BC HEALTH
Saved by @CodyyyGardner

Dear #MedTwitter please, please, if you are a licensed medical professional and/or in school to be, do NOT delete your tweets or comply with anyone telling you to do so. It will harm you far more than leaving them up and explaining. Nothing is ever deleted. Can be used in court.

 When I was at Harvard Med School and at an esteemed children's hospital, a case against an esteemed professor, that NO lawyer would touch cuz this was someone who had WRITTEN the textbooks and trained every expert, was won ..based on "a document was deleted" - creating suspicion
"Sunlight is the best disinfectant" you will hear me say OVER and OVER - wins & losses *should* be on data/standards but unfortunately wins & losses are in the court of public opinion. So be reliable, credible, and trustworthy. Transparency is one way to achieve that reputation.
The tweets I delete typically have a typo or the link did not populate the image as I wanted and I *immediately* repost THE SAME tweet, corrected. That way if anyone with "dark web" capacity were to try to "find dirt", ain't none. What you see is what you get.
I have been around the block enuf times, been a public servant w/ strict COI & scrutiny of my every word, & have been "in the room" when we have been deciding billions of dollars of state funding in Medicaid

You can decide whether you trust my advice/PSA
https://t.co/21rQMi8ljS
In fact, in any job interview, I have now learned I need to *warn* any potential employer: I take ethics, safety, quality, transparency VERY seriously. Take it or leave it. If that ain't how you do business, this ain't gonna be a good fit. I limit my choices, but sleep just fine.
I mean, no, I don't sleep a lot, but that's another issue. LOL My conscience is pretty clean apart from the things I realize were secondary harm from my trust in the system & being, what I now know is the so-called "model minority." That being complicit DOES keep me up at night.
Many of us come from cultures of shame - medicine, nursing, religion, "family name", regional culture (say a culture of "grit")

Shame will whisper to you "delete, delete..hide it..be ashamed"

NO

WRONG knee jerk reaction from when we were living in primitive conditions.
This matters on SO many levels. Most on #MedTwitter #NurseTwitter #AcademicChatter #AcademicTwitter want to have an impact in the world, want to build relationships, want to do #SciComm

First step for ALL of that is trust

Be trustworthy
Do NOT react to your reptilian brain
If you get past "reptile brain", can pause.

Think it through. What is your purpose here? (see above)

What is in your LONG TERM best interest?

Hiding/deleting only makes you look not trustworthy, poor judgment, unreliable.

https://t.co/0jfLqo7xlF

https://t.co/k6UwYwV4e3
Not to be reverse ageist but please consider the life experience & matched professional experience of anyone from whom you take advice.

Now that I am at @MIT & @MITSloanFellows the classmates who "get it" are engineers who must maintain licenses.

Is a #mindset: accountability
If ANYONE tells you to delete, and EVER uses an "or else" threat..just listen to the recent recording of Trump to GA governor. First, even POTUS cannot seem to hide what he does so exactly how do YOU expect to succeed?

Most importantly, NEVER be goaded into being unethical.
Personally, my brain is SO fully of SO many more important things that, long ago, as a child, I realized lying/hiding was just a recipe to fail - I am transparent. Plus, my mom? OMG...NOTHING got past her. Plus am Muslim so a belief I can hide anything would make me delusional.
I'm old school, with my paper chart experience from having worked in community hospitals that were slow to onboard to #EHR as well as my having been an intern a while ago.

You all training on electronic only may feel it is easy to just hit "undo"/delete.

https://t.co/veFz4j1Pqg
Please know that hospital-employed NON-LICENSED HR or communications people will give you BAD advice. I have seen it SO many times. A relative of mine, was asked ("asked") to delete her EHR note documenting the processes to led to a patient discharged from care service.
I can't go into more details and have enough relatives in my extended family in healthcare that I have left that sufficiently vague. That said, this is a CLASSIC example of how a business/communications person will tell you something AGAINST ethics - what attorneys DREAM about.
Never, ever, EVER protect an institution's "reputation" or any boss's/faculty member's pressure on you at the risk of your own credibility. You have tremendous power as a licensed professional that others WILL use for themselves AND leave you to go under the bus when 💩 hits fan.
I know life is complicated & you get a ton of mixed messages. There are people with clear COI who are selling their advice either directly to you and/or to administrators who buy "reputation management" services (in house or consultants). I don't envy today's students/trainees.
Stay very clear in your own head. You are here for your patients. Your credibility & your license are YOURS. Employment or student status, institutions, do NOT define you (you are a mere cog in their system).

YOU define you.
Your credibility is based on consistent data points.
The last needs to be unpacked. You can and will make mistakes. Leave those mistakes up.

The data points I mean are of being factual, using vetted/verified/validated facts, leaving UP when you make a mistake.

Have a "paper trail" that shows transparency & honesty.
Not that we should be here for the "clicks" but if you need a metric of success of documenting failures, this is probably my single most popular tweet > 7K likes. You can look at the metrics yourself. I'm kinda a numbers shmumbers kinda gal tbh.

https://t.co/umWeKEtieT
Meaning, numbers not what excite me. Impact does. Metrics are important but we all know they are not the whole story yet we overfixate on numbers/metrics, often withOUT questioning their value, definitions, or true impact.

That is the other thing, please refocus on impact.
If you follow me you likely already are a "change the world" type and/or seek to have an impact & likely seek to destigmatize. You also likely are trying to show some kind of leadership. Leaders MUST lead by example. Be the leader who can leave any error up with confidence.
You can always respond, retweet with an explanation.

Will some people do "gotcha' screenshots? Yes.

It is impossible to avoid all misinterpretation or bad faith misuse.

If that worries you, then just post less or not at all. No one *has* to have a social media presence.
I know there is a lot of talk these days on #cancelculture. Everyone hates it (yet people who are most vocal about it seem to be super inconsistent with their words & actual actions).

That is just the world we live in.

It's not easy.
Titrate your exposure/risk to your comfort.
Personally, being Muslim, if I breathe = a "terrorist." I will ALWAYS be "gotcha" vilified by immutable things about my identity. This has made me more risk tolerant.

Gave me A LOT of practice early in life about navigating these complexities prior to social media screenshots.
I think some others did not have this experience of constant bullying from your earliest memories like I do. Bullying affects people in different ways. I finally saw thru it - it is about the other person's insecurity, fear, need for power, manipulation. https://t.co/5dqZ373fJh
I would not wish the multitude of experiences that give me "grit" on anyone else, tbh. I would LOVE you all to spend your energy/time on not just surviving but going out and making this world better (not developing chronic illnesses from chronic stress).

https://t.co/YoextwHK2u
It has made me skilled effective in high profile, high risk roles: where I when I am an expert witness in a Grand Jury trial for the AG's office, when enforcing quality standards going toe-to-toe with another CMO, when I negotiate out of a bad employment situation, etc.
In ALL of these types of leadership & many others, they WILL try ad hominem

If you lose your cool, you lose
If you get nervous about an "error" or by an overt or an implied threat, you lose
If you doubt yourself & backtrack (delete), you lose

Don't set your own self up to lose
Failing fast & failing often is different from setting yourself up to lose/fail. First is driven by #improvement #mindset of #engineering and #systemsthinking to identify vulnerabilities and correct. Latter is poor #strategy, preparation, or poor decision making under pressure.
The #narrative is taught as the goal by so called #SciComm or #communications or #marketing folks who are bad at what they do. Those good at this do #valuesbased "marketing." A non-negotiable must be ethics, credibility, reliability. https://t.co/wb2vgDImqz.
The #narrative, in fact, is how you tell the story of the #data points that are REAL of your consistent commitment to your #values. The other thing you find with low ethics/bad at their job people is manufacturing "evidence" posthoc to craft a fake narrative. Don't be that.
I am intentional on what "record" I create. This had value on many levels. I do genuinely want to provide a free resource, vetted & validated by @AAMC standards to #MedEd

these are my values: marginalized populations, multidisciplinary, #mentalhealth, etc https://t.co/tVjZNbgsVY
This is another intentional use of my time/talent for #AI #futureofwork #diversity #policy #healthcare #innovation

If I get one tweet or a few tweets wrong, will it end a career? It is possible. Anything is possible. Unlikely, given my track record.

https://t.co/qbUGmmkoQq
I worry about you all, tho, in early career

often getting bad advice from:

non-clinician “consultants”
or
faculty from this era of old boy network where they *could* delete, erase, and make inconvenient people disappear (kill someone’s career or professional reputation)
None of them will face the accountability that YOU face
“growing up” professionally in an era of high accountability & high transparency

You aren’t a gray-haired professor w/old boy network who can leverage contacts to do #MedBikini types of ethics shortcuts & gamble not caught
I know because I don’t get those kinds of passes myself

I have to check off every single box in exactly the right order = 100+ edits

if I don’t, my high-quality publication that gets glowing reviewer comments

still rejected/delayed

many women experience this @JulieSilverMD

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Thread on how atheism leads to mental retardation (backed with medical citations🧵💉)

To start with, atheism is an unnatural self-contradicting doctrine.

Medical terminology proves that human beings are naturally pre-disposed to believe in God. Oxford scientists assert that people are "born believers".

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It should be known that atheism could never produce an intelligently-functioning society and neither ever will.

Contrastingly, Islam produced several intellectuals & polymaths, was on the forefront of scientific development, boasting 100% literacy


It is also scientifically proven that atheism led to lesser scientific curiosity and scientific frauds, which is also why atheists incline to pseudo-science.

Whereas, religion in general and Islam in particular boosted education.

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Atheists are also likely to affected by pervasive mental and developmental disorders like high-functioning autism.

Cognitive Scientists and renowned Neurologists found that more atheism is leads to greater autism.

https://t.co/zRjEyFoX3P
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is ADHD a mental illness ?

a thread

ADHD is a neurodevelopmental disorder - people with it are born with it and it cannot be altered because it's part of their brain structure and is seen on brain scans. ADHD is also linked to premature births and hypothyroidism during pregnancy, among other things

from the WHO website: "neurodevelopmental disorders are disabilities in the functioning of the brain that can affect behaviour, memory and/or ability to learn."

neurodevelopmental disorders are not caused by external/environmental factors. you cannot *develop* these conditions

mental illness is a general term for a health problem that significantly affects how someone feels/thinks/behaves. mental illnesses cause suffering to those who experience them, as well as often their loved ones. ADHD does not directly cause suffering.

neurodevelopmental disorders are not mental illnesses. ADHD however, does make it more likely for a person to experience mental illness. ADHD can cause dysfunction and stress, but more often than not this comes from lack of accommodation rather than the symptoms themselves.
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I think @SamAdlerBell in his quest to be the contrarian on Fauci gets several things wrong here. 1/


First, the failure last year actually was driven by the White House, the #Trump inner circle. Watch what's happening now, the US' scientific and public health infrastructure is creaking back to life. 2/

I think Sam underestimates the decimation of many of our health agencies over the past four years and the establishment of ideological control over them during the pandemic. 3/

I also am puzzled why Tony gets the blame for not speaking up, etc. Robert Redfield, Brett Giroir, Deb Birx, Jerome Adams, Alex Azar all could have done the same. 4/

Several of these people Bob Redfield, Brett Giroir, Alex Azar were led by craven ambition, Jerome Adams by cowardice, but I do think Deb Birx and Tony tried as institutionalists, insiders to make a difference. 5/
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1. “Dr Tomas Ryan : Sociopath Or Psychopath : Or Both ?”

Answer = Both. Shortest Thread Ever. Only joking. Let’s jump in and try to see what makes Dr Tomas Ryan tick 🧵 1/21


2. Dr Tomas Ryan is a Neuroscientist at Trinity College Dublin. He has appeared on Claire Byrne Live, Prime Time & The Tonight Show in addition to radio appearances. He calls himself a Scholar on his Twitter bio.


3. He is part of the Zero Covid Cult Crew (ZCCC) out of that hallowed institute of learning, Trinity College Dublin. Other contemporaries of his in the merry little band are Luke O Neill, Kingston Mills & Aoife McLysaght.


4. Kingston Mills & Aoife McLysaght are staunch proponents of the Zero Covid strategy. Mills is an agenda contributor to the World Economic Forum and recently wrote an article for them entitled "Is reaching zero Covid-19

5. Did I forget to mention that TCD got funding from the Bill & Melinda Gates foundation for Vaccine development to the tune of $230,000. Tomas was also sponsored by Wellcome Trust Sanger Institute to complete his Phd in Cambridge. Let's just say he has connections to Big Pharma
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Why can cefepime cause neurological toxicity?

And why is renal failure the main risk factor for this complication?

The answer requires us to learn about cefepime's structure and why it unexpectedly binds to a certain CNS receptor.

#MedTwitter #Tweetorial


2/
Let's establish a few facts about cefepime:

🔺4th generation cephalosporin antibiotic
🔺Excretion = exclusively in the urine (mostly as unchanged drug)
🔺Readily crosses the blood-brain barrier (so it easily accesses the brain)

https://t.co/rjYG1BfGPR


3/
The first report of cefepime neurotoxicity was in 1999.

A patient w/ renal failure received high doses of cefepime and then developed encephalopathy, tremors, myoclonic jerks, and tonic-clonic seizures.

✅All symptoms resolved after hemodialysis.

https://t.co/u7JLVitQpp


4/
Cefepime neurotoxicity is surprisingly common, occurring in up to 15% of treated critically ill patients (w/ symptoms varying from encephalopathy to seizures).

💡The main risk factors = renal failure and lack of dose adjustment for renal function.

https://t.co/nxbnzSq8AR


5/
What about cefepime induces neurotoxicity?

One clue is that it's not the only antibiotic that causes neurotoxicity, particularly seizures.

This actually is a class effect w/ other beta-lactam antibiotics (including penicillins and carbapenems).

https://t.co/Lf4BhON9IY
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एक बार देवराज इन्द्र अपनी सभा में बैठे थे, तो उन्हे खुद पर अभिमान हो आया।


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Today is Jayanti of Ahilyabai Holkar

She was a widow who became Malwa's greatest queen. Defended our country & personally led armies into battle.Never plundered anyone. Developed Malwa into a prosperous kingdom. Rebuilt temples destroyed by Mughals. Built Dharmashalas at Tirthas


Unfortunately, her memory has been blemished by inaccurate representations in modern popular media.

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This is far from historical truth!


Ahilyabai was born on May 31 1725 to Patil Mankoji Shinde.

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Cherthala Karthyayani Kshetram
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#KeralaTemples 🚩

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Vilwamangalam Swamiyar was passing this area after Prathista of Padmananbhaswamy Temple, he felt Devi chaitanyam and recognized as Karthyayani Devi. But Devi seeing Vilwamangalam went inside the pond. Swamy searched for Devi continously for 6 days and on 7th day Vilwamangalam


got hold of Devi's hair. Thus only Devi's head is Prathishta here. Devotees do Kozhi parathal ( offering cock) here as an offering to Karthyayani Devi.

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