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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 23 Apr 2018

      It's 9PM on a Monday, time to mock Fox's medical conspiracy show #theresident. Tonight's episode "And the Nurses Get Screwed"pic.twitter.com/14yLK2Qzsj

      1 reply 10 retweets 30 likes
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    2. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

      Ok, no one can screw up a lipoma excision, even HODAD.

      1 reply 1 retweet 4 likes
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    3. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

      Dude, an OR fire? During a lipoma excision? And he stands there with his hands in the air? Sterility is less important than fire. Already dumber than I could possibly have expected.

      2 replies 1 retweet 12 likes
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    4. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

      The surgery "went perfectly" except for that OR fire. OK plotline two, the intern is in the ER, with a hypochondriac. Let me guess, she's secretly sick.

      1 reply 2 retweets 9 likes
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    5. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

      His boss suggests giving her a placebo prescription to make her feel better. Unethical, unrealistic, and stupid. One doesn't treat delusions by reinforcing delusions.

      1 reply 1 retweet 14 likes
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    6. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

      I like how their OR cams have complete coverage of every inch of the OR, like there's a director of photography running 4 cameras in every room with such high res you can see every single detail.

      1 reply 1 retweet 7 likes
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    7. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

      NP Nic tries to blame Hunter for excessive chemo with no evidence. She finds out it was the K, even though as we discussed, 40meq of K in a hypokalemic patient, diluted in a liter of fluid isn't going to do squat.

      1 reply 1 retweet 9 likes
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    8. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

      Conrad convinces OR burn patient he will be cured with plastic surgery using the power of...Photoshop.

      1 reply 1 retweet 4 likes
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    9. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

      Back to Nic, 40meq of saline even in 30 minutes in a hypokalemic patient is not fatal. This is physiologic stupidity.

      2 replies 1 retweet 6 likes
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      Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

      When the test results come back on Lane's patients (not Dr. Hunter because she's female) they "go directly to her", as opposed to into the EMR. Conrad says he hasn't drawn blood since med school. Accurate. Our first accuracy!

      6:17 PM - 23 Apr 2018
      • 1 Retweet
      • 23 Likes
      • Dr. Chim Richalds Laura Dickerson That's vaccinated Dr. cancoi Shannon Mitchel Heightsmomma Scott Krugman, MD joypath Richard Goldman Liz "The Mask Goes Over Your Nose AND Mouth" Ditz
      1 reply 1 retweet 23 likes
        1. New conversation
        2. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          Back to the intern in the ED. Patient with right sided abdominal pain. Xray is sown in the corner, and is "normal", except for all that free air.

          1 reply 1 retweet 10 likes
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        3. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          Also a paucity of bowel gas, look out for that. I like the rapid turnaround from the senior from, do nothing to, "yeah, OR".

          1 reply 1 retweet 4 likes
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        4. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          Back to Hunter trying to frame Nic, there's no way 40meq of K in a liter of fluid given in 30 minutes is going to kill anyone with low K. Ok a bunch of stupidity is going down.

          1 reply 1 retweet 4 likes
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        5. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          Burn patient is going to code for airway threat and Conrad wants to do an escharotomy, but because he's worried about infection, he wipes with an alcohol-containing chlorprep. Awesome. Even if some of the tissue is dead, any living is going to hurt like hell.

          1 reply 1 retweet 5 likes
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        6. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          That's a good place to use betadine if anything, and once again they're obsessed with doing aggressive horrible things for drama. Conrad makes a horizontal incision across the neck to free the eschar, which looks like a great way to hit every single external jugular you can.

          1 reply 2 retweets 13 likes
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        7. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          And why not call anesthesia and at least try to intubate? So many of these people reach extremis before intervention, your patients should not always be reaching a point while monitored where you have to do crazy aggressive lifesaving interventions. So much bad doctoring.

          1 reply 1 retweet 11 likes
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        8. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          Now the intern is trying out some phlebotomy, good time for alcohol but it doesn't seem in use. Also, what little phlebotomy I do, it's better to feel for veins than stab randomly in the cubital fossa.

          3 replies 1 retweet 4 likes
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        9. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          Also why does Nic being out mean no blood gets drawn? No other nurses? No phlebotomists? Have I missed a sneaky phlebotomy conspiracy? Back to the ER.

          1 reply 1 retweet 7 likes
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        10. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          Are these idiots really going around drawing blood on patients surreptitiously for their own medical vendetta against Hunter, without telling the patients what they're doing? That's really messed up. That's battery.

          2 replies 1 retweet 7 likes
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        11. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          I like how a resident can just walk into the hospital administrators office and yell at her and threaten the whole hospital. So many fireable offenses and we're only half way though.

          1 reply 2 retweets 6 likes
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        12. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          And I spoke too soon, someone has shared the hospital video with the burn patient and despite having a neck escharotomy an hour ago to save his airway he's had time to autotune a video of himself singing to it. The hospital PR person has "contacts at NetTube". Uggh.

          2 replies 1 retweet 3 likes
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        13. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          This show is made by people who think, "Wag the Dog" was accurate political commentary as now they're suggesting the hospital is going to import a war orphan to treat for good PR. I can't even.

          2 replies 1 retweet 4 likes
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        14. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          If you can hack into a "surgical learning database" and download sensitive patient information including video of surgeries, this hospital has a bigger problem than a hospital fire, it has total insecurity of all of its hospital records and will be shut down forever.

          1 reply 4 retweets 7 likes
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        15. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          So after a round of illegal battery of patients to draw their blood for their private vendetta against Hunter, with no informed consent, our "heroes" have found everyone is healthy - but like any conspiracists, contrary data should never discourage your belief.

          1 reply 1 retweet 2 likes
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        16. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          Again, I have to reiterate, no one could have changed the flow rate fast enough to make 40meq of K in a liter of fluid kill a hypokalemic patient. Alleging someone else is murdering the patient as part of a grand conspiracy makes you sound craaaazy.

          1 reply 2 retweets 5 likes
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        17. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          This show could only be appealing to the conspiracy-minded. It's bonkers. I know that in the end these crackpots will be validated, that's the inevitable narrative arc, but in the real world anyone who thinks this way should be kept far, far away from patient care.

          2 replies 2 retweets 7 likes
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        18. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          Intern back in ER, getting cocky, patient c/o snakes in his through. I hope snakes pop out like out of one of those fake peanut brittle cans.

          2 replies 1 retweet 5 likes
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        19. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          Again, the doctor, who is apparently "good" treats the patient by participating in their delusional behavior. That's not treatment, that's just abuse.

          1 reply 1 retweet 3 likes
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        20. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          It's a consistent theme of this show, that while complaining about error, and patient harm, this show lionizes characters who lie, cheat, steal, batter, sexually-assault, and deliver unethical, harmful care. In the first episode Conrad even attempted murder.

          1 reply 2 retweets 7 likes
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        21. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          Then when it comes time to finally do something about HODAD, he's finally screwed up to the point that he's vulnerable, our heroes don't want to be whistleblowers, don't want to go on record about observable, ridiculous criminal behavior.

          1 reply 1 retweet 3 likes
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        22. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          I've said it before, there's a great smart show that could be made about the complex relationship between care, error, and hospital profits, but this is not it. People are harmed by good people with good intentions more often than ridiculous comic book villains.

          2 replies 2 retweets 13 likes
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        23. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          HODAD in a genius move of villainy, blames the cameras for the problem. Uses the "NetTube" video to show the administrators incompetence. I agree, the fact that someone could access video from this hospital means she should be fired.

          1 reply 0 retweets 2 likes
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        24. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          The truly horrific plotline, ignored here, is that someone easily accessed video from patient care areas, including ORs, where people are nude, undergoing procedures, and completely vulnerable. This is a sick violation of privacy, and it's not even the point of the episode.

          1 reply 0 retweets 6 likes
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        25. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          Finally, Conrad confronts Hunter, and she rightly puts him in his place. After all, what evidence do they actually have? None. Only evidence that would convince a conspiracy theorist - belief. But because this is a conspiracy show, I'm sure he'll be right in the end.

          1 reply 0 retweets 2 likes
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        26. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          The hypochondriac is back, and now insisting to see an oncologist - who will be Hunter. Let me guess, she gives her chemo without a tissue diagnosis for fun and profit while cackling and saying, "excellent."

          1 reply 0 retweets 3 likes
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        27. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          HODAD is now CEO, his first act, firing Nic. She'll be fine. Lots of jobs for NPs out there. Why would you want to work at this place anyway if you're really convinced it's being run by HODADs and murderers?

          1 reply 0 retweets 3 likes
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        28. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

          This is the Infowars of medical drama.

          2 replies 2 retweets 13 likes
          Show this thread
        29. End of conversation

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