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MarkHoofnagle's profile
Mark Hoofnagle
Mark Hoofnagle
Mark Hoofnagle
@MarkHoofnagle

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Mark Hoofnagle

@MarkHoofnagle

Trauma/Critical Care/Acute Care Surgeon. MD/PhD. FACS. UVa/UMD/UPenn. Asst Professor of Surgery at Wash U. Blocking is curating.

St Louis, MO
surgery.wustl.edu/people/mark-ho…
Joined March 2012

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    Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

    Time to review the 4th episode of #theresident. I'll start at 9pm EST, only 24 hours late, because, you know, trauma. Is this the week they go full conspiracy theory? (never go full conspiracy theory)pic.twitter.com/7i9kVdPdBN

    5:21 PM - 27 Feb 2018
    • 3 Retweets
    • 28 Likes
    • Cassie P KY R.N. Votes Blue😷✊🏿✊🏿 Gina the night is dark and full of covid Dr. Tideliar  #FBPE 🔬🏴󠁧󠁢󠁥󠁮󠁧󠁿🏳️‍🌈 Seth Trueger Mostly ghostly Mage of Micturition and Vaccination💉🧙🏾‍♀️ Rami S. Kantar, MD, MPH
    5 replies 3 retweets 28 likes
      1. New conversation
      2. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Starting again with the "third leading cause of death" BS. Would anyone like a more sophisticated estimate? Also from BMJ? The scientific literature is like a chorus, one voice is not the chorus, and that estimate? It's about an octave high. http://www.bmj.com/content/351/bmj.h3239 …

        2 replies 3 retweets 10 likes
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      3. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Sounds like HODAD is officially on Benzos. That's not OK. I feel guilty when I take Benadryl on backup call. And this will be the M&M episode! I was the M&M Czar for my residency program for my last 2 years, let's guess how far off it will be from reality.

        1 reply 0 retweets 4 likes
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      4. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        So, for some reason we are starting with a patient with atrophied testicle and they're suggesting removal. They declare it's not cancer (impossible to say without path), then say recommended treatment is removal because it hurts - even though the patient seems opposed. Hmm.

        2 replies 0 retweets 3 likes
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      5. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        2nd plot line, a kid lies about an illness to bring his mother into the hospital, and the nurse starts trying to scare her into staying. The nurse promises to get her "the best doctors". That's not unprofessional at all, suggesting you are the arbiter of access to quality.

        2 replies 0 retweets 7 likes
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      6. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Who is York?

        1 reply 0 retweets 0 likes
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      7. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Ok, here's the meat, third plot line - now the decision for "concurrent surgery" is being pushed from above by administrators! This is bananas in so many ways it's hard to describe. For one, the reaction to this practice is a source of public hysteria, it sounds frightening.

        1 reply 1 retweet 5 likes
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      8. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        However, like many things in science, the "common sense" gut reaction is not supported by rigorous study. It turns out, the rare surgeons who coordinate overlapping surgeries studied their outcomes and, they weren't any different.

        2 replies 0 retweets 6 likes
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      9. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        A more recent analysis suggested that there may be a risk in for orthopedists performing hip surgeries, but, read the paper! The risk in elective surgery didn't increase until > 2 hours of overlap (hip replacements shouldn't take more than about 2 hours)https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2663757?redirect=true …

        1 reply 0 retweets 3 likes
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      10. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Are you measuring risk from overlap? Or are you inadvertently measuring complexity? The other key feature is that emergency surgeries with overlap had a much more rapid time to increased risk - this suggests overlap doesn't work well with complex cases.

        1 reply 0 retweets 2 likes
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      11. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        But in elective, planned cases, if the surgeon has a mature, efficient system and well trained support staff, senior residents and assistants, the evidence instead suggests the attending surgeon does not need to micromanage the less complex parts of an operation.

        1 reply 0 retweets 2 likes
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      12. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        I have no dog in this fight. I do not overlap surgeries or have any interest in it.

        2 replies 0 retweets 1 like
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      13. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Oh, now I see who York is, it's our chance to mock a patient for DIY sex toys. I take this mildly personally, guess who gets called when things get stuck. General surgeons. It's all fun and games until you need an ostomy.

        3 replies 0 retweets 9 likes
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      14. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        We could use this as an opportunity to educate people on the importance of a flange.

        4 replies 1 retweet 17 likes
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      15. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Nurse insists that Dr. Sociopath is the best for patient dragged in by her son. That is debatable, he's a creep. She has a "abnormal pulsation in her abdomen" and orders a CT. Maybe ultrasound first? That's standard. I guess if you had high clinical suspicion...

        1 reply 0 retweets 4 likes
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      16. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        New plotline, HODAD selling his technological device. Crudite used as sign of eminent corruption.

        1 reply 0 retweets 1 like
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      17. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Back to mom dragged in by son. I'm impressed he knew that mom needed an aneurysm repair. That's usually a pretty silent killer. But yes, 7cm aneurysm? In a woman? That young? Get that fixed. EVAR time.

        2 replies 0 retweets 6 likes
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      18. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Ok, back to DIY anal toy guy, they have left the intern to remove the object from an awake patient! What?!/!11!. No. Anesthesia, twilight at least required. It is also not a simple prospect, risk of perforation is significant. Again, intern torture for drama.

        1 reply 0 retweets 7 likes
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      19. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Now HODAD is forcing a postcall resident to stay for an afternoon case. Granted I trained after the new rules. But I have never, ever, seen that happen. It probably helps that in house residents (1,2,3s) are junior and are pretty ancillary when it comes to complex cases.

        2 replies 0 retweets 3 likes
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      20. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        A 7cm aneurysm needs to be repaired, but it isn't an emergency. Also, why is the only discussion seem to revolve around open repair? EVAR would be standard of care in a young person who likely has straightforward anatomy. Also, HODAD does urology, HPB and now vascular?

        2 replies 0 retweets 7 likes
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      21. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        I get the feeling they're trying to build up a "concurrent surgery" story around HODAD doing three wildly different, wildly unplanned surgeries at the same time. Overlapping surgery is done by surgeons doing the same operation, assembly line style, super efficient.

        2 replies 0 retweets 1 like
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      22. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Agree or disagree with the practice (against the data mind you), but this is *not* what it looks like. It's usually very advanced technical surgeons with mature practices, maximizing efficiency in an elective setting. Not this fly by the seat of your pants nonsense.

        1 reply 0 retweets 2 likes
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      23. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        But why present a complex medical safety issue with any pretense of reality? Instead, show that the people doing it are HODADs.

        1 reply 0 retweets 1 like
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      24. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Back to York, the DIY anal toy patient. Now he's apparently left a bad Yelp review for his intern who is very upset about it. No one actually cares about online reviews. They're computer-generated nonsense. Want to see mine? They're terrible! My wait times are awful.

        1 reply 0 retweets 3 likes
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      25. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        It's for an office I've never had, in a state I've never had a practice in, and also, I'm trauma, so...I rarely meet my patients in the office. Anyway. My wait times are terrible! And someone from *California* thinks I talk about my blog too much. https://www.healthgrades.com/physician/dr-mark-hoofnagle-ggr4b …

        2 replies 0 retweets 3 likes
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      26. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        I feel like the M&M as a plot device has been way abandoned. It was just one scene in the beginning and then just a regular episode. I take it no one who wrote for this episode has ever actually been in an M&M? They're nothing like this.

        3 replies 0 retweets 4 likes
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      27. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        OK Concurrent surgeries to start! HODAD times out his resident (who apparently has saved him from his incompetence multiple times) on the non-complex case. Let me guess, that's the one that goes bad.

        1 reply 0 retweets 0 likes
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      28. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        I would like to once again point out that the special effects on this show are so bad it's silly. Why don't they just put an "operation" game in the field. What is going on?

        1 reply 0 retweets 3 likes
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      29. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Oh man! The resident passes out while apparently holding a clamp on some giant sheath of tissue attached to the aorta! Why even try to show gory details if you're going to make them look so cheesy! It looks like he just pulled a wet paper towel out of a real doll.

        1 reply 0 retweets 2 likes
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      30. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        That's not how you deal with bleeding. Pack. Get control. Stay cool. Unpack systematically, look at what you're doing. This is idiotic.

        1 reply 0 retweets 8 likes
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      31. Mark Hoofnagle‏ @MarkHoofnagle 27 Feb 2018

        Now they're trying to suggests general surgeons would pile an emergency ruptured AAA on top of two running cases with one going bad. This makes so little sense it's hard to critique. Experienced surgeons, even HODADs, know when to call for help. Are they the only two surgeons?

        1 reply 1 retweet 4 likes
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      32. Show replies

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