Chris Moriates, MD
@ChrisMoriates
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Chief of Hospital Medicine @losangelesVA and Professor of Med @UCLA . Executive Director @costsofcare
Los Angeles, CA
Joined January 2013
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Pinned Tweet
The coffee was mediocre at best, but for this man it was worth risking his life for.
My essay, "The Coffee Contract," in
@JHospMedicine
about remembering what really matters in the hospital:
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My wife is seriously over here sewing me surgical masks in anticipation of us running out at the hospital at some point❤️
#COVID19
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1K
17K
The UT football stadium where there will be a home game on Saturday with 25k fans.
View from the 5th floor COVID unit.
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Is there any more clear sign that our hospitals are not actually financially structured to care for sick people than having an influx of sick people and hospitals saying they are concerned about remaining financially viable
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I just tried to explain the whole
#Medtwitter
saga to my wife
Wife: wait, so the guy who kneeled in his scrubs had a fake acct that called the eye guy racist and it turns out he had been harassing someone called dr meow-something?
Me: yeah, that’s about right
@DGlaucomflecken
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One positive thing from national
#COVID
attention - people are seeing what us hospitalists already know: that ID docs are some of the smartest, most helpful and interesting people around. Appreciate your ID specialists!
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If you’ve ever visited the Texas medical center area in Houston, it is enormous - biggest in the world. Hard to imagine running out of beds there.
Just heard adults now being admitted to Texas Children’s Hospital due to overflow.
Texas, we are facing a rapidly worsening crisis
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“Retreat” is the nicest possible way to say “5-hour meeting”
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Don't ever tell a patient "I am just covering." Youre a doctor now and when you are covering, you are that patients doctor
#TipsForNewDocs
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Is it a good time to mention that in 2004 UCLA wouldn’t give me an interview for Medical School? 😆
Please join us in welcoming Dr. Chris Moriates (
@ChrisMoriates
) to the DoM. He joins our leadership team as the incoming chief of the hospitalist section at
@LosAngelesVA
. Learn more about Dr. Moriates at
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Patients don’t “refuse” things you recommend, they “decline” or “prefer not to.” No need to make this a power struggle. Seeing yourself as a team w patients is more effective, and more satisfying for you
#TipsForNewDocs
#WordsMatter
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As a frontline hospitalist that cares for COVID patients, it was my turn to get vaccinated
Hospitalists are proud to lead from where we stand and get vaccinated because we care about our community
#SelfieShot
#ProtectTexasTogether
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Ok it’s happening. Today a resident quoted landmark NEJM study that came out AFTER I was done with residency training and stated “it’s a pretty old study though”. Oof.
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As the systems around us seem to fail us, one thing Americans can be sure of: the doctors, nurses, PAs, pharmacists, custodians will cont to work to help as many people as we can, providing care and comfort. To be a part of this group feels like a tremendous gift and privilege
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What culture change in the hospital looks like:
Resident: 50yo woman with substance abuse... I mean substance use disorder.
Me (attending): thank you 😊
*that’s it.
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I often talk about overused tests.
One of the most UNDERUSED (cheap) tests is urine potassium in SIADH.
If Una+Uk < Sna then you know they are excreting free water and should respond well simply to fluid restriction.
Worked last night like a charm for Na=117.
#MedEd
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Peak nerd internist moment:
*Rounding in covid icu with team that includes critical care attending who is titrating pressors, vents, etc.
Me: Has anybody noticed her calcium has been elevated since admission?
*diagnoses primary hyperparathyroidism
You’re welcome, universe
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Reviewing residency applications.
Truly amazing to me how many medical students now have an expressed interest and experiences in high-value care and in "addressing affordability of health care."
We are witnessing a real sea-change. The next gen gonna help us fix this thing!
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Kegs in the resident work room
(They are full of drinkable water)
Our community is awesome
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I voted.
In person.
In Texas.
They even gave me a finger condom for my voting finger.
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Seriously when did this “soft blood pressure” thing start and how widespread is it?
I agree “hypotension” sounds scary, as it should.
@medicalaxioms
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A hospitalist recently told me “QI’s not really my thing.” At this point as a hospitalist, improvement is literally part of the job description. You might as well tell me you don’t really treat pneumonia.
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Seriously though, what a profound privilege it is to be a doctor
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It is increasingly untenable to justify living in Texas
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People been reaching out to me to ask “how bad is it really in Texas right now?”
Welp, bad enough that Governor Abbott actually did this.
So, yeah, pretty bad.
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Everyday in hospitals around the world patients are awoken with a pre-dawn needle in the arm.
Can we FINALLY make some coordinated progress on reducing repetitive routine lab testing?
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When did “are you caring for the patient in room 450” become “are you following the patient in 450”?
I’m not following her - I am her physician, actively taking care of her. You are her nurse, also caring for her.
#wordsmatter
@medicalaxioms
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Thank you everybody for the outpouring support and response. I have been reassured that at our specific hospital we expect to have enough masks for the foreseeable future. This is not true everywhere though. Also, as many have mentioned, this is a LAST RESORT option.
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Last week I couldn’t sleep due to so much worry about a critically sick young patient
My lack of sleep did not help him but I think my level of caring did
(And sometimes it’s hard to separate the two)
Today he’s doing so much better and my entire week is made just knowing this
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“It’s pretty thin, the wall separating healthy confidence and unhealthy pride”
- Haruki Murakami
Remind yourself this often, or the patient’s disease will.
#TipsForNewDocs
#tipsfornewR3s
#tipsforOldDocs
@medicalaxioms
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Our students are united.
We recognize that supporting health means addressing systemic racism.
This is the start of so much more work we need to all do together
#whitecoats4blacklives
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People don't seem to understand "capacity" is not a real number, it is a gradation of tradeoffs.
As census increases, so will bad outcomes.
Sure, you have "capacity" to make that floor an "ICU," but there'll be tradeoffs
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The idea that what I want for
#DoctorsDay2019
is a bunch of long-winded emails in my inbox from every administrator and professional organization telling me “Happy Doctors Day” explains a lot about our current situation.
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"Immaculate catheterization"=pt w/ foley but docs don't know its there nor how it got there-
@FutureDocs
@WrayCharles
#SGIM17
@medicalaxioms
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I truly believe I'm joining one of the best academic hospitalist groups in the country and can't wait to share more about the incredible talent at
@LosAngelesVA
. They are a 🚀launching on the national stage and its a privilege to serve them:
Please join us in welcoming Dr. Chris Moriates (
@ChrisMoriates
) to the DoM. He joins our leadership team as the incoming chief of the hospitalist section at
@LosAngelesVA
. Learn more about Dr. Moriates at
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I just gave a talk in a large conference room at ACP. A guy in front row center took off his shoes and socks, which was a little distracting... then a few minutes later he took out nail clippers and began CLIPPING HIS TOENAILS. Right in front of me. Was this a prank?
#im18
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“There’s a somewhat encouraging study of 5 patients published in JAMA” I said, then realized how insane that statement sounds and how much the world has changed in a few short weeks.
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In 2012, 14% of 120 hospitals could not provide ANY price estimate for an ELECTIVE total hip arthroplasty.
In 2016, of those same 120 hospitals: 44% could not provide ANY price estimate.
What the hell? What are we doing?
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Sometimes it seems crazy how much being a hospitalist is me advocating on behalf of my patient for a subspecialist (and/or “the system”) to do - or not do - something
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Honestly I love being around the wards in July. The earnest dedication and enthusiasm of our new interns and medical students is an energy that reinvigorates the whole hospital
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80 medical students from 40 medical schools across the US are here
@DellMedSchool
to learn about
#ChoosingWisely
and then to LEAD! Future of health care is in good hands.
#ChoosingWiselySTARS
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Reminded again this weekend that we will know we have an actual working health care system when as health professionals we no longer need to personally advocate for our family members to get appropriate care
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How cool! Dell Med students edited their own Hippocratic oath. Includes responsibility for pt's "economic stability"
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How often do you say something nice to your patient about the physician coming on after you?
Maybe you should.
@SHMLive
@WrayCharles
@FutureDocs
@Bob_Wachter
@medicalaxioms
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Depressing chapter on physicians. Physicians should have to publicly read aloud med school personal statement ea yr to re-center our mission
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I envision a world in which no one has to choose between their life and their life-savings.
What do you envision?
Let's share our vision, and then let's work together to get there.
@CostsofCare
#CoCMoonshoot
#LifeOverLifesavings
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My son is watching
@DellMedSchool
Grand Rounds today with me to learn from my colleagues all the amazing work happening at
@DellMedIntMed
in response to
#COVID19
#HomeschoolLife
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My favorite day of the year! We have more than 100 students from across the country here
@DellMedSchool
to learn about
#choosingwisely
and how they can lead change in
#MedEd
.
#ChoosingWiselySTARS
So inspiring!
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My buddy Parker Hudson and I wrote editorial for
@JAMAInternalMed
about time-motion study of interns that quantified just how much time interns spend w/ the EHR (A LOT), w/ patients (very little) and in education. We end with quote by
@Bob_Wachter
#meded
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“Twitter is the modern day doctor’s lounge” -
@WrayCharles
It is where we convene and share things professionally and personally interesting with our colleagues.
#hospmed19
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"You can do everything right your entire life and still be destroyed (financially) by a single diagnosis"
Unaffordable health care costs can affect anybody. Forever.
This is a crisis.
We need to create solutions.
@CostsofCare
#AffordabilityAccelerator
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If you want to understand how broken and complicated the medical system is, and how it is held together by the extraordinary efforts of individual professionals, attend a multidisciplinary (disposition) rounds on any floor at any hospital in the US.
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Don't ask "Do you have any questions?" Always ask "What questions do you have?" (Of course your patients have questions - your job is to invite them!)
#TipsForNewDocs
#TipsForAllDocs
#WordsMatter
CC:
@medicalaxioms
@uthealthcomm
@AnnalsofIM
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That was fun! Loved presenting with the amazing Carrie Herzke from
@HopkinsMedicine
in front of so many of our friends at
#HospMed19
“Updates in Hospital Medicine.” Great opportunity to highlight the clinical literature, and make a few jokes.
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🚨 Read Pierce is new Division Chief of Hospital Medicine
@DellMedSchool
. Woah!
Legendary former
@UCSF
Chief Resident,
@SFVAMC
,
@CUMedicalSchool
and
@SocietyHospMed
leader, and my first career mentor.
Thx to Carlos Meza + Kirsten Nieto, we have strong group ready to 🚀
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First day of med school year
@DellMedSchool
.
These students applied to med school in the height of the pandemic.
They saw exactly what society expects from health professionals in crisis, and they bravely signed up to join us!
So proud and hopeful for our profession.
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Those frustrated by the current state of the health care system, take heart. This is our future! 50 med students from 25 schools across US here to lead.
#ChoosingWiselySTARS
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All the vaccine selfies are amazing and energizing.
Want to remind our community we are still doing this too.... no time now to let down our guard
#ProtectTexasTogether
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When I first worked on decreasing low-value care, I thought it would improve care equally. Turns out there are different patterns of overuse based on race, so we must factor equity when approaching low-value care.
@bmj_latest
editorial by
@UREssien
& me
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Look ma, we made the cover of The BMJ!
(not quite the Rolling Stone cover I dreamed of as a kid, but my goals have changed)...
Hope this has some impact.
#ChoosingWisely
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In
@JHospMedicine
,
@FutureDocs
and I warn of "minimizers" who now hide behind more socially-acceptable banner of "high-value care." We've been some of the most vocal hoisters of that banner, but need to also recognize-and mitigate against-potential risks.
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Today on rounds:
Intern: We checked a folate level
Me: There is this great article called "Folate testing: time to retire your VCR"... ever since folate supplementation in the '90s we NEVER see low folates anymore and we shouldn't test for it
Intern: ... the folate was low.
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Medicare, u don't always do the right thing,
But this year u made my heart sing,
By approving end-of-life counseling
#HealthPolicyValentines
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The most salient commentary on the "Hotspotting" study came from Dr Brenner himself in the New York Times: "We're coordinating to nowhere, essentially."
We need a working health care and public health system, and we need to fix underlying problems like homelessness.
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"Nurses treat COVID...
Give me a 3:1 nursing ratio vs remdesivir and I would pick the nurses every time to improve outcomes"
- Dr. Mike Brode at our
@DellMedSchool
/HNI Value-Based Clinical Academy for Hospitalists
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As someone often frustrated with hospital meetings, the often slow pace of change and endless barriers - suddenly we are having the most efficient and impactful meetings with sudden innovation and change happening. Everybody pitching in. It’s incredible!
#JHMChat
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If you want to know why training
@UCSF
will always be the privilege of my lifetime, it was because of learning with people like
@MarleneMartinMD
:
@NEJM
If you have not read this yet, stop now and read it. Beautiful.
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Not everybody needs to be on “frontlines” but ppl definitely noticing which leaders are “showing up” and which aren’t.
#JHMChat
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I sincerely and spontaneously said to a patient, “I hear you’re fixin’ to get outta here,” and honestly fam I can’t even comprehend anymore what’s happening to me.
Please come visit!
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Big news: It's official,
@KBDeSalvo
is joining
@DellMedSchool
! We are excited to welcome her.
"Karen is an absolute star who is defining the future of medicine" -
@ClayDellMed
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According to healthcare leaders: Building culture is most important leadership skill needed:
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David Cutler (
@Cutler_econ
) breaks down the problem with US Health Care spending -- the percent of GDP is not necessarily the problem; waste and worsening inequality is! In
@Health_Affairs
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#ChoosingWiselySTARS
2020!
Med students from 50 US Medical Schools, ready to help lead change in
#MedEd
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New
@BMJ_Qual_Saf
editorial by me and
@ValueVictoria
describes common key elements for value improvement programs in hospitals that have emerged thru work by
@UCSF_CHV
,
@vivianleemd
et al (UofUtah), and
@nyulangone
(
@leorahorwitzmd
et al):
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Haven’t busted out the ninja scrubs since CCU
@UCSFHospitals
my third year of residency. Today felt like a good day to bring ‘em back. Thinking about my
@UCSF
resident colleagues now all over the country leading the charge. (Like my old buddy Seth Cohen in Seattle!)
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A simple decision aid helps clinicians + patients chose best antidepressant; included costs!
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People will never trust our health system as long as they continue to receive surprise bills.
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The insanity of medical billing. She got a bill where she owed >$1000, saw a TikTok telling her to ask for an itemized bill since hospitals often get rid of the most ridiculous charges, and then she got a bill that said she now owes nothing.
#CoCMoonshot
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Wait, is this... is this what it was like to work as a doctor in a hospital before we started all those committee meetings?
It is glorious.
[corollary: ain’t nobody getting discharged today.]
Cc:
@medicalaxioms
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One of the biggest takeaway images from excellent session today, which sums up our current situation:
“We are in the same storm, but in different boats”
@D_R_Williams1
#abimf2020
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Hospitalists can and must address opioid use disorder during hospitalization. With strong partnership with our FQHC, nearly 1/4 of patients still following up in care 1-year after discharge!
This is life-saving.
🧵
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My wife’s advice to me was powerful and true for all, including new interns.
“Remember you are trying to lead and help during an impossible situation. Your goal is not perfection. It is maintain humanity and humility. And do your best”
#TipsForNewDocs
😘
@JessMore80s
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When I go on wards, I attend 14 days in-a-row. Been thinking bout it like a half-marathon. Start out strong and energized, but need to pace myself.
Today is mile 12 and I feel ok but the to-dos in my inbox building up like lactic acid in my muscles.
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Psst, you want to know about the next amazing leader joining us
@DellMedSchool
...
Luci Leykum (
@LeykumLuci
) will be Associate Chair for Clinical Innovation in Dept of Internal Medicine.
Welcome Luci - can't wait to work with and learn from you.
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Hey look, it's Ade!
Top 25 rising star
@AdeAdamson
helping lead the way
@DellMedSchool
, and nationally.
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We are proud to announce Choosing Wisely STARS 2020!
We are looking for 50 US Medical Schools to participate. Local faculty mentors can sign-up their schools at this link:
We can't wait to welcome 100 first-year med students to Austin in January!
#MedEd
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Can you pls document "toxic-metabolic encephalopathy" and "moderate-severe protein malnutrition", I got an alert
#thingsmyattendingneversaid
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.
@NEJM
shouts out our work
@DellMedSchool
,
@CostsofCare
,
@UCSF_CHV
. It's nerd version of making it in
@RollingStone
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Our student-designed Choosing Wisely STARS pins are here!
Our
@DellMedSchool
students will nominate and award clinical teachers who support choosing wisely education during their clinical clerkships
#choosingwisely
#ChoosingWiselySTARS
#meded
@ABIMFoundation
@macyfoundation
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We can't ignore costs in health care.
It affects our patients and their outcomes.
Also, isn't it strange how many jaw-dropping U.S. outlier graphs we have in health care (and not in a good way!)
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Some of the letters of recommendation I am reviewing for residency are abbreviating "student doctor" as St. Dr. Lastname ...
It takes the trope that everybody is a saint in their med school letters of rec to a whole new level 🙃
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When Gil Welch comes to visit
@DellMedSchool
, you take him to the
@BrewersTableATX
for beers around an open fire before an awesome dinner discussing trade-offs: football, beer, speed limits, and presidential candidates
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🚨 More incredible news
@DellMedSchool
:
THE
@gracefarris
is joining our division of hosp medicine!
Amazing physician, leader, ethicist, and visual storyteller/cartoonist!
I love reading her stuff (eg:
) and couldn’t be more excited!
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So excited to welcome Deepak Agrawal from UTSW and
@hvpaa
to
@DellMedIntMed
as our new Division Chief for GI and Hepatology. He also will co-lead our new "Bridges to Better Care" value improvement program with me! Can't wait to work directly with Deepak.
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If you pushed me to pick, I would say that the Choosing Wisely STARS program in the US is the thing I am most proud of creating, professionally.
The program inspires students, who in turn inspire all of us with their ingenuity, energy, and commitment to better healthcare
Proud to be hosting our 4th cohort of
#ChoosingWisely
STARS at our virtual Leadership Summit 2021 this weekend - impressed by the continued commitment from the medical students and faculty ✨
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My 90-year-old (!) grandma who lives independently in her home despite breaking her hip recently, because that is what matters to her. She is inspirational.
#WhatMattersToYou
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Happy National Hospitalist Day!
This year, we all certainly earned it.
#ThisIsHowWeHospitalist
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First M&M today of the new year, with our brand-new interns in attendance, featured both a framework from and a shout-out for
@CPSolvers
.
I told our residents I listen to it in the car on the way into work and that they should too!
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