John Paul G. Kolcun
@JPGK_MD
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Find your power. Be good, or at least don’t be bad.
Chicago, IL
Joined January 2019
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@MiddleearthMixr
Neurosurgeon here. Caveat that I don't have context or more of that scan, but the brain almost certainly isn't "missing," it's just compressed by enlarged ventricles (fluid-filled spaces inside the brain) that probably grew very very slowly over time, allowing the brain to
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@WestMichP2
@MiddleearthMixr
That, I cannot speak to. I might even agree, it’s a question far beyond me or physical science. But whether antenna or engine, the brain is pretty cool! Nervous tissue is extraordinary
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@MiddleearthMixr
Yes exactly! There’s a lot of water in brain tissue that gets squeezed out, and atrophy of supportive cells/tissue surrounding the neurons. So the tissue gets denser
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@doclauravater
Not allowed to be married, not allowed to have children, had to live in the hospital (hence “resident” and “intern”), and - best of all - no set training duration! Graduated when Halsted decided you were ready
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@EricRWeinstein
@P_McCulloughMD
@joerogan
MD neurosurgery resident here. Medicine is not a science. It is a trade guild who do what seems to work while beating our chests and proclaiming ourselves “evidence-based.” Clinical reasoning is not scientific reasoning. Doctors don’t think like scientists.
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Or, hear me out, you can freely choose to make personal sacrifices for a finite period of personal transformation and thusly become competent and worthy of the responsibility of another human life.
Being (and becoming) a Doctor is not just a job.
Amen
@LisaRosenbaum17
Residents often work very long hours 6 days a week like 3 out of 4 weeks on average. God forbid you need a day here and there to recuperate, go to the dentist/bank/doctor. Medical educators will voice widespread concerns about a “slippery slope.” Then wonder about burnout. Smh
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@DrDiGiorgio
There are too many employees in the American healthcare system. Not just admin. Regulations/requirements with no health benefit inflate workforce demands ad absurdum.
Be honest: how many employees in your hospital impact outcomes? But doc reimbursement keeps dropping.
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I’m a toxic gaslit victimized alpha old-timer, and I’m not even out of training 💪🏻
@DrDiGiorgio
@SpineNeuro
@cscla
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@EricRWeinstein
@P_McCulloughMD
@joerogan
To be clear I say this as someone who loves my field and practicing in it. Medicine can’t be a science. Our goal isn’t disconfirmation or even information-based, our goal is manipulation of physical systems to achieve a desired effect (often subjective). It’s pragmatic.
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Just dropped part 2 today, when things really opened up 🔥 what a tremendous guest!
This week we’re joined by
@VPrasadMDMPH
, an oncologist and professor of epidemiology and biostatistics at
@UCSF
, as he delves into the quest to sort through biases and find the truth in research
#neurosurgery
#meded
@JPGK_MD
@UCSFMedicine
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When I told my dad I was doing a podcast, he said “don’t quit your day job.” So, I also talk about lumbar drains. SCPP on the rise!
@NSGYPodcast
@spinesection
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@ChivalryGuild
Brother, the hospitals are drowning in this garbage. I, an adult and physician, had hours of modules about recognizing emotions in other people. Can you imagine?
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@viviendoama
I haven’t met
@AaronGoodman33
but all evidence I’ve seen suggests he’s a good guy and a good doc. I think it’s possible to do the right thing, accommodate patients/families compassionately, etc, and still vent about workplace frustrations to a community who gets it. 🤷🏻♂️
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“UCLA must grasp with the core questions: What makes a good doctor? How can you assess it? How can you pick students capable of achieving it? And how can educators develop the courage to push students to be better than they imagined?”
"Imagine if I drafted an NBA team with Lebron, Stef Curry, and Nikola Jokic, (and celebrated average results) ... You weren’t supposed to be average. You were supposed to be great. And if you can’t see that you shouldn’t be the coach."
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@VPrasadMDMPH
TLDR: he wasn’t getting good outcomes so walked away
Key observations:
- MIT doesn’t train surgeons, seems he did undergrad there maybe
- sounds like he counts residency in “9 years” so was likely in practice for around a year, realistically
- wanted to do functional
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@Socalmegan
You think a physician should lose license for not offering a specific treatment, because you really like that treatment? That’s not a good precedent to set, and it’s not generally how our medical system/culture works
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A man to be heard
Dr. Ed Benzel, chair emeritus of
#neurosurgery
at
@ClevelandClinic
and
#EIC
of
@WorldNeurosurg
, speaks about morality in surgery and academia, and how balancing “doing the right thing” with productivity can be a struggle, especially for the young surgeon
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What’s left to make physicians resilient, resistant to fatigue, strong? Frankly, we don’t all have an inner drive. Step 1 is gone. Overnight call is going. Our residencies churn out more docile, shift-minded employees for large corporations. Thank god I’m still challenged.
24 hour call is a necessity in neurosurgery.
Patients are too critical for multiple handoffs.
Staffing is too short.
We have tried it other ways. It’s simply not safe.
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Props to Will for speaking about this publicly. And thanks to
@visishs
for suggesting this interview
This year was another highly competitive year for the neurosurgery match. This week
@WilliamMualem
shares his own path to matching into
#neurosurgery
at VCU after overcoming the adversity of initially not matching. Congrats Will!
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@DrCasteelEM
Also a perfect example of scope of practice.
There is a reason some of us make diagnostic plans and others make armchair quarterback comments: training, and experience (or lack thereof)
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@Gabby_Brauner27
If you’re really the only doctor there, you with a few drinks will still be more helpful than no doctor at all in a real emergency (until, of course, EMS arrives). Enjoy the celebration and have fun - happy doctors are better doctors
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How often do you get Thomas Sowell and EHR advice in one place? Listen up!
This week we hear
@DrDiGiorgio
from
@NeurosurgUCSF
on the concept of economic scarcity in healthcare and neurosurgery - both of resources and physicians
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@sgremminger
You profile says “health policy guy.” So you sort of have to understand why it is this way, right? It’s not the doctors, my friend.
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@Dr_mac2
You did a good thing.
No matter how you spend your time, you will lose youth, relationships, and health.
You spent those resources becoming something useful, important, and GOOD.
Think how many people lose them with little to show for it.
I commend you.
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@ShilpaGhatnekar
NSGY typically scores like this. It’s self-selection, after good honest “advertisement” of training/lifestyle for applicants. So the expectation:reality mismatch is very low
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What a no brainer, and another massive victory for my hometown! No rest for the weary. Mayo is lucky to have
@Richbyrne37
at the helm
We are pleased to announce that Rich Byrne, M.D., Neurosurgery, has been named chair of the Department of Neurosurgery at Mayo Clinic in Florida, effective June 19. Dr. Byrne joined Mayo Clinic in April 2024, as a senior associate consultant in the Department of Neurosurgery. 1/6
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@DrCasteelEM
Hi! FYI we have 2 female residents in our department, both of whom deny having this conversation with you. Are you sure it was a neurosurgery resident? Personally I would blame anesthesia…
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@awsumpowers
That said, I have literally never met anyone who views publishing in Cureus as a red flag. I have published in Cureus, and reviewed for them. If you write a good paper and it’s published, you wrote a good paper that got published. 🤷🏻♂️
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On thank a resident day, I’m grateful to have the privilege to show up and do good, honest, challenging, often tragic work - a lot. This is my job, and exposure makes me better at it. I thank everyone who is pursuing this constant transformation with me. The patients need us.
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@HIPAAcampus
This person draws a salary for advising you. Think about that when you start paying loans. Unacceptable
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“It’s better to be lucky than good”
Every surgeon knows these words. It’s what we say to ourselves when we make a mistake and get away with it.
I’ve always hated it.
I’m old enough now to know that I happen to have good luck, and to appreciate it – not everyone does. But luck
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@blikethecheese
This was not my experience in medical school, nor an accurate description of my classmates or other students I’ve met in almost 10 years within medical academia.
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Should neurosurgery residency be seven years? At every program in America? Mandatory?
@DrDiGiorgio
@SpineNeuro
@cscla
🚨 December Issue News Article!
"It's a 7-Year Program"—Allostasis in Neurosurgical Training 🌐 Explore the challenges and experiences in the 7-year journey of neurosurgical training in this report!
@JPGK_MD
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@VPrasadMDMPH
“Knowledge”, or “beliefs”?
This grinds my gears. Like the phrase “Western Medicine”
Guess what? If it works, if it’s confirmably true, it’s science/medicine. That’s it. End of conversation. No crowd-pleasing qualifiers needed.
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@olsonplanner
I’m glad they don’t know.
It’s training, it’s hard, and we sign up. Just like the real job is hard.
The point is for us to make people feel better, not the other way around. So if a patient feels bad for me, I’m not doing my job.
This is called being a professional.
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All hail
@CNS_Update
and
@JasNsgy
for the
#CNS_NsgySymposim
! To
#MedStudentTwitter
&
#Neurosurgery
applicants: please reach out with any questions about
@RushMedical
neurosurgery 💪🏻💀🧠🇺🇸
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@DrDiGiorgio
The same trend happened in universities, where administrators far surpassed professors in number and pay. And we all know how well they’re doing!
Administrators take care of their own. The managerial class has grown far beyond scope. But no one will cut their own paycheck.
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@DrDiGiorgio
But who would do mindless data-entry for the billing dept, legal dept, joint commission…? Isn’t that what residents are FOR??
This is a dangerous idea. Talk like this could lead to (*clutches pearls*) a foley order not getting renewed until morning rounds 😵
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Amen amen amen
“OMG JCO IS HERE TODAY” = terrible day at work
It needs to end
The Joint Commission is a joke
Hospitals pay to get JCo stamp of accredidation
It’s a total racket that places ridiculous requirements on medical staff as a result
And if that weren’t bad enough accreditation doesn’t even produce better outcomes
Why do this?
#medtwitter
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We’re a lot better at spine surgery, anesthesia, and postop care than in 1954, or 1984, or even 2004. The Golden Rule applies here, and I think most of us would want early (let’s be honest, ultra-early) decompression. Great paper - time is spine!
@SpineNeuro
@DrDiGiorgio
Our meta-analysis of over 5,000 patients demonstrated that early decompression was beneficial in terms of ASIA motor score, VTE, complications, and hospital LOS. Furthermore, early decompression did not increase mortality odds.
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Kolcun's Quadrants!
Thank you
@SpineNeuro
and
@DrDiGiorgio
for going on the record - this was a long time coming
This week
@SpineNeuro
and
@DrDiGiorgio
weigh in on the trend towards the more incendiary online altercations that have become more and more common in the medical Twitterverse
#neurosurgery
#meded
@UCLANsgy
@NeurosurgUCSF
@UCLAHealth
@UCSF
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Behold evil
In this Viewpoint, the authors explore how artificial intelligence could support surrogate decision-makers while addressing some of the attendant epistemic and moral challenges.
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@DrDiGiorgio
Logic? Policy citations? Rookie move! Learn by DG’s example: you need to make up a sympathetic fairy tale to make your point. Bonus if it’s incredibly detailed while explaining an isolated photo of a bill without context.
Cue ‘Sympathy for the Devil’
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As always, a thorough, contextualized history lesson from Dr. Kazemi.
Time is spine.
Central cord syndrome is likewise a surgical emergency.
Decompression --> perfusion.
@UAMSneurosurg
@SpineNeuro
@DrDiGiorgio
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Today I, an adult professional, learned that when people raise their voices, it may indicate they are upset and not thinking logically.
Thank you, mandatory corporate online module.
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@nspiuzzi
@AAOS1
@AAHKS
@ORSsociety
@OREFtoday
@jbjs
@JArthroplasty
@Clinorthop
@Ryortho1
@Ortho
Is it wrong for US programs to prioritize US applicants? I would expect no less from any other nation, e.g. if an American applied for a position there. This seems non-controversial
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@DrCasteelEM
I sing, play guitar/piano, and write music. I cook and bake bread. I lift heavy, run, and bike. I’m an avid reader and cinephile. I write poetry. I have family and friends who I love to spend time with. I travel.
I’m also a hardcore doc and I’m one of “these ppl.” FYI
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@thegothdoc
I did not enjoy learning about magic in medical school. I would have rather learned about teeth
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@DrSandman11
This is actually remarkable. It’s a monumental task to expel someone from medical school in modern America. Which is why it doesn’t happen as often as it (maybe) should. Wow
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@DrDiGiorgio
Amen. I can’t hold a candle to Tom, but I often say “we aren’t special people, but we can do special things.” It’s the willingness to do the thing, not some innate magic. 💪🏻
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Preach
“When my four year old daughter says she’s playing doctor, she takes out her toy laptop and starts typing.”
I am honored to add a physician voice to the
@SenateBudget
hearing on administrative burdens in healthcare. I hope I could convey the crushing burdens physicians face in
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This was a great conversation, which I entirely owe to hearing
@halpernc
on The Huberman Lab Podcast. I’d strongly encourage any
@NSGYPodcast
listeners to check out this and all content from
@hubermanlab
, I’m a big fan. And we always love to hear from
@PennNSG
!
This week we’re joined by
@halpernc
, chief of functional
#neurosurgery
at
@PennNSG
, as he shares his approach to the critical - but often overlooked - nuanced art of explaining surgery to patients, physicians, and other neurosurgeons
#MedEd
#MedTwitter
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Required reading.
A shameless plug, simply because anyone interested in these issues should hear
@DrDiGiorgio
talk at greater length about scarcity in neurosurgery (and by extension, medicine)
People like this seem to think "fixing" the problem of sleep deprived physicians is simply a matter of political will.
Just throw some money at the problem and it will go away. The answer is simple, right? We can certainly "design" a better system...
This line of thinking is
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@Emaperidol
@Pacers__
@DrDiGiorgio
@CaptShehata
@SpineNeuro
@MayaBabuMD
@cscla
@anish_koka
There is absolutely nothing unsafe about a 24hr shift. Using the word “unsafe” in this context is extreme, uninformed, and promotes unfounded fear for patients who are already dealing with disease.
If you don’t WANT to work, be honest about it. Don’t pretend that you can’t.
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@_mooncube
Any physician can determine capacity.
That’s what I was taught in medical school, and that’s what I was told by every psychiatrist I ever met who was consulted to determine capacity.
So, we can save that month.
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Sub-I gives grands rounds at end of away rotation; PD listens quietly
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@VPrasadMDMPH
I think the time until a professional salary/status is a big driver. But the modern culture in training is awful. The brightest, best-intentioned, leadership-oriented people are treated like dirt in hospitals, and answer to every other non-physician employee. Nonsensical
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@action_ap
I never anticipated the number of times each week that a complete stranger would bark a (usually wrong/silly) command at me, with no introduction whatsoever, in public, in front of colleagues/patients/families…and expect me to agree, obey, and apologize. Nah 🤡 🤣
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@Medical_Niyi
And if ER residents rotated with specialists, they’d realize how few of the consults are real/significant to the specialty.
The problem is our overly legal-minded CYA system. It’s a massive suck on time and resources, to probably little comparative benefit.
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At this point I don’t even feel alive if I’m not called a corporate stooge and an elitist snob in the same conversation. God I love this app 🤣
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@DrDiGiorgio
@planetmoney
I experienced the tail-end of verbal orders with repeat back and a cosign later, where I work. A wonderful, distant memory. We also, as a department, disabled the Epic “chat” feature to discourage this sort of communication. Never fear, they still page
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After years of resentment, still in training, I’ve changed my mind:
“Back in my day…” is a good thing.
We need context to know things are better, or we’ll never recognize Good Enough.
In a life of finite time and resources, there has to be a Good Enough.
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@DrDiGiorgio
Synchronicity! I was on call in-house last night, walking around seeing people, thinking to myself how transformative PGY2 was. It made me a different person, professionally and otherwise. Transformative experiences are invaluable - indescribably so to the uninitiated.
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@DrDiGiorgio
@SpineNeuro
When an elective postop patient has a hematoma, should they transfer to a regional center?
After a decade of hearing these arguments and reading about the TRAUMA of FATIGUE, I remain convinced some people just don’t want to work as much. Fine, don’t. But someone has to.
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@TheRealDoctorT
I didn’t go into medicine to be an activist, advocate, or effect social change. I fix physical problems if I can, and help people feel/function better. That’s what I signed up to do. That’s meaningful. Lots of us have no interest in activism. We’re not part of a problem.
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@nickmmark
Ok let’s come up with a new phrase that will be considered rude in 10 years 😇
Some people are bad historians. It’s a description, not an insult. We should document reality as we encounter it, for the next doc.
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@CaptShehata
@Emaperidol
@Pacers__
@DrDiGiorgio
@SpineNeuro
@MayaBabuMD
@cscla
@anish_koka
There is published “evidence” in both directions. That fact, in combination with how inherently murky the question/outcome is, inclines me to also consider the lived experiences of me and almost everyone I know. 24hr shifts are not harmful to us or patients and everyone knows it.
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@fuzzymittens
Fun fact: this professor went on to write Epic pop-up prompts at login. True story.
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The merchants are in the temple
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Helped operate on a jiu jitsu instructor, and he brought tshirts from his gym for the whole team. Obviously I’m wearing my jiu jitsu shirt on call now. So I guess you could say things are getting pretty serious 💪🏻
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@SurgeryBro
Bro you never never never know who will need you one day. Learn it all. Whatever you plan to do, the people will still come into ER/clinic. And you’ll be ready. It’s all good 💪🏻💪🏻💪🏻
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@DrDiGiorgio
Not to mention the benefits to trainees, which translates to societal benefit by producing new surgeons
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What happens to your job if we stop practicing medicine?
What happens to our job if you stop getting paid for contributing nothing and being an ass about it?
Food for thought 🤷🏻♂️
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@jason_ryanmd
Great practice. With the loss of step 1 score, the temptation to artificially boost pub# has never been greater. But the cost - your integrity - isn’t worth it; and we always know! Never put your name on something you didn’t contribute to meaningfully
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My dad is a self-employed attorney. My brother just made partner. I have friends in biotech, finance, banking.
I don’t know anyone who can just not show up for a few days. Literally no one. They have commitments. They have clients.
Where do people get these expectations?
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I am (technically) a Millennial, and currently in training. I completely agree with Dr. Holthouser’s observations/concerns, from my own experiences going through medical school. We have done a disservice to a generation of doctors and their patients. It must change.
In this episode of Not Otherwise Specified, hosted by NEJM National Correspondent
@LisaRosenbaum17
, a medical educator goes on the record with widespread but rarely publicly voiced concerns about the slippery slope from “wellness days” to inadequate medical training.
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@jzaraterod
Mixed reaction. Yes, surgical training is demonstrably more complex clinically/technically for the reasons listed. But we all know the sheer physical demands and ability to have a life outside of work etc are obviously better now. Different aspects of the life
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@Joanna_Liberty
Ahem. Per your bio, you aren’t a surgeon. Thus, you haven’t experienced how safe/common/etc it is to do surgery on 4hrs sleep. I literally did so today; felt great, went great.
Criticizing poor criticism is not toxic. It’s 2024, name-calling doesn’t work anymore.
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“…so long as I never work more than 8 hours a day, five days a week; never overnight; periodic days off; for higher salary; without grades or adversity; if the patients ascribe to my politics and are never rude; if all my loans are forgiven.”
There, now it’s not toxic
"I will care about each and every patient more than if my own body were at stake."
Dr. Paracelsus.
Prof. of Medicine at Basel, Switzerland.
Father of modern pharmacology and toxicology.
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