Chad Ruffin, MD 🦻🏻

Which ear had the cochlear implant?! This is a postop audiogram prior to activation. Gray is the preoperative. Shared with permission. Crazy that this is a regular occurrence for me. I counsel patients, "It's possible but unlikely that you may lose your residual hearing"

@chrissyfarr Is that *the* Tony Robbins? Why on earth is he there?

This is a great step and should be applauded. But is anyone on the list who lives in a rural area and qualifies for Medicaid? Love to suggest that for humble consideration.

@aspergian1 What about at his age (60s)?

@ChadRuffinMD Re-implant Left Main Coronary artery into Aorta

My cherry has been popped. Read about it, looked at imaging but never have found one in the wild.

@drsharisse @mcuban Another example of insurance companies gouging independent docs.

I stopped doing lumbar punctures in clinic once I realized the reimbursement didn’t even cover the cost of the kit. A relatively simple bedside procedure became financially unsustainable in an outpatient setting—so now it gets done in the hospital under interventional radiology

The wild part is how every layer of the system pushes hospitals into roles they were never built for - lender, bill collector, insurer, bureaucracy manager and then we blame the patient for the bill. A huge part of the dysfunction starts upstream: insurers design plans where the average deductible is now over $2,000 and nearly half of Americans can’t cover a $500 emergency. That gap forces hospitals to front the cost of care before they ever see a dollar. Then come the delays: prior auth backlogs, denials that get overturned 80–90% of the time on appeal, and payment ‘adjustments’ months after care is delivered. Every delay is an interest‑free loan from the hospital to the insurer and an administrative tax on the system. Hospitals respond the only way the math allows: facility fees, 340B arbitrage, site‑neutrality games, consolidation, and revenue engineering. Not because they’re greedy but because the reimbursement model punishes anyone who doesn’t scale, merge, or invent new billable categories. Meanwhile, the cost structure is upside‑down: administrative staff now outnumber physicians, and the fastest‑growing line item in healthcare isn’t medicine - it’s paperwork. Every new rule, denial, and clawback creates another layer of people whose job is to fight the system the system created. None of this resembles healthcare. It’s the predictable downstream math of a system where every incentive from premiums to prior auth to consolidation rewards complexity, delay, and financial engineering over actual care.

@mirrash7 Nice! Are the subtle pivots and rotations w the wrists (Graf slice, Federer forehand) visible with this? Cant explain it but can def see it w the best players.

My latest computer vision project - Tennis🎾 Featuring: -Player, ball, racquet detection -Player poses -Exclusion zones to kill false positives -Interpolation and smoothing for clean ball trails All running at over 30FPS!

@northwoods1980 Is this finding also seen in lower back imaging?

Due to heterogeneity, few high-quality studies and insufficient data on individual MR findings no definitive conclusions could be drawn about prevalence of thoracic degenerative MRI findings or their relationship to pain and disability share.google/pgOvftjDo2yL7w…

Iran’s strike last night wiped out 17% of Qatar’s natural gas export capacity, repairs are expected to take three to five years -Reuters (Based prewar market estimates, Iran managed to destroy ~3.5% of global LNG capacity in a single strike.)

@noahkaufmanmd This is misinformation.

Maybe we should hire even more administrators to help fix the problem of administrating more administrators.

@jointdocShields @WallStreetApes Did you watch the whole thing?

@WallStreetApes 🤦🏼‍♂️🤦🏼‍♂️🤦🏼‍♂️🤦🏼‍♂️

FINALLY someone is saying it out loud Casey Means explains the only reason everyone has to go and see a “specialist” for every single different part of the body now instead of just one doctor is because the medial industrial complex makes more money It’s by design. For profit.

@WallStreetApes Jesus. Fellow MDs need to watch the whole thing. This isn’t some radical anti-specialist video. I know plenty of specialists who don’t approach patients holistically.

With all eyes focused on Iran, Trump and DHS are pushing forward on border wall construction through Big Bend National Park. They will hand the Rio Grande to Mexico, destroy thousands of jobs, and ruin the last remaining wild West, all for less than 1% of all border crossings:

@SeattleWXGuy Reminds me—Why does the Burien/Seatac area consistently have greater snow? Slightly higher elevation?

The Southwest USA insane Heat wave incoming reminds me of probably the most anomalous event in the Pacific NW during my lifetime, the June 2021 Heat Dome. Nailed that record all-time high forecast perfectly...

Nothing is permanent enough to fear. Keep climbing anyway.

Congressional advisers call to rein in Medicare Advantage spending amid industry pressure I’ll summarize for you. EVERY SINGLE FAMILY IN THE USA IS PAYING $800 A YEAR to the big insurance companies because taxpayers pay them more than it costs to support Trad Medicare That’s insane. And it doesn’t even include the increased premiums trad medicare plan holders have to spend. Medicare Advantage was meant to cost LESS than trad Medicare. Yet here we are Support the Break Up Big Medicine bill from @HawleyMO and @SenWarren If your representative is up for election in Nov and they don’t support this bill. Don’t vote for them. They support higher healthcare costs. To reduce healthcare costs, this bill is the most direct path statnews.com/2026/03/12/med… via @statnews

@SeattleWXGuy Was. I think we went through 3 sets of pilots. We’re airborne now! AS414

@ChadRuffinMD is the door open and you are at the gate?

Taking a break from training at Alaska Airlines to watch the #snow

@SeattleWXGuy On Alaska! Boarded at 7:50AM! Approaching 5 hours.

@ChadRuffinMD If that's true you'll be getting compensated!

@TheAtlantic Love your stuff, but your captions are atrocious and are inaccessibly small. You're missing out on a large audience regardless of hearing loss status.

A lot of Pentagon figures “are surprised that Hegseth has lasted this long,” Jeffrey Goldberg says. “In this second Trump term, you really have to screw up to get fired.” theatln.tc/XcsZmaF4

We continue to try to teach this technical point today, but these principles have been known for many decades. The photos from this 🧵were taken from a 1947 book by Bancroft. ⬛️