Alex Fixler, MD

Internist

[Ashley Miller @icmteaching]

The Surviving Sepsis Campaign has shaped sepsis care for decades. But do some of its core recommendations now lag behind the physiology and the evidence?

Rory Spiegel @TheEMNerd led this new dissenting opinion, which I was very pleased to contribute to.

We challenge:
• fixed 30 mL/kg fluid loading
• chasing lactate with fluid
• fluid responsiveness as a sufficient reason to give fluid
• pressure-centric resuscitation
• the omission of POCUS from modern haemodynamic assessment
• rigid bundle-driven care

The argument is not for less treatment. It is for more individualised, physiology-driven treatment of shock.
https://t.co/ImJeVAsbi1
The 2026 Surviving Sepsis Campaign Guidelines: The dissenting opinion
Spiegel et al. AJEM, just published.

[Alex Fixler, MD @alex_fixler]

Congressional antitrust investigation of medical residency accreditation and matching programs https://t.co/zRdszr2x6v

[Roger Seheult, MD @RogerSeheult]

Total US Healthcare expenditure:
Red controls the $. Red has decided to let everyone know where the bloat is and has informed their mouth pieces to parrot this: Blue (physicians). Don't worry, they will be going next after purple (nurses).

[Real Doc Speaks @realdocspeaks]

The blame the physician for all of the issues with healthcare makes no sense. Physicians do NOT control the healthcare system and the vast majority are now employed.
Here are things that physicians don't do:

1. Set the premium rates as they are set by payers

2. Determine the formulary that denies generic options for medications and makes the choices unaffordable to many Americans.

3. Set the Hospital charges for both inpatient and outpatient care. The ER doctor is not in charge of the facility fee charged by the hospital.

4. They don't develop and implement AI algorithms that deny care to Medicare Advantage patients.

5. They don't use spread pricing, rebates, and other behaviors to increase the price of drugs. They don't pay independent pharmacies less than the acquisition price of a drug to force them out of business.

6. They don't set the price of medications; pharmaceutical companies do this. A combination of the actions by PBMs and pharmaceutical companies causes the US to pay 4.9 times as much for branded drugs as other comparable countries do.

7. They don't write the rules for Medicare and Medicaid; CMS does.

8. They also don't determine how much they will get paid for any service paid through insurance.

9. They are NOT allowed to own any new hospitals, or expand currently owned hospitals after passage of the ACA.

10. Physicians do not control the system by design. It is controlled by large corporations that have monopoly power.

[Andrew D. Huberman, Ph.D. @hubermanlab]

The book Outlive by @PeterAttiaMD is remarkable. First off, I have no financial relationship to the book whatsoever. I love the book because it’s clear and actionable. It provides both data-based motivation and the protocols for specific ways to exercise, eat, do personal analysis etc. for mental and physical health. Outlive is the best book on human health that I am aware of.

[Alex Fixler, MD @alex_fixler]

Thrilled to announce our teams publication! A pleasure working with everyone on exciting ways to bring human centered interface design to EHRs

Alert to Action: Implementing Artificial Intelligence–Driven Clinical Decision Support Tools for Sepsis https://t.co/Q3uIKSa5Cn

[Vanderbilt University Medical Center @VUMCDiscoveries]

A recent study finds promise in the artificial intelligence program ChatGPT for speeding review and improvement of computer system alerts used to support day-to-day clinical decision-making.

Study led by @siru_liu and @adamatw. Reported in @IJMedIn.

https://t.co/bedmjwM6Qw

[Alex Fixler, MD @alex_fixler]

@seamonkey___ @brock331 @hayche_pylori @localav0cado I feel unseen

[Swetha Kanduri @SwethaKanduriMD]

Another great interactive clinical reasoning discussion with med students. Love ⁦these sessions ⁦@OchsnerNephro⁩ ⁦@OchsnerHealth⁩ ⁦@UQMedicine⁩ #MedEdu

[JAMA Internal Medicine @JAMAInternalMed]

In this cohort study, an #electronicmedicalrecord-based intervention was associated with a 6-fold increase in serum parathyroid hormone assessment among outpatients with chronic #hypercalcemia, nearly all of whom had primary #hyperparathyroidism. https://t.co/w8a0GF0KiK

[Alex Fixler, MD @alex_fixler]

Hello #MedTwitter! My name is Alex, I'm a current 4th year student at UQ-Ochsner, excited to be applying to #InternalMedicine in #Match2023.

Looking forward to connecting with programs and fellow applicants - Feel free to reach out!

[Alex Fixler, MD @alex_fixler]

Had a blast at @OchsnerHealth Research Day! We had the opportunity to discuss our EHR clinical decision support tool implementation for sepsis. #ClinicalInformatics