I research/educate/make policy/practice with this: Patient goals + thoughtful use of evidence = appropriate care, sustainable health systems, and joy in work.
www.drotte.ca
- Tweets 13,396
- Following 5,096
- Followers 5,902
- Likes 5,239
Time for some blue sky thinking
Come #MEDTwitter, #quaternaryprevention #deprescribing #choosingwisely #surdiagnostic #planetaryhealth folks, let’s make social media useful again!
@ChooseWiselyCA @SlowMedicine @PreventingODx @jamoulle @courtghoward
bsky.app/profile/drotte.bsky…
1
350
What do a rhinoceros, a puffer fish, and a snail 🐌 have in common? They are all in my #fmf2024 talk about how to treat prolonged (and acute) cough 😷!
Room 118-120 at 13:30 today!! @CFPC_e @FamilyMedForum #urti #coldandflu #cough
2
3
479
Going to try @bluesky
see you there? bsky.app/profile/drotte.bsky…
2
175
Help me find my #surdiagnostic #overdiagnosis #choosingwisely @QuatPrev #sustainability etc people again! Any "good" social media platforms for this? @rwittmer3 @vmontori @DeeMangin @medmyths @DrDavidWarriner @drjohnm @hhask @MedicineSlow @AKECassels @KariTikkinen @RealisticMed
3
3
875
Nov 6 noon: #deprescribing enthusiasts, especially @pharmacists
This webinar (using #tramadol example) will help empower you to do drugectomies in your #longtermcare facility, with applications for clinic + community too!
#polypharmacy @bc_pharmacy @deprescribing @SeniorCareRx
ALT Nov 6th webinar at noon highlight the processes and learnings from a pharmacist-led tramadol deprescribing project in long term care facilities
3
6
2,117
Lack of regulation on for-profit genetic data stewardship: one of the reasons @DoctorsOfBC developed policy about direct to consumer marketing of genetic testing.
I know, “told you so” won’t protect patient privacy. This never should have been allowed to happen!
15 million people trusted 23&me with their DNA. Now the company is almost bankrupt, the stock about to be delisted, and almost the entire board has resigned.
Who will they decide to sell your info to?
1/
1
2
3
1,065
Urine testing to r/o infxn: more harm than good cfp.ca/content/70/9/551
Your mantra may be "don't treat asymptomatic bacteriuria" & "not every $@%# delirium is a UTI!" but it is often a challenge convincing others.
This @CFPJournal article has some helpful scripts for this!
3
4
592
Oct 19 virtual/in person! Polypharm, (es)citalopram, CHF Rx, treating cough, rational labs ordering, exercise, pain scores +more!
REGISTER: ubccpd.ca/learn/learning-act…
@SCDoFP @SRPCanada @RuralRemoteDFP @kootenaysdoc @drcadesky @DrRitaMc @GoldisMitra @DeprescribeNet @deprescribing
1
6
6
721
Oct 19 virtual or in person! Polypharm, es- vs citalopram, CHF Rx, treating cough, rational labs ordering, exercise, pain scores + more!
REGISTER: ubccpd.ca/learn/learning-act…
@bc_pharmacy @UBCDoM @ResidentDocsBC @ResidentDoctors
* learners: @ me if $hardship and want to attend
181
You may know about #tramadol pharmacology = 🤪
But do you know why one of the most abused #opioids is not regulated internationally? @chriscaurla dove deep:
dw.com/en/opioids-old-high-n…
@Drug_Evidence @DavidJuurlink @DrGolfShirt @srrezaie @First10EM @ToxAndHound @picardonhealth
3
7
994
Pharmacists in non-dispensing positions could prescribe but I guess apparent access to health care > COI in the minds of our leaders.
Dangerous path. Good intentions.
1
1
40
I recognized the title …. Same as a great book I read in an undergraduate class on Darwinian Medicine. Very interesting to think about why we choke or why depression exists….
29
REGISTER NOW: UBC Therapeutics Initiative Best Evidence Conference Sat Oct 19 (18th pre-)
ubccpd.ca/learn/learning-act…
@DeeMangin on polypharmacy and primary care, @drjohnm on CHF drugs, (es)citalopram, HTN myths, rational lab testing, exercise vs drugs, treating subacute cough ++
2
3
2,363
Just signed up for this great way to introduce my kids to culture, geography, and charitable giving + make a small impact!
With Paddington's Postcards, set up a $25+ monthly donation to @UNICEFCanada; they'll deliver your monthly gift for up to 12 months secure.unicef.ca/page/126646…
1
152
For those of us who preach "lots of infections don't usually need antibiotics, at least not right away, like URTI, bronchitis, sinusitis, AOM, conjunctivitis... but diverticulitis? Yah, definitely treat that sh*t!!!"
Well🚽that idea cfpclearn.ca/tfp370/
#AMR #practicechanger
1
1
227
Did you know there is a BPMH interview guide? 1 pager ismpcanada.ca/wp-content/upl… via @GeriMedRisk
Run, don't walk!
cc @Drug_Evidence @BCPharmacists @ubcpharmacy @islandhealth @BC_pharmacy
#polypharmacy #BPMH #pharmacy
2
699
The @cantaskforce has a tough role. It is obvious from this explanation of their process that they prioritize evidence and thoughtfulness above vested interests. I wish all guideline orgs could do the same.
Saying “no” takes courage, even when you know it’s the right thing.
Why screening guideline committees should not include ‘experts’ as voting members healthydebate.ca/2024/02/top… via @HSingh_MD et al
3
6
1,310
Thanks to @CWIMorg @cwimgather
I’m a little parenting-star-struck. Joanna Faber is at #cwim2024 teaching us skills for our patients and our kids!
Thanks to her and @howtotalker, and the late Adele Faber, for the tools they have given struggling parents worldwide!
1
1
377
I used to travel a lot, not much since becoming a mom. Dad is holding the fort for a few days while I go to a conf ✈️
The overhead announcement just said “forthosecustomerstrugglingwithsmallchildren, please proceed to the gate to board now.”
That agent is a mom 😝
#struggling
2
304
Also … ARBs have higher cost and a little less volume in the RCT department. And ACE-I cough is not as common as people think. See @Drug_Evidence letter 133 ncbi.nlm.nih.gov/books/NBK59…
Surprised to see losartan topping this list.
When starting an ARB, losartan is the last option I'd go with, for one simple reason.
🧵 /1
1
4
7
2,396
Oh isn’t it funny when a book about Easter from the library is also about #integrativethinking
@JenniferRiel @RogerLMartin @Candlewick
(You can tell the @CMA_Docs /@rotmanschool course I took on this continues to influence my perspective on the world) Thanks @VI_Library
1
7
339
Many ask "Why do we still order so many unnecessary or harmful tests, procedures, and medications?"
We tried to find out.
bmjopen.bmj.com/content/14/3… @BMJ_Open
#overdiagnosis @WoncaWorld @jamoulle @PreventingODx @vmontori @Drug_Evidence @mgtmccartney @ChooseWiselyCA @JuanGrvas
ALT Screenshot of Enablers and barriers to a quaternary prevention approach: a qualitative study of field experts research article in BMJ Open
4
41
80
16,801
📢 BC family #physicians & #NPs:
Sign up & receive personalized #prescribing feedback from the UBC Therapeutics Initiative Portrait program: ti.ubc.ca/portrait
2
4
541
Anyone doing #oncology care must watch this @csoncol video 📺, via @CADTH_ACMTS
How do we ensure as many #cancer patients as possible get the best possible care?
piped.video/watch?time_conti…
@BCCancer @cancersociety @GeriPalBlog @htai
*spoiler: it doesn't require spending more 💰*
1
3
1,102
Speech Language Pathologists = the best!
They help patients communicate (w voices, eyes, hands, &), navigate (w words, wheelchairs), eat (safely, or at risk), and a LOT more. They are so instrumental to a person’s experience of the world. They give hope & power. And laughs:
ALT Office door - speech language pathology office
1
1
3
568
It's not all in our heads!
People are sicker and more complex!
med.ubc.ca/news/hospitals-de… via @UBCmedicine
New @UBCmedicine research sheds light on the complex, changing needs of patients in B.C. hospitals: ow.ly/7caP50Qq6b9
1
6
9
2,253
Dying for Beginners | Dr Kathryn Mannix
this is an excellent video
piped.video/ayMhA1pRLeY?si=63ZE…
#death #palliative
1
1
1
550
Help me #choosewisely:
Which liver enzyme(s) or function tests should be used monitoring for hepatic injury from meds, eg. carbamazepine? Guidance says "liver function tests" but no specifics.
Would ALT be sufficient? LDH any help?
Where is reliable info on this? #hepatology
4
2
4
4,570
We @Drug_Evidence did a thing.
Because getting your prescribing feedback along with the latest evidence = best care for British Columbians!
thischangedmypractice.com/im…
#TCMPed #feedback @BCFamilyDoctors @BCCFP @UBCCPD shout out to @PathwaysBC @HDCBC_Canada @DoctorsOfBC FPSC+ more!
3
6
680
Missing all the learning/energy/like-minded people & solutions at #podc2023
🙏🏻for tweets @wiserhealthcare
@brooke_nickel @mgtmccartney @rwittmer3 @GenBois
My colleague (new FP!) shared our study on drivers&enablers of Quaternary Prevention #p4. One piece of the crisis puzzle
1
2
4
1,143
Seems @CMA_Docs left this out, which gives me the opportunity to highlight @DoctorsOfBC work on solutions:
doctorsofbc.ca/news/creating…
Look specifically at the Burdens Solution tool - brainchild of the policy dept/CHEP, mainly led by Katie Bowers #physicianburnout #burdens
Solving administrative burden is a critical step towards a more efficient healthcare system that supports physician wellness &improves patient care. It is complex &needs engagement at all levels. @CMA_Docs @AlikaMD @DoctorsOfBC @OntariosDoctors @CFPC_e cma.ca/physician-wellness-hu…
1
1
2
1,540
The Restaurant of Mistaken Orders piped.video/QvbSCLpwq6w
A lovely and practical effort & a fable that beautifully illustrates how and why we should value of our elders.
#dementia #eldercare
(I checked re: reservations, should I ever visit Tokyo; alas it is/was only a pop-up)
1
874
Osteoarthritis imaging:
DO THIS: weight-bearing knee x-rays
NOT THIS: MRIs
A survey of British Columbian doctors and evidence-based recommendations bcmj.org/articles/osteoarthr… via @BCMedicalJrnl #choosingwisely @ChooseWiselyCA
2
5
19
2,342
📢Calling all British Columbia FPs & NPs🩺
Improve patient care with distilled evidence + prescribing feedback💊 = UBC Therapeutics Initiative Portraits
Register online by Oct 14 & you'll be entered to win an iPad!📱
reg: secure.ti.ubc.ca/register.ph…
info: ti.ubc.ca/portrait/
5
10
1,459
Watch “Learning about the true meaning of "palliative care" @VirtualHospice #pallmed #mythbreakers #Cancer vimeo.com/286459797?ref=tw-s…
1
347
There’s a whole business/management field all about finding a way to bring together two ideas that are very much conflicting eg: high quality medical care and low price.
Anthony, your approach - making comfort with both - is a unique solution.
1
1
31
Oh it’s snowing again in Nanaimo!
(Outside the hospital 🏥 )
@VanIslandHealth @nanaimohospital @NanaimoDivision #snow #vancouverislandproblems
1
5
670
Surprising!
/... NOT!
Revealed: experts who praised new ‘skinny jab’ received payments from drug maker theguardian.com/business/202… #conflictsofinterest #ozempic @DavidJuurlink @CaulfieldTim
2
611
A happy coincidence in #SanDiego @SanDiegoAirport
As the sun descended, a rainbow lit up the sign for an inclusive bathroom. #pride #inclusive 🌈 ☀️
1
1
18
2,012
9 years on here?! Hoping it doesn’t go totally sideways as it has been a great tool for connecting with #overdiagnosis #surdiagnostic #hta and other niche medical communities #MyTwitterAnniversary
7
1,114
I keep a tiny longitudinal practice even though I have a lot of other roles.
For a few of my patients it has been a rocky year; as their family doc, I am honored to hear that they know I’m on the journey with them🥊🎢🩺❤️🩹
What a lovely card to receive!!🥹
14
1,412
Very little medicine is based on high quality evidence. Most MDs know this, but we carry on as if all Tx are EBM since we want to do _something_. Where there is high quality evidence (SDOH, exercise) it just seems too hard to make change :/
sciencedirect.com/science/ar… via @MarcP2050
ALT highlights from the article
3
8
23
Can’t knock that commute! Quick hop to Vancouver to do a @Drug_Evidence talk on evidence based management of constipation for BC’s Naturopathic Doctors.
Not a glamorous topic but a very important one especially in #cancercare and #PalliativeCare
I guess I really know my $&35t#
1
1
14
At #podc2022 @OtisBrawley suggests we need to reject faith-based medicine.
“Screening is a religion.”
…We need to challenge that.
#overdiagnosis #ebm #cancwr #screening
2
3
Dr S Klarenbach of @cantaskforce at @PreventingODx summarized what women may consider when they are choosing whether to have a #mammogram or not for #breastcancer
Tribalism is high on the list.
#surdiagnostic #overdiagnosis #cancer #screening
2
2
Did you know? #choosingwisely @ChooseWiselyCA #PODC2022
#overdiagnosis #surdiagnostic
DID YOU KNOW: 1 blood draw per day for ‘routine’ daily lab testing = ½ a unit of blood per week. That's 20-30 blood tubes wasted, & lots of iatrogenic anemia!
1
9
23
Wow @professormaja
I am not sorry you are presenting @cwimgather
#sorrynotsorry #cwimconference2022 #feminism
1
1
9
The hilarious @DrJenGunter educating #cwimconference2022: Menopause is NOT a disease
The roots of this idea that medicalizes normal aging? A pharma-funded book Feminine Forever
#feminism #womeninmedicine #overdiagnosis 😍 @cwimgather
❤️ it when professional interests collide!
3
10
Yeah so many people think of EBM in isolation and forget the triad ncbi.nlm.nih.gov/pmc/article…
1
4
MDIs have a big carbon footprint.
The Climate Conscious Inhaler Prescribing Collaborative (UofT) seeks primary care teams to helpinitiative for more environmentally sustainable inhaler prescribing
#climatechange
#deprescribing
@CAPE_ACME
@Drug_Evidence
cascadescanada.ca/courses/cl…
1
3
My family doctor cares!
Thank you Dr Ehman for all that you do for our family. Mastitis? Serious neurological issue? Kid not growing? Baby not coming out? Occupational injury?
No problem, he helps us. We are so lucky to have a (great) Family Doc!
vimeo.com/707149515?ref=tw-s…
2
6
At 13:30 it’s time to get the 💩 on 💩
We’re going to have some fun figuring out how to treat constipation in adults, including those on opioids
A practical @Drug_Evidence session that will change your practice!
#SRPC2022 #ruralmed #therapeutics
1
2
