SlideShare uma empresa Scribd logo
1 de 63
Baixar para ler offline
A Talk by
                                       Chris Nickson




                                     All
                                   Doctors
                                     Are
                                  Jackasses
Photo	
  by	
  Publicenergy	
  
WHAT DO I
 MEAN ?
BLINDSPOT
   BIAS



            Photo	
  by	
  Zanthia	
  
Photo	
  by	
  Zanthia	
  
What?
                                Me..
                             A Jackass?




Photo	
  by	
  Zanthia	
  
The
dual process
   model
From:	
  Croskerry	
  P.	
  Healthc	
  Q.	
  2009	
  PMID:	
  19667765.	
  
PATIENT
       PRESENTATION



              Pattern
             PROCESSOR
recognised               NOT recognised




SYSTEM               SYSTEM
  ONE                 TWO
Reason?
                                    Probability?
                                       WTF?!



                                    SYSTEM
                                      ONE	
  

Photo	
  from	
  Star	
  Trek	
  
Captain Kirk is
       in charge?
     That’s illogical!




SYSTEM
 TWO	
  

                Photo	
  from	
  Star	
  Trek	
  
Photo	
  by	
  Loupe	
  Clean	
  




How they interact
Photo	
  by	
  Loupe	
  Clean	
  




COGN
     ITVE
 MISE
      R
Photo	
  by	
  Loupe	
  Clean	
  




RELEGAT
       I ON
Photo	
  by	
  Loupe	
  Clean	
  




OVER RIDE
Don’t
                                  forget
                                   AAA!



 Loin pain +
haematuria =
   RENAL
   COLIC




               Photos	
  from	
  
                 	
  Star	
  Trek	
  
That’s not a
                    good idea
                      Jim..




                    Set
                  phasers
                 on STUN!

Photos	
  from	
  Star	
  Trek	
  
Off to work
                                       we go..




Photo	
  by	
  Charles	
  Fred	
  
Is the Well’s
               Score 0 or +3?


                                       ENTER THE
                                       COGNITIVE
                                       MINEFIELD	
  




Photo	
  by	
  Defence	
  Images	
  
Not too
                                tight…
                                OUCH!



                             MEET THE
                             PATIENT	
  



Photo	
  courtesy	
  
	
  of	
  Cliff	
  Reid	
  
I’m
                             starving!




Photo	
  courtesy	
  
	
  of	
  Cliff	
  Reid	
  
Could it be
                            acute
                           coronary       Perhaps if
                          syndrome?      the D-dimer
                                         is negative…




Photo	
  from	
  Dr	
  Strangelove	
  
I said “NO
 CHEESE”!




             Photo	
  courtesy	
  
             	
  of	
  Cliff	
  Reid	
  
I’m NOT
laughing…
My chest
 HURTS!




            Photo	
  courtesy	
  
            	
  of	
  Cliff	
  Reid	
  
hNp://lifeinthefastlane.com/ecg-­‐library/anterior-­‐stemi/	
  
Photo	
  from	
  Wikipedia	
  




                   CABG then OFF WE GO
                       TO THE ICU	
  
hNp://lifeinthefastlane.com/2010/04/to-­‐err-­‐is-­‐human-­‐002/	
  
What were
                                they
                              thinking?




Photo	
  by	
  	
  
Klearchos	
  Kapoutsis	
  
1	
  


     Over-attachment
to a particular diagnosis




                   Photo	
  by	
  visualpanic	
  
Anchoring
confirmation bias
premature closure




               Photo	
  by	
  visualpanic	
  
2	
  


         Failure to consider
        alternative diagnoses




Photo	
  by	
  Darwin	
  Bell	
  
SEARCH SATISFICING
                     SUTTON’s slip




Photo	
  by	
  Darwin	
  Bell	
  
3	
  


Inheriting someone else’s
        thinking




                    Photo	
  by	
  just.Luc	
  
DIAGNOSTIC MOMENTUM
   FRAMING EFFECT




                Photo	
  by	
  just.Luc	
  
4	
  



        prevalence perception
            or estimation



Photo	
  by	
  Darwin	
  Bell	
  
AVAILABILITY BIAS
                       BASE RATE NEGLECT



Photo	
  by	
  Darwin	
  Bell	
  
5	
  


patient characteristics
or presentation context
NEGATIVE STEREOTYPING
    TRIAGE CUEING
6	
  


physician affect,
 personality or
 decision style




                Photo	
  by	
  Tal	
  Bright	
  
UNDERCONFIDENCE
 VISCERAL BIAS




              Photo	
  by	
  Tal	
  Bright	
  
Only a
                      JACKASS
                    would do that
                         job!




                                    UNUSUAL
                                    DEMANDS	
  



Photo	
  from	
  Apollo	
  13	
  
Image	
  by	
  Nasa	
  Goddard	
  Photo	
  and	
  Video	
  




A PERFECT
  STORM	
  
Being a Jackass
                                             ain’t so bad… At
                                              least I’m not a
                                                   doctor!




Photo	
  by	
  The	
  Flying	
  Gerbil	
  
Can we think
  better ?
HOW we CAN
think better	
  
Metacognition	
  




Image	
  from:	
  hNp://www.usask.ca/educa]on/coursework/802papers/Adkins/SEC1.HTM	
  
USE
cognitive
checkpoints	
  
REDUCE
Cognitive
  load	
  
Turn experience
 into expertise	
  
think
critically	
  
OPTIMISE work conditions	
  
look after
                            yourself	
  




Photo	
  by	
  Kugel	
  
FINALLY…

  What you
need to do now	
  
Think
Learn
Talk
  Do	
  
The End!




           Photo	
  by	
  asibiri	
  

Mais conteúdo relacionado

Mais de precordialthump

Nickson training for stress 20170720
Nickson training for stress 20170720Nickson training for stress 20170720
Nickson training for stress 20170720precordialthump
 
Mechanical ventilation pitfalls in asthma management
Mechanical ventilation pitfalls in asthma managementMechanical ventilation pitfalls in asthma management
Mechanical ventilation pitfalls in asthma managementprecordialthump
 
ECPR by Vincent Pellegrino 2016
ECPR by Vincent Pellegrino 2016ECPR by Vincent Pellegrino 2016
ECPR by Vincent Pellegrino 2016precordialthump
 
Toxicology: What NOT to do
Toxicology: What NOT to doToxicology: What NOT to do
Toxicology: What NOT to doprecordialthump
 
Antidotes in the Emergency Department
Antidotes in the Emergency DepartmentAntidotes in the Emergency Department
Antidotes in the Emergency Departmentprecordialthump
 
An Approach to the acutely poisoned patient
An Approach to the acutely poisoned patientAn Approach to the acutely poisoned patient
An Approach to the acutely poisoned patientprecordialthump
 
Why Don't We Wash Our Hands?
Why Don't We Wash Our Hands?Why Don't We Wash Our Hands?
Why Don't We Wash Our Hands?precordialthump
 
The future of medical education
The future of medical educationThe future of medical education
The future of medical educationprecordialthump
 
No apologies: intubation of the shocked patient
No apologies: intubation of the shocked patientNo apologies: intubation of the shocked patient
No apologies: intubation of the shocked patientprecordialthump
 
Hacking medical education 20150604
Hacking medical education 20150604Hacking medical education 20150604
Hacking medical education 20150604precordialthump
 
Euboxia and abnormality smacc gold
Euboxia and abnormality smacc goldEuboxia and abnormality smacc gold
Euboxia and abnormality smacc goldprecordialthump
 
FOAM for University of Melbourne MD Student Conference 2014
FOAM for University of Melbourne MD Student Conference 2014FOAM for University of Melbourne MD Student Conference 2014
FOAM for University of Melbourne MD Student Conference 2014precordialthump
 
WICM 2014 Toxicology Quiz
WICM 2014 Toxicology QuizWICM 2014 Toxicology Quiz
WICM 2014 Toxicology Quizprecordialthump
 
Why FOAM?... Facts, Fallacies and Foibles
Why FOAM?... Facts, Fallacies and FoiblesWhy FOAM?... Facts, Fallacies and Foibles
Why FOAM?... Facts, Fallacies and Foiblesprecordialthump
 
SMACC: How to Create a Medical App
SMACC: How to Create a Medical AppSMACC: How to Create a Medical App
SMACC: How to Create a Medical Appprecordialthump
 
Fever, Friend or Foe? - Paul Young's Talk at SMACC
Fever, Friend or Foe? - Paul Young's Talk at SMACCFever, Friend or Foe? - Paul Young's Talk at SMACC
Fever, Friend or Foe? - Paul Young's Talk at SMACCprecordialthump
 

Mais de precordialthump (20)

Nickson training for stress 20170720
Nickson training for stress 20170720Nickson training for stress 20170720
Nickson training for stress 20170720
 
Mechanical ventilation pitfalls in asthma management
Mechanical ventilation pitfalls in asthma managementMechanical ventilation pitfalls in asthma management
Mechanical ventilation pitfalls in asthma management
 
ECPR by Vincent Pellegrino 2016
ECPR by Vincent Pellegrino 2016ECPR by Vincent Pellegrino 2016
ECPR by Vincent Pellegrino 2016
 
Shock... Now What?
Shock... Now What?Shock... Now What?
Shock... Now What?
 
Ecg in Toxicology
Ecg in ToxicologyEcg in Toxicology
Ecg in Toxicology
 
Toxicology: What NOT to do
Toxicology: What NOT to doToxicology: What NOT to do
Toxicology: What NOT to do
 
Paracetamol toxicity
Paracetamol toxicityParacetamol toxicity
Paracetamol toxicity
 
Antidotes in the Emergency Department
Antidotes in the Emergency DepartmentAntidotes in the Emergency Department
Antidotes in the Emergency Department
 
An Approach to the acutely poisoned patient
An Approach to the acutely poisoned patientAn Approach to the acutely poisoned patient
An Approach to the acutely poisoned patient
 
Why Don't We Wash Our Hands?
Why Don't We Wash Our Hands?Why Don't We Wash Our Hands?
Why Don't We Wash Our Hands?
 
The future of medical education
The future of medical educationThe future of medical education
The future of medical education
 
No apologies: intubation of the shocked patient
No apologies: intubation of the shocked patientNo apologies: intubation of the shocked patient
No apologies: intubation of the shocked patient
 
Hacking medical education 20150604
Hacking medical education 20150604Hacking medical education 20150604
Hacking medical education 20150604
 
Euboxia and abnormality smacc gold
Euboxia and abnormality smacc goldEuboxia and abnormality smacc gold
Euboxia and abnormality smacc gold
 
We all need to speak up
We all need to speak upWe all need to speak up
We all need to speak up
 
FOAM for University of Melbourne MD Student Conference 2014
FOAM for University of Melbourne MD Student Conference 2014FOAM for University of Melbourne MD Student Conference 2014
FOAM for University of Melbourne MD Student Conference 2014
 
WICM 2014 Toxicology Quiz
WICM 2014 Toxicology QuizWICM 2014 Toxicology Quiz
WICM 2014 Toxicology Quiz
 
Why FOAM?... Facts, Fallacies and Foibles
Why FOAM?... Facts, Fallacies and FoiblesWhy FOAM?... Facts, Fallacies and Foibles
Why FOAM?... Facts, Fallacies and Foibles
 
SMACC: How to Create a Medical App
SMACC: How to Create a Medical AppSMACC: How to Create a Medical App
SMACC: How to Create a Medical App
 
Fever, Friend or Foe? - Paul Young's Talk at SMACC
Fever, Friend or Foe? - Paul Young's Talk at SMACCFever, Friend or Foe? - Paul Young's Talk at SMACC
Fever, Friend or Foe? - Paul Young's Talk at SMACC
 

Último

Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableVip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableNehru place Escorts
 
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...CALL GIRLS
 
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...Garima Khatri
 
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...Taniya Sharma
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...jageshsingh5554
 
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual NeedsBangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual NeedsGfnyt
 
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Dipal Arora
 
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...aartirawatdelhi
 
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...narwatsonia7
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Dipal Arora
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Servicevidya singh
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Call Girls in Nagpur High Profile
 
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls DelhiRussian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls DelhiAlinaDevecerski
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...narwatsonia7
 
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...narwatsonia7
 
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...hotbabesbook
 

Último (20)

Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableVip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
 
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
 
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
 
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
 
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual NeedsBangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
 
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
 
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
 
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
 
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls DelhiRussian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
 
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
 
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
 
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
 
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
 

All Doctors Are Jackasses