Andrew Boyd, MD

Appalachian FQHC. “Good medical care is to do as much nothing as possible.” Safetyism is infinite. Unfettered executive power is a threat to democracy.

[Andrew Boyd, MD @VC_Doc]

WHO Director 3/3/20:
“We don’t even talk about containment for flu - it’s just not possible. But COVID spreads less efficiently than flu and it can be contained.”

We soon learned COVID is MORE contagious, but still tried containment at huge social cost.

https://t.co/BouMADAKPI

[Andrew Boyd, MD @VC_Doc]

@hstupak1 @DrJoelGator You are correct that prescribing in this situation is a business practice. It’s good for the prescriber, not the patient.

[Andrew Boyd, MD @VC_Doc]

@DrJoelGator When I tell a patient I expect their condition to resolve without treatment, I often hear something like “Guess I didn’t need to come in then.”

That’s true in hindsight, but you needed my judgment to know that.

[Handre @Handre]

Power selects for a specific personality type, and it is not yours.

F.A. Hayek spelled this out in 1944. In a centrally planned system, the people who rise are not the most competent or the most honest. They are the most willing to exercise force against strangers, the most comfortable with contradiction, and the most skilled at coalition-building through favors rather than merit. Government filters for the bad ones from the start.

The mechanism is straightforward. Political power means controlling resources you did not earn. Capturing that control requires outcompeting rivals who have no ethical constraints. A principled candidate refuses to promise contradictory things to different voter blocs. An unprincipled one does it without blinking. The unprincipled one wins. Repeat this selection pressure across hundreds of electoral cycles and you get the U.S. Congress in 2026: a body where the average member has held office for over a decade, raised millions from interested parties, and delivered almost nothing measurable to the people who voted for them.

Bureaucracy compounds the problem. Once entrenched, state agencies attract people who want authority without accountability. You cannot fire most of them. The FDA, the TSA, the Federal Reserve all function this way, staffed by individuals whose career advancement depends on expanding the agency's reach, never on serving you efficiently.

[Andrew Boyd, MD @VC_Doc]

Actual NP note I saw today:

CC: hemorrhoids and toe fungus

HPI: hemorrhoids and toe fungus

ROS: irrelevant template

Exam: NONE

IMP: hemorrhoids and toe fungus

Plan: refer to gastro and podiatry

[The Radiology Sheep @Radiologysheep]

Radiology used to have something that was almost invisible because it was so routine:

The reading room consult.

Rounding teams came down.
Surgeons pulled up their cases.
Internists brought the scan that didn't quite fit the clinical picture.

Sometimes the radiologist solved the problem.

Sometimes the clinician supplied one piece of history that completely changed how the images were interpreted.

And usually everyone simply walked away a little sharper.

But something else was happening during all of those conversations.

We were learning each other.

As a radiologist, I learned what individual physicians cared about.

I knew which findings mattered to a particular surgeon.
Which measurements an oncologist was following.
Which details a specialist wanted emphasized.
What questions they were really asking, even when the order just said "pain."

And they learned me.

They knew who was reading their study.
They knew they could walk in, point at something, challenge an interpretation, or ask, "What do you think?"

That relationship created context.

It created feedback.

It created trust.

And over years, it created a kind of institutional knowledge that never appears in the medical record.

When radiology becomes a report produced by someone hundreds or thousands of miles away, we don't just lose proximity.

We risk losing that entire feedback loop.

The report may still be technically excellent.

But the radiologist knows less about the physician.

The physician knows less about the radiologist.

The radiologist sees less of what happened after the report.

And both sides lose opportunities to make each other better.

The reading room was never just a room.

It was where imaging became part of the clinical conversation.

We should think very carefully before designing that conversation out of medicine.

Inspired by a conversation yesterday with @PaleoOnc . Also @909One and @brianchiong .

[Andrew Boyd, MD @VC_Doc]

Remember when the U.S. spent as much as the entire annual budget trying to contain a highly transmissible respiratory virus?

[Andrew Boyd, MD @VC_Doc]

Given the current (and well-deserved) attention the public debt is receiving, it’s worth remembering that the U.S. squandered $5 trillion on pandemic relief measures.

The stimulus bills were archetypal grandstanding and grift, and we have nothing to show for them except an accelerating economic emergency.

[Andrew Boyd, MD @VC_Doc]

😷👀
Osterholm completely called out the directors of NIH and CDC and the Surgeon General regarding federal masking guidance.

“None of the studies the CDC uses to support its statement as to the significant protection of face cloth coverings stand up to scientific scrutiny.”

[Andrew Boyd, MD @VC_Doc]

Excellent thread.

As best I can I let my patients know what additional testing and treatment could mean, and that a palliative approach is always an option.

My mother was told she was “lucky” to be surgical candidate to treat cholangiocarcinoma. It was hell.

[Paul Schofield @pschofie79]

My dad died of glioblastoma on Friday. Two things that are significant when you get diagnosed with this at age 72: You're not going to live very long and much of the time you have left is going to be unpleasant. I've been struck my how *little* attention was paid to these things.

[Andrew Boyd, MD @VC_Doc]

@Chesschick01 Everyone’s for fighting crime until your first amendment right to assemble is criminalized.

[Andrew Boyd, MD @VC_Doc]

@Seanfrank It’s worse than you think.

Half of federal spending is indexed to inflation and can’t be “inflated away”.

What happens to bond prices and interest rates when debt buyers realize the U.S. is not committed to containing inflation?

[Andrew Boyd, MD @VC_Doc]

@rshereme This is blatantly false. There have been ZERO measles deaths in the U.S. this year.
How can a professor be this obtuse?
How can 6k people swallow such an obvious lie?

[Andrew Boyd, MD @VC_Doc]

@justin_hart Here’s @AmerAcadPeds reassuring everyone the obvious outcome wouldn’t happen.

[Andrew Boyd, MD @VC_Doc]

“No one takes them seriously, no one knows how to treat them, and there is no effort to study this.”

The dismissal and censorship of people who experienced adverse effects of the COVID vaccines were an affront not only to science, but also to human dignity.

[Andrew Boyd, MD @VC_Doc]

@DrJMarine It was sad to learn how many physicians are sheep at heart.

[Andrew Boyd, MD @VC_Doc]

This is an easy way to select for a smart doctor. Unfortunately, “smart” in this case really just means good at memorizing the information that others told them is important. The pandemic revealed this intelligence is quite different from critical thought and the application of knowledge to new scenarios.

[Andrew Boyd, MD @VC_Doc]

@KrugAlli The rarity of disease also makes it impossible to directly study vaccine efficacy.

I personally know 2 healthcare workers whose adolescent children died of meningococcal infection. They were both vaccinated.

[Andrew Boyd, MD @VC_Doc]

Just saw a new patient with intermittent chest pain and a murmur suspicious for AS. Has multiple risk factors for CVD. He was recently hospitalized and had inpatient echo (read as “normal” with no valve abnormalities) and stress test (reported as “unremarkable” in discharge summary).

In reality, his aortic valve area was 1.1 cm2 and he was only able to walk 107 seconds on the treadmill. I’m not reassured.

[Ferrariic, MD @ciirarref]

Read your own scans

[Andrew Boyd, MD @VC_Doc]

“All [healthcare] screening programs do harm: some do good as well, and of these, some do more good than harm at reasonable cost.”
Sir Muir Gray

[Andrew Boyd, MD @VC_Doc]

We keep hearing he did the best he could with what we knew at the time.

In reality, Fauci knew in early 2021 that variants were going to make the original vaccine useless against infection while still publicly claiming the vaccinated became a “dead-end” for the virus.

[Jeffrey A Tucker @jeffreytucker]

Exactly correct. Perfect article

The vaccine warnings hidden in Fauci's diary, by @MaryanneDemasi https://t.co/ix6yXz70zU