Reminders: Got a packed day at the hospital so can’t answer all questions But many Qs are already answered; read my timeline. Consult your doctor for individual medical care My approach is practical, not ideal. If you’re looking for 100% certainty, I’m not your man:) Be well!

Humanity First USA is close to my heart. Today, I’m speaking about the importance of health and global development work @HFUSA Global Telethon. Join me then, and support HFUSA to be 20,000 strong for 20 years of impact!

In the honor of #AmjadIslamAmjad Two pages of my diary from the college days بہت ہی اچھا تھا جانے والا۔۔۔

Excellent thread on decision making (for doctors & patients and their families) when end of life is near..

In summary, patients and families should: - Know that it’s your decision - Read about end of life care - Have realistic expectations - Turn guilt into empathy Choosing to stop treatments is NOT quitting. It’s understanding. Life is short. Go. Live, give and forgive. End/

In summary, doctors should: - Let patients/families decide - Prolong life, not suffering - Offer facts, not just hope - Believe that it’s empathy - Consult palliative care - Stop tests when futile

What if the patient wants to fight on? Absolutely. Their life, their decision. But make sure they understand the risks, benefits and odds of winning the fight. Don’t give them “I have seen one patient like you survive this before” kind of false hope. Share data, not anecdotes.

Isn’t this euthanasia? Aren’t we playing God? No. This is do-unto-others-what-you’d-want-others-do-unto-you. Living is a science. Dying is an art. Learn the difference below via @StrathU

What to do if the medical team believes that life expectancy is <3-6 months? - Stop tests, procedures - Start pain management - Document “No CPR” - Go for home hospice CPR is rarely (<10%) successful at this stage. https://t.co/s1HUQZwxz2

What is palliative care? It’s a medical specialty designed to minimize pain, improve quality of life, while avoiding major procedures. Patients live for weeks & months ( rarely years) on palliative care. It’s a bridge to end of life. Learn more 👇 https://t.co/M3GxeIjWXz

What should we do instead? Consult palliative care. Be honest with the patients/families and let them decide how and where they’d like to spend their last few weeks/months. Don’t waste PRECIOUS time on “more tests.” Read this guide. https://t.co/g8QMzidr3j

Why most doctors don’t talk about it? - Patient family’s pressures - Lack of time, experience - Sense of failure/quitting - Fear of litigation - Other biases Most docs are specialized in 1-2 body systems. End of life care requires a global understanding of ALL systems.

Why? With modern medicine, death can be a choice. Ask yourself: Would I like to “stay alive” for months on a ventilator, semi-conscious, with multiple tubes pierced through my body? If you don’t want it for yourself, why want it for others? Turn your guilt into empathy.

3/ Tip for patient/families: What to ask your doctor? “What would you do if this were you or your loved one” Look for body language and probe deeper if you don’t get a straight answer. Most doctors won’t do to themselves what they do (or are forced to do) to their patients.

2/ When? This discussion should start when 2-3 of the following conditions are present in a patient/loved one: Heart’s pump function <20% Oxygen dependent COPD Requiring dialysis Can’t walk or eat Advance cancer Failing liver Age >80 Strokes

What? Death is part of life. I’ve learned that most doctors, patients and families avoid this topic. Perhaps it generates anger, shame, guilt and other -ve emotions We forget that there is a time to save a person’s body and then there’s a time to save a person’s dignity…

A Dignified Death An elderly loved one is worsening, your heart says it’s futile, but the doctors are NOT giving you straight answers? Read this 🧵 Here is what I have learned about end of life issues after treating >25,000 patients. Read on…

Lots of questions about if future SARS-CoV-2 variants might be more or less severe. I don’t have a crystal ball. But in this thread, I’ll describe what happened with other rapidly evolving respiratory viruses after initial pandemic, & describe some relevant SARS-CoV-2 data.

COVID booster shot provided ~95% protection against severe disease. Mild adverse effects (fever, aches, chills etc) were common. “People dying of sudden heart failure” is a myth. No patients developed any serious cardiac side effects in this study. https://t.co/lMxtoPLVkz

Tip: After a couple of hospital visits, if your doctor doesn’t give you specific answers or says “well, you’re a mystery” it means they don’t know what the heck is going on. Nudge them to consult a specialist. Never be a mystery in a hospital.

Health tip: Don’t like to go to doctors or take pills? Do the following three things CONSISTENTLY: Healthy weight 👇 BMI between 18-25 Sleep 7-8 hours/night Exercise 30 min 3-4 times/wk It takes a little bit more than “an apple a day” in 2023:)