Lisa Hamill

@jayplemons @spencerpratt I've seen enough, Spencer Pratt should be mayor of LA. This is what an actual person sounds like, not a politician. I have yet to see a single clip of this debate where he falters or sounds canned. What a performance, he knows EVERY issue, absolutely incredible.

When I was 20, I was on a TV show. When Karen Basura was 20, she was volunteering with a communist terrorist group in Cuba that bombed the US Capitol. Who is a better fit for LA?

Update: The women lost.

There is a "No Kings" movement happening right now in Washington state. They wave every flag you can imagine... The argument is that Republicans are operating like royalty. Unaccountable. Unelected. Making decisions that affect millions of people without a vote. I want to talk about something closer to home. Who dictates your utility bill costs... Puget Sound Energy serves 1.1 million customers in King and Snohomish counties. Snohomish County PUD serves another 370,000. Seattle City Light covers most of Seattle. Every single person in this region wakes up and pays whatever these utilities charge. You have no choice. You cannot switch providers. PSE's electric bill is up 30% since 2023. If you are an Avista customer in eastern Washington, you are up over 40% since 2022. Nobody asked you. Nobody voted on it. Here is how it happened. Three people set PSE's profit rate. Not elected. All three appointed by Democratic governors. The current chair came from a clean energy advocacy organization. The governor who appointed him signed the law that requires PSE to make billions in new capital investments. Under the rules these three commissioners enforce, every dollar of that investment earns PSE a guaranteed 9.9% annual return. Collected from your bill. For decades. The profits do not stay in Washington. PSE is owned by a consortium of Canadian and Dutch pension funds. Your utility payment leaves this state every month. In King County, you can vote for your school board. Your city council. Your county executive. You cannot vote for a single person who decides what you pay for electricity. That is not a Republican system. That is not a Democratic system. That is three people, appointed by one party that has held the governorship for 40 years, setting the price of a service you cannot refuse to buy. The "No Kings" crowd wants you looking at Washington D.C. I think we should start by looking at Olympia. I publish the full research and sourced breakdowns on Substack every week. Search Shane Kidwell if you want the deeper dive. @GovBobFerguson @komonews @KING5Seattle @KIRO7Seattle @fox13seattle @seattletimes

They not like us

@Jason @MayorofSeattle @ZohranKMamdani @GavinNewsom @RoKhanna Yes, these fears aren’t just overblown, they are super overblown. That was Kathy Hochuls’ attitude - before it wasn’t. 🧐

Now the @MayorofSeattle has joined @ZohranKMamdani and @GavinNewsom / @RoKhanna is waving goodbye to the job creators and large tax payers This would be comical if it wasn’t so disastrous! 🤦

@drokane @DrDiGiorgio Yes, exactly. These patients need to be managed by physicians who routinely take care of the extreme elderly. It would serve these patients so much better as well as off-loading the ER. Unless this happens, this problem will not be solved.

@dr_hamill @DrDiGiorgio Call the geriatricians - we will take them and sort

We are awful at caring for the elderly. A common story: a 94-year-old woman with dementia is found on the floor of her memory care center. She has a DNR order, but the rest of her goals of care remain murky. So she is brought to the ER, where she undergoes a CT scan. There is something there: a small spot of blood in the head, a chronic spine fracture, or some other abnormality that may or may not have anything to do with why she fell. So neurosurgery gets consulted. In a younger or healthier patient, these findings might warrant admission, repeat imaging, further workup, and monitoring. But this patient is different. She is 94. She has dementia. She cannot tell us what she wants. Her family is not immediately available. And the ER doctor is asking the only question the system has trained them to ask: “So… should we admit her?” The problem is that this patient has no real quarterback for her care. For someone like this, there should be a doctor, nurse, or care team who knows her and knows what she would want. Instead, she is sent to the ER, scanned, labeled with an abnormal finding, and placed onto the hospital conveyor belt. We do not fund elder care in a way that rewards compassionate care. We fund hospital bounce-backs, scans, and admissions. But we do not reliably fund the person who can say, “I know her. I know her family. I know her wishes. This is not what she would want.” The question was not, “Can we do more tests?” Of course we could. The question was, “Would more tests help this woman live better, or would they simply trap her in the hospital?” If she would never want brain surgery, ICU care, a breathing tube, invasive angiography, or a drain placed in her brain, then repeating scans and chasing every possible abnormality will not help her. It will only expose her to confusion, restraints, needles, alarms, and hospitalization just to generate information that would not change the ultimate plan. Sometimes the humane thing is to recognize that the scan found a problem, but the patient’s dignity, comfort, and goals matter more than the abnormal image.

@DrDiGiorgio In our local system, anyone > 65 y/o who falls is put into the "trauma pathway". Mechanism of fall/injury doesn't matter. This entails pan-scanning before trauma team ever sees the patient and then management per scan results. It happens over and over.

The medical system needs to champion the idea that we recommend and order the aggressive measures and at some age, aggressive measures are just not indicated. Many of these patients have had goals of care and DNR discussions with their doctor, but the question gets asked - patient by patient - on every admission. The "system" is clearly overwhelmed. I've had healthy 72 year olds get labeled "DNR" in the hospital because the question wasn't asked in the right way and I've had 87 year old frail patients have "DNR" changed to full code based on some in-hospital discussion. At some age, we have to admit as a society and as a medical community that aggressive medical interventions are not medically indicated and it really doesn't take a personal review while the patient is in the midst of acute symptoms. We need a separate system that manages the extreme elderly in a more appropriate, humane and supportive manner.

It’s the fundamental misapplication of the “prudent man rule”. We generally presume that anyone would want their life saved if they cannot speak for themselves. This makes sense in most cases, but people of an advanced age with irreversible pathology are unlikely to benefit from any intervention. They are very likely to suffer tremendously before death, however. “Extraordinary measures” are considered unnecessary but no one wants to be the one to say “no”. The system is so fragmented that the patient and physician are meeting each other for the first time at the time of the crisis. There’s not much to go on to guide decision making. Many physicians just do the usual so that they can defend themselves later if necessary. If you have an older loved one, please speak with them before the moment of crisis and ask what their wishes are and clearly document them. It’s such a shame to see wonderful people spend the last moments of their lives being tortured by futile care.

As you go to work today and settle into the week, please study the form below. You will soon need to fill this out EVERY year and tell the government what you own and then allow them to tell you how much its worth. That is the framework that is enabled by the Trojan Horse "Billionaire Tax" that is trying to get passed. Give them credit: they cleverly use Billionaires as the hook, but build in the language and the framework that will allow the Legislature to simply extend the tax to everyone and make it yearly. And this is where the form below comes in... In this case, ask yourself, will it be you or the Billionaires that will be able to fill this out properly and avoid penalties. As much as Billionaires can be pushed to do more for society, we all know that they have the infrastructure to manage these kinds of disclosures...middle class Californians do not and they will be the ones that get penalized in the end.

Those are not clinical distinctions. During the past 30 years of practicing primary care and listening to thousands of people talk about their sleep problems - there are many things that disrupt sleep. Some you can control (ie, your habits, surroundings) and many you can’t (having young children, menopause). Your thoughts about all of this is what drives the anxiety. If you’ve been given the thought that a full nights sleep is possible for everyone, you’ll run into problems as that’s just not true. The more that then bothers you, the worse your sleep problems get And you can work on those thoughts. Wearable tech drives more anxiety on the whole. Anything that directs your daily focus on the “problem” is not really helpful on balance. A few people can let it steer habits without anxiety, but there’s only so long you need that feedback Insomnia Coach podcast has loads of illustrative case studies 👍🏻

Agree on the anxiety point The distinction worth drawing is between someone with primary insomnia driven by hyperarousal versus someone with chronic sleep restriction from lifestyle The mistake is applying the fear based framing universally rather than contextually The wearable point is interesting too. Do you find it helps or hurts your patients on balance?

Literally just having a delusional golden retriever mindset measurably changes outcomes and physiology. Sleep badly? Convince yourself you're well rested. Stressful day? Convince yourself it's fuel. Failed? Convince yourself it's useful data.

@Davembmd @BrentAWilliams2 👍🏻👍🏻😄

No matter how you feel about AI scribes, they are somewhat unregulated at this time, the unintended consequences of their use is not know, and there are many people (patients and physicians) that don't want to use them.

Focus on having sleep-conducive habits, then focus on changing anxiety-inducing thoughts to more empowered or at least less anxious ones. The one thing I can guarantee - medicated sleep is not healthy sleep. Telling people “you must sleep 7-8 hours or you’ll have heart attacks and strokes” is not an empowering message for most There is nothing therapeutic about wearable tech unless it helps direct habits and lets your anxious thoughts decrease. Mind Body

“Just think you’re well rested” sounds good until biology shows up Placebo can shift perception, not physiology Sleep restriction still: • impairs reaction time • worsens glucose control • elevates cortisol That study changed belief about sleep, not sleep itself Mindset can mask fatigue but it can’t fix it

Have you heard about or studied Mind Body syndrome or Mind Body Connection?? You can’t overstate how much your personal thoughts affect your experience of things. And once you recognize you actually DO have some control over your thoughts, you unlocked the secret. Not easy, but doable and part of the solution How about: sleep badly? Tell yourself you can function anyway.

@MehtaScribe @BrentAWilliams2 I do too, but eventually when you’re seeing the patient for the 3rd+ time and get consent, it starts to get silly. Medical scribing systems have to be HIPAA compliant, no?

@BrentAWilliams2 And informed consent is crucial especially with the data sharing & processing within these tech companies - no guarantee of HIPAA /patient privacy once it's within their servers. Colleagues I know who use AI scribes do explicitly obtain patient consent prior to use at an appt💡

Why is AI scribing considered “recording”? Our AI note is formatted in medical style. The entire AI “document” in that tool is erased in 30 days. We never had to get verbal consent that “Ms Jones is transcribing this note” or “I’m using Dragon voice recognition”. I’d say AI scribe much more accurate than templates cut and paste where many things never done or examined are documented As long as we’re using dedicated medical scribe tools, why do we let this happen? (And I’m sure they’ll continue to narrow so the document is erased in 3 days - best motivator for chart closure I’ve come across)

Why do patients care how a doctor generates a note? Also California is a 2 party consent state so they have to have consent for any recording. But AI scribes are very nice and let a doctor look at the patient instead of the computer during a medical visit. Then the doctor doesn’t have to chart from 7-9 at home every night.

I’ve been scribing for Epic for 26 years. Worked at an early adopter hospital based system that got Epic in 2000. I’ve been on there this whole time. Can’t even comprehend the lifeblood of time and energy that scribing all these years has cost me. I started using Epic before I had children and now all three are out of college. AI note-writing tool is a godsend. Full stop. Not sure why it can’t place orders yet. Here we are on the brink of world domination by AI and I’m still entering “follow up CT scan per radiology request”…

@BlackOpsRX @MarlaFights @BrentAWilliams2 Epic/EHR is data mining

@MarlaFights @BrentAWilliams2 Catch 22. Private equity is here. Legislative policy will dictate if you are not using vetted AI tooling, you are liable for malpractice; but w/o tort reform on liability you may still burden malpractice alone. FYI, Scribing is data mining, they need you to do it chump.