Cowboymed

Throwback to one of my speeches to the school board regarding their inane covid policy.

@ENPDoc @SteveDu56581507 @DrNice2026 @ColtKidMcGee @DrDiGiorgio You may want slow your roll on claiming that you're "board certified"

You may want to reread the thread. Nobody is comparing EM physicians to EM NPs. We are discussing different paths to the same statutory clinical authority. As for my boards, I am board-certified in my specialty, just as you are in yours. I don't take your exams for the same reason you don't take the Bar exam—I am licensed under a different regulatory body. When I say "independent practice," I mean exactly what the law in 27 states says it means: I have the full authority to evaluate, diagnose, treat, and prescribe without a "supervisor." You may live in an ivory tower, but in rural America, many hospitals are staffed by solo NPs. I collaborate with specialists just as you do; the only difference is my specialists are 100 miles away, not in the same building. If you think I’m "unqualified" because I didn't take your specific test, take it up with the state legislatures that looked at the data and decided I’m perfectly capable of running an ER. Your "doubt" doesn't change the law or my 35 years of experience. Independent Practice: In Full Practice Authority (FPA) states, the "supervision" requirement is removed because decades of data show it doesn't improve outcomes—it only creates bottlenecks. You are implying that because I didn’t take the USMLE, I'm not "tested." It ignores the rigorous national certification exams for ENPs and CRNAs that are specifically designed for those scopes of practice.

Nurses aren’t neurosurgeons, and this one is wrong. A patient with a traumatic brain injury does not blow a pupil BEFORE losing consciousness. That fighter might have an optic nerve injury, but he doesn’t have a traumatic intracranial hemorrhage.

@ENPDoc @DrDiGiorgio Osteopath requires 350ish credits, is not totally online, requires clinical hours, and you can't work full-time. Comparing that to an online, 35 credits degree, while working full time, and w/o any clinical hours is beyond pathetic.

@DrDiGiorgio I have a clinical doctorate just like DOs, Podiatrist, clinical psychologist, pharmacist etc. Not all “doctors” are MDs. We can all see how arrogant you are. You must be a joy to work with. Looks like you are wrong again.

@HogheadJBone @nickmmark @cfishman Well, he did support: mask mandates, school closures, vaccination blocking transmission, and vaccine mandates, so ¯\_(ツ)_/¯

@nickmmark @cfishman That's not an argument, Nick. You're merely supporting my assertion.

A “moment” is a medieval unit of time defined as 1/40 of an hour (90 seconds). Whenever we lose someone in the ICU we take a moment to honor them. Today, at shift change, we took a moment to remember Alex Pretti, RN. To colleagues working tonight I hope you can take 90 seconds to do the same.

@pagingdrsank Also, most are unaware that active labor, >20 wks, complications, etc means an expedited beeline to L&D. I've done one section in the ER, but there was no time to move the patient; they had plenty of time to avoid sectioning in the episode.

The Pitt is disrespectful to OBGYNs. Lmao. First season, they acted like they’d deliver a shoulder dystocia by themselves & NOW, an eclamptic patient + bedside csection in the ER with NO OBGYN present in a major hospital?! Someone get me the writers number bc I have words to say!

@LangmanVince Ernie youtube.com/shorts/60pYJGa…

What do you call a white guy on a carnival cruise?

@Clip_Station_ The only salvation for that guy not getting shot is that black patrons don't like water sports. And I'm the white not from Detroit, so I can say that.

I feel bad for the last guy 😬 This would literally freak me out in a river or a lake where I can’t see much

@WCJB20 His story was lying, gaming the system, and using crack cocaine whilst a pediatrician. The damage he caused to vulnerable clinicians, while holding their livelihood in his hands and extorting >$650/day from, is sweeping. Don't revel, but don't lionize.

UF Health Florida Recovery Center announced the death of Dr. Scott Teitelbaum on social media. Teitelbaum died during surgery Thursday night. 🔽 wcjb.com/2026/04/17/uf-…

Swalwell case: offer immunity and $1 million reward for the person(s) that he acquired the drugs from. If not recent, litigating he said/she said isn't always fruitful.

@DesireeAmerica4 Situs inversus totalis for the patient and cretinism for the surgeon?

The Worst Surgeon in America ​A Florida doctor was just indicted for manslaughter after ripping out a patient's liver instead of his spleen, killing him on the operating table. ​How do you confuse a massive liver on the right side of the body with a tiny spleen on the left? He didn't. When the surgery went wrong, he panicked, fired a stapler blindly into the man's abdomen, and then tried to cover it up by telling the grieving widow the spleen had magically "migrated." ​The most terrifying part? He did this before. In 2023, he accidentally removed a different patient's pancreas and used the exact same "migrating organ" excuse. ​Absolute monster.

@DrDiGiorgio @cardiojaydoc02 @CardioNP @SpineNeuro Adding: '12 pt ROS was performed and negative, but for pertinent positives and negatives mentioned above', to my note macro sufficed when I dealt with insurances/hospital requirements previously. Hope that helps, man.

@cardiojaydoc02 @CardioNP @SpineNeuro Didn’t mean to sound belittling. Being able to take a good history and physical is completely different from tying ROS to reimbursement. It’s like the CMS bureaucracy is trying to use payment schemes to make us into their version of a good doctor.

It’s hard to imagine a doc who spends most of their time seeing patients who believes this. Who wants their brain tumor surgeon to waste precious visit time listening to their lungs instead of explaining the surgery & treatment ?

@PharmWise A physician would never exclude vital info like age, sex, HPI/symptoms/signs, pertinent +s & -s, etc. A Cx inappropriately performed for asymptomatic bacteriuria from catheter-induced colonization changes the solution. But I doubt this is an honest question.

As the physician, what's the solution to this

@RepMariaSalazar @PalmettoBayVlg @WestMiamiFL @CityCoralGables @CitySweetwater An anchor baby saying illegals "deserve" the (dignidad, not dignity) act with a thick accent is as grating as a tone-deaf karaoke singer. Maybe say gracias to us for providing you an amazing opportunity to live a life you otherwise never would've known.

Great turnout today!! Thank you to everyone who came out to our Passport Fair and to our partners at the State Department and local municipalities who made it happen. This is what delivering for the South Florida community looks like: real services, real results. Thank you, @WestMiamiFL, @CityCoralGables, @PalmettoBayVlg, @CitySweetwater

@TrackYourHeart B. Induction with diazepam 20 mg PO q1h x 3, with hold/subsequent therapy dc parameters, in the outpt setting. (maybe a few lorazepam (SL is best) given to their ride that they're going home with.

First-line drug in alcohol withdrawal (no liver disease): A. Lorazepam B. Diazepam C. Phenobarbital D. Disulfiram

@VinoNStrosGal Libby Zion and the two best surgeons ever to pick up a scalpel, Charlie Lucas & Anna Ledgerwood, would exercise caution about the pendulum swinging back to where it was in the 90s.

Can you imagine time traveling back to the 1990s, when doctors were taught that pain was the 5th vital sign? There was a time when clinicians couldn’t tolerate watching a patient sit in agony. If someone came into the ER doubled over, crying, begging for help, relieving pain wasn’t optional. It was the job. Somewhere along the way, the culture shifted. Now a person can be on the floor in visible agony, and nothing about it guarantees help is on the way. A grown man on the floor of a hospital waiting room, on his knees, folded over himself, crying out in pain, begging for help, while everyone around moves like he isn’t even there. And now, you don’t have to imagine it anymore. You’re looking at it. This is what ERs across the United States look like today. One day, this could be you. Or someone you love.

@WallStreetApes The only medical contraindications for the vaccines are: anaphylaxis (not allergic reaction) to either a PREVIOUS dose of the same mRNA or PEG (a med we give the elderly and little kids for constipation. It's inert, like Nitrogen, so like 4 people on earth have this). Bullshit.

American Nurse Practitioner explains what her “Breaking point” was that caused her to quit “I was a nurse practitioner, and my dad's a doctor. My sister's a nurse. My mom was a nurse. So I'm very medical, and the reason that I went down the rabbit hole is because in 2020 we were giving something (the Covid shot) And as a nurse, you're supposed to ask every patient like, Hey, the first thing, name, date of birth, you gotta identify the patient. And then you have to ask for allergies, right? So if they're allergic to shellfish, you can't use iodine. If they're allergic to latex, you have to get a different glove. So you always ask every patient” She said she asked what was in the Covid shot, she wanted to inform patients Incase there was an allergy so she wouldn’t harm them “I'm like, Hey, what are the warnings on this for allergies? Like, I don't wanna administer this shot if like someone's allergic to it” When she tried to get the information, she was told, “I kid you not — they were like, it doesn’t matter”

@Hakim_Adinew @ape_aldo @CoffeeBlackMD You're right. I just assumed no attending could possibly be that dense, but some FP grandfathered in EM was mismanaging a trauma patient when I was a gen surg intern and kept saying "in my experience...", to which I replied "repetition of error isn't experience"! ¯\_(ツ)_/¯

@Cowboymedpc @ape_aldo @CoffeeBlackMD I think the point he is trying to make is that if you got enough bleeding to make a patient with trauma hemodynamically unstable, there is no way that it is from the head and the patient is still neurologically intact. There would have been some neurological signs.

Ordering an H&H every four hours for a GI bleed admit in the ICU patient grinds my gears. “How will I know if they are bleeding tho …” There might be signs. Ffs.

@ape_aldo @CoffeeBlackMD No no. You were. I was evidently obtuse because I didn't think that could be a thing. Lol. Femoral less likely, but I assumed we all were taught chest, abd/pelvis, retroperitoneal, and the ground.

@Cowboymedpc @CoffeeBlackMD Guess I wasn't clear. Talking about the patient with anemia and suspected occult bleeding (no trauma no neuro signs) where somebody will order a brain CT scan to make sure the blood loss isn't intracranial

@SecKennedy It might be worth a look to offer these under appreciated, culturally similar, English physicians and surgeons an opportunity here. Win win win.

Last month, I had the pleasure of meeting with medical students from across the country to discuss the importance of nutrition education in medical schools. Nutrition is a key component in addressing the chronic disease epidemic to Make America Healthy Again.

@Gwing21 @DavidESmitty @realDonaldTrump @SecKennedy @OIGatHHS @CivilRights Maybe "fatal" in the same way that nicotine withdrawal can be fatal if you're distracted by it and accidentally walk into oncoming traffic. But medically speaking by itself, without MAT is almost never fatal.

@Cowboymedpc @DavidESmitty @realDonaldTrump @SecKennedy @OIGatHHS @CivilRights Sorry bud, but yes you can. If not treated you die from the high blood pressure/heart attack, dehydration due to diarrhea and vomiting.

One of our MANY physicians ARRESTED (many years ago, now free) for the "crime" of treating pain. IT HAS GOT TO STOP! @realDonaldTrump @SecKennedy @OIGatHHS @CivilRights

@BBGreatMoments 1 and 1

Which two get in?