Andre Freire

“How did I do?” is not a feedback request. It’s an anxiety offload. Real feedback-seeking requires you to name what you were uncertain about before you ask. Specificity is the price of admission. 🧵

Mostly agree, but I’d offer that the most useful voices here aren’t always the most credentialed. Bedside clinicians, trainees are asking really great questions and sharing impactful perspectives. Influence should follow the impactful voices, not rank. Also, the absence isn’t neutral. Misinformation doesn’t wait for experts to chime in. That gap gets filled, just not by us. 😬

We need influential medical experts to be active here on X. We can help by providing good medical information and updates for patients and colleagues. We can network. We can counter misinformation. Clarify complex questions. Share accomplishments and publications. And more. I learn every day. Although X has is not the same as the amazing platform Twitter used to be, it’s still the Number one social media platform for medicine. I’m happy to be here.

What's the hardest thing you did in training with zero deliberate practice beforehand?

The most human skills deserve the most deliberate practice. We've got it backwards. Time to course correct.

I want to practice telling patients they’re "going to die" with someone that’s not a patient, before I have to say that to a real patient. Intentional or not, that one sentence from @laurahturner is the whole argument for deliberate practice in medicine. A short 🧵

@AdamRodmanMD @itmeded Honestly, just happy to gain insights from those who have gone before me.

@BloodSweatxED @itmeded ... uptime. I think this is part of a greater trend towards cloud computing that predates the "LLM era" and I have a hard time seeing IT governance shift. Unfortunately think it's more likely we'll be running small models (like Gemma) on GCS ...

Wish to use #LLMs to process sensitive data, but concerned about privacy? Try locally-hosted SMALL LMs. To find out how, see our just-published paper on the topic doi.org/10.1080/014215… #MedEd #HPE #Ollama

@AdamRodmanMD @itmeded Hmm. Every new model install needs clearance. On Prem is nice but institutions default back to cloud because the path of least resistance wins. Quiet part out loud: solving the privacy problem isn't local storage, but picking which cloud you trust. 🥸

@mcuban The hospitals that close first won’t be the corrupt ones. They’ll be the safety net hospitals taking the patients no one else will. Insurers would have the upper hand here. I’m not against transparency. I’m against “problem solved.”

The path of least resistance to reducing the cost of medical care is to require all Non Profit Hospitals and providere to be required to post on their website a Real Time and downloadable General Ledger with all entries The same for all supply chain transactions In detail There is no reason why taxpayers shouldn't see every penny they are subsidizing None There are no competitive reasons we don't subsizie you to maximize revenues or profits We let you be NP to maximize outcomes and we deserve to see every penny and where it comes from and where it goes, and why Problem solved

Built something similar. The app was the easy part. Finding someone with budget authority who sees what you see turns out is the actual project. Once I framed the convo around ROI the conversation changed. The liability was the issue. Then X. The wheels of change in medicine and education need to loosen or we get left behind. Feels like a bad time to get left behind…

I am not a developer but I built a fully functional #MedEd AI app. I’ll tell you what surprised me most. I had to build it without a developer, keep the cost low, and add no extra work for teachers. Three years ago, I would not believe I could build and deploy a real app on our university servers without human help. But with AI, I built a medical learning platform where students practice diagnosis and get personalized feedback without hallucinations. Our study showed it improved learning, and it did this without adding faculty workload. So I expected the medical faculty administration to support the AI API cost. I thought this was easy. A working app, low cost, better education, no extra staff. But funding the API became harder than building the app. The app taught diagnostic reasoning. The budget taught me how universities really work. Would your university fund the API cost if a faculty member developed such an app?

@MicrosoftLearn Patient intake workflows by building on existing EMR infrastructure instead of around it. Early, but the friction points are already obvious. And finding health systems who want to take the chance on a clinician developer is a major pain point.

What’s the area you’re exploring right now, even if you’re still early in it?

Built a SMART on FHIR layer that turns fragmented cross-institutional patient data into a clinician-trusted longitudinal view. We're pre-seed, moving fast on real clinical workflows. Serves to be the kind of vertical AI infrastructure that saves clinician time and reduces errors at scale. Would love an intro to those in the health/informatics tech space.

I've now made over 100,000 introductions. Founders and investors. Companies and talent. Operators and co-founders. You name it. Tell me below who you're looking to meet and I'll make the right intro for you.

@PavanKumarNY @sama DM sent!

I am giving away 10 referrals for YC Startup School. What you'll get: > Jensen Huang & Sam Altman @sama fireside chat. > Access to 25k in credits (OpenAI, Anthropic, AWS, etc) > A network of top talent, NeurIPS authors, Olympiad medalists. > After parties across SF hosted by YC alumni & partners > Be in San Franscisco for free* (flight coverage) If you want it, let's connect 🤝 Tell me about what you are building & why you.

Before your next interview with a stigmatized diagnosis - name the question you’re avoiding. Then ask it. Directly. With curiosity, not apology. The patient will feel the difference. So will you.

The questions that actually matter: How did you find out you were positive? Who knows? How has it changed how you navigate sex and relationships? That’s not rude. That’s the history. You’re not expected to be gentle. You’re expected to be worthy of sharing their story with. Everyone has a story.

Your patient with HIV has been interviewed by every rotation, every student, every attending who was “being careful.” The softened question isn’t kind. It’s useless. The patient knows the difference. A 🧵on bias in the Healthcare System.

@ALMannixMD My dad was a fisherman. So he knew nothing about emergency medicine other than the stories I shared of the wins and losses. He once pointed out to me that, “…you weren’t drafted, you asked for the mission.”

The ED is where everything else that didn’t work ends up. That’s not a flaw. That’s the mission.