Palliative care/family doc in Nanaimo, BC. Clinical Associate Prof, UBC Medicine Focus: the intersection of Palliative Care + sustainability. Was @lessismoremedicine.❤️quaternary prevention, preventing overdiagnosis, goal-concordant EBM, choosing wisely.https://bsky.app/profile/drotte.medsky.socialhttps://bsky.app/profile/drotte.medsky.social/post/3mf6fpdwyuk2qMore is not always better. This patient clearly explains why and how patients can/should say “hey, could I take fewer medications?” Sometimes a prescriber just needs a nudge to reconsider how adding more and more pills is not the only answer to help people feel well again. [contains quote post or other embedded content]19 Feb 2026 01:06 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3mf6fpdwyuk2qhttps://bsky.app/profile/drotte.medsky.social/post/3mcq4nmq7us22https://www.cbc.ca/player/play/9.7048962 A balanced piece on #chroniclyme from @cbcnews.ca The symptoms are real. The tests, diagnosis, and treatments… unfortunately are usually full of snake oil.18 Jan 2026 21:56 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3mcq4nmq7us22https://bsky.app/profile/drotte.medsky.social/post/3m5uydvjz4k2l“While you are on chemotherapy …” Myths: - Avoid large social gatherings - Wash clothes w body fluids STAT - Use a separate toilet - Avoid all EtOH - Avoid certain foods, coffee --> lack evidence, cause harm https://academic.oup.com/jnci/article-abstract/doi/10.1093/jnci/djaf239/8266250 great article from @csoncol.bsky.social #oncology18 Nov 2025 05:17 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3m5uydvjz4k2lhttps://bsky.app/profile/drotte.medsky.social/post/3m5kbl3uhas2uThis is a huge challenge for patients. Proprietary parts for their means of mobility and very few vendors, lots of rules about who can fix them, etc and it means many simply can’t be mobile. That is not ok! [contains quote post or other embedded content]13 Nov 2025 23:03 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3m5kbl3uhas2uhttps://bsky.app/profile/drotte.medsky.social/post/3m5kbe477ys2uAs it turns out, escitalopram is just a marketing parachute for citalopram. Oops! /undoes escitalopram Rxs that could have just been cheaper and equalky safe/effectivr citalopram… 😬👀 [contains quote post or other embedded content]13 Nov 2025 22:59 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3m5kbe477ys2uhttps://bsky.app/profile/drotte.medsky.social/post/3m47l77l4us2sthis makes no sense. Clearly investing in exercise and social programs for vulnerable elders would be a much better use of resources. [contains quote post or other embedded content]27 Oct 2025 23:30 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3m47l77l4us2shttps://bsky.app/profile/drotte.medsky.social/post/3m3n73uxki22pCheck it: - low cost ($49 for students/etc, $99 for MDs by Oct 31st) - virtual - we dissect the evidence so you don't have to - free of financial COIs (no industry funding), - full of practice changing pearls and no BS Please join us in your pyjamas from home Nov 28/29. #cme #ebm #familymed [contains quote post or other embedded content]20 Oct 2025 16:06 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3m3n73uxki22phttps://bsky.app/profile/drotte.medsky.social/post/3m2ktgwrhnk2danother TI @drug-evidence.bsky.social + collaborators publication: It is possible to reduce the unnecessary over-use of TSH and related #thyroid tests!!! But it can be a challenge! (DM me to ask how I know!) https://qualitysafety.bmj.com/content/qhc/early/2025/10/05/bmjqs-2025-019042.full.pdf?ijkey=0sjHzDIKCdIhQvj&keytype=ref #choosingwisely #overtesting07 Oct 2025 00:07 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3m2ktgwrhnk2dhttps://bsky.app/profile/drotte.medsky.social/post/3m2d65cvsm22cOne + of covid-era delays: learned Rx like rituximab for MS in lower/less frequent doses are still effective = lower cost & easier for patient! Opposite, nefarious: drug companies pushing higher doses of #cancer drugs than are needed, just for profit 🤮💰 #cancercapitalism #palliativecare #pallmed [contains quote post or other embedded content]03 Oct 2025 22:57 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3m2d65cvsm22chttps://bsky.app/profile/drotte.medsky.social/post/3lyxwnmnaw22q@cfpjournal.bsky.social ah! you do have a Bluesky account! Couldn't find it the other day, sorry about that, would have @'d you otherwise :)16 Sep 2025 18:18 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lyxwnmnaw22qhttps://bsky.app/profile/drotte.medsky.social/post/3lyvj3g44qs2cOur @drug-evidence.bsky.social team has worked so hard on Portraits www.ti.ubc.ca/portrait/ and we have RCT evidence that it improves prescribing patterns. How excited, grateful, & proud we feel to be recognized by @ubcmedicine.bsky.social for our innovation in #CME https://www.med.ubc.ca/news/faculty-of-medicine-awards-2025/?utm_source=newsletter&utm_medium=email&utm_campaign=fomawards2025&utm_content=announcement#professional-development15 Sep 2025 19:10 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lyvj3g44qs2chttps://bsky.app/profile/drotte.medsky.social/post/3lyoybsenvs2rTook a few years... but we got it done and in print thanks to @cfpc-cmfc.bsky.social's CFP. Tramadol (with or without acetaminophen) efficacy and harm: Systematic review and meta-analysis. https://www.cfp.ca/content/71/9/574.abstract?etoc #tramadol #pain #palliativecare #opioids13 Sep 2025 04:54 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lyoybsenvs2rhttps://bsky.app/profile/drotte.medsky.social/post/3lwzyqj654s2tI also have questions! [contains quote post or other embedded content]23 Aug 2025 03:11 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lwzyqj654s2thttps://bsky.app/profile/drotte.medsky.social/post/3lwrxgwiwgs2loh #academictwitter where you at?! When you get the abstract accepted but it says "you can do it as a poster" x 2 in my case. But... no..... I really need to TALK to youuuuuuuuu #academic #conference #palliative #ohwell https://media.tenor.com/aWwoJDlC1VkAAAAC/wwe-alexa-bliss.gif?hh=278&ww=49819 Aug 2025 22:26 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lwrxgwiwgs2lhttps://bsky.app/profile/drotte.medsky.social/post/3lva2s342mk2n🎆It's here!!!!! 🎆 10+ TEN years in the making!!! Choosing Wisely BC! We are the LAST but not LEAST province/territory. https://healthqualitybc.ca/choosing-wisely-bc/ I'm so so so happy! @healthqualitybc.ca @choosingwiselyca.bsky.social #lessismore #quaternaryprevention #choosingwisely31 Jul 2025 02:13 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lva2s342mk2nhttps://bsky.app/profile/drotte.medsky.social/post/3lubwpebqp22ha reasonably accessible explanation of overdiagnosis and why it matters in cancer screening: https://iai.tv/articles/50-of-some-cancers-diagnosed-by-screening-are-better-left-untreated-auid-325719 Jul 2025 02:40 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lubwpebqp22hhttps://bsky.app/profile/drotte.medsky.social/post/3lty4jo7b6c2zIf it’s on purpose, that’s just good legacy planning 😉 [contains quote post or other embedded content]15 Jul 2025 04:58 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lty4jo7b6c2zhttps://bsky.app/profile/drotte.medsky.social/post/3lsowljhwks2eDon't eat THIS. Opened up the mozzarella and it was the same shade of violet as PUBS (purple urine bag syndrome). Had to wonder: "What in the fresh !$%#^* got in there?!" No it isn't a UTI. It's pseudomonas fluorescens! https://www.pagepressjournals.org/ijfs/article/view/ijfs.2011.1.81 #medsky #purpleurine #purplecheese28 Jun 2025 19:52 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lsowljhwks2ehttps://bsky.app/profile/drotte.medsky.social/post/3lsjcuchv2s2dWell, it happened folks: I received a “mild update.” ‼️ And they also request that I submit my manuscript, even if it’s by accident. How should I proceed?! PS is this low rent AI or a maltreated ESL laborer generating these emails?! #scamjournals #academia #medacademia #predatorypublishing26 Jun 2025 14:16 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lsjcuchv2s2dhttps://bsky.app/profile/drotte.medsky.social/post/3lsdau2qsoc25Autism remains both under and over diagnosed RFKJ remains one of a handful of current leaders who will no doubt make the health status worse for all autistic people and probably all Americans. [contains quote post or other embedded content]24 Jun 2025 04:24 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lsdau2qsoc25https://bsky.app/profile/drotte.medsky.social/post/3lrsmpy5hrk2sPalliative care seeks neither to shorten or lengthen life but in a study of lung cancer patients on chemo, those randomized to palliative care lived 2.7 months longer on average, had better quality of life, and had fewer invasive/costly treatments near end of life pubmed.ncbi.nlm.nih.gov/20818875/ [contains quote post or other embedded content]17 Jun 2025 13:41 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lrsmpy5hrk2shttps://bsky.app/profile/drotte.medsky.social/post/3lrlqx4fcpc2tI had to look up the 3.5% thing to understand this https://www.bbc.com/future/article/20190513-it-only-takes-35-of-people-to-change-the-world [contains quote post or other embedded content]14 Jun 2025 20:08 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lrlqx4fcpc2thttps://bsky.app/profile/drotte.medsky.social/post/3lquzsvn4jc2sDr Mohamad Hamadeh identified unique tensions for Muslim #palliativecare pts #ALPM - truth telling is valued but so is protecting loved ones, especially elders from painful news as a kindness and sign of respect CONT'D05 Jun 2025 19:16 +0000at://did:plc:d4ohckabyz4m5elzqi3kvhim/app.bsky.feed.post/3lquzsvn4jc2s