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Sandeep Palakodeti, MD MPH
9.1K posts
Sandeep Palakodeti, MD MPH
@DrDeepMD
Author, The Ultimate Asset: https://t.co/ZL9EcEU5DO. Physician, CEO & Founder @join_velocity ex- @harvardmed @mayoclinic
Katılım Aralık 2021
1.1K Takip Edilen7.6K Takipçiler
@dmorris345 It’s astounding when you put it in that perspective. People have no idea how much $$ is in healthcare. Bigger than the next 5 departments COMBINED
Massive. And lots of dollars flowing to status quo who will clutch to the current system as long as we let them
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@DrDeepMD This is my favorite stat to use to ask people to guess the # of seconds in
1 million?
1 billion?
1 trillion?
I’ve never had anyone get even close with a trillion….Which is about as big of a problem we have in this country because our citizens are clueless to the real debt
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Sandeep Palakodeti, MD MPH retweetledi
We spend almost $5 TRILLION dollars in healthcare every year
For perspective:
- 1 million seconds from now = 11.6 days
- 1 billion seconds from now = 31.7 years
- 1 trillion seconds from now = 31,688 years
Barely even a rounding error on ONE year of spend
How many are there?
Mario Nawfal@MarioNawfal
🇺🇸 Brett Blackman, owner of a healthcare software company, just got convicted in a $1 BILLION Medicare fraud conspiracy. His platform auto-generated fake doctors’ orders and prescriptions to scam Medicare and other programs out of over a billion dollars. The DOJ literally coded the fraud at industrial scale. Guilty. Source: U.S. Dept. of Justice
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@graymatterhaver @TakeWeightOffMD I’m sorry to be so depressing
But. It’s important for us to be eyes wide open about reality
Incremental change through the current system sure as hell isn’t going to do it
Some of us are trying to build in parallel and show a different way
I have hope as an eternal optimist!
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@DrDeepMD @TakeWeightOffMD Everytime I read your posts from your point of view from the inside I just get sad. It’s all so backwards and just flat out wrong. Is there hope of change going forward, at a large scale?
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Let me explain how this works in real life
A PHQ2 score is collected on almost every patient that walks in the door of a primary care clinic. At best, a PHQ9
Posted both here for your viewing pleasure
TWO questions asked ONE time and MDD is “likely”. 9 questions seals it
Sandeep Palakodeti, MD MPH@DrDeepMD
@john_malone It’s not malpractice when all the professional society guidelines say to prescribe after a 2 (at best 9) question survey that basically anyone would test “positive” for on any moderately tough day “But judge, that’s what the gUiDeLiNeS say” Case dismissed
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@CoffeeBlackMD This post GETS ME
The MBAification of healthcare is one of the worst things to ever happen to healthcare
And to anyone considering this degree - outside of the networks you tap into at the top 3: HBS, Wharton, GSB - it’s an absolute waste of time
Useless trolls
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Had a former business partner who really leaned on his having an MBA as a reason to being part of the business.
It turned out he knew nothing. Did nothing (except eat sandwiches). But made sure to inappropriately cash owner distribution checks that we thought was correct because “Tom [not his real name] has an MBA and is watching out for the business”
When we finally figured it out and kicked him out I thought he was going to cry. And he then raged about how much money we owed him after he took his third of the bank account on the way out.
If Tom had known how to do a P and L he would have seen a cratering business that had exactly zero real value outside of the cash on hand (no other assets) his delusions and dreams of doing jack shit and collecting checks while everyone else worked, notwithstanding.
University of Phoenix Online. And I’m NOT even joking.
SightBringer@_The_Prophet__
⚡️The real signal is credential deflation. MBA demand is falling because the market is finally separating elite network access from generic credential theater. The top MBA still has value because it buys access: elite peers, recruiting funnels, status compression, VC/startup networks, private equity pipelines, consulting/IB placement, alumni power, and social sorting. That part survives because the product is not just education. It is access to a protected human network. Everything below that is getting exposed. A huge amount of MBA value was built on the idea that business knowledge was scarce. It is not scarce anymore. Basic finance, strategy, marketing, ops, accounting, management frameworks, case studies, memo writing, market analysis, valuation, and presentation structure can now be learned or generated faster, cheaper, and more directly through AI, YouTube, work experience, online courses, and actual operating reps. The credential moat is cracking. This connects directly to the broader white-collar quake. AI is attacking the value of generalized cognitive packaging. A mid-tier MBA used to signal polish, ambition, managerial readiness, and business literacy. Now the market is asking a colder question: What can this person actually do? Can they sell? Can they build? Can they operate? Can they allocate capital? Can they lead? Can they use AI to produce leverage? Can they own a result? The paper matters less when the work product becomes visible. Business schools are being hit by the same force hitting software agencies and white-collar labor: the collapse of artificial scarcity. When knowledge, frameworks, decks, models, and analysis become abundant, the value shifts to judgment, network, trust, execution, taste, distribution, and real-world outcomes. That is why tuition cuts matter. Price is truth. When schools slash tuition, they are admitting the old willingness-to-pay broke. The deeper cultural signal is brutal: the professional-class bargain is weakening. For decades, the advice was: get the degree, buy the credential, enter the managerial class, rise safely. That path worked when credentials controlled access to information, employers, and status. AI and labor-market saturation are breaking that bargain. The winners will be elite institutions with network power and operators with proof of work. The losers will be expensive middle credentials selling generic knowledge. The real truth: The MBA is splitting into two products. At the top, it remains a status-and-network asset. Everywhere else, it is becoming overpriced business school cosplay in a world where AI can teach the frameworks and the market wants proof you can actually move reality.
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@TakeWeightOffMD Insidious slow fall into cookbook medicine because that’s the way the man wants it to be
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Ever feel a certain type of weird pressure when you go to the doctors office?
Some of these are good evidence based practices. Many are not.
Docs aren’t getting directly paid by pharma to prescribe
But here’s how the flow of funds works:
Pharma puts pressure on professional societies to create guidelines a certain way —> payors take guidelines and operationalize into incentive structures —> health systems want that extra $$ and to be seen as “high quality” to the public —> they bonus docs for meeting thresholds on their panels —> patients get put on meds —> pharma has recurring revenue for life
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@medsiri I wish every bit of that post was false. But unfortunately, that’s the reality we live in
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It’s not turtles all the way down, it’s incentives all the way down. In this case incentives that don’t have your health as the top priority. Great post doc 👏
Sandeep Palakodeti, MD MPH@DrDeepMD
And no the docs aren’t getting paid by pharma to prescribe But here’s how the flow of funds works: Pharma puts pressure on professional societies to create guidelines a certain way —> payors take guidelines and operationalize into incentive structures —> health systems want that extra $$ and to be seen as “high quality” to the public —> they bonus docs for meeting thresholds on their panels —> patients get put on meds —> pharma has recurring revenue for life 82% of docs are employed by a corporate entity. It’s so easy to see how we got here if you just follow what drives the world in every other industry. And this is why @SecKennedy considering RICO charges for collusion at the top level. And why it’s so important to find an independent physician who reports to no one but YOU the patient. It’s all one big club. And we ain’t in it. Godspeed and good luck out there
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@BowTiedHRT @allicovington It is the primary tool used by most to make the diagnosis of major depressive disorder
🤷🏾♂️
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@DrDeepMD @allicovington Was about to do the page 2 inventory and realized the instructions ask that you identify the specific “problems” you’ve been “bothered by” in the last two weeks.
The questionnaire is obscenely subjective. Is that inventory used for depression diagnostics?
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If you’re railing at the peptide bros for unproven interventions
Please show the “data” on 20+ consecutive years of being on these meds, as we put folks on during teens/early 20s and leave them on for life
No one has any real moral high ground
Everyone is just vibing
Sandeep Palakodeti, MD MPH@DrDeepMD
1 in 3 college aged kids being on psych meds is absolutely bonkers We’ve completely lost the plot
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SSRIs are dangerous and their efficacy is questionable
Exercise, diet, sleep, meditation and socialization/community are well established solutions for depression or the blues.
Mock @joerogan, @TomCruise or me for pointing this out, but this is the established truth
Go research it.
Be very careful with these drugs, as joe points out, they are known to make people suicidal and their efficacy is unknown.
And they are brutally hard to get off of x.com/overton_news/s…
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@allicovington @BowTiedHRT It’s not malpractice if every professional society in the country has “consensus” on this topic
In the traditional sense as in a judge would never rule against a doc for following the guidelines
In a moral sense, it’s an abomination
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@DrDeepMD @BowTiedHRT That’s terrible. Do you know many hours a therapist would spend with a client before even suggesting someone might have some level of depression and could potentially benefit from meds if a doctor agreed?? This is malpractice.
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@allicovington @BowTiedHRT Why does everyone get “screened” for depression and thrown on these meds?
I have one explanation…
Sandeep Palakodeti, MD MPH@DrDeepMD
Let me explain how this works in real life A PHQ2 score is collected on almost every patient that walks in the door of a primary care clinic. At best, a PHQ9 Posted both here for your viewing pleasure TWO questions asked ONE time and MDD is “likely”. 9 questions seals it
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@BowTiedHRT @DrDeepMD Too many overly medicated moms helicoptering over their kids and seeking medical help instead of making their kids resilient because they aren’t themselves. This was inevitable from the boomers coddling their past offspring unlike Gen X
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Why does this happen?
Because all the guidelines start kicking in bonuses and threat of “low quality” if we don’t start asking everyone at 12 YEARS OLD
As if angsty adolescence wasn’t a thing 🤷🏾♂️
Sandeep Palakodeti, MD MPH@DrDeepMD
Let me explain how this works in real life A PHQ2 score is collected on almost every patient that walks in the door of a primary care clinic. At best, a PHQ9 Posted both here for your viewing pleasure TWO questions asked ONE time and MDD is “likely”. 9 questions seals it
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1 in 3 college aged kids being on psych meds is absolutely bonkers
We’ve completely lost the plot
Rob Henderson@robkhenderson
“Roughly 1 in 6 American adults, an estimated 44 million people, are now on antidepressants. In young adults, those numbers are even higher. Thirty percent of college students take psychiatric medication, up from 9% in 2007.” wsj.com/opinion/behind…
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And no the docs aren’t getting paid by pharma to prescribe
But here’s how the flow of funds works:
Pharma puts pressure on professional societies to create guidelines a certain way —> payors take guidelines and operationalize into incentive structures —> health systems want that extra $$ and to be seen as “high quality” to the public —> they bonus docs for meeting thresholds on their panels —> patients get put on meds —> pharma has recurring revenue for life
82% of docs are employed by a corporate entity.
It’s so easy to see how we got here if you just follow what drives the world in every other industry.
And this is why @SecKennedy considering RICO charges for collusion at the top level. And why it’s so important to find an independent physician who reports to no one but YOU the patient.
It’s all one big club. And we ain’t in it.
Godspeed and good luck out there
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This one is from our friends at United, the largest insurer in the country
Doesn’t show AMM, but you get the point, this is how medicine is coerced into being practiced a certain way
Notice the other incentives and why you might feel certain “pressures” at docs visit…
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@john_malone It’s not malpractice when all the professional society guidelines say to prescribe after a 2 (at best 9) question survey that basically anyone would test “positive” for on any moderately tough day
“But judge, that’s what the gUiDeLiNeS say”
Case dismissed
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@DrDeepMD Who keeps prescribing all of this medicine?
I'm not opposed to treatment of mental illness, but when family doctors give tweens meds like this perpetually, isn't that some kind of malpractice?
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