Me leaving the clinic with all notes completed and signed- thanks to AI scribe:

Sing it brother!

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...

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...

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/...

That’s sad. I never imagined it would happen. youtube.com/watch?v=AuqE...

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?

“Does not smoke, drink, or work” Made my day 😂

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...

#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

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.

Viewpoint: Delegating Medicare Advantage coverage and payment decisions to a third party could limit claim denials and improve access to care. ja.ma/3HZuPnm

The Krebs cycle is worse than death

@askrenal.bsky.social @asnkidney.bsky.social Why do we not have a course, say on Coursera, that’s available for new fellows that covers the essentials of starting on the specialty?

The world we live in! Who doesn’t rely on reviews?! youtube.com/shorts/AxQXR...

“If international medical graduates can’t start their medical residencies on time on July 1, the ramifications are so far-reaching that it is really unconscionable,” said Kimberly Pierce Burke, executive director of the Alliance of Independent Academic Medical Centers.”

Quality of online time is an “admixture of content and quantity”, and is “not without cost”. Texting the AI boy/girlfriend is a new one!

From the Special Collection on Diabetes & Kidney Disease: Urine Albumin-Creatinine Ratio Variability in People With Type 2 Diabetes: Clinical and Research Implications bit.ly/4asLbxT (temp free) #VisualAbstract

Doximity dialer and text messaging services are GREAT! I love that I can call from the app or from the browser on my computer. My calls show the office number. The texts are secure. It's very rare to see something as well done! Thx, @doximity.bsky.social ! 5/5 stars!

Seems good, but what does "un-ionized" mean? 😵‍💫 "Resident physicians secure the first *unionized* contract at MGH.." www.wgbh.org/news/health/...

Please don't do this! This figure stuffs a lot of information in one graph: outcome, program size, comparator, length of follow up, and type of assistance. Comprehensive, but so hard to read => wasteful. journals.lww.com/cjasn/abstra...

Do you live in SE Michigan? Are you an incoming nephrology fellow or a nephro curious resident? Join us for the second annual Nephrology Fellow Bootcamp on July 27 in Ann Arbor. www.nephjc.com/bootcamp-2025

Ha! Surprise Question has been used outside medicine! What a surprise! “What do you think is the probability of a catastrophic stock market crash in the U. S. ... in the next six months.. ?” @grahamabra.bsky.social www.marketwatch.com/story/most-i...

Perspective article discusses medical and surgical treatments for obesity in kidney transplant candidates seeking to lose weight to qualify for transplantation and/or improve obesity-related comorbidities. https://bit.ly/KID0813 #ASNKidney360

Huge car. Almost crushed me while walking in the staff car park. I followed it. It parked at [chief of neurosurgery]. Ah, ok! Makes sense! 😂

- Why is the patient on IV fluids? - Oh, just "maintenance fluids"! A common false belief is that everybody needs "maintenance fluids", particularly when they are NPO. Start with simple:

#askrenal Why is serum bicarbonate reported as "CO2" in biochemistry results?

Urea to Treat Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Systematic Review and Meta-Analysis bit.ly/3XM0b53

Want to impress but feel it’s too hard? Don’t stress! Just lower the bar. Let everyone panic and s### themselves. Then step up with the minimum and brag about how awesome you are! 😟

Patient with multiple kidney stones. Drinks 3 L water a day religiously + other liquids. On chlorthalidone (also for BP) and K-citrate. Lab calls: K = 2.4 mEq/L. #SuperCompliance!! Every once in a while, I see a pt taking medical advice to the extreme.

Your importance to a company: Potential customer: ++++++++++ 🍕🥂🎈🎉 Customer: ++🙃 Locked-in customer: --------- 👊🤕

Consumers beware youtu.be/x2AOJbDnoyE?...

Computer pin Windows username and pw EPIC launcher Citrix- user name and pw Epic screen - user name and pw Interspersed with some “give permission” and Edge few messages. Walla! Now I can see my clinic patients. I love you, IT team, for simplifying my life ❤️❤️

Washed the dishes Cleaned the kitchen Going to sit down. Then, Apple Watch: 😵‍💫

The story of serum creatinine values ========================== Inspired by real life Lab sys -> EMR -> Dr note with a lot of jumble mumble -> several results scattered across the report -> printed -> faxed -> received -> scanned -> Dr 2 scrolls forever to put values together in a meaningful way.

It's surprising how, in this day and age, OCR software can't read text that has gray or noisy background. Why do I have to manually edit the image contrast/sharpness and remove the background? Computers are still stupid!

Open AI protecting their intellectual property rights! That's it! That's the joke!

I hate HIPAA! Yes, I said it! 😭 I still respect it a lot and I understand its importance. But there is no escape hating the complexity it brings to data acquisition and processing.

Outside records for new clinic patients can easily be more than 20 pages long. One time I had 160 pages. Awful repetition. Labs in single lines all over the doc. Can only skim over it and hope I not to miss something. Ripe for AI summary. Anyone has a reliable HIPAA compliant tool?

2 to 3 irrelevant alerts every time you open a chart! I promise you: We are waiting for the msg to pop up, just to kill it asap. What a waste! Alert fatigue is quick and lasting.

Elderly woman on HD. Frequent dislodgement of dialysis tunneled dialysis catheter. Not infected. 👉 Can you guess what keeps pulling the catheters? 💡 Reminds me of why we examine patients lying and standing when planning PD catheter placement.

hospital systems: copy, paste, bill.

@askrenal.bsky.social A practice that I see in the US is the daily measurement of S phos in hospitalized patients with AKI/ CKD/ AKI on CKD. If there's a reason eg Rhabdo or CRRT - ok. Otherwise, is there a reason to routinely check it daily and manage it?

I wasn’t able to convince the voice ChatGPT to stop saying “Good question” or some version of it every time before answering. Is it just me, or is this a universal experience? And no, please don’t reply with “Good question.” I see you. 😂

Glad to see an RCT in this field. I hope we see more of these, run for longer, and with more hard outcomes. (I know.. I know..😴!!)

I wonder if companies record the customers interaction with voice prompts before getting to a human representative. I wonder if they’ll be surprised with what they will hear if they listened to that!!