Paleoncologist

Got lost on the way to dinosaur school. Now an MD

Would rather learn than “be right”. Questions are in good faith.

[Paleoncologist @PaleoOnc]

Strong opinions …
… Loosely held (with humility)

Is not a bad way to approach life on this planet

[rohit @krishnanrohit]

Truly excellent find. "a leading paleontologist on the meteor impact theory of the dinosaur extinction (in the NYT in 1985). “The arrogance of those people [proposing the meteor impact theory] is simply unbelievable”"
h/t @michael_nielsen

[Paleoncologist @PaleoOnc]

@japan_nobunaga I appreciate you always telling the best parts of America.

It’s not all good

But it’s not all bad either.

The good side deserves a voice too

And you are doing a fine job

>> bows deeply <<

[Paleoncologist @PaleoOnc]

@molsjames I do that too.
I want to get a feel for how they treat you.

But of course I’m poised and ready to jump in if needed.

[Paleoncologist @PaleoOnc]

@sethmhardy I had a hunch but can’t say i remember that spot.

But I’ll be back ..

[Paleoncologist @PaleoOnc]

Pic OTD

"Russian sage"

From my Maine Coastal Botanical Garden trip
I've got to get back there

[Paleoncologist @PaleoOnc]

@sethmhardy Is that Maine?

[Paleoncologist @PaleoOnc]

@tmac622 When did I say that???
🤣🤣

[Paleoncologist @PaleoOnc]

And this is how they control physicians practice using EMRs

Preventing automatic ordering of daily labs sounds innocent enough.

But they are trying to save money at the expense of increasing “provider” … busy work

They figure if it’s too much hassle we won’t order daily labs

And if we really need it we have pay a “toll” - which is to remember to order the labs

Every
Single
Day

I have leukemia patients who unequivocally will need daily labs.

Now I have to make sure not to forget their labs. Or they get missed.

😡😡😡

[Paleoncologist @PaleoOnc]

@DrDiGiorgio @mungowitz @DRsLoungePod It occurs to me that the reason for our mutual hate of Epic Chat ... is transaction costs!

They've lowered the cost of accessing the attending to zero ...

Which means they will use it for just about anything ...

[Paleoncologist @PaleoOnc]

@reallyoptimized They gave a free year of their first paid tier w/ Venmo so I use it often

It's good but nothing I can't get for free other ways

But it's my go to for long projects since I am not limited compared to others that I still use for free

[Paleoncologist @PaleoOnc]

Tumor marker has doubled 😢😢😢

Looks like the subtle changes on MRI were more significant than it appeared

Normally I'll take a film over a tumor marker but sometimes labs win ... (especially if its a dramatic reversal as here)

Guess it wouldn't have mattered if I had the MRI in time
Might've been worse - I would've had to back track

😢😢😢

[Paleoncologist @PaleoOnc]

Me to patient:
So the schedulers messed up and scheduled your MRI for tomorrow but we needed that for today. Sorry about the mixup.

I’ll have to call you later this week after the report is ready and update the plan

Patient:
Oh, I saw that and thought that was a problem but I figured you wanted it that way

Me:
No. We always need results *before* I see you. Getting them after is not really a good use of our time

Patient:
<blank stare>

Me: I hate to say this but sometimes the radiology schedulers don’t look at your appts. If this happens again you should always call us so we can fix it

Patient:
But I thought you wanted it that way

Me:
No. We never want scans after appts. Always before
I need that information to determine if your chemo is working

Me:
Moves on to other topics and wraps up appt

Patient:
OK. So I don’t need to go to the MRI tomorrow?

(Me: to self. If you want to make things even worse …)

🤦‍♂️

[Paleoncologist @PaleoOnc]

Follow up

MRI was ok.

Still waiting on tumor marker

😞

[Paleoncologist @PaleoOnc]

@molsjames Did you play the doctor card or go anonymous?

[Paleoncologist @PaleoOnc]

@IndexAndForget Technically yes ... but not if ~everyone~ did it.

Someone has to set the prices. Not every buyer and seller can be passive

[AtlasMD @AtlasMD]

Time for physicians to...shrug? https://t.co/hpffpUMPcX

[Paleoncologist @PaleoOnc]

@edgarrmcgregor Beautiful shot!

[Paleoncologist @PaleoOnc]

@IndexAndForget Unless its on purpose and working as intended

[Paleoncologist @PaleoOnc]

@DrDiGiorgio Not at all .... just be nice to him on the pod
😜
(kidding)

[Paleoncologist @PaleoOnc]

@crappiedoc @BBTop2017 They make the simplest things SOOO difficult
Like ... it might not be a big deal to order daily labs every day ... but they make it harder than necessary adding insult to injury

And they create new problems where none existed ... and difficult solutions for them too

[Paleoncologist @PaleoOnc]

@DrDiGiorgio @mungowitz @DRsLoungePod That's awesome!

When?

[Paleoncologist @PaleoOnc]

@DrDiGiorgio The irony is Medicare ~supposedly~ has "low admin costs" ... so why are they the worst physician payor? Where does that money go? (We know)

[Paleoncologist @PaleoOnc]

@CynicalPublius Agree 100%

As Buffett said (in a different context) - You pay a high price for a cheery consensus

[Paleoncologist @PaleoOnc]

Another great TAITC pod
This time Munger approaches cancel culture from a transaction cost perspective and it makes a bit of sense. No real solutions unfortunately

But the real cherry on top is the "listener letter" he reads at the end including one from @DrDiGiorgio (in full as best I can tell) in response to last week's pod (about the Flexner report and the AMA) as well as a letter from @SurgeryCenterOK . Both well articulated.

@mungowitz

https://t.co/C3WmS8hQpW

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

@JOSEPH45075332 Love munger. Will listen. His one on insurance is great too