Terry Hoffmann

@EPotterMD That is ridiculous. HE needs to escalate the case & decision. If he’s not qualified to approve it, he sure ask heck isn’t qualified to deny it.

Another peer-to-peer call. The reviewer was kind. Really kind. But, respectfully, not my peer. He listened as I explained why my patient needs lymphovenous bypass surgery. It’s a surgery that can treat the painful swelling in her arm caused by breast cancer treatment and prevent it from getting worse. She has done everything right. Compression. Therapy. Expensive garments. She’s changed her life to spend an hour a day with every resource she can afford. It’s affecting her ability to work as a nurse. And she is getting worse. This is the window where we can fix it. Early enough that surgery can actually change the course. We can do this surgery outpatient. Two hours. CMS even has a code for it. The man on the phone agreed it would help her… But he couldn’t approve it… Because he’s not a plastic surgeon and doesn’t have the specific knowledge necessary to make this recommendation. He gave me the help he felt he could. He told me to appeal and told me not to expedite it, because that wouldn’t work in my favor. Every human involved in this case knows what we should do. But the system is inhumane.

@alt_w_v_g @LeeAase My company provides team coaching to c-suites executives and their teams in healthcare. You have captured the essence of each healthcare interaction I have had over the past 20 years. That analyst lives in my head! Well done 😁.

Went to the doctor yesterday My wife made the appointment She also filled out the pre-visit forms online All of them She said "did you go alone" I said "yes" My analyst drove separately When I arrived the receptionist handed me a clipboard With a Bic pen Attached to a string Like I was going to steal it The form asked for everything my wife already submitted online Name Date of birth Address Insurance I filled it out again Handed it back My analyst was already at the counter He leaned over the receptionist's screen Looked at it for three seconds Then looked at me He said "boss man, the headers have gridlines on" She minimized the window He sat down She said "have a seat, we'll call you shortly" I sat down at 2:14pm At 2:31 she handed my clipboard to another woman Who sat down at a computer eight feet away And typed everything I just wrote into the screen At 2:38 she came back Said she couldn't read one letter of my address An address they've had on file since 2022 An address my wife typed into their portal three days ago I spelled it out loud In a waiting room full of strangers Then sat back down My analyst had his laptop open I glanced at his screen He was on Zillow Looking up my home address The one I just spelled out loud He closed the laptop At 2:51 a nurse called my name Mispronounced it Four years She walked us to a room She looked at my analyst She said "family member?" I said "closest thing I have" She didn't ask follow-up questions She took my blood pressure Wrote it on a piece of paper Then typed it into a computer Then wrote it on another piece of paper Three records of the same number My analyst looked at me I looked at him We didn't say anything We didn't have to She said "the doctor will be right in" She left at 2:54 My analyst opened his laptop Built a model I said "for what" He said "the wait time" He projected the doctor would arrive at 3:38 The doctor came in at 3:41 Three minutes off He was disappointed in himself 87 minutes total in the building He said "so what brings you in today" I told him He looked at his chart My analyst said "you have his date of birth wrong" The doctor looked at him Then looked at me I said "he's right" The doctor corrected it My analyst said "the insurance ID is also off by one digit" The doctor put his pen down He said "and you are?" I said "he's with me" The doctor continued He said "let's keep an eye on it" That's what he said last year He said "alright, now the fun part" He said "I'm going to need you to drop the cargo shorts" I looked at my analyst My analyst looked at me He covered his eyes The appointment lasted four minutes I waited 87 minutes for a four-minute appointment It's 2026 We can launch a rocket into space and land it vertically on the exact square foot it left from But my doctor's office is using a string to protect a Bic pen I texted my wife from the parking lot She said "how'd it go" I said "they lost my address again" She said "I submitted it online three days ago" I said "I know" She said "did you bring him" I didn't answer She said "I'm switching doctors" First time we've agreed on anything all week Make common sense common again Plz fix. Thx. Sent from my iPhone

@noahkaufmanmd @steveMmattison @KaufCare I did the same thing in 2008 then added a DBA when the time was right. I will be following & cheering you on. Doctors, patients & employers can align for health!

Haha totally. I mean also I didn’t want something lame like “Pinnacle Health”… something generic. Also, it’s amazing how every single URL and social handle is pretty much gone. So that really limited our options. We spent a lot of time on it. At the end of the day we will focus on doing the best we can!

After 20 years working in emergency departments, I decided to try something different. We're opening a new kind of clinic in Denver called @KaufCare. Advanced urgent care run by board-certified ER physicians. Transparent pricing. No insurance games. Opening in about a month.

@mehdirhasan @RepSwalwell I didn’t even know who he was. Now in a week’s time he’s sure Bad Bunny broke FCC regs although he speaks no Spanish and has hot bothered to view the transcript, has been video taped allegedly cheat voting on the floor, and now this super xenophobic post. What an a hole.

@RepSwalwell Thank you Congressman

America is BETTER because of our Muslim community. *And we are WORSE when assholes like this guy spout hate. Every Republican who fails to call out this vitriol only gives it more oxygen.

@JasonKuperberg @mattshumer_ How it’s going….

How it started…

Excellent must read @mattshumer_ tells it truthfully!

@RepFine I’ll take what are things that ignorant racist say for a thousand Alex. Or… I’ll take what are impure thoughts that will require some explaining at the pearly gates for 1000, Alex.

You can't say the f-word on live TV. "Bad Bunny"'s disgusting halftime show was illegal. Had he said these lyrics -- and all of the other disgusting and pornographic filth in English on live TV, the broadcast would have been pulled down and the fines would have been enormous. Puerto Ricans are Americans and we all live by the same rules. We are sending @BrendanCarrFCC a letter calling for dramatic action, including fines and broadcast license reviews, against the @NFL, @nbc, and "Bad Bunny." Lock them up.

Representation matters. Mentorship matters. Women physicians matter, today and every day.

@mariachong @OwenGregorian People who suffer from night terrors are tortured. It’s probably in everyone’s best interest if they have a private room.

@OwenGregorian Valid questions. But night terrors aren’t “silly.” They’re a serious psychological condition resulting from severe trauma, PTSD, childhood abuse, parental neglect, violence, etc. May not require a single room but easily could deserve accommodation for other reasons.

Nearly 40% of Stanford undergraduates claim they’re disabled. I’m one of them | Elsa Johnson, The Times In 2023, one month into my freshman year at Stanford University, an upperclassman was showing me her dorm room — a prized single in one of the nicest buildings on campus. As she took me around her space, which included a private bathroom, a walk-in shower and a great view of Hoover Tower, she casually mentioned that she had lived in a single all four years she had attended Stanford. I was surprised. Most people don’t get the privilege of a single room until they reach their senior year. That’s when my friend gave me a tip: Stanford had granted her “a disability accommodation”. She, of course, didn’t have a disability. She knew it. I knew it. But she had figured out early what most Stanford students eventually learn: the Office of Accessible Education will give students a single room, extra time on tests and even exemptions from academic requirements if they qualify as “disabled”. Everyone was doing it. I could do it, too, if I just knew how to ask. A recent article in The Atlantic reported that an increasing number of students at elite universities were claiming they had disabilities to get benefits or exemptions, which can also include copies of lecture notes, excused absences and access to private testing rooms. Those who suffer from “social anxiety” can even get out of participating in class discussions. But the most common disability accommodation students ask for — and receive — is the best housing on campus. At Stanford University in Palo Alto, California, where competition for the best dorm rooms is fierce, this practice is particularly rife. The Atlantic reported that 38 percent of undergraduates at my college were registered as having a disability — that’s 2,850 students out of a class of 7,500 — and 24 per cent of undergrads received academic or housing accommodations in the fall quarter. At the Ivy League colleges Brown and Harvard, more than 20 per cent of undergrads are registered as disabled. Contrast these numbers with America’s community colleges, where only 3 to 4 per cent of students receive disability accommodations. Bizarrely, the schools that boast the most academically successful students are the ones with the largest number who claim disabilities — disabilities that you’d think would deter academic success. The truth is, the system is there to be gamed, and most students feel that if you’re not gaming it, you’re putting yourself at a disadvantage. That’s why I decided to claim my legitimate illness — endometriosis — as a disability at Stanford. When I arrived on campus two and a half years ago, I would have assumed that special allowances were made for a small number of students who genuinely needed them. But I quickly discovered that wasn’t true. Some diagnoses are real and serious, of course, such as epilepsy, anaphylactic allergies, sleep apnea or severe physical disabilities. But most students, in my experience, claim less severe ailments, such as ADHD or anxiety. And some “disabilities” are just downright silly. Students claim “night terrors”; others say they “get easily distracted” or they “can’t live with others”. I know a guy who was granted a single room because he needs to wear contacts at night. I’ve heard of a girl who got a single because she was gluten intolerant. That’s why I felt justified in claiming endometriosis as a disability. It is a painful condition in which cells from the uterus grow outside the womb. I’m often doubled over in agony from the problem, for which there is no known cure, so I decided to ask for a single room in a campus dorm where I could endure those moments in private. The application process was very easy. I registered my condition on the Stanford Office of Accessible Education website and made an appointment to meet an adviser later that week. The system is staffed largely by empathetic women who want to help students. As I explained my diagnosis and symptoms over Zoom to one woman, she listened, nodded sympathetically, related my problems to her own life and asked a few basic questions. Within 30 minutes, I was registered as a student with a disability, entitled to more accommodations than I asked for. In addition to a single housing assignment, I was granted extra absences from class, some late days on assignments and a 15-minute tardiness allowance for all of my classes. I was met with so little scepticism or questioning, I probably didn’t even need a doctor’s note to get these exemptions. Had I been pushier, I am sure I could have received almost any accommodation I asked for. While I feel entitled to my single room, I would feel guilty about some of the perks I have — except that so many of my fellow students have gamed the system. Take Callie, a recent Stanford grad with ADHD and Asperger’s who agreed to be quoted under a pseudonym. Callie was diagnosed with her conditions in elementary school; in return, Stanford granted her a single room for all four years, plus extra time on tests — and a few more perks. “In college, I haven’t had that many ‘in real life’ tests as opposed to take-home essays,” Callie told me. “When I did use the extra time, I felt guilty, because I probably didn’t deserve the accommodations, given the fact I got into Stanford and could compete at a high academic level. Extra time on tests — some students even get double time — seems unfair to me.” But at Stanford, almost no one talks about the system with shame. Rather, we openly discuss, strategise and even joke about it. At a university of savvy optimisers, the feeling is that if you aren’t getting accommodations, you haven’t tried hard enough. Another student told me that special “accommodations are so prevalent that they effectively only punish the honest”. Academic accommodations, they added, help “students get ahead … which puts a huge proportion of the class on an unfair playing ground”. The gaming even extends to our meals. Stanford requires most undergraduates living on campus to purchase a meal plan, which costs $7,944 for the 2025-26 academic year. But students can get exempted if they claim a religious dietary restriction that the college kitchens cannot accommodate. And so, some students I know claim to be devout members of the Jain faith, which rejects any food that may cause harm to all living creatures — including small insects and root vegetables. The students I know who claim to be Jain (but aren’t) spend their meal money at Whole Foods instead and enjoy freshly made salads and other yummy dishes, while the rest of us are stuck with college meals, like burgers made partly from “mushroom mix”. Administrators seem powerless to reform the system and frankly don’t seem to care. How do you prove someone doesn’t have anxiety? How do you verify they don’t need extra time on a test? How do you challenge a religious dietary claim without risking a discrimination lawsuit? I often think back to that conversation with my upperclassman friend. She wasn’t proud of gaming the system and she wasn’t ashamed either. She was simply rational. The university had created a set of incentives and she had simply responded to them. That’s what strikes me most about the accommodation explosion at Stanford and similar schools. The students aren’t exactly cheating and if they are, can you blame them? Stanford has made gaming the system the logical choice. When accommodations mean the difference between a cramped triple and your own room, when extra test time can boost your grade point average, opting out feels like self-sabotage. Who would make their lives harder when the easiest option is just a 30-minute Zoom call away? thetimes.com/us/news-today/…

This young hero shares his secret to accomplishing unbelievable feat. He swam 2.5 miles through enormous waves to get help for his mom and two younger siblings after they were all swept away. What was his mindset? “I distracted myself with happy thoughts.” Mindset is everything.

They tested to see if their dogs will save them 😂😂😂

@RepFine @RepRaskin Simmer down Randy. Are you implying it’s justifiable to kill him for what he did three weeks prior? His crime- helping people being pepper sprayed & shoved to the ground. ICE went after HIM, as he (a nurse) HELPED FELLOW AMERICANS STAND UP. That was his crime. Watch the clip.

You’re an idiot, and worse, a gaslighter. Pretti engaged physically with law enforcement while carrying a gun, something every responsible gun owner knows not to do. This after he spit on them, physically attacked them, and called on them to hurt him. When you FA, you FO. Your fetish for illegal immigrants over the safety of Americans is sick, disgusting, and shameful.

Second Amendment impostor and hypocrite Randy Fine has no problem with federal agents confiscating a citizen’s lawful firearm and then shooting him dead with ten bullets. You don’t lose your Second Amendment rights because you’re lawfully exercising your First Amendment rights. Fine isn’t a constitutional patriot—he’s a Trump toady and autocratic sycophant. nytimes.com/2026/01/26/us/…

This! Mr. Rogers famously quoted his mother, “Always look for the helpers.” youtu.be/-LGHtc_D328?si…

@JamieMc46313002 @EugeneWong3188 @BSwirlsi @tedlieu @DHSgov He looks ready to lose it. Look in his eyes. I hope someone in his line of leadership sees this and intervenes. That’s an activated time bomb.

@EugeneWong3188 @BSwirlsi @tedlieu @DHSgov The person who was filming this interaction *very* wisely repeated his words back to him twice, and he acknowledged that's what he said both times. Given ICE's recent actions, can this not be construed as a death threat???

Dear @DHSgov: You need to implement an immediate stand down of ICE and Border Patrol interior operations so your agents can learn the Bill of Rights to the Constitution of the United States.

Quietly assured talents offered thru a challenging and under appreciated profession. I’m sending prayers of comfort to everyone Alex touched and HUGE thank you to all of you nurses out there taking care of patients day in and day out. Read below the words of his last preceptee.

@EricTopol @BMJMedicine What are the possible correlates with swimming? Am I reading it correctly that 5-15 hours weekly actually demonstrated increased mortality?

As many commenters have noted, walking is notably effective as a physical activity, here compared with the other types of exercise for dose-response vs all-cause mortality in the 2 large cohorts

Physical activity and the reduction of all-cause mortality, from 2 very large prospective cohorts 1. The relationship is non-linear, suggesting a threshold effect for many types of exercise as seen below

I can’t accept this person is actually real...

@SPuro88 I used to use the assumptive close when they started down that road- “oh, they definitely meet medical necessity. What haven’t we discussed that will get you a more accurate picture of what’s going on?

Had the pleasure of yelling at two “peers” from insurance companies denying care for ureteroscopy for stones. I cannot imagine that the most basic, common thing we manage as urologists now require peer to peer insurance approvals.

VOLUME UP and listen to this little girl's spontaneous, breakout moment, as she channels Aretha Franklin! 😉