Let’s be clear. The machine only rewards physicians for wRVUs. No meaningful recognition for self audit, quality improvement, teaching, or any deviation from the **see more bill more system**. Painful 😣
Wael Hussein
@waelhussein.bsky.social
Nephrologist. Informatics and data analysis enthusiast. #MedSky #NephSky
Weighing scale app: need access to my full health info and now adding a monthly subscription. Vizio external speakers now has something with Walmart and requesting a subscription for god knows what. Stop the madness!
Let me charge you more for the doctor visit you scheduled last minute. No other doctors available? Higher bill then. Oh, you want to sit? Extra fee. Let’s start with all those in the airlines business/ hotels/ apartment rentals. Who else wants this? #dynamic_pricing greed!
Billing! Tell me your BP didn't go up! Some surveys estimate a physician spends more than 7 hrs/wk on billing. A 2018 JAMA article: 5 mins/ inpt visit. I'd rather spend that time on teaching, learning something new, or improving the service.
I swear to God if EHR designers, healthcare admins, and policy makers were seeing patients, these systems would not be as crappy. Nothing is optimized for a streamlined physician experience. Can’t wait for new systems to shake their control.
Patient with CKD, eGFR 7, declines dialysis. Let’s see what her kidney function has been doing… eGFR ranging between 5 and 8 since late 2023! Way to go, kidneys!
40. Sickle. Lupus. ESKD on HD. Avascular necrosis, multiple joint replacements, recurrent infections. Many patients have it tough. Life can be brutal. Count your blessings.
Help me out here. Why on earth do we have these two conditions when the second encapsulates the first? Can you have 3 events in 12 month without 2 of them being within a span of 6 months??!! #askrenal
A visit to the emergency room. Sit before you look at this:
Do you check labs after starting SGLT2i in CKD patients? What % of pts drop eGFR >30% after starting SGLT2i? What are the usual causes if that happens? Do you know of any studies that specifically looked at that? @askrenal.bsky.social #flozinators
- y do u want to put me on januvia after my pcp stopped it? - It'll slow down ur dis.. (explaining and discussing) - yeah, but my pcp stopped it because of my kidney numbers. - Yes, and I'm ur kidney specialist (another round of explaining). - but my pcp said it was bad for my kidneys.. Me: 😭
a man is carrying a suitcase through a living room in a house .
ALT: a man is carrying a suitcase through a living room in a house .
media.tenor.com
Patient was told to reduce his work hours so his lower income qualifies him for savings on health insurance. Ends up with more money if he works less. How ironic! Not a US-only problem. Seen it in Europe too.
a bald man wearing a plaid shirt and a black vest
ALT: a bald man wearing a plaid shirt and a black vest
media.tenor.com
Noise or signal? eGFR fluctuating from 42 - 33 mL/min over a few weeks in a *stable* 57-yo man (Cr ~2.0): biological noise or reason to worry? 🧵⬇️
Me leaving the clinic with all notes completed and signed- thanks to AI scribe:
a man in an orange suit is dancing in a room
ALT: a man in an orange suit is dancing in a room
media.tenor.com
Humans: - Taking my job? ----- I hate AI!😡 - Helping me get rid of another human when doing something? ----- I love AI!🥰 We are doomed!! www.msn.com/en-us/health...
MSN
msn.com
A fascinating story about prevention of scurvy shows how it can take CENTURIES between discovery and practice. Meanwhile, there will be winners and losers. Here is the story and some valuable lessons. A thread 🧵 below. doi.org/10.1001/jama...
Disseminating Innovations in Health Care
Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly—if at all. Diffusion of innovations is a m...
doi.org
15 L interdialytic wt gain. Record? Pt was trying to beat nausea with chips and water.
How are our patients dealing with these tremendous costs? Do you have ppl in ur clinic to help pts obtain these medicines at an affordable cost? Source: Primer on Diabetes Management www.vumedi.com/video/primer...
In case you missed it on the #AJKDBlog: AJKDBlog Interviews Editor Timothy Yau caught up with Dr. Subhash Chander to discuss if urea is effective for managing SIADH-induced hyponatremia. bit.ly/ChanderBlog25 (FREE)
Do u have a local policy for picc- and mid-lines for pts with renal impairment? 🧭 Any simple algorithm that can be shared with other specialties? ⛔️ “Has to be discussed with nephrology” is a battle- we r the bad people who r inconsiderate of realities of the pt’s (immediate) care! #askrenal
⚠️ Calciphylaxis is a debilitating and painful condition that is hard to treat. ▶️ Do you use daily dialysis as part of treatment? If so, what criteria do you use? #askrenal pubmed.ncbi.nlm.nih.gov/21872378/ doi.org/10.1093/ndt/...
Is it just me or is it really awkward? ".. and they are all known as non-steroidal anti-inflammatory drugs, or NSAIDs". I am sure I lose patients at "non-ster.."! How do you tell ur pts about them?
Will AI tools make your job as a doctor more enjoyable? Think twice! Imagine investors developing tools to help builders. Their real focus would not be to improve job quality, but rather to boost productivity = ⬆️ ROI💰 Here’s how the game unfolds: open.substack.com/pub/sensible...
When AI Listens In: How Conversational Data Could Disrupt Medicine
When I began practicing medicine, use of the Internet or a smartphone could not have been imagined because neither existed.
open.substack.com
#Vibecoding a #Perl interface to a #C library - Part 2 chrisarg.github.io/Killing-It-w... Conclusions: > #AI requires substantial subject matter expertise to deliver > Constant vigilance for hallucinations, omissions and biases is required! > They will not make a God out of a novice
Vibe coding a Perl interface to a foreign library - Part 2
Of makefiles and alienfiles
chrisarg.github.io
My patients live at the margins of society. They don’t have much. Just getting to dialysis three times a week is a big ask. Taking from them to fund tax breaks for the rich is just cruel. I want to be outraged but I just feel like crying.
