Aakash Saraiya

Emergency Medicine Physician | Fellow @ Susa Ventures | Building NXGN

[Aakash Saraiya @EMedVC]

@ScottHickle @ThroneScience Scott you are a gem of a person, extremely proud investor and user!

[Aakash Saraiya @EMedVC]

@ClearThinker66 @CanesDavid Agree on the imaging, labs I would argue otherwise.

Triage nurses are actually very very good at what they do. Can usually determine accurately which patients should have labs cooking.

[Aakash Saraiya @EMedVC]

@jaschmd @CanesDavid agreed, def not ideal, but extremely common place. Gives the illusion of care moving forward, and to be fair, many of those labs would be ordered anyway.

Imaging should not be. But commonly is.

[Aakash Saraiya @EMedVC]

David, the level of condescension is abhorrent. I did a urology rotation, does that make me a urologist?

My job is not to make a home run diagnosis, it’s to rule out the shit that can be disastrous if missed. We make med students and residents do ER rotations so they appreciate the need to keep a broad differential, not oh I’ve seen this 15 times so let me try to pattern match. Sounds like you may need to repeat one, if the approach you take to a septic post op patient is a kub?

Yes you are right, I can read a note, but can I tell you how often notes aren’t completed or done at a different facility?

I didn’t say I’m getting a ct on every patient that walks into the ER, I said in the patient you described I have and I would. Surgeons botch shit all the time.

[Aakash Saraiya @EMedVC]

Brother, this is a hyper specific and a great example of “you have all the information”.

This is an undifferentiated septic patient, until proven otherwise. So unless I get a call from the urologist who is sending this person in or I see an Op note, I am ordering a CT 12/10 times. No inpatient team will admit this, just because the stent is properly placed. Unless you are the admitting and want to take the liability.

I would encourage every specialist who thinks similarly to come work a shift in the ER, if I could have patient who can articulate what procedure they had done, have a urologist who would pick up my call at 11pm while also maintaining a door to dispo time sub 4 hours, and an admitting service that would accept this, I would pay you any amount of money.

Also let’s not forget the other 20 patients I have with similar vitals and history and the waiting room full of patients.

A CT, hate it or love it, allows me to gauge stability - does this person need the OR, ABx, stat consult, IR, etc.

[Aakash Saraiya @EMedVC]

@YultideH My friend this is every healthcare startup company ever. Lots of promises and very little data…yet

[Aakash Saraiya @EMedVC]

As a doctor who uses ultrasound daily, seeing other doctors overreact to a generation 1 product from a startup is hilarious.

Abundant imaging is and should be the only future.

MidJourney may or may not be it, but it’s directionally correct.

[Midjourney @midjourney]

Announcing a new division of Midjourney called "Midjourney Medical"

[Aakash Saraiya @EMedVC]

@7uomoki Agreed! We have 4-5 ultrasounds in the ED, I use them for everything from cardiac arrests to soft tissue analytics.

[Aakash Saraiya @EMedVC]

@bartek_wl I use it daily for lung, abdomen, and boney anatomy…

Lung: https://t.co/RJi3NmCjP8

Abdomen: https://t.co/WRStbgBFoh

Bone: https://t.co/ByLoZuvddA

[Aakash Saraiya @EMedVC]

Agreed, scopes have risk. But we only have this data because we have done millions of scopes and yet it still remains the standard of care.

My larger point:

1. Crucifying an early stage company that currently doesn’t have quality data/applied for FDA approval or even a comparable product to any other imaging modality is ridiculous. Thousands of early stage companies make all sorts of bold claims everyday, should we penalize/dunk on all of them? 99.99% will fail. Doesn’t mean they shouldn’t try as long as it’s from a consenting patient who understands that it’s for data collection.

2. I strongly agree, we need to have more data on whole body scans - MRIs, CTs, USs, etc. Cost has historically been the barrier, and now it’s become data ownership/financial incentive. If this is a cheap/effective way to get data, it may be worth it.

3. MidJourney isn’t backed by a VC/some capital institution, it’s entirely owned by @DavidSHolz. And if he needs to sell the med spa to justify the data collection price, that’s his choice. Instead of taking VC dollars to build this out he’s trying to break even with the spa angle. Worst case, you got a sauna and immersed in a tube.

[Aakash Saraiya @EMedVC]

@BenMazer US isn’t unproven, this form factor is.

I didn’t say they couldn’t issue the opinions, just thought the overreaction was funny.

Also, calling it an intervention is incorrect, as from the post and the video it seems to be “diagnostic” data collection at best.

[Aakash Saraiya @EMedVC]

lol? Who says anyone has to act on this data? Still a shared decision by a consenting patient and physician.

Also, i would love to see more longitudinal data on non pathological findings via US or any another modality. In fact, that’s how our Lung nodule guidelines were established, so we don’t make “medical mistakes”.

[Aakash Saraiya @EMedVC]

Agreed. This could 100% be snake oil, I don’t know, we don’t have the data. But that doesn’t mean the attempt shouldn’t be made? As far as I can tell, it’s a no harm product. Worst case the data is trash, and you wasted 5 minutes.

But if it presents an opportunity to finally get longitudinal none pathological imaging data…

[Aakash Saraiya @EMedVC]

Most criticisms I have seen are centered around:

1. Incidentalomas and how we are going to biopsy everything and anything
2. Comps to other imaging modalities
3. Is this healthcare or another med spa feature disguised as SoC

My answer to all the above is paternalistic medicine is not how trust is built with patient care. If someone wants to go purchase this product, let them, it’s their choice. But at the same time, if they ask me to act on said data when they see me, I can say yes/no and have a dialogue.

But taking the knees out from under a protype (has sub 100 users if that) that in itself causes no harm, just adds to a data pool that users voluntarily signed up for, is ridiculous.

[Aakash Saraiya @EMedVC]

@ryanstellar Only a sith deals in absolutes

[Aakash Saraiya @EMedVC]

@swdhldr I call these “Blue Collar” residencies.

Clinically fantastic, no corporate bs, gets the job done, the doc you want taking care of your mom.

[Aakash Saraiya @EMedVC]

Check your privelage here friend - I know you mean well but this is a disservice to every anxious, non-doctor parent on here who will go into my ER expecting an MRI, and become enraged when they can’t get one, and blame me - the ER doc because a “neurosurgeon told me”.

I’m sure you can get one at your hospitals ER because of who you are, but most will not have that pull.

[Aakash Saraiya @EMedVC]

@kahnfessions NXGN!!

[Aakash Saraiya @EMedVC]

@kaiarhodes @anatar I need to cop