James Nelson MD

Emergency physician #Physicaldiagnosis, #bedsidemedicine, #diagnosticreasoning

[James Nelson MD @tothebedside]

@TheScarletRN @cvs How did we ever get a system where patients do not control their own prescriptions? We were okay with that on paper but not okay with it when we went digital? Sorry to hear this. Patients should completely control it.

[James Nelson MD @tothebedside]

Start with your biggest frustration at work this week. Just solve one thing. Then next week solve the next biggest frustration. Continue for 3 decades. This matters.

[James Nelson MD @tothebedside]

I see doctors on X (and everywhere) complain about bureaucratic medicine and barriers to care. While this may be more true today than 20 years ago, medical staff is responsible for approving clinical policies. If you want great practices at your hospital, all it takes is:

[James Nelson MD @tothebedside]

Examples: standing orders for everything related to patient comfort (including pain), flexible processes for physicians to do something off protocol to benefit a patient, make complicated situations easy and clear, etc.

[James Nelson MD @tothebedside]

@DrDiGiorgio Standing order sets are an option. Physicians have to lead operations. Empowers nursing too. Saying this to support you. Next time you pass your chief of staff in the hall, ask for this.

[James Nelson MD @tothebedside]

@MattZirwas Every diagnostic tool we use in medicine has limitations. An expert will use the tool skillfully and derives value from it. Some think of AI as competing with the doctor rather than as just another tool the doctor uses.

[James Nelson MD @tothebedside]

So your awareness of wrong ideas has to at least stretch back a generation so you can tactfully and respectfully communicate through those things. This is part of the orientation of real life in the hospital 4/

[James Nelson MD @tothebedside]

Students: you have to learn the classic teachings in medicine... and you have to also learn why they are wrong (or at least misconceived). 1/

[James Nelson MD @tothebedside]

The reason you do have to know these things is you will commonly encounter people in the hospital who also learned out of date teaching, but think it is current. When you meet someone more experienced than you who is out of date, they sometimes think you are wrong! 3/

[James Nelson MD @tothebedside]

Lay down flat or even head lower, palpate your jugular vein. Feel for the swish of fluid as you press your vein, and feel the smooth frictionless slide of apposed endothelium - this is what JVD will feel like in a patient sitting up 2/2

[James Nelson MD @tothebedside]

Students! Hone your bedside cardiac skills for pathology: rub your hair near your ears: this is crackles 1/2

[James Nelson MD @tothebedside]

Agenda setting is the best way to improve patient satisfaction. It not only commits the patient to the goal for the visit (making satisfaction achievable), it also gives structure for authentic caring - when the doctor knows what the patient wants, they connect on a human level.

[Keith Siau @drkeithsiau]

This phenomenon is known as “attention-modulated pain amplification”. Pain is not purely a nociceptive signal but is heavily modulated by attention, expectation and emotion. Hypervigilant states driven by expectation can worsen pain and can be addressed by distraction techniques.

[James Nelson MD @tothebedside]

There are lots of options, these are just a couple.

[James Nelson MD @tothebedside]

If you are new to emergency medicine, you will find that the demands for your attention outstrip your ability to meet them. What not to do, and what to do instead 1/

[James Nelson MD @tothebedside]

Alternate: some people go into space out mode where they don't respond right away. Although this seems bad at first, it is much better than acting rude. After completing your mental processing, you can then respond 4/