Dr. Tired

Taking a crack at the twitter world. I've been told you can learn a thing or two. #FOAMed #MedEd

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Breaking news:

Trade association admits its facilities run too inefficiently to stay open without government largess.

[Dr. Tired @DrRohanMD]

How can I update my @Tesla iPhone app and then it’s still ready to update again?

What kind of update loop is this???

[Dr. Tired @DrRohanMD]

@DrSuneelDhand That’s great — let them have the liability too.

Get back to me after that.

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

This ridiculous statistic keeps appearing: medical errors are the third leading cause of death.

It is a powerful narrative that has spawned a massive quality-control bureaucracy.

It is also completely wrong.

Taking care of sick patients is not like flying an airplane. Pilots fly machines that have been maintained and cleared for takeoff. Doctors often take over when the plane is already on fire and heading toward a mountain.

Also, not every airplane is destined to crash. Yet, every patient is destined to die eventually.

When reviewers judge bad outcomes backward, they routinely classify the brutal, inevitable tradeoffs of medicine as preventable errors. Critically ill patients have more interventions and higher mortality. That does not mean an adverse event killed them, or that a new bureaucratic rule would have saved them.

The two papers often cited, one by the Institute of Medicine, another by Marty Makary, have substantial flaws. They often struggled to determine whether an adverse event actually caused the death. Shojania and Dixon-Woods, writing in BMJ Quality & Safety, criticized the “third leading cause” claim for exactly this reason. They argued that the estimate combined prior studies too simplistically, failed to follow accepted standards for quantitative synthesis, and did not adequately address whether the adverse events detected by review tools actually contributed to death.

In my latest essay, I explore how the exaggeration of preventable error has actively harmed patient care. The safety movement did not stop at identifying clear, recurring failures. It became a governing philosophy that gave administrators a moral language to control the clinical encounter.

Today, physicians spend hundreds of hours a year feeding quality metrics, hospitals game the data to manage their mortality statistics, and independent practices are crushed under the fixed costs of compliance.

When the metric becomes the target, institutions optimize for the metric. In some cases, like the push to reduce hospital readmissions, that optimization has actually caused more patients to die.

The honest path to patient safety begins by admitting that medical care involves dangerous tradeoffs, not deterministic guarantees. Read the full essay in the reply below.

[Dr. Tired @DrRohanMD]

@RadarScope Correct, it’s not preserving the product I selected.

No, other settings seem to be preserving fine (or at least I haven’t noticed.)

[Dr. Tired @DrRohanMD]

.@RadarScope hi. Why is the iPhone app no longer persevering my settings after I close the app? I don’t want to open the app to super res.

[Dr. Tired @DrRohanMD]

@CARN0N What was the SoC? 10%?

[Dr. Tired @DrRohanMD]

@SawyerMerritt Survival bias.

Obviously those that fell off the cliff….. aren’t vocal to tell us not to do this.

[Dr. Tired @DrRohanMD]

@redpillb0t I know very few docs that actually want to see their patients on a regular bases….. and those regular bases are annual wellness visits…..

Very ignorant post to rage bait. This is a very intellectually lazy b

[Dr. Tired @DrRohanMD]

@BrentAWilliams2 @HeartOTXHeartMD We can say a lot that’s political in his medical care but credentials of his PCP is not one.

[Dr. Tired @DrRohanMD]

@DR__MEDICINE G10 now P10

[Dr. Tired @DrRohanMD]

@IM_Crit_ @American_Heart Not only that but I’m pretty sure he is taking the higher dose ASA too.

[Dr. Tired @DrRohanMD]

@JeebsTX @Tesla_AI @Tesla @enhauto Interesting. Let’s see if this actually stays this way through future updates…..

[Matthew Herper @matthewherper]

Relaxed FDA rules unleash flood of unvetted blood pressure devices

Tech companies including Oura, Samsung seize opportunity, while experts raise concerns

⁦@mariojoze⁩ has the story. https://t.co/Vt2TvSco9g

[Dr. Tired @DrRohanMD]

@DrDiGiorgio We are offering the SAME surgeries but use code LOBOTOMY at checkout for 15% off.

*offer valid only for the first 100 customers.

[Avi Roy @agingroy]

Stop a statin and your LDL cholesterol rises 30% in four days. Nobody writes a WSJ feature about it. Stop certain blood pressure medications and your BP can spike within hours. Nobody calls it a design flaw.

Levothyroxine, antidepressants, insulin, metformin, antihistamines. Chronic treatments for chronic conditions, and all of them stop working when you stop taking them. None of them generate think-pieces questioning whether patients should have started.

The AMA classified obesity as a disease in 2013. Thirteen years later, it’s still the only chronic condition where “you have to take it forever” is framed as an argument against treatment rather than a description of how medicine works.

[Dr. Tired @DrRohanMD]

And now — Sentra mode is picking up phantom movement. I got 84 events yesterday.

[Dr. Tired @DrRohanMD]

Gosh — hope it’s better than 14.3.2.

I felt that update be WORSE.

[Sawyer Merritt @SawyerMerritt]

Tesla FSD V14.3.3 just started rolling out, and it comes with the Spring Update!

Actually Smart Summon’s top speed has also been increased to 8 mph (from 6 mph)!

Downloading it on my Model Y right now. Software version 2026.14.6.6.

[Dr. Tired @DrRohanMD]

@realdocspeaks yes

[Dr. Tired @DrRohanMD]

@nikillinit Ask them to write you ivermectin.