Steven Napierkowski, MD, FACC, FSCAI

AMEN!!

@aceddeca1 @drdanchoi @mcuban Great point!

Ya. It is wild. Cataract surgery reimbursement for surgeon fee is around $550. At one point in time I would get phone calls telling me the post op drops prescribed would be $200+ dollars … literally the post op drops generated almost half the cost of my pay for doing surgery. And that pay is before expenses get subtracted out such as equipment, staff, and other costs.

.@mcuban asked “Are doctors overpaid?” Credit: How I Doctor Podcast with Dr Graham Walker

@Rick_Pescatore This is the right attitude!

I'm a 38 year old ER doctor sitting at my kitchen table after a long day at work. I saw 50 patients today (seriously!) The dog is snoring on the couch. The wife is definitely NOT snoring. The cat plots. I'm toiling away at articles and research. ...and I'm just struck by how incredibly lucky I am. To be free of the type of mental and physical disease that grips and destroys my patients. To have escaped the financial morass that does the same. To have found love and acceptance and to have the opportunity to work hard. It can all dry up way too fast. Trust me on this one.

@BBGreatMoments Jeff Bagwell

Who was your favorite ball player when you were 12 years old?

@panagis21 Love it! Also, nice office!

Brought my dad to work today. A retired union painter, all he did was stare at my degrees 😊 Degrees that wouldn’t be possible without his emphasis on prioritizing education and working to afford the schools I attended. Thank you, Dad😊

@drjohnm Anatomic info > risk score.

Highly recommended 👇🏻 I don’t think a CAC scan is ever very useful but this well written paper on when NOT to do a scan is quite good b/c I see errors like these every week. If you do CAC when PCE is > 20% you fail Medicine 101

@Tesslagra @ctayg @DrRajeshG1 @HeartOTXHeartMD @iamritu @mmamas1973 @Hragy @ShariqShamimMD @abadkhan2002 @georgetolisjr @GianTorre610 Rich - Judkins developed the femoral approach in mid-60s; wanted Sones to visit. Favalaro, who studied Sones' films, did his 1st CABG in 1967. So I assume by the mid-to-late-60s selective angiography was standard, esp. after Judkins made the technique much simpler. #AngioHistory

Beautiful animation of metabolic flux in the mitochondrial Kreb (TCA) cycle The three "CO2" coming off the cycle is how you lose weight: carbon from your material body coming off as gas you end up breathing out By @janetiwasa

Would energy balance improve stress tests? PET scans already track blood flow to the heart muscle. Add oxygen saturation + hemoglobin, and you’ve got calories delivered. Then estimate or preferably measure calories burned. Match supply to demand to guide revascularization

Ever see a large language model multidimensional dataset splashed down on a 2D graph? Looks just like the scatter plots we have in our research trials. Scary to think how rudimentary our current tools are. #AI #medicine #research

@DiscardedJ0ker @Paul_Wischmeyer @HeidiEngel4 @TantamKate @KatarzynaKotfis @nickmmark @DaytonICU @IvensGiacomassi @fisioprecoce @icurehab @Manu_Malbrain @IM_Crit_ @TomVargheseJr Yeah not sure this makes sense to me. Usually trach before ambulating them if vent dependent like this. Seems like less risk to the oropharynx to me.

@Paul_Wischmeyer @HeidiEngel4 @TantamKate @KatarzynaKotfis @nickmmark @DaytonICU @IvensGiacomassi @fisioprecoce @icurehab @Manu_Malbrain @IM_Crit_ @TomVargheseJr I struggle to see a time to do this. Why aren’t they extubateable? If not then are they not for a trachey? It’s very cool and I’m sure I’m missing some very niche point to do this but “a standard” just sounds like soooo many emergency reintubations in the middle of the floor

🙋‍♂️ INCREDIBLE ICU MOBILITY in intubated patient on ventilator 👉This should be the standard of care in all ICU’s and hospitals worldwide 🌎 ❓Does your ICU walk and mobilize intubated patients? H/T @HeidiEngel4 #ICUrehab #FOAMcc #PhysicalTherapy #MedEd #MedTwitter @DukeAnesRes @DukeAnesFellows @WesElyMD

@DrBIqbal If I recall correctly it was Grantham that described this several years ago about bival in cto PCI. He said that it tends to clot if there’s not a good flow of blood unlike heparin. I think he said this used to happen during brachytherapy cases performed with bival.

Sharing an educational case. The perils of Bivalarudin for #retrograde #CTOPCI. Heavily calcified post-CABG RCA CTO. Previous HIT, so bivalirudin used. Distal vessel and retrograde channels unclear, but pre-CABG angiogram is useful. Extremely tough impenetrable proximal cap! #BASE to get knuckle going ➡️ retrograde via S1-PLV collateral ➡️ tough impenetrable distal cap ➡️forced to work around calcium in EP space ➡️complete RCART and procedure with good result in RCA. But final donor angiogram ➡️large thrombus burden in LMS/LCX 😱. Multiple runs of Penumbra CAT RX removes thrombus. Patient stable. Integrillin infusion for 24h. Patient discharged and asymptomatic at 6wk follow-up. In this case, frequent saline flushes and maintaining ACT>350-400 with Bival boluses, still resulted in thrombosis. Should we use Bivalarudin for complex long retrograde CTO PCI cases? What’s everybody’s experience with this?   #Cardiology #cardiotwitter #PCI #complexPCI   @Can_CTO @CtoEuro @SanjogKalra @DrDarshanDoshi @KambisMashayek1 @RinfretStephane @KovacicMihajlo @AgostoniPF @mornei2011 @swissCTO @A_B_Hall @SmithElliotjs @YbarraLuiz @dautov_MD @ammozid @MohamadAlmutawa @BElbarouni @jcspratt @tomkaier @AnjaKsnes @RajaHatem @LAzzaliniMD @jedicath @Laserrman @FaroucJaffer @MohanedEgred @stefan_harb @BostonEdney @AHRavandi @DrIHHashmi1 @ogoktekin @OpolskiMP @K_DeSilva @KVM83 @FaurieBenjamin1 @MichaelMegalyMD @ignamatsant @agtruesdell @ziadalinyc @rickytiago @aspergian1 @realarainmd @MauroCarlino3 @mbmcentegart @yassersadeknhi

@YuvalBibiMDArt Well said!

Here’s a proposal for DOGE to reduce physician burnout and improve physician access: revoke the nonprofit status of monopolistic federal “medical organizations” such as the American Board of Medical Specialties (ABMS) and its specialty subsidiaries, and file an injunction to stop the Maintenance of Certification (MOC) process. These organizations force physicians to “maintain” their hard-earned board certification by paying annual fees and participating in various activities that claim to maintain and improve quality. This is in addition to—and often just as burdensome, if not more so, than—the Continuing Medical Education (CME) requirements that all physicians must complete regularly. There is no evidence that these activities, which are largely generic and disconnected from actual clinical practice, provide any meaningful benefit. They were gradually introduced over the past few decades by fiat and imposed without question, leaving no control group or clear metrics for evaluation. This is unrealistic from the outset, given that every physician manages different patients under unique circumstances. The MOC process—now renamed the Continuing Certification Process (CCP)—directly impacts a physician’s ability to obtain insurance credentialing, hospital privileges, and malpractice insurance rates. This amounts to a cartel-like system that drains physicians of their time and money, enforced under the threat of severe financial consequences and loss of professional standing. And this happens after a physician has already completed specialty training, passed board exams, and been certified. Ironically, these measures were introduced under the banner of “public demand.” Yet few outside the medical field even know what these boards are or what they do. Meanwhile, non-physician professionals are now creating their own “boards” and claiming “board certification,” further eroding what little public awareness or prestige the concept of board certification ever had. In summary, the Maintenance of Certification system is a monopolistic racket that forces physicians to spend valuable resources without proven benefit. It demoralizes countless physicians, restricts patient access to care, and has become increasingly meaningless to the public with the rise of alternative professional boards. @elonmusk @DutchRojas @realdocspeaks @noahkaufmanmd @anish_koka @CoffeeBlackMD

@praneet_manekar Himalayan p-waves. Afib. Ebsteins.

A classical A4C view of a CHD. What are the classical ECG findings and the most common arrhythmia associated with this condition? #echofirst #ase #cardiotwitter

@anish_koka This is such a great take.

Medical errors is the 3rd leading cause of death only if you believe no deaths should happen in severely ill patients presenting to hospitals. In this world every post operative bleeding complication and aspiration pneumonia is preventable. Wish this was true, but it’s not.

@DutchRojas Agree 100%

Independent physicians aren’t “providers.” They’re doctors or physicians. The only ones who call them “providers” are insurers and bureaucrats who want them interchangeable with a chatbot or a massage therapist. Stop using their language. #healthcare

The independent practice of medicine is about more than business, it’s about better outcomes. Health systems prioritize profits over patients. They impose quotas, cut visit times, and dictate care based on contracts, not clinical judgment. Independent physicians? They don’t receive special funds from the federal government. They also don’t receive special bond raises from municipalities. They answer to patients, not corporate executives. That’s why outcomes are better, prices are lower, and trust is higher. That’s #healthcare

@JeffryGerberMD @sweatystartup I agree with this take. I will usually order a reasonable test for a patient if it’s requested. I guess our job as physicians is to decide what is reasonable. I don’t see why something like a CBC should be a big deal.

Should not deny testing from anyone with curiosity, but this "test everything" mentality can often lead to finding incidentalomas (findings, often benign, that may require more testing.) Like anything there are risks and benefits to testing, all need to be discussed prior to testing.

Honest question: What part of medical school teaches doctors to fight against doing full bloodwork panels? I got a full work up. Hormones, cancer markers, etc. 5+ of my friends went and asked PCPs for it. ALL of them fought back. You don’t need it. Unnecessary stress. Why the hell is this a thing?