@EPotterMD I’m stunned by how many biopsies I receive for metastatic malignancies of unknown primary where no one has done either a breast or genitourinary exam.
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Mustard
20 posts
Mustard
@Saintdrogo
Catholic, mother of many, physician. Drawn to the unusual.
State of Constant Confusion Katılım Eylül 2010
180 Takip Edilen24 Takipçiler
I sat with a patient today who first noticed a change in October. It’s April now. In all those months of appointments and follow-ups, her breast had only truly been looked at twice. That stayed with me.
If something has changed with your body — especially something under your clothes — please don’t just describe it. Show your team. Point to it. Say, do you see this?
Your care team should be asking to look. But if they aren’t, advocate for yourself. What I see with my eyes tells a story that no words ever could. You deserve that level of attention. Don’t let anyone just hear your words without truly seeing you.
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@AdamWax3 @nandaguntupalli Most billing companies use automatic claim creation, scrubbing, and submission. Do you mean you have software that does all of your coding review? How are denials handled?
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@Saintdrogo @nandaguntupalli We’re tech-first, so we pull from your EHR and submit claims instantly using software, not manual labor. That means faster reimbursements at much lower cost than traditional billing companies.
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I grew up at my dad's medical practice. Quickly, I realized that clinicians just want to treat patients, not deal with administrative tasks.
So, my cofounder @nandaguntupalli and I are now building Taiga, a full stack medical billing service for independent practices. We handle coding, claim submission, and denials so providers can focus on patients. We’re already working with practices and helping them resolve their trickiest claims.
I’ll be at Pri-Med West in Anaheim later this week. If you run or work at a small practice, I’d love to buy you coffee and learn about your billing workflow :)
usetaiga.com
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@Joeinblack As a fellow Michigan alum I totally agree with you. I always said there’s nothing better than living in Ann Arbor to turn you into a Spartan.
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I graduated from UM and I have some thoughts.
To be clear, I am a Spartan, through & through, but I am a convert. I began life as a wolverine.
If you attend UM or spend a lot of time there, you’ll notice that there is a way of thinking that is acceptable and a lot of ways of thinking that are not.
For better or worse, UM embodies that extremely narrow, left-wing world that allows very little ideological dissent.
There is tremendous contempt for any way of thinking that doesn’t fit in their narrow scope and two days in a classroom would reveal that.
When I see much of the fan base that adores them, I get irritated as I recognize how much the university they worship would absolutely despise the way their fans that are not graduates, think, live, etc.
I’m glad you and your son cheer for them, you seem like a decent fellow. I mean that.
But a ton of their fam base is staffed by people who embrace an arrogance for accomplishments they’ve never earned, and do it for a university that would absolutely despise them.
It’s weird.
Brandon Brown@BSB_Wolverine
Can this narrative go away and die forever? It’s such a stupid angle. My son is 6. He didn’t attend Michigan so I guess he’s out? I never played for the Tigers or worked for any branch of Comerica — can I cheer for them? My dad went to U-M but only for one year before he decided to become a millwright and start his own company. Did he go long enough to be a fan? Seriously….dumb af.
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My oldest, who is very careful with masking & works from home, asked his friends for a small gathering to celebrate a couple of big moments with him. They rented a karaoke room as a group. They all tested beforehand (or said they did)
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What are the highest fertility groups in developed nations that are not “insular” or “closed off” from the rest of society like Amish, Mennonites, Haredi? Basically, a group that interacts with the greater world, isn’t extremely insular, but still has high fertility ?
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@StefanMolyneux What’s the difference between an inner dialogue and just thinking?
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It is ESSENTIAL to remember that between a third and a half of people have NO inner monologue or dialogue.
They don’t debate with themselves, they have no inner conversations – they exist in a blur of images and sensations and feelings.
And they are all around you…
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@JahangirAsgha10 And the information you actually need often isn’t in there. Can’t tell you how many skin bx I’ve gotten with an accompany physical exam that states “skin normal, no lesions or masses”.
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I was reviewing a chart today from a patient that was referred to me. She was seen in a local hospital system after sustaining an injury due back from trauma.
90% of the chart was useless. It also had three different injuries described… for the same patient… for the same injury…
And the chart was 60 pages long for a 24 hour stay … of which four or five pages were useful…
However, our healthcare governmental/insurance bureaucracy requires all of that to be present…, none of which is relevant to the care of the patient
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@lilsquilz @realjayg No blood test for those tumors. Requires biopsy.
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@realjayg @IFNAlphaMale biopsy is still standard, but you can test via a simple blood draw for certain tumors (breast and prostate afaik, correct me if i'm wrong).
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@Coleidoscopes Ok but how did you get diagnosed with it if you never got a biopsy?
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I once posted that I would never allow a biopsy of my cancer if diagnosed with it because that sounds like a good way to spread it around the body, and I had so many doctors and laymen criticize me like that was the dumbest thing they ever heard.
It just made sense to me because… idk… duh????
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@DrDiGiorgio @UCSF Poor study, but how does overutilization of CTs compare between physicians and midlevels?
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Doctors order CTs for every minor head bump, not because it's good medicine, but because it’s legally safe.
Missing a trivial brain bleed? Career-ending.
But irradiating 20 people to find one? No lawsuit. No friction. No second thought.
Yet this new @UCSF study shows that medical radiation causes up to 5% of all U.S. cancers.
Overtesting isn’t benign. It's just delayed harm that no one tracks back to us.
This is exactly what @ThomasSowell meant by unseen trade-offs. We protect ourselves from rare, immediate harms by inflicting diffuse, long-term ones. The incentives are perfectly misaligned.
Real policy fix?
For non-emergencies, adding cost friction isn't a bad thing. "Just taking a look" isn't harmless. It also shouldn't be "free."
We also need to enact common-sense med mal reform that distinguishes rare misses from negligence.
Build a culture of risk literacy, not just risk aversion.
Until then, we’ll keep harming more patients to protect fewer doctors, and feel morally superior doing it.
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@CMichaelGibson Yep, 12 other big names and 9 AI companies think so too: open.substack.com/pub/sergeiai/p…
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Will AI replace doctors?
What say you ?
Gokhshtein@gokhshtein
🚨NEW: Bill Gates predicts AI will replace doctors and teachers within a decade.
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@SeanDreyer I’ll take this any day over the 4 page copy paste pablum in Epic
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@SpineNeuro @DrDiGiorgio @drdanchoi @VPrasadMDMPH @anish_koka It’s ok, we got a Teams meeting from the CMO of Press Ganey.
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Thankfully not my hospital, but a striking example of how little physicians are valued by too many health systems
@DrDiGiorgio @drdanchoi @VPrasadMDMPH @anish_koka
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@drantbradley Because it’s a lot easier to get a kid to spend hours playing ball with their friends than it is to convince them to spend the same amount of time studying math or practicing piano.
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Question for an article I'm writing: Why do middle-class suburban parents believe focusing on [travel] sports is a better path to college admission than dedicating the same time outside school to strengthening math, science, or reading skills? Looking for perspectives. Thoughts?
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Completed my first total plasma exchange (TPE). Removing all the plasma in my body and replacing with Albumin.
This is different from what I did last year: removing 1 L of plasma from my body and then replacing it with 1 L of plasma from my blood boy @talmagejohnson_ . I gave my one liter of plasma to my father.
This time around there's no blood boy involved.
TPE removes all of my body’s plasma and replaces it with Albumin. The therapy objectives are to remove toxins from my body. The evidence is emergent.
Others use TPE for autoimmune disorders, blood disorders, neurological conditions, transplant-related complications, and replacement of missing plasma components.
As we normally do, we completed a bunch of baseline measurements before this therapy including toxins but other things too such as speed of aging, organ ages, microplastics and many other biomarkers. I'll do six total treatments.
The operator, who’s been doing TPE for 9 years, said my plasma is the cleanest he’s ever seen. By far. He couldn’t get over it. When we finished, he couldn’t bring himself to throw it away. He was imagining all the good that it could do in the world.
On people’s face as PRP therapy. In their body, rejuvenating organs. There is probably a path to auction off or donate my plasma on this next go around. Liquid gold.
Remember that when my father received 1 L of my plasma his speed of aging dropped by 25 years and stayed that way for six months. We don’t know if it was from my super plasma or if it was from removing his plasma, but the results are interesting nonetheless.
The whole procedure took just under 2 hours.
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Congratulations to Loyola #pathologist Güliz A. Barkan, MD, on being named the 69th President of @cytopathology!
Dr. Barkan, a genitourinary pathologist and director of #cytopathology at Loyola, will be inaugurated on November 7: bit.ly/3dPukcn
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