๐™ณ๐šŠ๐šŸ๐š’๐š ๐™ฒ๐šŠ๐š—๐šŽ๐šœ

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๐™ณ๐šŠ๐šŸ๐š’๐š ๐™ฒ๐šŠ๐š—๐šŽ๐šœ

๐™ณ๐šŠ๐šŸ๐š’๐š ๐™ฒ๐šŠ๐š—๐šŽ๐šœ

@CanesDavid

Father of 5๏ธโƒฃ | Urologist @laheyuro | Associate Prof | MIS robotic onc | ๐ŸŽธ| Personal finance rants | Workplace efficiency enthusiast | Founder @wellprept ๐Ÿ‘ˆ

Katฤฑlฤฑm Ekim 2012
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๐™ณ๐šŠ๐šŸ๐š’๐š ๐™ฒ๐šŠ๐š—๐šŽ๐šœ
When I was 15, I learned firsthand what grit truly looks like. It was 1990. My mother was 42 and two years into a confirmed Multiple Sclerosis diagnosisโ€”a condition she had suspected since her twenties. She was a dynamic middle school French teacher, beloved by her students. Her South African accent captivated them whenever she snuck in a few sentences in English. She had a way of lighting up any room. My mother's passion for French took her from South Africa to Paris as a teenager, where she studied at the Sorbonne. Though English was her native tongue, she also spoke Afrikaans and Hebrew. Fast forward to 1990: she was teaching at a private school in the NY suburbs, but the public schools offered better salaries (is this still true?). My mother wanted a position in the local public school system. However, the demand for French was dwindling, with Spanish on the rise. She couldn't get a public school teaching job. So, she took a bold risk. She left her job and took a year off to get certified as a Spanish teacher. Only a year? How would that work? Despite not speaking Spanish, her strong foundation in romance languages gave her the confidence to learn quickly. What she did next was remarkable. She went to the local community college and declared she wanted to take Intro and Spanish 101 simultaneously. The registrar said it was impossibleโ€”Intro was a prerequisite for 101. "How about I register for Intro and audit Spanish 101?" she proposed. "If I pass both, you give me credit for both." They agreed. She aced both classes. That summer, she immersed herself in Spanish literature and Telenovelas. She used a Spanish-English dictionary and even a French-Spanish dictionary, finding it easier to map French to Spanish than English to Spanish. This detail still amazes me. She repeated her (now precedented) request for Spanish 201 and 301 and aced them both, earning all the credits needed for Spanish Teacher Certification in one year. This landed her a job, eventually tenured, teaching both French and Spanish at the local public school. My mother passed away from complications of Multiple Sclerosis three years ago. Her determination and resilience continue to inspire me. Where did she get this incredible determination? Her father, my grandfather, immigrated from Lithuania to South Africa at age 14. He worked in a furniture factory, saving half of his weekly salary for English lessons. Through sheer hard work and perseverance, he eventually owned the factory. As a young child witnessing her perseverance, I witnessed the true meaning of grit. Now, as I steer @WellPrept from idea into existence, and now help it expand... I frequently reflect on her tenacity. Every day, I try to embody her ability to tackle challenges head-on and her unwavering belief in herself. I think you can see it in her eyes in the photo.
๐™ณ๐šŠ๐šŸ๐š’๐š ๐™ฒ๐šŠ๐š—๐šŽ๐šœ tweet media
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๐™ณ๐šŠ๐šŸ๐š’๐š ๐™ฒ๐šŠ๐š—๐šŽ๐šœ
Agree with you generally but specifically hereโ€ฆ hospital wide daily labs are probably more often unnecessary than useful. Itโ€™s a general epidemic of ordering tests where rhe results wonโ€™t change outcomes. I can imagine that for leukemia itโ€™s of course not soโ€ฆ should be able to โ€œenableโ€ daily labs by specialty.
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Paleoncologist
Paleoncologist@PaleoOncยท
And this is how they control physicians practice using EMRs Preventing automatic ordering of daily labs sounds innocent enough. But they are trying to save money at the expense of increasing โ€œproviderโ€ โ€ฆ busy work They figure if itโ€™s too much hassle we wonโ€™t order daily labs And if we really need it we have pay a โ€œtollโ€ - which is to remember to order the labs Every Single Day I have leukemia patients who unequivocally will need daily labs. Now I have to make sure not to forget their labs. Or they get missed. ๐Ÿ˜ก๐Ÿ˜ก๐Ÿ˜ก
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Amelia
Amelia@ameliapond1969ยท
I also donโ€™t want the โ€œsnackโ€ visit from the tooth fairy administration who comes buy with that freaking plastic cart on wheels, loaded with diabetogenic, uber processed food, pushed, inevitably, by someone who looks woefully overweight and unhealthy. Smile and wave. Just smile and wave. Ugh.
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brianb
brianb@frdriversยท
@CanesDavid Sheets to the left of me no basal cell layer to the right. Me oh my.
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Dr. Mac MD, MBA
Dr. Mac MD, MBA@Dr_mac2ยท
Attendings > 5 years outโ€ฆ whatโ€™s there left to do now? Tried watches, not a car guy, and I hate flying + feel Iโ€™ve vacationed enough these daysโ€ฆ Even had a brief phase where I got into landscaping and grilling which was way more expensive than I thought lol.
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Faisal Ahmed
Faisal Ahmed@FlavorFazeยท
@CanesDavid I'm with you and you know more than I do but my idiot opinion: AI will become a tool to make pathologists more "efficient". Ultimately the need for an actual human MD to sign off on studies will become less and less. 15 yrs too soon but I bet we see it in our lifetimes.
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Faisal Ahmed
Faisal Ahmed@FlavorFazeยท
@CanesDavid AI would never give that read. Path will be the first boring unsexy non headline grabbing AI takeover in medicine
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liradonc
liradonc@liradoncยท
@CanesDavid Have seen it go to 3+4=7, which is...quite the change
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Ann L. Jennerich, MD MS ATSF
Generational divide in medicine: 2006: Resident isnโ€™t responding. Page the attending. 2026: โ€œDr. Smith has been added to the Epic chat.โ€
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๐™ณ๐šŠ๐šŸ๐š’๐š ๐™ฒ๐šŠ๐š—๐šŽ๐šœ retweetledi
Amy Faith Ho, MD MPH
Amy Faith Ho, MD MPH@amyfaithhoยท
Hey @DrOz, When you started practicing medicine in 1993, the RVU reimbursement rate was $31.60. @CMSgov is proposing that in 2027, it is $33.40. Adjusted for inflation (+132%), thatโ€™s a 54% cutโ€ฆ No wonder you quit practicing medicine. The financials donโ€™t make sense. Can you tell @CMSGovโ€ฆoh, wait a minuteโ€ฆ ๐Ÿค”๐Ÿคจ๐Ÿ˜’
Dr. Oz CMS@DrOzCMS

We're proposing one of the biggest Medicare updates in yearsโ€”strengthening primary care, expanding accountable care, and modernizing physician payments. The goal is simple: help clinicians spend less time on paperwork, more time with patients, and deliver better outcomes.

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Simon C
Simon C@scserendipity1ยท
@CanesDavid @TylerSbrt Thanks David. A beautiful and inspiring story! The apple doesnโ€™t fall far from the tree ๐Ÿ๐Ÿ’•
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๐™ณ๐šŠ๐šŸ๐š’๐š ๐™ฒ๐šŠ๐š—๐šŽ๐šœ
When I was 15, I learned firsthand what grit truly looks like. It was 1990. My mother was 42 and two years into a confirmed Multiple Sclerosis diagnosisโ€”a condition she had suspected since her twenties. She was a dynamic middle school French teacher, beloved by her students. Her South African accent captivated them whenever she snuck in a few sentences in English. She had a way of lighting up any room. My mother's passion for French took her from South Africa to Paris as a teenager, where she studied at the Sorbonne. Though English was her native tongue, she also spoke Afrikaans and Hebrew. Fast forward to 1990: she was teaching at a private school in the NY suburbs, but the public schools offered better salaries (is this still true?). My mother wanted a position in the local public school system. However, the demand for French was dwindling, with Spanish on the rise. She couldn't get a public school teaching job. So, she took a bold risk. She left her job and took a year off to get certified as a Spanish teacher. Only a year? How would that work? Despite not speaking Spanish, her strong foundation in romance languages gave her the confidence to learn quickly. What she did next was remarkable. She went to the local community college and declared she wanted to take Intro and Spanish 101 simultaneously. The registrar said it was impossibleโ€”Intro was a prerequisite for 101. "How about I register for Intro and audit Spanish 101?" she proposed. "If I pass both, you give me credit for both." They agreed. She aced both classes. That summer, she immersed herself in Spanish literature and Telenovelas. She used a Spanish-English dictionary and even a French-Spanish dictionary, finding it easier to map French to Spanish than English to Spanish. This detail still amazes me. She repeated her (now precedented) request for Spanish 201 and 301 and aced them both, earning all the credits needed for Spanish Teacher Certification in one year. This landed her a job, eventually tenured, teaching both French and Spanish at the local public school. My mother passed away from complications of Multiple Sclerosis three years ago. Her determination and resilience continue to inspire me. Where did she get this incredible determination? Her father, my grandfather, immigrated from Lithuania to South Africa at age 14. He worked in a furniture factory, saving half of his weekly salary for English lessons. Through sheer hard work and perseverance, he eventually owned the factory. As a young child witnessing her perseverance, I witnessed the true meaning of grit. Now, as I steer @WellPrept from idea into existence, and now help it expand... I frequently reflect on her tenacity. Every day, I try to embody her ability to tackle challenges head-on and her unwavering belief in herself. I think you can see it in her eyes in the photo.
๐™ณ๐šŠ๐šŸ๐š’๐š ๐™ฒ๐šŠ๐š—๐šŽ๐šœ tweet media
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Adam B. Weiner, MD
Adam B. Weiner, MD@Adam_Weiner535ยท
@CanesDavid @HeyEpic have you gotten the latest? We have to go a new tab and click "medications reviewed" to sign an encounter. The MA or RN med review does not count anymore....................
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Jeff Ryckman
Jeff Ryckman@jryckman3ยท
@Adam_Weiner535 @CanesDavid @HeyEpic Always love the mandatory allergy review for ordering a CT without contrast Epic sure is on top of their game Entire ecosystem was clearly built around billing, thatโ€™s it.
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Dr. Alexander Sheppert
Dr. Alexander Sheppert@alexsheppertยท
@CanesDavid @HeyEpic The useful classification is too specific to have on a dropdown anyway. Itโ€™s not like my telephone notes are very long anyway, half the note is why I called the patient!
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RJ
RJ@northwoods1980ยท
Itโ€™s also amazing how many comments argue this is acceptable simply because a percentage of patients had their diagnosis changed by CT. By that logic, almost any test in medicine could be justified regardless of how low the positive yield is. You could make the same argument for screening colonoscopies in 19-year-olds. If thatโ€™s the standard, why even require physicians to be trained to determine when imaging is appropriate? In the end I just don't care anymore because most logic has been lost. My efforts now are on reimbursement for our work and legal liability. CTA reimbursement loss for example in the face of massive widespread abuse.
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๐™ณ๐šŠ๐šŸ๐š’๐š ๐™ฒ๐šŠ๐š—๐šŽ๐šœ
I'm coming to terms with the fact that I may be part of a dying breed of physicians whose mentors back in the day used to berate them for ordering any scan without being able to clearly articulate what exactly you're looking for and what the pretest probability is Instead now CT scans have essentially been continually abused as an extension of the physical exam. All anyone needs to articulate is: I think something bad's happening.... Let's get a CT scan or evenโ€ฆ. I'm not sure if there's anything bad going on, let's make sure there isn't anything bad on the CT scan. It doesn't even appear to be necessary anymore to explain what you mean by 'something bad' I sound like a grumpy old man, I know, but I think it's a sad state of affairs. The perverse thing about it is there's no real incentive on the part of any emergency room or hospital system to curtail this kind of behavior because they get paid for every single scan.
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