burnt out MD. telling the good/bad/ugly about working with humans & admin. chaotic good. laughs. ethical AF. knows 4 letter words. coffee keeps me woke.
a child died from measles in Ontario.
the first in 35 years.
our “health” minister
@SylviaJonesMPP
did not say a peep.
no comment about underfunding of
@PublicHealthON
and no comment from
our premier
@fordnation
whose daughter is antivaxx.
elect idiots: get idiots.
drove past a truck with a large Canadian flag today and my initial reaction was “ugggg”.
and then realized it is Canada Day this weekend.
a special FU to the convoy for ruining the joy of our flag.
and also to
@PierrePoilievre
for politically capitalizing on that event.
@average_mammal
us: we want a kitten.
shelter: ok. at least consider this cat that has been here for 18 m.
us: fuck. load him up.
everyone: meet Parker. now 19 yrs old.
Ontario is backlogged 90 thousand PCR tests. which may or may not get processed in the next week.
currently ~ 30% of them are positive.
ffs: we are two years into this rodeo. how in the hell did we get caught with out pants down again?
where the hell is
@fordnation
?
we never dropped masks at the office.
any basic science background will tell you it’s not rocket science to do this basic preventative measure.
I did this with pts yelling at me. some still do.
and 0 backup from
@cpso_ca
and
@fordnation
masking will likely never be dropped at my office.
re: I solely deal with immunocompromised pts who are for the most part elderly (local pop’n dynamics).
UV/hepa filter in all common areas and the exam room.
CO2 meter in the exam room.
I take “primum non nocere”seriously
😷I'm still seeing 3-4 COVID-19 cases each week.
Luckily, NONE has recently required hospitalization lately.
MASKS are still required in our clinic.
🏥Patients feel safer
🦠Asymptomatic spread
⤵️Risk for the vulnerable
⤵️Staff infections & absenteeism
⤵️Long COVID
today:
patient refuses to put on a mask after the secretary gently tells them it is office protocol.
me: so let me explain…
pt: I DO NOT NEED A LECTURE!!!!
me: I just want to explain the rationale for the request. 🤦🏻♀️🤷🏻♀️
thanks for the back up
@cpso_ca
@fordnation
🙄
#burnout
// NEW: Pierre Poilievre caught red-handed in bot farm scam. Nothing the Cons do is clean. They’re always breaking rules, lying, Photoshopping, being punished by Elections Canada & using their supporters’ donations for dirty purposes. Your parents’ “law & order” Cons are gone.
hey
@fordnation
can you please tell us “armchair quarterbacks” if there are going to be more ICU or ER closures and what is being done to reopen the ones already closed?
asking for all of Ontario.
#ONpoli
this is a leadership failure.
I work with exclusively immunocompromised patients.
the clap back from antimaskers is exhausting.
I am sick of explaining that we share the exam room with 20 people a day and getting yelled at by some.
#humanityinmedicine
#burnout
@ChristyCeeCK
An unmasked parent berated our staff yesterday for insisting on masking before entering our waiting room accusing us of not keeping up with the rest of the medical community as our own hospital no longer requires masking. We are holding our ground but it’s exhausting.
we had to put down our cat of 19 years today.
he has been declining for the past 3-4 m so it was not unexpected.
I cancelled clinic this afternoon.
no idea how I am gonna explain the puffy face and red eyes to patients tomorrow without crying.
#humanityinmedicine
Remember last fall when
@fordnation
had enough medical staff and beds to help out AB and SK disastrous “best summer ever” fallout?
good times. how did we get from there to here in one year?
poor leadership.
#onpoli
seeing a 80-90 year old in clinic.
-yeah. I am going to order a MRI.
-you can’t do that.
-why?
-I have a bullet in my spine.
he was the navigator on a Lancaster. tasked with bombing Berlin.
they successfully completed their drop and were heading back to England. 1/n
I had to go to the hospital today. for a basic investigation.
I see the hospital entry way is just the way I remember it from 11 years ago: damp and smelling of mould.
good luck
@fordnation
to fix 20-30 years of systemic underfunding overnight.
@queensu
@SPuro88
-I can’t help you before you do something.
-what’s that?
-you need to ask your other doctor, who is a respirologist, to transfer you to me. I will accept then.
he never asked.
the “Paki”doc was Hindu.
1. racists can’t even get slurs right.
2. standing up matters.
2/n
so my husband went to our
@ShopprsDrugMart
today to get his
#COVID19
vax.
only to be told they are out and unsure when they will get more.
hospitals are struggling to cope.
COVID is running rampant in the community.
and our
@ONgov
“leader” and “health” minister are AWOL.
new patient, ~80 yo.
described her colonoscopy as
“S&M with no safe word.”
needless to say she was immediately lumped into the fav patient category.
#humanityinmedicine
@UbakaOgbogu
has it occurred to anyone the only way this can end peacefully is more people show up in Ottawa, the Ambassador bridge etc. Canadians…the the majority of Canadians.
to peacefully counter protest and ask the truckers et al go home.
1/2
yo
@fordnation
I don’t have customers.
I don’t have clients.
I have patients.
I practice longitudinal care.
I know about all of their drama and joy in their lives.
even when I am on “vacation” I check into my EMR daily in case I need to make a phone call.
1/2
"We're backlogged. The docs don't have a lack of customers,"
Premier
@fordnation
, we don't have customers. We have patients. Perhaps your still in the business mindset?
Ford sidesteps doctors' criticism over proposed new pharmacist powers
long rant in a thread.
about how fucking broken healthcare is in
@ONgov
so 2 months ago…I see a patient for “is this rheumatoid arthritis”
found swollen wrists and nothing else. (RA needs >/= 5 swollen joints to consider the diagnosis)
say in my consult letter: 1/n
ffs we are 4 years into this rodeo. every Dec there is a spike in cases.
maybe, just maybe we can get ahead of the curve next year and recommend masking from Nov onward into Jan?
“top doctor” indeed.
sigh,
#burnout
.
this is not fucking rocket science.
Oh yea--back to my rant re covid. You can't find a RAT anywhere. It's almost like---it wasn't a huge problem 🙄
These should be readily available on request.
they made it home.
coasting for a bit to get the fire out.
and then my patient manually pumped fuel into the still functional engine when altitude got too low.
I remember. you remember.
privileged to hear this story first hand.
#humanityinmedicine
#RemembanceDay
4/4
tending to him for new sizes or needs outside of the dressing room…it dawned on me: would you like a dress or a skirt?
-yes please.
-what size are you?
-4. thank you so much.
if an unexposed kid off a farm can get it. why can’t you?3/3
@GoodishIntent
…and the person you spoke to’s name.
she gives me the info and hangs by the desk anxiously waiting to hear the outcome.
me: cover your ears dear. there are gonna be some 4 letter words used.
#humanityinmedicine
I f’n love stuffing it to unscrupulous insurance. 2/2
I stayed 30 min late after work today.
my last patient had to put his dog down last Friday.
glad it was end of the day…
so that I could listen to his stories and see his pictures without being rushed.
#humanityinmedicine
I have gone to work:
-with slowly resolving viral labrythitus and walking into door ways x 6 m.
-non weigh bearing post ankle ORIF x 3.
if we call in sick…WE ARE SICK.
and now you want to charge us if we can’t come in to work?! f*ck off.
#burnout
@NaheedD
if “
@ONThealth
“ goes private I suspect a lot of physicians will quit. for ethical or hassle of collecting payment reasons.
I will be one of them.
I would be just as happy bagging groceries to pay rent and not have to deal with the moral injury I already face daily.
@alisadoc1
when did it become the patient’s responsibly to monitor their lab results (
@LifeLabs
) or basic doc to doc communication?
I abort this broken telephone game by telling the patient to have their doc call me (if it is minor) or by making a call myself (if major)
leading by example…just do it.
I mask in public. always.
to protect my ability to serve my patients. if I get ill…I can’t work.
can we have some leadership from our “leaders” please?
#onpoli
@fordnation
1/2
@AlanaKinrich
@amy1weber
if this pandemic has taught me anything…it’s that the public is horrible at relative risk assessment and adapting accordingly.
- correct answer. thank you. please never refer to me again unless there is some meat to the consult. I don’t care if a nurse is examining the patient. I need you to do better.
this is what corporate medicine will look like folks.
fix this
@SylviaJonesMPP
@ORAexec
5/5
enter exam room today to find a pt with their mask below their nose.
me: please keep your mask up when in here. this space is shared by at least 20 other ppl/day.
pt: sorry doc.
me: not trying to be a jerk but ~1:25 Canadians have COVID right now so I am being careful. 1/n
Dear Mr Bernier,
I was 18 and fresh off a farm in SK working in Saskatoon at a clothing store.
I knew gays existed. had no idea transgenders did.
it was dead in the store when I saw a small man walk in.
I noticed he spent most of his time in the men’s section….1/n
me shopping today:
why are you still wearing a mask? you don’t have to.
skipped the actual explanation for why…
and just said:
I have COVID. would you like
me to take it off?
quick. easy. no arguments.
and now my go to.
#humanityinmedicine
I am not afraid of end of life talks.
I am skilled at guiding families/pts through the vortex that is end of life care.
today I sat with a couple that lost their baby. in the worst circumstances imaginable.
med school did not prep me for this.
#humanityinmedicine
@SPuro88
a patient came up to me while I was rounding on my int med patients.
-hey can you take over my care?
-sure. let me look at your chart while you explain why.
-I don’t like Pakis.
-ok. I see here you are admitted for COPD.
-I want you to take over my care.
1/n
so I had to call a “Good Doctors” clinic today.
re get multiple referrals from one doc in Toronto. it’s obvious he has never seen the person live.
just spins the consult wheel for patients and refers to local specialists of the patient.
he actually returned my call.
1/n
@GoodishIntent
me in ICU rounding on a dude who had a cardiac arrest going on his first ever vacation in 70 years to t/f him to the ward.
wife comes up in tears. insurance covered his “cancellation” but would not cover hers.
me: give me the name of the company, the policy number…1/2
@birgitomo
@KeriCrewsonMD
the bigger question is who will have to live with the consequences of this if a patient is harmed? I am sure our leaders, admin, admin our colleges will sleep fine.
HCW and patient’s families will carry that burden.
@DrGRuralMD
word.
dietician in a hospital setting with a 80 something who was palliative with cancer…
-he is eating gummie bears. you need to do something!
actual order I wrote in the chart:
d/c glucose checks
gummie bears prn
I had never seen a man in a dress before!
there is a queen competition later that night and he can’t get his boobs right.
me: I got a set of those. lemme help you.
it’s literally that fucking simple to support something you don’t understand.
that was 1989.
#Pride2023
2/2
@KingstonHSC
patient tells me a walk in clinic referred her. it’s not her GP.
she has no quarterback to manage care.
so I, will pick up the pieces and get her access to the tests/referrals she needs for now.
9/n
81 year old
today in clinic:
I don’t have a GP as of October. what do I do?
me: I got you for my meds. but you are going go have do go to a walk in for the rest of your meds.
me also: write your MPP.
patients and doctors are both confused with
@fordnation
“plan”
#onpoli
It's "just my personal opinion" Hawaiian pizza is amazing but it would be stupid to make that the basis for the menu at all pizza parlours for all 14.5 million Ontarians. The experience of Premier Ford and the late Mayor Rob Ford should not be the foundation of public policy.
so with the shortage of family docotors in
@ONThealth
many patients are seeking walkin care.
there has been a flourishing trend of “virtual walkin clinics”.
as a subspecialist I am starting to see an increasing amount of referrals from these.
and it’s a problem:
1/n🧵
it’s astounding in this day and age of “immediate” information that
@ONgov
has not figured out how to notify a patient’s circle of medical care of a death.
to prevent incidents like this.
#humanityinmedicine
#burnout
2/2
@EM_RESUS
also my dad…
me walking to the IM ward though ortho … see his name on the board….
go into his room. ORIF for a #.
me: what the hell dad!? why did you not call me?
him: get the f*ck out of here. they always order extra tests when they know we are related.
today the sec called a pt to remind them of their upcoming appointment.
wife answered and started sobbing.
the pt passed away in Nov. she was wondering why we did not reach out to her.
it was traumatizing for the wife and for us as well. re I took care of him for 12 y. 1/2
I called them. because I know how things get lost in this system.
@KingstonHSC
radiology did not inform me that there was an error on the form. they just chucked it out.
I am sorry I made an error. there is a patient on the line here.
5/n
@DGlaucomflecken
I went to play paintball in my 40s. I had an active police officer and and a former US military guy on my team.
the other team were teens.
we were slaughtered in 20 min.🤣
good luck man.
grocery store:
-why are you wearing a mask!?
-I am a doctor. I wear it to protect myself so I don’t get sick and can continue to care for patients….
AND I wear it because 2 of the 4 people I went on a trip with last week tested + for COVID…
which reason would you prefer sir?
roadside cross and flowers. it’s been there for years.
driving by today I see a young man sitting by the cross, hunched over, openly weeping.
it took every fibre of my rational brain to not be a total weirdo…park…and wrap my arms around the guy.
they got ambushed by the luftwaffe. bullets shredded though the plane.
2-3 members of the crew were instantly dead.
an engine was on fire. the other one dead.
they coasted for a bit to get the fire out. 2/n
I am at the burnout level of:
I will give the patient a preprinted MPP addy label for their riding and a postage stamp…
..if I get another complaint about wait times for anything from radiology of any sort…to ORs.
1/n
hubby returning from work trip:
-I don’t feel good.
-do a covid test babe.
-there is something going around at work. lots of people are sick this week.
🙄🤦🏻♀️
@brianlilley
this from the guy who wrote a DOCTATOR headline for
@Torontosun2
🤣🤦🏻♀️
you Sir are part of the problem. stoking anger has consequences.
reflect on your actions Sir.
contentious topic:
I am a doctor. not a provider.
not because I have an ego larger than God’s nor because I need accolades for my degree.
the term provider reduces the doc/pt relationship to a transaction. it’s not.
that relationship is built on trust and sharing.
1/n
@PremierScottMoe
like it was time to not recognize the 3rd wave coming and then having to transfer patients out of SK to other provinces?
your lack of respect for the 2 year strain on SKs HCWs and disregard for SK lives at this point is simply astounding.
I pay $460 a month for healthcare and dental coverage (includes hubby). But it doesn’t cover my cancer drugs…not even close. If it wasn’t for Ontario Trillium Benefit and Pfizer, I would not be able to afford my medication. Poilievre should talk to ordinary Canadians.
so I was one of the peeps saying
@LCBO
is not an essential service and should be
closed early pandemic.
I was met with arguments that people are gonna go into DT’s and overwhelm hospitals.
to which I countered, having extensively worked with additions under my belt… 1/n
There is no concern about a 'diminished supply' of doctors in Ontario: ministry
~1:10 of my patients don’t have a GP.
I guess they don’t matter to
@ONThealth
this is epic gaslighting by
@SylviaJonesMPP
and
@fordnation
Sometime in 2020-21 we figured out that C19 spreads through the air in small drops that can linger in the air. They can travel >2m (though they’re more concentrated close to the patient).
Masking and fresh/filtered air helps reduce transmission. Hand/surface cleaning does not.
with small forays into the women’s section. touching the dresses but only picking out some women’s jackets to try on.
he was very quiet and shy. so I let him do his thing.
eventually he ended up in a dressing room on the men’s side. 2/n
as a frontline HCW who has seen the system progressively crumble over 20+ years….
I am glad our federal/provincial leaders met with experts today to combat auto theft.
get your shit together
@fordnation
@JustinTrudeau
lest it seem like y’all don’t care about healthcare.🙄🤦🏻♀️
Doug Ford is up in Northern Ontario trying to buy votes like he did four years ago with his totally failed of buck a beer. He is insulting your intelligence by thinking he can give you “goodies” that could or should have been given to improve Northern Ontario 4 years ago.
Returned from a much needed vacay earlier this month.
2 of my travel buddies tested + for COVID on return to Canada.
one got quite ill.
#covidisnotover
no matter how tired of it we all are.
A parent unplugged our air purifier because it was too noisy and too “cold” adding that Covid was over.
I tried explaining patiently but part of me, with no + patient tests for weeks, had me questioning my own resolve.
And then today this 2 mo old baby struggling to breathe. 🦠
@ONgov
@ONThealth
@fordnation
@LCBO
@fordnation
will lie, cheat, fuck people
over and then rinse his hands and start the game again.
ETOH sales should have never gone before medical care early pandemic.
I hope the
@LCBO
strike takes him to lunch.
7/7
the “leader” that could not organize distribution of a vaccine to “open the economy”
managed to come up with a ETOH map less than 72h after the
@LCBO
strike began.
elect idiots.
get idiots.
we get the leaders we deserve.
@fordnation
#ONpoli
"Will Premier Doug Ford also provide Ontario residents with an online map to find a family doctor?" A one sentence Letter to the Editor by Christine Alousis in Toronto.
I don’t blame COVID.
I blame complacency. as soon as kids started back live at school…vx schedules should have resumed. that was 2 fucking years ago.
I blame this on weakened/underfunded public health.
and I blame this on poor leadership. looking at you
@fordnation
@KingstonHSC
this week…almost two months after I ordered the test…
I get the report.
nothing looks like RA. but there is periosteal reaction in the femora. hypertrophic osteoarthopathy is in the Ddx.
this is clearly not a Rheumatology issue.
6/n
@KingstonHSC
call the patient to tell them about the CXR and to let them know I have sent the GP a letter outlining further steps:
CT chest, serum Ca and an ALP.
re this is no longer a Rheum issue. 8/n
80 yr old...
-oh since when did you have to start using a cane?
-I use it when I have to go out.
-to help because the joints are sore?
-no dear. to clear idiots out of my way.
#humanityinmedicine
month later pop up comes up and I have
the sec call the patient to see if they have had
their bone scan.
nope.
call the university hospital radiology dept to find out what is going on.
get told I did not fill the form out correctly.
4/n
To those who attacked me personally for complaining that my taxi driver wasn't wearing a mask while coughing and sniffling. I'm a frontline ER MD. We wear masks EVERY shift. If I get covid, a colleague will have to work my shift which adds to their stress. Think about that.
pt: that many?!!
me: yeah anyone you pass with a cough prolly has COVID right now.
finish exam and medical visit.
pt goes into hallway to cough before coming back to reception to schedule their followup appointment.
😩🙄2/2
#burnout
does not fit with RA but gonna order a bone scan to make sure there are only 2 joints that
light up.
tell the referring doc that with swelling in the wrists and a 40 pack year smoking history hypertrophic osteoarthropathy is on the ddx and to to to order a CXR. 2/n
OMG.
a patient was feeling so well with the RA he made me a cane!
complete with a little bird for the handle and a snake on it because I am a doctor.
#humanityinmedicine