Country-fiedMD

@emlitofnote Do you think scribes are on their way out over the next 3 to 5 years in favor of AI?

Come on over and contribute to the discussion – thinking about how to mitigate performance impact on ambient scribes: roon.com/doctors/rounds…

@Mr_Yanczy Glad to see you’re still kicking

An African coming to America & a Black American moving to an African country is looking for 2 extremely different things. Sacrifice all for opportunity Vs Sacrifice all for peace Quality of life is different for everyone 🇰🇪 for me

@DeafFly Every day

Raise your hand if a single doctor has ever sacrificed their health for you.

@drrachelrubin @PriMedCME What about use of vaginal estrogen in patients with endometriosis??? Contraindicated??

A room full of thousands of primary care clinicians 🥹 All learning how to prescribe hormone therapy Estrogen Progesterone Testosterone Vaginal hormones What are you afraid of? Thanks for having me @PriMedCME Get your education: rachelrubinmd.com/education

@CoffeeBlackMD Hey, now 🤨

The importance of cardio is understated in my corner of FitX. Just like there are 1.0, 2.0, etc lifting standards we should have distance running time standards. But … If you can’t jog a 5k that’s a problem. If you can’t walk one, that’s like showing up with a mass on CT.

@CoffeeBlackMD 😂

Hurt my hand doing a beastly 225 clean and jerk and now that hair on my chest ego lift seems rather ill advised. The pain is weirdly in the middle of the hand. Did my weak ass just break something? Seriously F*CK THAT. This is bullsh*t. 🤣😭 Green lights though. 😎 (worth it)

@DrBrittaniJ You are correct. And no, the ACA didn’t do that. It just shifted.

To the people arguing that Healthcare is a disaster right now because of the ACA... Let's not re-write history and pretend patient access wasn't an absolute DISASTER 16 years ago. No. We NEEDED to improve access to healthcare. The ACA did that. But the ACA was a mixed bag. It create negative effects too. We need to understand those negatives and address them now. That's all we can do

@cliffreid @emlitofnote Potential being the key word

This is an extremely important potential explanation by @emlitofnote of the otherwise surprising finding that procalcitonin saves lives: sick patients with low PCT may have prompted consideration of diagnoses other than sepsis, leading to appropriate resuscitation #PatientsWithoutSepsisDontDieOfSepsis open.substack.com/pub/evidencetr…

@CoffeeBlackMD @cremieuxrecueil Truth

@cremieuxrecueil Too many have really made this anti-seed oil stuff their whole persona and reason for existence.

As a reminder: - The trials show seed oils are fine - The genetic evidence shows they're fine - The observational evidence shows they're fine The contrary evidence is animal studies, mechanistic reasoning, and incautious inferences from old studies without clear relevance.

@emlitofnote Misallocating resources to sepsis detection and early antibiotic therapy are two way different things…. I’m gonna stick with being early

@Country_fiedMD So worried they're willing to cause harm by overprescribing and mis-allocating resources to sepsis detection versus the rest of the zero-sum ED game.

“We recommend antibiotics early, even though what little evidence exists are observational studies showing no difference, because we’re Really Worried About Sepsis.”

I stopped doing lumbar punctures in clinic once I realized the reimbursement didn’t even cover the cost of the kit. A relatively simple bedside procedure became financially unsustainable in an outpatient setting—so now it gets done in the hospital under interventional radiology at a much higher cost. Same procedure. Different setting. Dramatically different cost.

Our clinic’s lactation consultant (also a nurse and a friend) sends her kids to a relatively strict Christian school that emphasizes things like memorization and public speaking. Until recently, she worried that the school was “behind” because they don’t use much tech. Now she realizes that her school is actually ahead!

@CoffeeBlackMD If they stick with it for 3 to 4 months, it’ll kick in all of a sudden

I often consult with women dealing with low testosterone and a low sexual desire. Total testosterone in these lady's is often 30ng/dL or less and "rock solid normal range" I often hear something like this, "I love my husband, and he wants more sex than I do, and I want none," and they genuinely feel bad about this. They may not admit this to their husbands, idk, but they tell me the truth. A low dose of testosterone per week will nudge this testosterone back up into a range where they again find interest in sex. They are not "sex maniacs" but are also not apathetic towards it any longer. It can take a bit of time to move, and I never expect overnight changes. This small dose of testosterone does not cause masculinization, but also needs to be watched closely until satisfactorily stabilized. These women are NOT "witholding sex" they have no interest in sex. This is an important point. It's like they aren't refusing to eat pizza, but rather eating pizza simply doesn't come to mind.

@adamjaymartin You can teach me some new stuff

I bought a guitar a couple weeks ago to help with depression, and stuff. So… yeah

@DocLibertarian Tertiaries 😂

Tele neuro: let’s get a lumbar puncture to cover our butt. IR: we aren’t in house, call anesthesia Me: That isn’t an anesthesia procedure oh and it isn’t really indicated, the neurologist who isn’t here and can’t evaluate the patient is just shotgun testing and diagnosis with another obvious cause. Hospital NP: but the neurologist ordered it. Me: Then he can do it. I fucking hate tele consults. Just bullshit.

@CoffeeBlackMD @DocLibertarian Too be clear, it’s actually CRNAs

I’ve never heard of anesthesia anywhere doing diagnostic LPs. I know you have the skill set to but that’s not the point. People that don’t “do things” have little conception of just how much time this takes, how little it compensates, and how much extra bullshit administrative documentation is required. It’s the same categorical type of moral hazard I was talking about with the ICU. When you want someone else to do what should be your work, it’s not going to work. “*Someone* should LP this guy, but NOT me”. Ok. If that’s that case then you need to wait for the person that does that work regularly can do it.

@CoffeeBlackMD @DocLibertarian Anesthesia does almost all out LPs

@CoffeeBlackMD @CyborgPeds I would actually know how to use it… But I am 917 years old

@CyborgPeds I’d try it

That is the ugliest thing I’ve ever seen. I’d use a coffeemaker made out of a cyanide before I’d let that monstrosity into my kitchen.

@TheSGEM @amalmattu I think so

As an EM clinician, would you trust the Queen of Hearts (QoH) artificial intelligence (AI) to activate the cath lab? thesgem.com/2026/02/sgem50… #EBM #FOAMed @amalmattu