Ernesto Gutierrez, MD

@Liberty4Lisa @jk_rowling I've been listening from the start so my kids can follow the story. Currently about a third of the way through The Prisoner of Azkaban

I too am listening, and loving them. I sometimes get Harry and Ron confused bc I think the film an voice actors’ accents are swapped, somehow. But I am getting more used to the new voices as it goes on, and the whole experience is sooo much fun. I started on book 3, now on 5, and thinking about #2 next. The last two will be a thrill, I am sure.

If you're the mother who was reading Harry Potter and the Philosopher's Stone aloud to your child on the LNER train from London to Edinburgh yesterday, one of my grown up children was listening and says you did the voices brilliantly❤️🥹

@CoffeeBlackMD @bijans by normies you mean normie patients… or worse: normie doctors?

@bijans I don’t think normies will like it.

I'm fairly sure retatrutide will be the largest peak-sales drug in history (inflation-adjusted). My lingering question is the resting HR elevation of ~5–7 bpm and a 4–14% arrhythmia rate (vs. 2–3% placebo) seen in Phase 2 data, plus insomnia reported anecdotally in the gray-market users. These are glucagon receptor effects, not GLP/GIP - and could be a real-world limiting factor in certain patients. The full Phase 3 TRIUMPH study data set will be important of course.

@rossiadam We don’t deserve dogs. We recently lost our 14 year old Beagle. She was the best.

She is not allowed in the library, but now that she is on her last days the old rules no longer apply. I told her to follow me and when I walked in she hesitated and it broke my heart.

@Nicolascole77 Prompt

Writer Career Paths is officially LIVE! But I have a surprise... I wrote a secret chapter (not included in the book) about how AI is going to impact every major Writer Career Path. Comment "prompt" below and I'll send it to you for free 👇

@jasonfried Great news. Been loving fizzy so far. What does this mean for feature requests, though? We submitted a few and are hopeful they’ll get implemented.

Fuck it, we just made Fizzy completely free. The open source installable version was always free, but the SaaS version was pay. No more. Basecamp and HEY's largess will subsidize Fizzy for all. So go grab your account at Fizzy.do. It's Kanban the way it should be, not the way it has been. Fresh, fun, light, fast, and perfect for working with agents, too. An official CLI is coming soon as well. Stay tuned for that. The native iOS app should be out once Apple approves it (it's in approval right now...). Android is already out, you can get it on the Play store. (and BTW if you were a paying customer, you will no longer be charged moving forward)

@mckaywrigley I’m interested

looking for a handful of people to test something new... i've been using it for a few months and am prepping to share. if you're a fan of claude cowork, openclaw, manus, perplexity computer, etc then you're a perfect fit. this will self destruct in 4hrs - please dm or reply.

@mhp_guy As a physician, and as a dad, I can't emphasize how important it is to find a pediatrician whose mindset isn't totally locked in to their "peer approved" scripts and practices. Finding one is HARD though. But well worth it.

If I had to only give one piece of advice to parents this would be it. It could save your child’s life. A decade ago my 3 year old had breathing issues. She kept getting misdiagnosed with asthma. Her lips would turn purple and nothing helped. We were always in the ER. Then we found an amazing pediatrician who actually cared and actually listened. After hours of talking and research he referred us to a hospital to get her tested for pulmonary hypertension. An incredibly rare disease almost never seen in kids. All of that research and care by her pediatrician saved her life. Last week the same pediatrician saw my other child that has been struggling with ADHD symptoms. He spent 45 minutes asking him thoughtful questions. What excites you? What is your diet like? What are your goals? I don’t think any adult (aside from my wife and I) had ever shown him that much love. He then referred him to an ADHD coach instead of just giving him pills. So what’s the advice? Do everything in your power to find a pediatrician that actually, truly cares. You can see it in their eyes. Only 1-5% of them are this way. We’ve seen other pediatricians and always find like we were part of a soulless assembly line. Ask around and shop around. Don’t settle on the first one you find! It could save a life or a lifetime of unnecessary pain.

@rahulvohra @WizLikeWizard @SuperhumanMail @shishirmehrotra Looking forward to these updates. Thanks for the DM offer, can't think of anything too specific or too annoying right now (other than being able to change the label colors!!) Feel free to DM me if I can help. You should be able to now

@erngut @WizLikeWizard @SuperhumanMail @shishirmehrotra hey Ernesto, we have a lot on the way that I think will address this! in the meantime, I'll DM you! 🙏

Ok not to be an AI hater but @SuperhumanMail's AI is so so bad and it's so so sad because it could be so so good. @rahulvohra @shishirmehrotra I would pay $1,000+/mo today to get great contextual AI drafts from Opus 4.6...

@elonmusk It's better. That's for sure. But it takes way too many liberties and fails to adhere to prompts for every day use. It assumes too much from every prompt. But it *IS* way better than 4.1 in all its flavors

What are your initial impressions of Grok 4.20? Major upgrades are still landing every week.

Agreed. But that's NOT introspection. What you're referring to is RUMINATION. And yes, that's useless. What's more, the fact you're able to eloquently share your learnings in podcasts and elsewhere is BECAUSE you introspect. Introspection can be seen as simply processing -or digesting- your thoughts and ideas.

It is 100% true that great men and women of the past were not sitting around moaning about their feelings. I regret nothing.

@rossiadam @RyanNMayberry @WaffleHouse From now on, whenever people talk about "generational trauma", this is what I'll think they mean.

@RyanNMayberry @WaffleHouse I can’t believe she did it. Our family is still processing the shame and guilt.

My brother Ben is a hard worker. But he didn’t last a full night as a Waffle House cook. He then had my mom go pick up his paycheck for the partial shift. Respect to the @WaffleHouse crew.

@dranthonygustin @BigDadEnergyX they probably have "wOrDs hE cAnT pRoNoUnCe"

@BigDadEnergyX What is wrong with the ingredients?

If you look at the ingredients, you'll realize Paul is scamming you like Gary Brecka does. They're all the same.

@javiernegre10 Si fuera en X diría que lo reportásemos y que le tiren la cuenta. Dudo que Instagram haga algo al respecto.

Sánchez cazado comprando casi un millón de seguidores falsos en Instagram. Modelo Ana Pastor.

@martinvars Para UNA buena propuesta que tiene @vonderleyen y este gobierno la rechaza… Poco nos pasa.

Gilipollas.

After days tinkering with it, I still can’t get my @openclaw to do anything remotely valuable in an effective and efficient way… But I’m learning so many things about VPS, terminal commands, AI agents, and so on, that the investment in time and $ has been more than worth it so far.

Day 1 as an AI operator is in the books. You don't know where the real bottlenecks are until you start doing the work. Here’s my end-of-day debrief on finding limits, fixing friction, and building a system that scales: 🧵

@MedteckThiam @grok @openclaw Gemini Pro is ok if you keep context short. Once sessions get long, it starts hallucinating badly. I only use flash for simple stuff like heartbeats, cron jobs, and research tasks. Frankly, the best is Opus but it's pricey as hell…

@erngut @grok @openclaw I have the exact sams issue with gemini. I tried pro and flash models too. It says it has done things while it didn’t. Sound like an openclaw issue.

Is anyone using @grok as the main model for @openclaw ? I set up my first openclaw with grok-4.1-fast as the main and it wasn't a great experience. I tried again using Sonnet 4.5 and it worked much better. I don't know if the difference is how I approached the build (very possible) or the main model itself… Looking at using Grok as a daily driver to keep costs down but I don't know if its gaslighting and refusal to follow rules is something that can be mitigated…

Running a B2B podcast is hard. Growing one is harder. If you've hit a plateau, you don't need more 'hacks' — you need better data. We're doing data audits (Spotify + Apple) to find exactly where you're stalling. Reply 'AUDIT' to get yours. 🎙️