICU physician, travel, cooking, working out, not necessarily in that order. Eagles fan in Giants land. Tweets my own!

[James Wilson, DO, FACP, FAWM, CTropMed® @JamesWilsonDO1]

On academic rounds in the ICU, after positing back to the new intern, in the 2nd month of their physicianhood, that their working etiologic diagnosis was flawed; while offering every OMS/MS/PGY's favored format of MCQ of probable DDx including their IMprobable dx, they again chose their initial answer. DESPITE the rounds discussion.

When I corrected that it was NOT that, do you know what the response was..?

"...that's not what #OpenEvidence said..."

I asked them to show me the prompt they utilized to ask for OE to sift through the available literature. And it was... flawed.. to say the least.What ensued was a 5 minute papal decree of pontification.

We have NOT been doing a good job as a community & profession of teaching these new and soon-to-be-clinicians to THINK. CLINICALLY_AND_CRITICALLY.

If you don't have a working knowledge, a level of MASTERY, in a topic: how can you know when the LLM pulled the wrong set of studies to review? Not all literature is made equal. GENERALLY it pulls guidelines & landmark trials. But what happens when you're now visiting Esoteria..? You know, the land of esoteric questions.

My mentor in my first fellowship advised me that to best prepare for fall PGY4 by reading/knowing guidelines. Not memorize them; be able to reason through them all. As an ID fellow, there were only DOZENS. But, 6 months in at our 2nd mentoring sitdown, I told him that I had gone through all the guidelines at least once, and the major ones (UTI, SSTI, bacteremia, etc) SEVERAL times as consult coverage went on.

He said: "Great. Now toss that out. Guidelines are for non-specialists."

So: What did he MEAN by that..?

We all have to have a framework; where to start. #Guidelines allow all-comers to start the path of tx, but it's for us to be able to see where perhaps the consulting team fell off said path, or when we needed to intentionally deviate from it.

The #IDSA C diff guidelines reviewed studies that mostly dealt w mod to severe CDI. They publish recs in 2018 regarding CDI removing Flagyl from the equation. The works of Zar, Nijjar-Debbiny, Stevens, and more, are largely ignored in mild disease. I mean, Zar even has a SCORING SYSTEM named for him in C diff that is largely the criteria that the CDI classification system is BUILT upon.

The outcry: swift. Flagyl = viable tx for outpatient CDI. Further studies completed and more reviewed. The GI docs (ACG) publish competing guidance to the updated 2021 IDSA guidance. ACG leaves in narrow window for Flagyl in non-severe mild disease. Why the disparity? I can only speculate.

ALL TO SAY:

Train the AI to your patterns & do prompt design training. Because scanning title+abstract+n-value+CI+conclusion does NOT a physician make, as COVID showcased. But: unless you advise a "journal club," largely that's what AI does also.

Studies ALREADY SHOW we're offloading TOO MUCH cognitive load to AI.

As a Chair in #UME and faculty in #GME, it's EVIDENT.

I recommend to them that they hold off on AI for A&P until they can write up 90% of their daily charting As&Ps without looking up every detail. Until then, they're just skipping the development of a #physician's true tool: clinical reasoning. That's the WHOLE POINT of the training. Give the knowledge base in UME, train them how to talk and analyze in the order we all understand, then case after case after case of patients until they know normal to abnormal and which abnormal to which abnormal, all while highlighting #empathy, #professionalism, and #physicianleadership.

#meded #physicianled #AI #medtwitter #idtwitter #idxposts #FOAM #FOAMed #FOAMim #FOAMcc #FOAMid #academicmedicine #criticalcare #idcrit #AIinmedicine @DrNeilStone @DrToddLee @BradSpellberg @wwrighID @mohammad @DrDiGiorgio @djschuett @PulmCrit @pulmtoilet @IdVilchez @ABsteward @medrants @joshuadhartzell @Cortes_Penfield @IDiots_pod @JAMA_current @NEJM

[Camus @newstart_2024]

Roger Federer broke the internet with one statistic that will change how you see every setback in your life.
1,526 singles matches.
Won almost 80% of them.
20 Grand Slams. 103 titles.

Now answer honestly:
What percentage of total points do you think he won across his entire career?
70%? 65%? 60%?

Try … 54%.
He lost literally almost EVERY SECOND POINT he ever played for 24 years.

And still became one of the greatest of all time.

Watch him explain it himself (2:07 of pure life-changing wisdom):
“In tennis, perfection is impossible… When you lose every second point on average, you teach yourself to say:
‘Okay, I double-faulted — it’s only one point.’
‘Okay I got passed at the net — it’s only one point.’
Even a screaming overhead smash that ends up on SportsCenter Top 10… still just one point.

So when you’re playing your point, it has to be the most important thing in the world.
The moment it’s over — it’s behind you.

That mindset frees you to attack the next point, and the next, and the next with absolute intensity and clarity.”

Then he looked at the crowd and said the line that hit a billion people in the soul:
“The real sign of a champion is not that they win every point.
It’s that they lose again and again and again… and have learned how to deal with it.
Negative energy is wasted energy.
Cry it out if you have to. Then force a smile.
Move on. Be relentless. Adapt. Grow.
Work harder — and work smarter.”

Save this post.

The next time you lose a deal, bomb a presentation, get ghosted, miss a deadline, or just have “one of those days” — come back here and read it again.

You’re not falling behind.
You’re just in the 46%.
And the 46% is exactly where every single legend has spent most of their career.

Keep playing the next point.
(full 2:07 clip — sound on)

[Ami Bhatt, MD @AmiBhattMD]

On March 3, 2025, doctors saved THREE lives with ONE heart.

When 11-year-old Journi Kelly received a full heart transplant, her two healthy valves from her own heart were used to give two other girls a second chance at life.

Here is the story behind this incredible surgery:

[The Points Guy @thepointsguy]

Which airlines offer Apple AirTag's Share My Location luggage tracking and how to use it 🧳
https://t.co/Rs6Jj5GvE0

[JAMA @JAMA_current]

#Measles infection, including prevention, symptoms of infection, contagiousness, and treatment, described in this JAMA Patient Page. https://t.co/q665V8GXnb

[philly2hoboken @philly2hoboken]

One name: @CoachJayWright I will say.

For many years Jay would have his @NovaMBB team in March Madness but never could quite get past the Elite 8. I distinctly remember the media saying things like "Well, he's a good regular season coach but isn't good enough to get Villanova deep."

Villanova doesn't have the same scrutiny as the @Eagles but they were patient with him. And we are so glad he wasn't yanked out of his coaching seat.

If we fire Nick it will be the same kind of regret we had for losing Andy Reid. Remember the three NFC championship losses and he "can't win the big one" from the media??

Everyone needs to settle down.

[Ryan R. Lion, MD @RyanRLion]

📉The Hib vaccine has led to a dramatic decline in H Flu type B infections worldwide. From one of the leading causes of bacterial meningitis in kids to near elimination in many regions - just a reminder how vaccines have saved countless lives of children 💉🌍 #VaccinesWork #Hib

[Gokul Sahni @Gokul_Sahni]

A fantastic read about elite universities in the US:

“Family life changed as parents tried to produce the sort of children who could get into selective colleges. Over time, America developed two entirely different approaches to parenting.” 1/35

[Ron Barbosa MD FACS @rbarbosa91]

🧵regarding the introducer sheath commonly known as a 'Cordis' catheter.

We'll go over what it was originally designed for and why it ended up being adopted by other specialties for entirely different reasons.

Also we'll look at its accessories and see what's inside one.
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[Ron Barbosa MD FACS @rbarbosa91]

🧵regarding the side hole at the end of most endotracheal tubes. This is the 'Murphy eye'.

You may or may not have noticed the Murphy eye before. Here we'll briefly go over what it is for, some unintended consequences of it, and (of course) a little history.
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[Ken Tegtmeyer, MD, FCCM, FAAP 🇺🇸 🟧 @pccm_doc]

Yes. Way too few people to provide child care…but that’s not why it’s so expensive, it’s expensive because the people caring for kids need to get paid a living wage.

[Sam Ghali, M.D. @EM_RESUS]

Hi, ER Doc here.

Just a friendly reminder if your nose is bleeding, DO NOT TILT YOUR HEAD BACK. This just makes the blood drip down the back of your throat and you will then swallow and/or choke on it. Pinch the soft part of your nose and TILT YOUR HEAD FORWARD. Please tell all your friends about this.

[Jessica Valenti @JessicaValenti]

Let's be really clear here: When conservatives say that states allow 'post birth abortion' what they're actually talking about is palliative care for fatally ill newborns.

[Cory Rohlfsen @CoryRohlfsen]

#Medtwitter

Dot phrases in Epic are usually used for documentation purposes.

But don’t stop there.

When you learn something new, add it to your growing list of phrases for future decision support.

It’s a method of #interleaving to reinforce learning.

@Dr_Oubre

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[ATS Scholar @ATSScholar]

📣 ATS Scholar Most Viewed Article of the Year 📣

How I Teach: Ultrasound-guided Peripheral Venous Access

https://t.co/VmYPGy4LDn

[PALISI @PALISInet]

Hi #PedsICU - please consider participating in the following survey "Perfecting the Art of the Arterial Line: A survey of MAP national practices"

https://t.co/1oyGRva6Ww

[Robert Oubre, MD | The Doctor of Documentation @Dr_Oubre]

And if that includes bold and italics, do it. (But don't get carried away).

I typically:
👉 bold problems and
👉 use short, bulleted lists

This draws readers eyes to my plan (and makes it easy for me to edit the next day).

Don't let your notes become the wall of text meme.

[Ron Barbosa MD FACS @rbarbosa91]

🧵regarding the useful technique of 'straightening the wire' during central line placement when the plastic guide is no longer within reach.

If you do a lot of central lines (or a lot of percutaneous procedures), this technique will come in handy over and over again.
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[Ron Barbosa MD FACS @rbarbosa91]

🧵for the new residents and students on the meaning of 'French' and 'Gauge'.

We've covered this on here in the past, but a lot of new people are starting on surgical rotations, so let's look at them again.

As usual, we'll cover their history and what they mean.
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