While still not on Twitter, Ashley Shreves, MD, always gets the Twitterverse buzzing when she speaks at a conference, especially when speaking about her area of expertise: palliative care. From Richard Body, MB ChB, PhD (@RichardBody), came this tweet about a good death: “A study of 340 people found their top priority was to be kept clean. Fancy treatments way down list.” This is a great reminder that a large part of practicing medicine is not pushing actual medicine per se but simply being humanistic.

Kevin Fong, MSc (@Kevin_Fong), gave an extremely effective presentation on cognitive errors. While we need to take ownership of our failures and try to prevent them, that doesn’t mean we are always to blame when things go awry. New Zealand–based intensive care paramedic Haydn Drake (@paramedickiwi) noted that embedded in Dr. Fong’s talk was “a shout out for @EzDrugID.” EZDrugID is an important multinational nonprofit project that deserves much attention. Its simple mission is to improve the distinctiveness of medical packaging in order to eliminate dangerous look-alike drugs. Dr. Fong showed some cringe-worthy examples. Picture two vials that look identical in shape, size, and color. The only difference is the text. Now realize that one vial contains glycopyrrolate, a drug routinely used in normal deliveries, while the other contains oxytocin, which can be extremely harmful or even fatal to a fetus. We must be vigilant in our day-to-day practice, but we should also notice that, sometimes, it almost looks as if we are being set up to fail.

Simon Carley, MD (@EMManchester), editor of the hugely popular St. Emlyns blog and podcast, tweeted an important recurring theme from #smaccUS about the difference between knowledge and certainty. “Science backs this up. Dunning-Kruger effect shows confidence does not equal competence.” The Dunning-Kruger graph (see Figure 1) rings true.¹ Once you’ve seen it, you won’t forget it.

(click for larger image)
Figure 1. Dunning-Kruger Effect
The Dunning-Kruger effect states that unskilled individuals tend to overestimate their abilities, whereas highly skilled individuals tend to underestimate their competence relative to other people.

Finally, from Irish emergency physician Andy Neill, MBBS (@AndyNeill): “I wasn’t at #smaccUS but @KangarooBeach [Tim Leeuwenburg, MBBS] has posted his talk and it’s a must watch guys ….” This talk is so powerful that it is worth typing in that URL. In this rarest of talks, Dr. Leeuwenburg combines humility, personal vulnerability, and profound knowledge in a powerful 25-minute lecture about a medical error he made, how he came to terms with it after battling depression, and how he eventually made peace with both himself and his patient. It is a deeply moving account that happens to be packed with useful medical pearls.