If you spend a lot of time thinking about closed doors, you'll spot a lot of closed doors. If you spend a lot of time thinking about open doors, you'll spot a lot of open doors. You'll always find what you seek.

Bilroth 2 ERCP - There are still some patients with this ancient surgery and you only come to know when the scope is down. Challenges are to find the afferent loop and then finding/cannulating the "reversed"ampulla. Need a paed colonoscope or therapeutic gastroscope #GItwitter

Monthly reminder ❤️

Fangyuan Jin-Dominguez et al showcase "A case of duodenal variceal bleeding treated by Doppler-guided endoscopic cyanoacrylate injection" in this Original Article. videogie.org/article/S2468-… Kara Raphael

What I thought would make me happy: • Fast car • Fancy watch • Expensive clothes What actually makes me happy: • Free time • Quiet walks • Hard workouts • Time with loved ones Find what actually makes you happy—then prioritize it.

One thing I’ve realized during residency training is that there seems to be essentially zero correlation to the “tier” of medical school somebody went to and their medical knowledge or quality of doctor they end up becoming.

I tell my residents all the time when looking back on decisions, “Look back at your decisions with the information you had at the time, NOT what the outcome was” Doing the latter leads to major self judgement. The former leads to self-compassion. #MedTwitter

New data: The suicide risk for female physicians is 76% higher than the general population. Women in medicine need your support. We need reasonable workloads, adequate support, respect from colleagues, equitable pay, & work environments absent of discrimination & harassment.

New data: Most doctors take less than 3 weeks of vacation a year, and 70% work while on vacation. Both factors were associated with higher rates of burnout. We have to stop the vacation shaming and find realistic strategies for coverage without burdening our colleagues.

An important reminder:

Adam Cifu Seems like a good time to re-share this:

Be boring. Read. Write. Walk. Work. Workout. Spend time with friends and family. Sleep. If that ain’t the good life, I don’t know what is.

Sleep is not optional. If you cheat it long enough, it will take payment in anxiety, memory, weight, libido, joy, patience, and presence. No one applauds the exhausted doctor. They just expect him not to miss.

The older I get, the more I realize some people waste their entire lives fearing the judgement of people who were never even thinking about them. Nobody is thinking about you. Everybody is too busy thinking about themselves. That thing you’ve always wanted to do? Go do it.

For medical trainees in any interventional or surgical field, I'm not sure there's a more important lesson than this one.

Underrated life advice: It’s perfectly ok to live a life that looks confusing to others. Wake up early. Do hard things. Eat real foods. Go on long walks. Obsess over one thing. Read old books. Never gossip. Be loved by a few. The real recipe for a good life.

What is the diagnosis? How would you proceed with this case Keith Siau ERCP was indicated for a 58yr patient with a 43mm pancreatic tumour causing biliary obstruction. An attempt to cannulate the bile duct using the conventional method failed. Went with the precut.

Prevention of post-ERCP pancreatitis - from this new review in Gastroenterology 🆕💡 📸: gastrojournal.org/article/S0016-…

The older I get, the more I realize peace has a price. You buy it by saying no. No to drama. No to noise. No to people who drain you. No to shiny objects. No to temptation. No to opportunities that aren’t aligned. Every single no creates space for the yes that truly matters.

Major cheat code for life: Quiet progress. No announcement. No hype. No applause. Learn to work without validation. Build when nobody’s watching. Write when nobody’s reading. Train when nobody’s cheering. It doesn’t take talent, just courage. Quiet progress creates loud results.