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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 26 Mar 2018

    Uh oh. Monday at 9. Time for the latest installment of our medical conspiracy show #theresident. Tonights episode “lost love” will feature Conrad’s ex. Let me guess, he’ll be awful to her.pic.twitter.com/5hToocNUOb

    6:08 PM - 26 Mar 2018
    • 2 Retweets
    • 10 Likes
    • Emily Incognito, MD, PhD Seth Trueger Clinical Workhorse Awkwardmantys, MD 🏳️‍🌈Jenny🍭 Alice [ShutDownNazis] Renee ChopTart🏳️‍🌈🔪 Shannon Mitchel Chris Horn
    3 replies 2 retweets 10 likes
      1. New conversation
      2. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Bone marrow girl is back, still believing the procedure would kill her because the induction would make her kidneys fail. My reading suggests this is no longer a contraindication. Any oncologists with thoughts?

        1 reply 0 retweets 2 likes
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      3. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Our NP Nic, who seems to have every single job in the hospital, is delivering puppies in a box to the pediatric ward. In the most probable medical mistake so far on the show, a puppy escapes and an old lady sticks it in her purse! Everyone is terrible.

        1 reply 1 retweet 6 likes
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      4. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Way more likely than someone transecting the aorta in an open appy... Conrad is sitting on his ex’s bed, staring at her as she wakes up. That’s not creepy at all.

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

        He used to call her trailer trash apparently. What a charmer. Now they’re back to stalking Dr Hunter, who he calls by her first name, because she’s a woman. Her crime? Apparently prescribing an indicated procedure for a sick young woman.

        3 replies 0 retweets 4 likes
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      6. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Now we’re supposed to believe she’s shedding crocodile tears over her “near miss” with BMT girl. This representation is comic book villain evil manipulation. Oh god, and now more staff are hiding this puppy from the NP. That’s someone’s dog! Everyone is terrible.

        2 replies 0 retweets 5 likes
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      7. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Do I need to mention that Conrad treating his ex fiance is a gross boundary violation and creepy?

        3 replies 0 retweets 6 likes
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      8. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        It’s amazing what these writers think is wrong or what goes wrong, in medicine but they have no concept of things like it’s unethical to treat friends, family, and certainly sexual partners.

        1 reply 0 retweets 10 likes
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      9. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        This is a rule often violated by doctors for simple things (eg my mom stitched a laceration on my ankle once), but treating your former fiance as an inpatient? Delivering news of her pregnancy? Super inappropriate.

        2 replies 0 retweets 9 likes
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      10. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Who here thinks it’s weird that everyone in this hospital is treating puppies like change in the take a penny leave a penny tray?

        2 replies 0 retweets 6 likes
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      11. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Now the hospital CEO is making one of the most dangerous and stupid policies imaginable - they plan to fire anyone with a high complication rates. In reality this would do 3 things - 1. Make docs select only healthy patients 2. Code shifting 3. Suppression of medical errors.

        1 reply 1 retweet 7 likes
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      12. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Punitive measures for error do not actually encourage safety culture. They create the illusion of safety by incentivising dishonesty. They result in suppression of mistakes and avoidance of perceive high risk patients - the poor, the uninsured, the chronically ill and minorities

        3 replies 3 retweets 11 likes
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      13. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        This does happen, for instance in Britain, and the case of Dr Bawa-Garba is instructive. Basically, she was hung out to dry for a mistake anyone can make. Rather than fixing the system errors they destroyed a young physicians life. http://thehealthcareblog.com/blog/2018/01/30/to-err-is-homicide-in-britain-the-case-of-dr-hadiza-bawa-garba/ …

        1 reply 2 retweets 9 likes
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      14. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        This is the worst possible method to correct error as it will punish doctors taking higher risk (safety net) patients, damage careers, and ultimately fail to address the problem - systems need to be fixed/improved to prevent human error, because humans are going to make errors.

        1 reply 2 retweets 5 likes
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      15. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Conrad just performed the stupidest looking abdominal exam I’ve ever seen by rolling his hands on his ex’s superficial abdominal wall and diagnosing bowel ischemia. So, that’s not an internists call, that exam is not specific and she’s way young for that to be a first guess.

        2 replies 0 retweets 5 likes
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      16. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        In a pregnant, young woman, if ischemia is your first guess for abdominal pain, you’re probably an idiot.

        2 replies 0 retweets 16 likes
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      17. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Bad news, HODAD is the emergency surgeon on call. He apparently doesn’t even examine the patient himself, she just shows up in the OR. In an extension of Conrad’s creepiness, he threatens HODAD over his ex’s surgery. This is why you don’t treat your ex...

        1 reply 0 retweets 2 likes
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      18. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        HODAD is relieved because he knows he sucks (part of being a HODAD is not understanding your limitations). Now Conrads buddy, who has come in on his day off to treat his ex, is here to save the day (the guy that caused the pneumo last week). They still haven’t heard of Bovie.

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

        Once again a bizarre representation of the response to hemorrhage. Just shoving pack into a midline blind. There is actually a systematic way of doing that, even in an emergency. Also supraceliac clamp.

        1 reply 0 retweets 6 likes
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      20. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        And suprise of all surprises, acute abdominal pain in a young pregnant woman, at 6 weeks no less) isn’t ischemia, what a dolt. That’s ectopic until proven otherwise. This is why internists don’t make the decision for surgery.

        4 replies 0 retweets 10 likes
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      21. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Surprise of surprised, Conrad, who lies in his profession constantly, lied to Nic about a ring he gave her. She offers to give it back. He says, “you earned it”. Gross.

        3 replies 0 retweets 6 likes
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      22. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Did this NP just guve the chemo/BMT girl a puppy by dropping it onto her face? Isn’t this, you know, idiotic? She says it breaks all the rules but she doesn’t care. Her WBC of 0.1 might care. Also, if she’s got a life expectancy of 6 months, isnt that kind of cruel?

        1 reply 0 retweets 4 likes
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      23. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        She then objects to giving 40 meq of K because her “kidney function is coming back”. That’s not the problem with K in CKD, 40 meq isn’t going to hurt someone with normal k even if you bolused it if it’s mixed in a liter of saline. So many stupid problems with the writing.

        2 replies 0 retweets 7 likes
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      24. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        But aside from all the medical inaccuracies, how do they even manage to get puppy distribution wrong? Who is handing out puppies in hospitals like hard candy.

        2 replies 0 retweets 4 likes
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      25. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        I shouldn’t have written that before seeing Conrad checking an ulnar pulse. In a code. Wrong side of the wrist buddy. I’m sure they’re going to blame this on Nic and the K, even though thats a physiologic absurdity.

        1 reply 0 retweets 6 likes
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      26. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Even worse, it’s an assassination by Hunter to frame the NP! So now the oncologist, to hide her questionable overuse of chemo, is assassinating patients with potassium and framing nurses. But the writer says she is trying to make a show about safety. Yeah.

        1 reply 0 retweets 8 likes
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      27. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Their medical consultant is the murderer...of accuracy!

        1 reply 0 retweets 7 likes
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      28. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        It would probably be pretty hard to kill an adult with 40 meq of K (esp if her K was low). You would need it in a concentrated bag, you would need to squeeze it in, and it would burn like hell as it trashed the vein as that looked like a PIV. Not to say K isn’t dangerous.

        2 replies 0 retweets 4 likes
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      29. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        Historically, one of the most prolific murderers in US history was a nurse who overdosed patients meds on purpose. He preferred insulin and digoxin. K is probably too painful to inject in lethal doses to escape notice.https://en.m.wikipedia.org/wiki/Charles_Cullen …

        1 reply 0 retweets 2 likes
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      30. Mark Hoofnagle‏ @MarkHoofnagle 26 Mar 2018

        So medical professionals have purposefully killed before, a serial killer in medicine isn’t implausible. What’s so offensive about this show is this representation of lying, cheating, upcoding, stealing and extraordinary 1 time events as business as usual for healthcare.

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

        Their prescription for change - firing for error and video surveillance - would have terrible effects on quality, undermine safety culture, be insensitive for error and needlessly ruin lives. This is why you don’t take advice from people who believe the “3rd leading cause” BS.

        1 reply 0 retweets 5 likes
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      32. Show replies

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