James Peppers MD

Hospital medicine. Healthcare. Interested in AI, tech, the human condition and good stories.

[Dutch Rojas @DutchRojas]

The best way to avoid giving poor people free healthcare is to put your logo on a soccer jersey.

Saint Luke's Hospital in Kansas City figured this out.🧵...

[Michael Albert, MD @MichaelAlbertMD]

I’m sorry, but I disagree with this decision. We seem to operate under the assumption that physicians are responsible for fixing every aspect of society, which is unrealistic.

First, we already have trained professionals in nutrition—dietitians. Yet we consistently underpay them and fail to provide adequate access to their services. While physicians receiving 40 hours of nutrition education isn’t inherently a bad idea, delivering the behavioral interventions required to meaningfully change diet often takes hours of patient engagement. In the current system, many physicians are fortunate if they can spend 5–10 minutes with a patient a few times per year.

The problem is not that people are unaware they should eat more fruits and vegetables. The larger issue is that the food system itself heavily subsidizes and incentivizes highly processed foods. Structural changes to that system would likely have a far greater impact than physicians repeatedly telling patients to eat more fruits and vegetables.

At some point, we need to acknowledge the limits of what can realistically be addressed within a brief clinical encounter. It’s all so exhausting.

[James Peppers MD @JamesPeppers]

@SarahGreerSmith @CoffeeBlackMD Exactly. Nice = time and listening to patients. We may need only minutes to get the clinical info we need, but if we don’t give more and build relationships we won’t have downstream collaboration and buy in. And admin will ask why HCAHPS suck

[James Peppers MD @JamesPeppers]

Monday's Morning Report #1

News healthcare consumers and patients will want to keep an eye on.
#MedTwitter

https://t.co/7JvCdm6XXQ

[Michael Thomas @curious_founder]

This is the man who will be leading America's top health agency.

[James Peppers MD @JamesPeppers]

@drkeithsiau Years of academy training wasted!

[James Peppers MD @JamesPeppers]

It’s crashing and our leaders are worried about conspiracy theories

[Amy Faith Ho, MD MPH @amyfaithho]

Q: Why are waits at emergency rooms so long?

A: Because the rest of the healthcare system is failing.

The patient did everything right, but the healthcare system did them so so so wrong.

🧵…

They call their PCP, but can’t get an appointment. So they turn to the ER.

They call their specialist, but the call line (automated, no human to respond) says go to the ER.

They try to pick up their new medicine, but it’s 3x their monthly rent $ and they already work 3 minimum wage jobs…so they turn to the ER to get a dose of medicine.

They try to get their imaging done, but can’t get the prior auth approved. So they come to the ER to get it.

Their employer won’t let them take a sick day without a work note (and the ER is the only thing open they can get into TODAY).

They need to see their doctor in the clinic, but can’t afford to take time off work to go, much less arrange childcare, and the ER is the only thing open when all those conditions sync up.

They lost their job and now have no insurance and can’t see their doctors anyways. So they come to the ER.

The list goes on and on and on…

Healthcare reform is not about healthcare — it’s about economics, corporate greed, lobby dollars, transportation, housing, politics/policy, culture, and more…

[Amy Faith Ho, MD MPH @amyfaithho]

Q: Why are waits at emergency rooms so long?

A: Because the rest of the healthcare system is failing.

The patient did everything right, but the healthcare system did them so so so wrong.

🧵…

They call their PCP, but can’t get an appointment. So they turn to the ER.

They call their specialist, but the call line (automated, no human to respond) says go to the ER.

They try to pick up their new medicine, but it’s 3x their monthly rent $ and they already work 3 minimum wage jobs…so they turn to the ER to get a dose of medicine.

They try to get their imaging done, but can’t get the prior auth approved. So they come to the ER to get it.

Their employer won’t let them take a sick day without a work note (and the ER is the only thing open they can get into TODAY).

They need to see their doctor in the clinic, but can’t afford to take time off work to go, much less arrange childcare, and the ER is the only thing open when all those conditions sync up.

They lost their job and now have no insurance and can’t see their doctors anyways. So they come to the ER.

The list goes on and on and on…

Healthcare reform is not about healthcare — it’s about economics, corporate greed, lobby dollars, transportation, housing, politics/policy, culture, and more…

[James Peppers MD @JamesPeppers]

Looks like I should have taken a PPP loan to repay my student loan

[James Peppers MD @JamesPeppers]

@joshmcgoo Medically it’s fine. As you said though it’s the additional factors of a safe discharge that make people uneasy. This is where multidisciplinary system based care is needed to avoid simply admitting to observation because of our fears

[James Peppers MD @JamesPeppers]

@SRAnesthesiaICU @Crit_Care @giovannilandoni @alessanro_pruna @YukiKotani5 @Stefano__Turi @Laura_Pasin @nickmmark @iceman_ex @FOAMecmo @KhannaAshishCCM @DarrenDenney

[James Peppers MD @JamesPeppers]

@jtrebach Hospital medicine- black coffee, hand sanitizer, death breath, C diff

[James Peppers MD @JamesPeppers]

@HumeralO 1. Make blood pressure good
2. Make oxygen good
3. Antibiotics. Shoot first questions later
4. Fix the pH and electrolytes

Then the body heals itself

[Dr. Glaucomflecken @DGlaucomflecken]

This is the type of doctor @UHC employs as a “medical director.” This person is denying medical claims in the year 2023.

[James Peppers MD @JamesPeppers]

@EMPAthy_atrophy Flomax, Metformin, Lovastatin

[Eric Topol @EricTopol]

"In this study, COVID-19 was a leading cause of death among individuals aged 0 to 19 years in the US." @JAMANetworkOpen https://t.co/AWawqJ0KLl by @flaxter and colleagues

[James Peppers MD @JamesPeppers]

Call it

[nick wright @getnickwright]

The running game gave him 34 yards on 17 carries.

The top 3 WRs were out with injury.

He was on one leg.

He threw for 326, 2 touchdowns, a 105 ratings… and ran for the game winning first down.

He’s Patrick effing Mahomes and we’ve never seen anyone like him.

[Laura Vater, MD, MPH @doclauravater]

This just in: Congress has EXPANDED residency slots for only the second time in 25 years.

Congress has approved 200 additional residency slots for 2023. This is progress, but we still need a lot more. It’s projected we’ll be short 124,000 physicians by 2034.

Data: @AAMCtoday

[James Peppers MD @JamesPeppers]

@andreavbecker I thought I was the only one. I’m an MD and am regularly transported to undergrad where I’ve failed to attend calculus all semester until the day of the final. It’s horrific

[James Peppers MD @JamesPeppers]

This happens to me all too often

[Andréa (Dre) Becker @andreavbecker]

when do I stop dreaming that I’m months into a semester and about to fail a class I forgot about? I have a phd