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]

@DrKateEndocrine “Don’t they realize”

Do they care?

[Paleoncologist @PaleoOnc]

@FreddyLA7 @grok what’s better Hattie’s or Gus’s ?

[Paleoncologist @PaleoOnc]

@FreddyLA7 You MUST go to Gus’ World Famous fried chicken.

Must.

Just go

Seriously

Best fried chicken in the world

And after you go … it’ll really be world famous

[Paleoncologist @PaleoOnc]

@RxRegA Great question!

[Paleoncologist @PaleoOnc]

@RxRegA I think Oncology fares better than grok suggests.

But still …. Grok was quite insightful nonetheless

But hematology? That’s still voodoo

Kinda ironic to have one if the more evidence driven specialties paired with one of the more “this feels right” specialties 😁

[Paleoncologist @PaleoOnc]

@909One Yup

[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]

😂😂😂

It is funny how many so-called right-wingers adopt the "labor theory of value" when calculating doctor pay, and how it only seems to go in one direction ... down

Everything we do is supposedly more efficient and involves less time and resources

And our pay is only determined by time and resources, not our skill, intellectual value, or even scarcity

[Paleoncologist @PaleoOnc]

Briefly - the hospital gets a fixed payment per diagnosis

Everything they do comes out of that pie.

The less they do per admit, the more net profit.

In the mix is a good bit of unnecessary labs. No argument. But the counter argument is ... when you make physicians miss things the cost can be higher in the long run

[Paleoncologist @PaleoOnc]

@JPDeSimone See here - https://t.co/3ssh75R71B

[Paleoncologist @PaleoOnc]

Hospital payments are bundled. They get a fixed amount of $$ per diagnosis

They do NOT want them to stay an extra day. The opposite. Faster discharges lead to more profit per admit.

No. It’s something else

Daily labs are a small cost but … Across hundreds of patients day after day. It adds up.

Phlebotomist cost. Lab cost. None of it reimbursed per item

If a hospital could reduce lab volume by a good fraction … the savings would be notable

There’s no doubt that doctors would rather have “set it and forget it” daily labs. So lots of unnecessary labs get ordered. I get it

But this is prioritizing saving nickels when the cost comes out of doctor time and patient care

I’ve spoken about the silliness of unnecessary scans. Even unnecessary office labs recently.

But even I draw the line at extra labs in the hospital. Penny wise and pound foolish

[Paleoncologist @PaleoOnc]

@Hstlinghosptlis @Aphasia2105 We can be friends (but to be clear NOT to piss of the nurses. To piss off admin is ok ...

[Paleoncologist @PaleoOnc]

Hospital payments are bundled. They get a fixed amount of $$ per diagnosis

They do NOT want them to stay an extra day. The opposite. Faster discharges lead to more profit per admit.

No. It’s something else

Daily labs are a small cost but … Across hundreds of patients day after day. It adds up.

Phlebotomist cost. Lab cost. None of it reimbursed per item

If a hospital could reduce lab volume by a good fraction … the savings would be notable

There’s no doubt that doctors would rather have “set it and forget it” daily labs. So lots of unnecessary labs get ordered. I get it

But this is prioritizing saving nickels when the cost comes out of doctor time and patient care

I’ve spoken about the silliness of unnecessary scans. Even unnecessary office labs recently.

But even I draw the line at extra labs in the hospital. Penny wise and pound foolish

[Rocco @Aphasia2105]

And what’s their reasoning for doing this? Let me guess.. we’re finding out that patients are getting poked unnecessarily so we took the qAM order out because we want to reduce patient harm or by doing it this way, we’re able to get your patient an extra day in the hospital. It’s for the patient safety!!

[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]

@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?