NotTheAttending

There are four ways to spend money: 1.Your own money on yourself, 2.Your own money on others, 3.Other people’s money on yourself, and 4.Other people’s money on other people. The last is where you get the least value. — Milton Friedman @RonPaul has made this point before

@libsoftiktok @comsprincipal I like that the AC is set at 78… environmental stewardship.

Amy Fryda, a teacher at Cohasset Middle School (@comsprincipal) in MA, allegedly posted this picture online, appearing to celebrate the death of Lindsey Graham, and and hoping for the deaths of Mitch McConnell and President Trump. We reached out to the school multiple times for comment, but they did not respond. Would you trust this person with your children?

@PNWINS @claudeai @seti_park No fake teachers allowed. Although one could argue that those without formal training and certification need the help the most.

@Nottheattending @claudeai @seti_park Probably not without being a real teacher. (No disrespect intended)

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@rbarbosa91 Medical staff will never congratulate you for being cost-effective or thoughtful and judicious with finances. They will, however, send you to peer review if you miss something.

Occasional reminder to my trauma colleagues that if you’re ordering a CTA (or followup CTA) and the only thing you’re going to learn from it is whether or not to prescribe aspirin, that you could theoretically take aspirin for 50+ years for the same cost as that CTA. 🤷‍♂️🧐

@rbarbosa91 That’s a good reminder that in the US, in the acute setting, we often forget what tests cost.

@jasonryanmd I would like exams to have a few answers of “no acute pathology”. Now give a plan.

It’s good that USMLE exams test rare disorders. All doctors should be familiar with these, and patients suffer when we miss these diagnoses. It’s bad, however, that USMLE exams require memorization of the causative DNA mutations of rare disorders. This can be looked up in seconds. The massive time spent on memorization like this could be much better spent learning things more helpful to patients.

@theblanketdog What do you propose as the solution?

There's a pandemic of APPs acting like mini attendings, thinking they're mini attendings, and not actually helping physicians run a service and refusing to do so. Basically feeling they have their own patients and you're on your own (unless we get into trouble then please please help us). It's interesting as an outsider with no vested interest other than in taking care of patients. These organizations are almost uniformly horribly run.

Defense is 8% of US government spending. Education 15%! Welfare is 47%!

@molsjames Agreed. What are your thoughts on physical therapists, pharmacists, and other “doctors”?

Unpopular take: If you never took call, use the term 'doctor' with caution. If that pisses you off, I'm most likely talking to you.

@reverendofdoubt I’m blessed to work with an old school peds attending that will still admit for that. He might be the only one left.

Gone are the days of surgical services willing to admit patients for "serial exams" without advanced imaging. It is what it is. Not sure what we can do about that. They can't live in the ED for 24-48 hours while 50-70 wait in the waiting room to be seen. What's the solution?

@CanesDavid People understandably focus on the near-term risk. I've had a positive appy on a peds via US, and the surgeon still wants a CT to “rule out complications.”

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 even…. 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.

Do not eat these. Discard immediately if you recognize any of these in yours or a loved one’s kitchen, it’s the easiest act of love you can do for them today. A French study in PLOS Medicine examined the impact of emulsifiers (food additives used to improve texture and extend shelf life) on cancer risk. Researchers analyzed data from 92,000 adults over nearly 7 years and found that certain emulsifiers significantly increased cancer risk: Mono & diglycerides of fatty acids (E471)—found in processed baked goods, margarine, and ice cream—were linked to: 15% higher risk of overall cancer 24% higher risk of breast cancer 46% higher risk of prostate cancer Carrageenan (E407 & E407a)—a thickening agent in dairy alternatives, deli meats, and plant-based products—was linked to: 32% higher risk of breast cancer. Cancer is complex and multifactorial, but one thing is certain: the food we eat plays a massive role in shaping our long-term health. Cutting out ultra-processed foods and focusing on whole, nutrient-dense foods is one of the most powerful steps you can take to reduce disease risk. Thank you to my friend Vani Hari for this image + bringing awareness to this critical issue.

The Declaration of Independence is the greatest document ever produced by man. It’s no coincidence that it was the founding document of our nation and we went on to be the most prosperous civilization in human history. Any country founded on that document is worth loving and fighting to save. It is also, undeniably, a radically libertarian document that clearly states the validity of natural God given rights and that the only legitimate role for government is the protection of liberty. We have serious problems in our country today and we will be much better off if we follow the spirit of our founding document than the brain dead varying socialisms being promoted by both political parties.

We have added some additional special people to 𝕏 Money. If that’s you, welcome and feel free to reach out with feedback as the team is working to make the experience better.

@bryan_johnson Rand Paul

Who would you trust to run the world?

Tonight I plan to give Notice of Intent to bring forth a Privileged Resolution this week to force the release of all names of U.S. Representatives who have used your tax dollars to settle sexual misconduct claims. Do you want your Representative to vote for this disclosure?

@nicksortor Lobbyists are the fourth branch

🚨 BREAKING: President Trump has been BLOCKED from removing liberal Lisa Cook from the Federal Reserve Board, despite allegations of obvious mortgage fraud If the Federal Reserve isn't a part of the Executive Branch, which branch is it part of?! There is NO fourth branch of government. Abolish the Fed.

@ChefMattFSU But a huge difference in recruiting

Hard to believe this now, but if Jordan Travis doesn't get injured Mike Norvell would have the same amount of National Championships as Jimbo Fisher.

@Notwokenow @NatalieCarmody @amazon Yes. @ORIGINBJJ @GORUCK

If @amazon gave you a way to filter for American made products only, would you use it to buy American?

🚨BREAKING: Just moments ago, Sen. Rick Scott said he's a NO on the One Big Beautiful Bill in its current form. He's demanding more spending cuts and setting America on the path to a balanced budget. “Oh absolutely I’d vote no. If they brought it to the floor right now there’s not a chance it would get to 51 votes. We all know we have to balance the budget. We all know it’s getting harder to sell our treasuries.”