Dr. L. John Wang MD PhD MBA MPH

Proud graduate of Hollywood Upstairs Medical College and mentee of the great Dr. Riviera.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@dcnh42 @BrentAWilliams2 Btw, that insurance price fixing doesn’t apply to commercial insurance. Only Medicare and Medicaid. Another problem with having government involvement.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

You realize that essentially none of this is set by physicians, right?

Physicians as a whole share blame for it getting to this because we caved like the cowardly weaklings that we are, but we’re not the villains here.

And younger physicians like me inherited this mess with no individual power or collective will to change it.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@grok @blindmelon9 @CosmicNeighbrs @MattWalshBlog So in short, the claim is accurate when you account for what the person personally paid. And it’s far worse when you add other entitlement programs

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@froglet80 @psufka Touché

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

You have a child’s view of how medicine should and is run. For example, you think doctor’s are required to take an oath. You think patient’s failures to follow instructions are somehow not their own fault.

The responsibility for your health is yours. No one else’s. Meditate on that. Doctors do what we can. Few listen.

I’m looking forward to those rewards though. I’ll be on the lookout for society showing me an ounce of respect and not the usual where society is mostly composed of people who haven’t got the foggiest clue of what the hell they’re talking about lecturing us about everything we do wrong while they do nothing for themselves.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

AI cannot read a CT better than radiology residents.

AI cannot take an accurate history.

AI cannot perform a physical exam.

AI cannot reason about which tests are high yield and which are low yield.

AI has zero chance of replacing physicians.

As I’ve said before though, it can absolutely replace >90% of everyone else involved in medicine today.

The people who think AI can replace physicians are quite frankly retarded. They have no idea what they’re talking about and no idea what we actually do.

[Max Marchione @maxmarchione]

@GrantHesser Want to bet?

Within 5 years:
- PCPs will be replaced (excluding urgent care/procedures)
- Human reasoning / diagnosis will be replaced

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@MattWalshBlog I’ll agree when it’s successfully carried out.

These days we can’t even properly execute people.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

A subocclusive thrombus would not cause syncope alone. If you think you’ve seen a case of that, I invite you to improve your eye exams. It would cause additional symptoms and findings. The extent of tissue involvement to lose consciousness is too large.

I can think of a guy who had an episode of syncope and had a stroke later that day that was completely unrelated. It also may have been related via arrhythmia as you said, in which case the arrhythmia still requires investigation if it was enough to cause syncope and generate a thrombus (that’s not afib friend). Which brings us right back to my original statement that his cause of syncope still needs to be investigated if he actually had syncope and not something lazily and incorrectly described as syncope.

And I don’t know why this imagining was obtained beyond what is listed on the post.

Not sure how many times I can say this, but true syncope does not require a CTA (or any cervical/cranial vascular imaging). They get ordered constantly and they’re all dumb to get.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

Ordering a CTA for syncope without a really, really good reason is the real malpractice.

Probably the dumbest reason to order a CTA, and I say that as a fan of the CTA.

[Francis Deng, MD @francisdeng]

63-year-old man presents with syncope.
ED: CTA head and neck
This finding in the intradural left vertebral artery is alleged to have been missed (real case image).
The malpractice complaint states the patient re-presented 9 hours later with distal embolization to the basilar artery (subocclusive) and left superior cerebellar artery (occlusive), resulting in permanent injury.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@AnActualRad Sadly it probably is that high.

I get so many syncope referrals as well. Patients who haven’t even had an EKG with a stat neurology referral.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

The patient you’re describing would have exam findings and would not be a simple syncope.

People do not lose consciousness from a basilar thrombus (or any thrombus impacting the posterior circulation) and have normal neurological exams or at least a clear TIA syndrome. The extent of the area involved to cause loss of consciousness is too large.

Hence why I said if this was legitimate syncope as I defined above, then this test was not required in the first place and he still needs to be evaluated for syncope.

Considering this is the image shared for the lawsuit, this is likely the best he has.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@willessd @BBillDavis Your inability to read is not my mental gymnastics.

You have helped to convince me that at least one physician can easily be replaced by AI.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@willessd @BBillDavis Did I say any or did I say just about any?

Did I say difficult or did I say complex?

Not sure if you understand the differences.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@lfstevens AI is extremely useful in limiting diagnostic blindness. I use it partly for this reason. If you feed it accurate information, it is incredibly helpful. It gets you to think of things you otherwise wouldn’t.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@willessd @BBillDavis There was nothing vague and no flip flop.

There is a major difference between complexity and difficulty.

Saying just about any acknowledges that it’s not absolute.

Perhaps if you could read effectively, you wouldn’t require this explanation.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

The general distrust of physicians following COVID is an unfortunate and understandable reality. Totally earned and you may be correct in that large numbers of people are primed to choose an alternative even if it’s terrible.

[Mad Irishman @OneMadIrishman]

@realLongWangMD People will trust AI more than those that pushed an ineffective treatment and lied about it...

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@OneMadIrishman The general distrust of physicians following COVID is an unfortunate and understandable reality. Totally earned and you may be correct in that large numbers of people are primed to choose an alternative even if it’s terrible.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

Many people are gleefully awaiting the replacement of every job with AI.

I’ll say to all of you the same thing I said to people advocating COVID lockdowns.

You have no idea what you’re asking for and you will be unpleasantly surprised by the results.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@willessd @BBillDavis No.
I think clinical medicine is far more intellectually and legally complex than just about every other job/career in existence. Any AI capable of replacing me would be capable of replacing you long before that.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@JaysonLavie If he actually had syncope (sudden loss of postural tone and consciousness with rapid regaining of consciousness and return to baseline) and not a fall or syncope plus additional neurological symptoms with atypical recovery or protracted LOC, then it almost certainly is not.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

If I had a dime for every patient who refused to follow recommendations for statin, aspirin, blood pressure control, stopping smoking, exercising for 150 minutes weekly, and controlling their diabetes so their blood syrup I’d be able to retire 5 years ago.

People do view doctors poorly. They think we’re ignorant, just out for money, sociopaths, or controlled by pharma.

Doctors view patients poorly as well. Thankless and likely to sue them for their own personal errors. It’s a sad situation.

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@knottabott https://t.co/n1u0WxtLhY

[Dr. L. John Wang MD PhD MBA MPH @realLongWangMD]

@BBillDavis The day AI can replace me is the day it replaces everybody.