I have just posted on substack - why I believe KDIGO made an error with the label AKI. Would love to hear your comments. leadingrounds.substack.com/p/why-i-beli...

Amiloride is back. Now for resistant HT👏 jamanetwork.com/journals/jam...

#UncleBob proudly presents my first soliloquy podcast Annals On Call - Chronic Kidney Disease: What Generalists Need to Know (Annals of Internal Medicine) www.acpjournals.org/doi/10.7326/...

Cool diagnosis in a dialysis patient www.nytimes.com/2025/05/02/w... @rmcentor.bsky.social in the NYT H/t @doctorajgu.medsky.social #NephSky

Build sustainable schedules to support physician well-being www.ama-assn.org/practice-man...

Podcast Annals On Call - Lack of Control and Physician Burnout Annals of IM www.acpjournals.org/doi/10.7326/... featuring Dr. Chris Sinsky Please share with every administrator you know.

Recently had a relative (adolescent) with a severe sore throat, despite antibiotics (had a + strep test), was not improving. Embedded in this case report is how I think about worsening sore throat - pmc.ncbi.nlm.nih.gov/articles/PMC... The main differential was PTA vs mono - he had mono and strep!

Explore this gift article from The New York Times. You can read it for free without a subscription. www.nytimes.com/2025/02/24/a... Wonderful tribute to an outstanding singer.

Annals On Call - Teaching Diagnostic Reasoning | Annals of Internal Medicine www.acpjournals.org/doi/10.7326/... very worthwhile discussion with Rabih Geha and Reza Manesh

Wonderful morning (after a brutal windy storm overnight). Went for a long walk using the Peloton app. Listened to a walking outside featuring the music of Chaka Khan. It was 30 minutes, and I used it twice. Walked over 3.3 miles Any #PeletonDocs out there?

As I recall, this was the first song that I totally obsessed over. I was released in 1959 when I was 10. Just could not listen to it enough. Bobby Darin - Mack The Knife (1959) youtu.be/rRnXE6Z6NaQ?... via @YouTube

As you probably know, I host Annals on Call - based on articles from the Annals of Internal Medicine. While I often use new articles, sometimes I go back to classics. Do you have an old Annals article that you think would make a good podcast? Thanks in advance.

@kidneyboy.bsky.social has taught be this, but Perplexity has helped: To provide 15 mEq of bicarbonate using baking soda: • 1/2 teaspoon of baking soda contains approximately 27 mEq of bicarbonate . • Therefore, 1/4 teaspoon of baking soda would provide roughly 13.5 mEq, close to 15 mEq.

Annals On Call - Evidence-Based Treatment of Low Back Pain | Annals of Internal Medicine www.acpjournals.org/doi/10.7326/... Very useful discussion of this frustrating problem

Hoping some rheumatologists here. 30 years ago I had a patient with classic symptoms of PMR and sero-negative RA. The rheumatology primer mentioned that this was an overlap syndrome. PT responded dramatically to low dose prednisone. Has anyone else seen this? AI argues NOT

Monday at morning report, an intern asked a question & apologized because it was slightly off topic. I smiled, and said it was OK because my MR was like James Joyce. About 15 med students, interns & residents) stared. Not one of them had heard of JJ. Do you find that sad? #MedEd

I went to Brooklyn to stand in solidarity with the owner of Miriam, an Israeli restaurant that became the target of antisemitic vandalism. Jew-hatred will find no refuge in the City of New York. A hate crime against the Jewish community is a hate crime against all of us.

One more chalk talk enhanced by Napkin AI. Would love feedback and questions? How I teach Hypercalcemia diagnosis!

I am playing around with Napkin - an AI app that converts text into visual content. Please check out my NAGMA chalk talk in 3 visuals

For some reason, I have decided to reconstruct my musical favorites each decade. Here is my 50s spotify list of my favorite 15. As I left the 50s I was 10 years old. Favorites: Mack the Knife, Tears on My Pillow, (What A) Wonderful World open.spotify.com/playlist/7ls... Opinions expected!

part 2 of our conversation with the great Dr. Jerome Kassirer Annals On Call - Diagnostic Reasoning Part 2 | Annals of Internal Medicine www.acpjournals.org/doi/10.7326/...

Annals On Call - Diagnostic Reasoning Part 1 Annals of Internal Medicine www.acpjournals.org/doi/10.7326/... A conversation with Dr. Jerome Kassirer (one of my academic heroes).

#MedEd - www.perplexity.ai/search/liver...

#MedEd - a new series of questions that came up on rounds This one is very useful IMO www.perplexity.ai/search/pleas...

"The main thing is to keep the main thing the main thing," As a physician, what is the main thing? How much do we do that does not involve the main thing? Do administrative tasks and regulations help us do the main thing? Should I write an essay on this topic?

Watched "complete unknown" today. Absolutely wonderful for someone who remembers Dylan from 61-65. Most interested in how younger viewers understand the movie, it does it make you curious about Dylan. Anyway, I loved it.

youtu.be/sYOFXCXcSno A fascinating UnRemarkable labs

Annals On Call - Transfusion Thresholds in Myocardial Infarction | Annals of Internal Medicine www.acpjournals.org/doi/10.7326/... featuring Drs. Jeffrey Carson and Maria Brooks Fascinating findings

1/ #MedEd I'm experimenting with a new strategy for morning report - "Choose your own adventure". We start with the demographics and chief complaint. Then a resident has to ask for more information - any information - and explain how it could modify the problem representation. We had fun with it.

1/ #MedEd - would love feedback As one who is obsessed w/ diagnostic reasoning, it seems that there are several flavors: 1. Diagnosing routine conditions 2. Diagnosing when it is clear that the diagnosis is difficult 3. Recognizing that the "obvious" diagnosis is incorrect & then reverting to #2

#MedEd - Since internal medicine diagnosis works somewhat like "choose your own adventure", we should try to teach the thought process in a variety of ways. This is partly the principal for UnRemarkable Labs. Also my new style of doing morning report. We should try to teach thinking as it is done

#UncleBob proudly presents Annals On Call - Lifestyle Recommendations: Can They Really Improve Public Health? | Annals of Internal Medicine www.acpjournals.org/doi/10.7326/... featuring Minna Johansson, MD, PhD Outstanding conversation (IMHO)

1/ Full article: Inter-rater reliability of Centor score assessments between telemedicine and in-person examinations in patients with an acute sore throat www.tandfonline.com/doi/full/10....

I'm less optimistic about data collection. Assuming that history is important, how will AI understand the social cues, the dialects, changing slang, and perhsps it will understand what questions to ask after a physical exam, lab testing, or imaging.

Always find @adamrodmanmd.bsky.social interesting - but here is a question Adam - who figures out that the patient has a confusing diagnosis? Who decides that the "obvious diagnosis" might not be correct? The first part of noting diagnostic error is considering the possibility. #MedEd

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. 🤦🏻‍♂️

Why just GLP-1RA for OSA? Empagliflozin: pubmed.ncbi.nlm.nih.gov/33004464/ Ertugliflozin: pubmed.ncbi.nlm.nih.gov/35596030/ Same benefit with canagliflozin (unpublished) Considering examining this systematically through SMART-C - effects can't be explained by just rostral fluid shifts

The water intake trial: www.nephjc.com/news/waterin... on #NephJC Read the whole #Skytorial from @fperrywilson.bsky.social ⏬

How would you teach this? #MedEd Man admitted with decreased oral intake Na+ 129, K+ 4.2, Cl 87, Bicarb 21, BUN 13, creat 1.2, glucose 140 Will expound if asked

I have decided to develop an AI substack on medical issues. My first venture is the problem of using performance measures as proxies for quality. I actually like what ChatGPT wrote. open.substack.com/pub/leadingr...

We did a podcast on this paper - I highly recommend Annals On Call - The Challenge of Diagnosing Community-Acquired Pneumonia | Annals of Internal Medicine www.acpjournals.org/doi/10.7326/...

1/ Our study of inpatient rounding revealed that learners consider making our thought processes explicit as the most valued single attribute. Ask yourself, do I do that? Would love to start a conversation on this and how to achieve. #MedEd

I also found Bob Centor: @rmcentor.bsky.social

Hot take for #nephsky. I dislike the common use AKI for anyone with an elevated creatinine. Neither volume contraction nor obstruction cause significant injury. I find this use decreases thinking.

The pendulum regarding SGLT2 inhibitors increasing UOP via natriuresis or an osmotic diuresis has gone back and forth with conflicting studies. 👇 Trial shows improvement in natriuresis with dapagliflozin added to furosemide in pts with ADHF pubmed.ncbi.nlm.nih.gov/38569758/ #nephsky #cardiosky