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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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    1. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

      It’s Monday night, you know what that means...time to roast episode 6 of the world’s goofiest medical drama #theresident. What crime will our sociopathic hero Conrad commit tonight in the name of medicine?pic.twitter.com/dDe5afzDXY

      4 replies 6 retweets 42 likes
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    2. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

      I think I might trade in fire elmo for “medieval elephant” This is the drawing you get when an artist has never actually seen an elephant but draws one #theresident is the show you get when the writer knows nothing about medicine but writes a show about doctors.pic.twitter.com/u9WhCeZrL2

      1 reply 4 retweets 23 likes
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    3. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

      Ok. Already a bad decision. I like Dr Okefor, but probably best not to try to bring a handbag to a gunfight.

      1 reply 0 retweets 3 likes
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    4. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

      So finally we're figuring out why HODAD can't do anything about #theresident sociopath Conrad. His dad is the bigwig investor from last week. They meet and rehash their terrible relationship over breakfast. Because Conrad can't have a healthy relationship with anyone.

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

      The business guy literally has the gall to say "look at the industry you work in" as some kind of insult, like medicine doesn't have a professional ethic comparable to what? Wall Street?

      1 reply 0 retweets 6 likes
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    6. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

      Conrad retorts he "doesn't capitalize off other people's misfortune". Knowing the conspiratorial nature of the writer of this show, my guess is, by the end of the show he will learn a lesson about how he really is just a greedy capitalist. Well he may be. But he's a creep.

      1 reply 1 retweet 3 likes
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    7. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

      C-spine Xrays for the mugger? Is this 1990? Is this pediatrics?

      1 reply 0 retweets 7 likes
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    8. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

      I think a person who has been struck hard enough to cause loss of consciousness that you are concerned enough to try to rule out c-spine pathology deserves at least a head and c-spine CT.

      1 reply 0 retweets 9 likes
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    9. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

      Ok that's plotline 1, we'll call that Okefor's Mugger Plotline 2, bone marrow transplant girl. Oh my god, I just had to have Tivo replay him saying "hematopoietic" like 10 times. Also, don't underestimate the sophistication of your patients living with a complex disease.

      2 replies 0 retweets 4 likes
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      Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

      Ok, here comes the conspiracy, Lane, the oncologist, is overtreating cancer patients for fun and profit, including Lily, our BMT girl. The solution, if one was concerned, isn't to take out-of-context pictures of meds on poles, but referral to the medical board for chart review

      6:15 PM - 5 Mar 2018
      • 4 Likes
      • Ryan Marino Gina joypath Seth Trueger
      1 reply 0 retweets 4 likes
        1. New conversation
        2. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Plotline 3, "Chronic digestive pain" guy, showing that people who do have complex diseases often are excellent experts on their diseases.

          1 reply 0 retweets 3 likes
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        3. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Okefor's mugger is now going bananas, because he's "going through withdrawal". That's not what withdrawal looks like. I'm going to guess his violence is just the outward symptom of some disease #theresident will diagnose.

          2 replies 0 retweets 6 likes
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        4. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Oh man, yet another plotline with HODAD. The writers of this show should consider trying to decrease the complexity of their narrative structure, they barely can make 1-2 simple plotlines make sense. HODAD is asking about "a friend" who has a tremor to a neurosurgeon.

          1 reply 0 retweets 3 likes
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        5. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Is the nurse calling the family to try to pick up Okefor's mugger? The only people who should pick up this guy should be the cops, he pointed a gun at a woman.

          1 reply 0 retweets 6 likes
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        6. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Conrad creepy distance stalking nurse. Am I the only one who finds his staring at her from across two windows deeply disturbing?

          1 reply 0 retweets 4 likes
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        7. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          If Conrad is in charge of all these patients why are all these consultants here? Oh, his attending has shown up! Quick! Fire that guy for improper supervision. It's episode 6 before we've identified any actual supervision of Conrad by an attending.

          1 reply 0 retweets 7 likes
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        8. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          NP trying to find a ride for her mugger patient. If he's not going with the cops, you don't need a ride to leave a hospital. Feet work just fine. And woah! NP is now trying to give the mugger a ride home? Yes, Dr Okefor is right, this is a terrible idea.

          2 replies 0 retweets 7 likes
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        9. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          HODAD is now getting another plotline as recruiter for some guy named Carver. I guess the idea is he would be threatened by an actually competent physician? This show needs an editor.

          1 reply 0 retweets 4 likes
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        10. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Conrad fighting the good fight against his consultants. Is this really about his patient with the digestive disorder or about his ego? I'm guessing ego. The patient is apparently tolerating multiple consults just fine.

          1 reply 0 retweets 4 likes
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        11. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Now BMT girl Lily is showing she's fully aware of the risks of her disease and the mortality, morbidity and QOL issues. And onto the mugger plotline, NP and Okefor trying to convince mom to take a drug addict mugger who has previously robbed her business back in their house

          1 reply 0 retweets 4 likes
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        12. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          We have specialists, BTW, known as case managers and social workers who are experts in this stuff. It's probably best you don't just half ass a violent offender into a possible unstable family situation with no clear plan for drug rehab. Just saying.

          1 reply 1 retweet 12 likes
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        13. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Wow, they don't even do ass-kissing right. HODAD is giving the new recruit a tour and he's being mobbed like Britney at the airport.

          1 reply 0 retweets 3 likes
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        14. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Oh God. Now Conrad is lecturing on vestigial organs, saying the serve "no purpose". Can't they get anything right? Vestigial means it no longer serves its *original* purpose, not that it serves no purpose.

          1 reply 0 retweets 5 likes
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        15. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          An ostrich's wings are vestigial, they are no longer used to fly. That does not mean they do not help the animal with other tasks like running and balance.

          1 reply 0 retweets 5 likes
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        16. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Similarly the appendix probably has some functions. Removal increases risk of Crohn's disease, it's been hypothesized they maintain gut microbiota, but it doesn't serve the original purpose - which would be like a "crop" in an animal that is primarily vegetarian.

          2 replies 0 retweets 4 likes
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        17. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Ok, back to digestive guy. He doesn't want tests. Tell him to he doesn't have to do the tests! It's his body. You don't need to *hide* him in the hospital. Just have him refuse the tests he doesn't care for, or ID Conrad as the physician he trusts to Wilmot.

          1 reply 0 retweets 7 likes
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        18. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          They are introducing yet another story line? Dr. Okefor is now treating a kid outside the hospital? And no surgeon uses the pain scale. It is the devil, and clinically meaningless. Use your brain, not a subjective pain score.

          1 reply 0 retweets 4 likes
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        19. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          HODAD interviewing recruit, wants to know surgical error rates, suggests that some hospitals don't track them. Is this not a NSQIP hospital?

          1 reply 0 retweets 5 likes
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        20. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Ok, back to what I think is the 6th narrative? Okefor is running a clinic out of her home. "All of the big hospitals are closing their clinics for profit reasons". Umm, such clinics never made profit. Don't blame the hospitals for the failures of the social safety net.

          1 reply 0 retweets 5 likes
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        21. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Did we forget about the mugger? I must have missed it among the half dozen unconnected narrative threads tying this show together like a kindergartner practicing basket weaving.

          1 reply 0 retweets 4 likes
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        22. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Back to digestive disease guy, he does a careful history and diagnoses median arcuate ligament syndrome - which you probably should have been able to diagnose with all the imaging he's already had, and indeed, Conrad looks at a CT on a laptop which seems to show free air.

          1 reply 0 retweets 5 likes
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        23. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Wait, Lily's BUN is 27! Creatinine 2.1! Acute renal failure! Hardly dialysis level labs here, I don't know if a BUN of 27 means if you get a BMT you will *die* as the intern suggests. I mean, I'm not an oncologist or anything.

          1 reply 0 retweets 3 likes
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        24. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          MALS confirmed by ganglion numbing in IR for digestive guy. My guess is they're just plagiarizing this great "Think Like a Doctor" from the NYThttps://www.nytimes.com/2016/10/07/well/live/think-like-a-doctor-a-terrible-stomachache-solved.html …

          1 reply 0 retweets 5 likes
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        25. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Now Conrad's dad is back to talk about not investing in the hospital (7th story line? Holdover from last week?) HODAD burns the bridge by bitching at him for wasting his time. And surprise, they didn't know that's Conrad's dad. So why do they put up with Conrad's BS?

          1 reply 0 retweets 3 likes
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        26. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          The conspiracy is unleashed! Lane ignored a BUN of 27, potentially killing Lily with a BMT, because they are the "superbowl of cancer treatments" when it comes to billing. Is that a metaphor that works? Who writes this dreck?

          1 reply 0 retweets 3 likes
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        27. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Nepotism is definitely Conrad's best bet for eventual success. He should take the offer. Jobs are found by networking, who is going to write Conrad a recommendation letter? He's a monster who plays well with no one, sexually abuses colleagues and patients, and attempted murder.

          1 reply 0 retweets 3 likes
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        28. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          Would the superbowl of cancer treatments be a BMT? Or a clinical trial in which two cancer treatments are pitted against each other, with expensive ads? I think I'm better at this then the writers.

          2 replies 0 retweets 4 likes
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        29. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          So Lily's creatinine was 2.1 and BUN 27. I don't think that would exclude her from a BMT, and a quick search of the literature suggests renal impairment is not a contraindication as maybe it once was. Maybe the intern doesn't know as much as Lane? https://www.sciencedirect.com/science/article/pii/S1083879114001001 …

          2 replies 0 retweets 5 likes
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        30. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          You should also consider that in a young patient that is more likely to be resilient, and if the alternative is *death*, maybe you would accept a higher risk? Especially if the patient wants to take a chance at prolonged survival.

          1 reply 0 retweets 1 like
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        31. Mark Hoofnagle‏ @MarkHoofnagle 5 Mar 2018

          I'd be happy to hear from the oncologists on this. But, for some reason, I suspect this is a bit overblown. But that's this show in a nutshell.

          1 reply 0 retweets 1 like
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        32. Show replies

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