@AnilMakam Lose wt, exercise more, control basic cardiac risk. Maybe glp1? I feel like those are the one disease modifying things we know about for hfpef
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ShaqJones
878 posts
have there been trials deploying these scores finding better diagnostic work up or outcomes?
I find it very modest at best
mostly (entirely?) derived in patients seeing cardiologists and getting right heart cath for unexplained but concern for HFpEF
as such low scores don't effectively rule out HFpEF
a trial of diuretics to see response is easy, safe, fast too
NEJM@NEJM
Dr. Sanjiv Shah explains the H2FPEF score used to support clinical decision making. Watch “HFpEF Explained — Prevalence, New Advances, and How to Diagnose,” a new Double Take video, now available on our YouTube channel.
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@Papa_Heme The Va addresses this in some way by making one have to manually order labs daily . This also creates a problem wherein some folks haven’t had labs in 1 week but it was never re ordered with a clinical change .
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To all the fellows and young doctors out there, this criticism is to be noted and ignored
You don't have to design trials to use them in your practice
Criticism of trials is not personal; it is for our patients
#acc26
Giovanni Occhipinti@drgocchipinti
@drjohnm @theheartorg Good evening, Dr @drjohnm. I follow your updates with great interest. May I ask how many randomized trials you have designed and conducted throughout your professional career?
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@AnilMakam The people in charge have neither the patience nor competence nor integrity to assess the quality of the science someone is doing
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Not just the letters. The whole thing is performative. They dont care if you do good science. Only if your science comes with money, and mostly if that money comes from the NIH. Even if said NIH funded science is pointless or bad
Michelle Kittleson MD PhD@MKIttlesonMD
So, if basically no one ever writes a negative letter for academic promotions, doesn't that make the recommendation letter component of the process performative and a waste of the letter writers' time?
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@Papa_Heme lol the number of people with Stockholm syndrome in academics is staggering
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@DrDiGiorgio There has to be a medium between ruthless exploitation of young physicians in training and coddling them into incompetence
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Students claim disability to get extra time on tests. Those students become doctors and claim disability to avoid night shift.
Are they going to claim disability when they are full attending doctors and they kill someone because they don’t know how to operate at 2am?
Ash Paul@pash22
Junior doctors claim they have ADHD to avoid night shifts in @NHSEngland : Surge in medics using neurodivergence or mental health to reduce workload or explain poor exam results via @michaelsearles_ telegraph.co.uk/news/2026/03/0…
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@TheYZA13 @dominustweet @txsportsdoc Most reasonable people can agree that providing emergent care at some personal discomfort/expense is different from just exploiting resident physicians to work 140 hours per week and wrecking them physically and emotionally like they used to.
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@dominustweet @ShaqJones89 @txsportsdoc In this particular case that would result in permanent paralysis
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And this is why surgical residencies shouldn’t limit hours and should weed out those who don’t have the mental toughness and endurance to be a surgeon. Emergencies have no schedule. We have recruited and trained “shift workers” over the last 20yrs. I don’t want to hear about we must have well rested surgeons. Would you rather have no surgeon, or a surgeon show up when duty calls.
HustleBitch@HustleBitch_
🚨 HE WENT TO BED - THEN SPENT ALL NIGHT TRYING TO SAVE A PARALYZED STRANGER A neurosurgeon turns on the camera at 9:30 PM. He was already in bed. Half asleep. Then the call comes in. A patient just arrived paralyzed at a Level One trauma center. Coffee. Uber. Silence. By 11:30 PM, he’s making the incision. The case drags on for five straight hours. One wrong move and the damage is permanent. At 6:00 AM, he walks out exhausted. The surgery worked. The patient is doing well. But the night isn’t over. He’s still on call. Still writing notes in the back of an Uber. Still expected to function like nothing happened. Just a man trading his night so someone else gets a lifetime. While you slept… this happened. Would you trust your life to someone running on zero sleep - or does this reveal how broken the system really is?
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@txsportsdoc I love how all the boomer docs say “they’re not as good as we used to be” with absolutely zero evidence to back it up
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@AnilMakam @adamcifu @RecoveryDoctor One of the more reasonable takes I’ve heard on this . Good stuff !!
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In all the yelling about the FDA's flu vaccine decision, have we forgotten about this article?
nejm.org/doi/full/10.10…
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@j_fishback @elonmusk Agreed. The main issue is the lack of respect and pay for teachers. When you don’t pay a profession well, don’t be surprised when you get a suboptimal group populating it. The unfortunate joke of “those who can’t do teach” has become a self fulfilling prophecy
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@j_fishback @elonmusk Furthermore, teaching is a skill in and of itself . Someone who is an outstanding and skilled professional, say a nurse , isn’t necessarily going to make a good teacher, and vice versa . Totally weak take
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All 50 states would block @elonmusk from teaching a high-school physics class because he doesn’t have a government-issued "teaching certificate." We’ve got professionals and retirees in all 50 states—engineers who built bridges, pilots who’ve flown across the world, and doctors and nurses who’ve saved lives—who would love to volunteer to teach.
Yet they can’t because teachers unions have lobbied to create barriers. As Governor, I will tear down these barriers and invite professionals and retirees into our schools to teach and inspire young men and women.
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@JonTaschSpeaks @j_fishback @elonmusk The teachers certification and union isn’t the barrier to teaching . It’s the fact that no one wants to do a difficult job, for low pay and high responsibility . Change the pay, magically you will get better teachers
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@j_fishback @elonmusk The dearth of teachers is because it pays poorly relative to other professions that require a college degree and similar level of responsibility. You want better teachers, then you gotta pay more. Elon isn’t gonna teach high school physics for 60 k per year
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@MichaelAlbertMD All the people who say AI will replace “insert job here”, clearly have never done that particular job .
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AI “doctors” can’t—at least for now—write prescriptions, examine patients, order diagnostic tests, or perform surgery. Those limitations aren’t going away anytime soon.
I’ve worked on healthcare AI for over a decade, and for that entire time I’ve been told clinicians would be replaced “within 5–10 years.”
Could I eventually be replaced? Maybe. If that happens, I’ll adapt. The skills I’ve built translate well beyond medicine—and I’ll move on just fine.
m77777@m7777121
@MichaelAlbertMD Except with AI things are going to change real fast. An AI doctor will be way more valuable than an actual one.
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@j_fishback These are possibly some of the most innocuous and heartfelt comments. And it reflects the sentiments of many, if not the majority, of Americans . Your divisive and inflammatory rhetoric is what is attacking this country. You’re the real traitor
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He’s a traitor. He should be pulled immediately and sent home. You don’t insult your country on the world stage.
Oli London@OliLondonTV
Team USA freestyle skiers say they feel bad about representing America at the Olympics due to ICE. “It brings up mixed emotions to represent the U.S. right now it’s a little hard.”
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@AnilMakam I think there are multiple reports of this now . Not a one off
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something doesn't add up with this trial
it's too good to be true
if there was a polymarket, I'd wager it doesn't replicate
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@DrDiGiorgio “Give me the man, I’ll give you the case against him”
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I’m convinced large health systems deliberately flood physicians with nonstop emails so they can later claim noncompliance on demand.
“You missed the one critical message buried inside your 300 daily meaningless emails? That’s a professionalism issue. You’re fired.”
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@pranavmahajan An honest man can’t get ahead in India. It’s almost laughable to most people if someone just tries to behave in an upstanding manner and try to make an honest living it’s viewed as follows
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@pranavmahajan This is a problem with Indian mentality . It’s a classist and casteist society that, while has the veneer of progress, is still backwards. There’s no respect for people who do blue collar or “unskilled” jobs. It’s viewed as a failure . This points to deeper rot in Indian society
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This is how a human being should NOT behave.
Mocking an old schoolmate for earning his living as a delivery boy is not confidence. It is moral bankruptcy.
This woman has failed not only as a friend but as a human being. And in this process, she has also failed the upbringing of her parents and teachings of her teachers.
We have no idea:
• What hardships pushed this man into this job.
• What responsibilities he carries.
• What battles he fights silently.
And even if he
• failed academically.
• lacked discipline or effort.
• could not achieve what he once dreamed of.
If he is earning honestly through legal means, he deserves respect, not ridicule.
From a spiritual perspective, remember this:
• Karma does not need witnesses.
• Arrogance is the fastest route to downfall.
• Mocking someone’s struggle plants the seed of your own destruction.
If you cannot be kind, at least be wise. Do not insult honest labour.
Not for his sake. For your own.
Because life has a strange way of humbling those who laugh at others’ struggles.
#RishiToldMe
#WhatCosmosSays
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