Almost like people want socialized healthcare! Best we can do is cut the largest public insurance, replace vaccines with crank science, gut our research institutions, and prevent any new HCWs from coming here but here’s an AI video of our demented president saying he’ll make you live forever.

Trump: don’t take acepitoemponoene RFK Jr: *moth crawls out of mouth* A nude man is in the background, only referred to as “the colonel” Person watching on tv: well if they say so

Sad and important case. I’ll be looking for this EKG pattern but imo jury is out on ability to indicate PE in all comers. The Witting study has a low +LR (found in 11% with PE and 5% of controls) and is done as case-control so at real risk of spectrum bias. Would love to know about the controls here

I am loath to report the most parsimonious diagnosis is scurvy. I recommend continued palliation with poultices as seen here or perhaps cauterization of the most severe lesions, as well as an extra portion each of hardtack and grog for the remainder of his voyage.

Every hospital in the US had immediate access to expert toxicologists (via poison control). Most hospitals *lack* access to inpatient addiction medicine services. Structurally, we’re great at resus, but then we often fail at chronic tx of substance use disorders. jamanetwork.com/journals/jam...

This is correct. Any candidate cynically “triangulating” on trans kids is a non-starter, and now is the time to say so. There’s still so much time to advance candidates that DON’T suck.

As clinicians there is little we can do about radiology interpretations, but should try to stick to the diagnostic algorithms and avoid relying on hunches. Missed PE has <5% risk of recurrence and mortality which is probably less than major bleeding risk from cumulative years on an unnecessary DOAC.

Writing up a case with my residents and shocked at what I'm learning about diagnosis of PE. PIOPED II the last RCT of CTA had a PPV of only 58% in the low risk group; more recent retrospective had 25% of all positive scans deemed false positive on expert review (including 16% of lobar PE).

ID doesn’t want us to read the forbidden trial jamanetwork.com/journals/jam...

I’ve never wanted be embroiled in online cancel culture and I really hate to say this as a fan, but last night at the NY Liberty game I didn’t feel John Turturro was clapping with adequate enthusiasm during the Big Ellie Stomp.

Teaching Open Evidence jokes about neurosurgeons and then asking it to explain them to me so I can be sure it understands.

New hoofbeats let’s goooooo 😎🤙

Folk's...... The Tiny Desk www.youtube.com/watch?v=Gh9p...

Major innovation in medical education: the dyspnea pyramid is now the dyspnea rhombus

You know things are bad when trauma surgeons are talking about Stoic philosophy. Seriously, though, this is an interesting article. #EMIMCC

1/ 🚨 NEW #5Pearls: Pleural Effusions 🌊 Did you know up to 30% of pleural effusions of have more than one etiology? Let’s dive in! 🖥️: www.coreimpodcast.com/2025/07/09/p... Sponsor: Oakstone CME Featuring: @pulmpeeps.bsky.social

1/ 🚨 NEW #BeyondJournalClub w/ @nejm.org: REDUCE-AMI What is the long term benefit of beta blockers in patients with preserved EF following an MI? 🖥️: www.coreimpodcast.com/2025/06/25/b...

No, no. Wells is the scientist’s name, you’re referring to Wells’ monster. #emimcc

We set out to quantify U.S. academic contributions to medicines. The results stunned even us www.statnews.com/2025/06/06/u... via @statnews.com Strongly encourage reading this First Opinion piece

Grateful for the Andor S2 after credits scene where they finally explain what a Bothan is.

The titans of the tech industry say A.I. will soon match the powers of humans’ brains. Are they underestimating us? “Claims of A.G.I.’s imminent arrival are based on statistical extrapolations — and wishful thinking,” Cade Metz writes.

Diagnosing posterior MI

Googling JFK files revealed = for the boys 🍻

The new micronutrient review in NEJM references the secondary finding from VITAL (as well as the subsequent meta-analysis finding driven by VITAL) that, "vitamin D supplementation reduced total mortality from cancer by 25% in analyses that excluded the first 2 years of follow-up"... hmm....

Great graphic in the NEJM case this week (7-2025) for pancytopenia. Posting so I can find it later.

Reason for consult? The work is mysterious and important

A 19 year old called Big Balls has fired the people responsible for making your prescription medication affordable #USA

🛟 That last-ditch chemo trial your family member was hoping to be in 🥙 The investigation of a food-borne illness outbreak in the next town over 🧠The study looking for preventable causes of Alzheimer’s 🧪The assurance that TAXPAYER-PAID-FOR studies & data collection see the light of day

Rather than simply resetting us to the time of pre-ACA Medicaid expansion in 2010, the burden of millions more uninsured and decreased reimbursements from one of the largest payors will, in the post-COVID era and with aging baby-boomers, mean the actual collapse of the US hospital system.

Holy crap. Unbelievable evil.

Watching The Pitt with @ferrantememes.bsky.social and I’m impressed by some of the things they’ve done well. She asked if there were any hospitalists in the show… probably not but they did have like a 2 minute scene of the ED team rounding in the first ep.

The New York attorney general, Letitia James, has warned New York hospitals that complying with the White House’s executive order to end gender-affirming medical care for transgender youth could well violate state law.

Exciting new trial in the NEJM this week! Tirzapetide or semaglutide for adults with HF with or without preserved ejection fraction with or without overweight or obesity with or without diabetes.

GCA is frequently on the ddx for elderly patients with headache - migraine much more common but GCA thought of as “can’t miss” bc potential for vision loss. It can pose a diagnostic dilemma tho bc it can’t be ruled out by low ESR nor by negative biopsy… Fortunately there is a test with good -LR…

Playing around with dunceGPT and it tried to calculate eGFR in the setting of AKI 🗣️ haha! 👉 🤖

*chatgpt in conference* Given conjunctival suffusion, the answer is, of course, leptospirosis ;-) *putting in real case* The patient has red eyes, which refers to the appearance of bloodshot or inflamed eyes, where the white part of the eye (sclera) appears red or pink due to dilation of blood ves

Cases conferences have all the information you need - no surprise LLMs are better at solving them (no different than how a good “problem representation” yields the top result on google). I’ve still yet to see an LLM be very useful in a real case with diagnostic uncertainty. Have others had this?

Even though the sound of it is something quite atrocious, if you say it loud enough you'll always sound precocious Hemophagocyticlymphohistiocytosis

William Osler saw 40 cases of angina in his whole career... absolute rookie numbers! Today's MS3s see more than that at a half day of clinic at the VA... SMDH source Osler W. Lectures on Angina Pectoris and Allied States. 1st ed. New York: D. Appleton and Company; 1897

Nice article debunking GLP1ra micro dosing bullshit by @jeremyfaust.bsky.social insidemedicine.substack.com/p/a-new-fad-...

Shared by @darknatter.bsky.social

Abx duration decreased by less than a day. Mortality non-inferiority boundary set at 5.4% and barely snuck past with upper CI 5.3%… point estimate 1.5% or NNH 66… I’m just giving the extra day.

Little discussed fact: Choosing to not “treat” high blood pressure makes you look like a wacko to the nurses and CRNAs/anesthesiologists in the real world where I practice It requires lots of time, explanation, being present, and even documentation of your rationale

wow the parade this year was crazy

All modern inpatient hypertension research: "Whatever you do, don't treat inpatient hypertension" Current EHRs Blood pressure of 142/80 in red. With an exclamation point. 🤦🏻‍♂️

Short version on why it's wrong: ☠️Raw data is negative ☠️Mortality differences emerge late (only after 75 days) ☠️Confounding by indication ☠️Inconsistent with ACORN ☠️Inconsistent with Cochrane further discussion in blog here: emcrit.org/pulmcrit/pip...

Good news: the next 15 drugs subject to price negotiation by CMS under the inflation reduction act will be announced Feb 2025 Bad news: all 15 are Dr Oz’s Miracle Tonic™️

Honey, stop what you're doing, new hyponatremia research just dropped! What's it say? It looks like slow correction is associated with worse outcomes, like death and length of stay! Was it just a small study? No, it was a meta-analysis of almost 12,000 patients! jamanetwork.com/journals/jam...

@adamrodmanmd.bsky.social how do you think chatGPT won? After reading, I’m wondering if people were getting hung up on “noise” like the anemia or the AKI (when without the meta-cognitive aspects of a case-conference we’re better at ignoring). And GPT just listed known adverse effects (ie emboli).