Liked this opinion piece that cropped up in my emails this morning from another RD working on a cardiac floor. Good to see more people speaking up on this. How often are you all seeing this come up in your consults or conversations these days?
I’m admittedly a bigger fan of acronyms than most my colleagues, who tell me they sometimes have to google my notes to make sense of things (in my defense, I pale in comparison to optho). I even enjoy somehow doing the same on consultant notes, or using context clues to figure out what they meant.
A particularly useful one is USOH (usual state of health). Occasionally I’ll drop BIBEMS (brought in by EMS) as a nod to my former EM days as well. My specialty is also fraught with its own great acronyms to confuse other consultants that wind up on our cases.
It however slightly saddens me to see SOB now becoming SHOB (I get why, but still). Neurosurgery will forever be NSG to me, the newer NES, as a millennial, always makes me pause to query why duck hunter or the old school Zelda are being brought into the mix.
What about you guys?
With the increase of AI and patients using AI to help research symptoms, this lawsuit is flagging a potentially interesting precedent where AI companies might be seen as practicing medicine without a license. Sharing here as it seems useful to surface.
Pennsylvania has sued an artificial intelligence chatbot maker, saying its chatbots illegally hold themselves out as doctors and are deceiving the system’s users into thinking they are getting medical advice from a licensed professional.
The lawsuit, filed Friday, asks the statewide Commonwealth Court to order Character Technologies Inc., the company behind Character.AI, to stop its chatbots “from engaging in the unlawful practice of medicine and surgery.”
The lawsuit could raise the question as to whether artificial intelligence can be accused of practicing medicine, as opposed to regurgitating material on the internet.
Looking for insight from all primary care docs regardless of specialty!
I’m a primary care pediatrician in private practice, 2 years out of residency. I’m starting to feel pretty burned out and I’d like some advice on how those of you have been in the game for years are handling it. For what it’s worth, I’m leaving private practice to go to an FQHC in 2 months, but I’m interested in hearing from PCPs in any practice setting.
Hours. My current practice is open evenings until 8 pm on weekdays and all day Sat/Sun. Visits are 15/30 (15 for wells and most sick, 30 for adolescent wells, concussions, and if requested by provider for medically complex kids.) On Saturdays the place is staffed with the on-call physician seeing patients all day, an NP doing a half day, and during respiratory season, a second physician doing a half-day. The on-call physician also staffs the clinic all day on Sundays. (On our call days, we round on newborns in the hospital and see patients in clinic.) This leads to a lot of weekend time, there have been a few months where I’ve worked 3 weekends in a row, which is obviously nothing compared to residency, but much more than my PCP friends in IM/FM, who work no weekends at all. It also wasn’t made clear to me that I would have clinic on Sundays when I started this job, I assumed I would just be rounding on newborns and taking phone call, since this practice’s web site lists its hours as M-F 8-5 and Sat 9-1 with “evenings and Sundays by appointment only.” In practice this means a full schedule on evenings and weekends but when I started this job I assumed hours would be consistent with what was listed on the Web site. (yes, I was naive!)
Parent call. During evenings and weekends, parent phone calls are not triaged through a nurse line until 10PM, so it’s typical to come home on a Sunday at 4 or 5 PM and be answering parent calls for the next 5 or 6 hours on Tylenol dosing, rashes, constipation, in addition to actual triage. From what I have learned from friends in other practice settings, it seems like the parent call line is usually nurse triaged with physician backup - does our office’s set up seem typical?
The general primary care feeling of having not enough time. It’s starting to make me so angry that specialists get 1 hour for news, 30 min for wells while I get half the time to work up an undifferentiated patient. For example, I recently had a teenager who presented for evaluation of headache. On history, it turns out she had an unprovoked GTC seizure last month while on vacation (so no ED records available) with in addition to nighttime awakening. So I take a thorough history, including confidential portions (substance use), do a full neuro exam (obviously), manually recheck her BP (initially recorded as high, normal when I checked it), ordered a full workup (CBC, CMP, TFTs, EKG, urine drug screen, brain MRI), urgent neuro referral, talk to the family about my concerns, prescribe rescue Diastat and explain why it’s necessary to break a seizure lasting >5 min, provide a school nurse note to give Diastat if needed, etc. (As far as why I ordered the brain MR instead of deferring to neuro- I practice in a low SES area where people frequently miss specialist visits.) I was given 30 min, obviously this takes an hour and now I’m running behind. When Neuro sees this kid for a new visit, they’ll get an hour even though I packaged everything up for them in a bow. It’s hard not to feel resentful about this.
Pressure to work when sick. I have definitely learned that I need to mask in every room, practically every kid under 2 has a URI during their wells, and I just feel like I get sick so frequently! My threshold to call out is really high but in practice this leads to a lot of being at work while I’m coughing behind a mask (prone to lingering bronchospastic cough after viral URIs) and just generally feeling awful.
Most of the parents I work with are lovely, but I’m frequently having to tell families things they don’t want to hear - adolescent eating disorder outpatient weight restoration isn’t working, if this trend continues we’re going to have to go inpatient; 3 month old with bronchiolitis and retractions needs to go to the ED, yes I know you have no one who can look after your other kids but I don’t think this can be managed at home - in addition to mandated reporting to CPS (which happens rarely, but sometimes it does) and being a lightning rod for people’s anger/frustration is really tough. One of these interactions is enough to ruin my day even if the other 20+ are positive. How have you all learned to cope with this?
I do think transitioning to an FQHC will be a better fit for me (my residency clinic had a very similar patient population and I loved it) and will have better hours. It also pays better and offers loan forgiveness which will put me in a better place to go part-time in the future if needed. But I would like to hear other perspectives on burnout management. Thanks so much!
https://pubmed.ncbi.nlm.nih.gov/39475107/
To preface this, I work in a pediatric setting. I know they aren't new, but good night. From experience, it feels like we already are seeing a)more injuries and traumas and b) the outpacing of injuries and traumas caused by analog bikes by their battery-powered counterparts. The acuity is typically higher and it is an absolute nightmare. They can reach speeds as high as 30+mph(48+kmh). There is no regulation surronding them. Summer just started and it looks like it will be a busy one.
Surgeons are an integral part of the health care system, supplying critical and urgent care in nearly every field of medicine. But surgeons are already in short supply, with the gap between the number needed and the number working expected to get worse.
In a new study, researchers at The Ohio State University and The Ohio State University Wexner Medical Center found that nearly 10 % of surgeons left clinical practice within an eight-year period. These results are published** **in the Journal of the American College of Surgeons (JACS).
They found an overall cumulative attrition rate of 9.7% over eight years, with overall attrition rates steady from 2013 to 2018 before rising sharply in 2020, most likely due to higher rates of retirement during the COVID-19 pandemic, Pawlik explained. They also found that surgeons most likely to leave were mid-career surgeons with five to nine years of practice.
When it comes to subspecialties, researchers found the highest five-year accumulative attrition rates in oral and maxillofacial surgery (25.1%), obstetrics and gynecology (23.2%), and plastic and reconstructive surgery (19.3%). The lowest annual attrition rates were observed in orthopedic surgery (0.7%), otolaryngology (0.5%), podiatry/foot and ankle surgery (0.4%), and vascular surgery (0.8%).
Opinion:
47 is the worst Admin in U.S Hx, re public health & safety, by a light year - or maybe 10 light years.
Discuss.
With big tech trying to normalize mass surveillance (e.g., warrants placed on neighbors' Ring cameras for immigration enforcement, the increasing pervasiveness of Palantir), I wanted to share an anecdote by Dr. Gigi Magan, a bilingual family physician who intentionally paused her AI scribe especially for her Spanish-speaking patients and broaching the topic of immigration ("Voy a Pausar" [I am going to pause]).
Dr. Magan noticed that her patient had become more nervous over the past few months, especially when looking at the computer, and had begun shortening her answers. It was part of the trust and risk calculation, especially for undocumented people, given that AI scribes record conversations, and with the Bayesian consideration that ICE has gone ahead and detained/deported even US citizens. Specifically, before approaching a sensitive topic (e.g., immigration, domestic violence), Dr. Magan tells her Spanish-speaking patients this: "Voy a pausar esta herramienta para que hablemos en privado" [I am going to pause this tool so we can talk in private]. Her patient visibly relaxes.
Overall, Dr. Magan's anecdote highlights the real-world implementation considerations of putting AI scribes in the examination room, especially in settings underrepresented in vendor studies and even independent studies such as FQHCs, free clinics, and majority Hispanic clinics. That is an important consideration for consent, especially when immigration concerns enter the minds of a lot of Hispanic patients who come in to see you. Another aspect is for regulators and healthcare systems to interrogate how exactly and where exactly vendors store recorded conversations with their AI scribes, with strong emphasis on privacy, transparency, and health information security.
And I don’t mean stuff like not being up to date with the latest advances in the management of bullous pemphigoid or diagnosis of collagenous colitis. I mean the truly mind boggling stuff.
I saw this case online as a controversial management decision. Patient reportedly approached surgeon after maximal treatment for Complex Regional Pain Syndrome after undergoing a well-tolerated hip arthroplasty.
This sub doesn’t allow images and out of an M&M mindset, I’m not going to provide links to the surgeon nor site I saw it on/account.
I am a 4th year medical student and I have limited knowledge of CRPS. The images I saw showed a moderately edematous leg with a purplish, kind of livedo patterned skin with minimal hair (although this is a low specificity findings as it is common in the US for women to shave their legs). Also of note, the surgeon posted an exact location of where the pain syndrome region was, about 2 cm proximal to the knee joint. They also showed pre-op radiographs with a stable, uncomplicated artificial hip replacement with no downstream bone pathology.
Patient reportedly tried maximal medical therapy, nerve stimulation, and interventional pain procedures.
The red flags to me are the lack of what the “interventional procedures” and timeline for this arthroplasty were, and the other contributing medical history of this patient. It also strikes me as intriguing that the patient went seeking a very particular treatment for this issue. It might be my naïveté but the hip arthrosplastys I’ve been in on usually leave the region where the patient’s pain is very well alone.
I welcome your discussion, your teaching, and your thoughts on managing such a case. I am reaching out to the broader community to better inform my own opinions regarding this case, as I have many mixed feelings right now.
This drug, daraxonrasib, is the topic of an ASCO’s plenary session at the end of the month, likely the one with the most fanfare. Pancreatic cancer has been a graveyard for oncology drug development for decades. That’s part of why the reported RASolute 302 data are getting so much attention.
The eventual drug traces back through decades of academic work, failed hypotheses, and persistence after most pharma/biotech companies abandoned the field.
Reported OS in metastatic PDAC was 13.2 months vs 6.7 months with chemotherapy (HR 0.4, P < 0.0001). Obviously need to see the full dataset from RASolute 302 at ASCO, but at face value that’s a striking signal in a space that hasn’t moved much.
This is in the ITT population, not limited to RAS-mutated disease. Really interested in the subgroup breakdown to understand how much of the effect is being driven by RAS-mutant patients vs broader activity. Will need to see the break down of the chemo used and if there any imbalance with what was used in more fit pts.
The OS number also stands out in what’s a 2nd line setting, but looks more comparable to 1st line OS numbers. Curious what second-line regimens patients actually received. Will want to see gr 3/4 ADEs and what discontinuation rates are, but FOLFIRINOX, usual 1st line treatment, is not an easy regimen to tolerate. This is me trying to cool expectations, but genuinely happy to see this incredible advancement in the pancreatic space.
We have FDA approved KRAS G12C inhibitors for those with that mutation in NSCLC and even in pancreatic cancer, but with more marginal results. Results that don’t have an overall survival benefit of significant magnitude and are only for the G12C mutant subset. In panc, it’s small subsets, not controlled, and an OS near ~7 mos. In NSCLC, no stat sig significant difference OS benefit as monotherapy in 2nd line treatment.
Back to this story, KRAS is described as a target with minimal places for a drug to attach to, which is how became known as the undruggable target. Approach to overcome this described in the story is: “developed a strategy to stick a drug onto another protein in the cell, cyclophilin, and then use the larger combined surface to wrap around KRAS and shut it down.”
NYT story of how the drug came to be: https://www.nytimes.com/2026/05/12/health/pancreatic-cancer-daraxonrasib-kras.html?smid=nytcore-ios-share
Limited available results:
https://www.onclive.com/view/daraxonrasib-yields-significant-survival-advantages-vs-chemotherapy-in-metastatic-pancreatic-cancer
Specifically curious on quantitative data used to determine budgets, ie how the math maths.
Recently was at a medical conference. I get that you want something sexy to draw people to your booth, but some were SO over the top that it made me ill, especially when I would love to prescribe some of these drugs but my patients can’t afford them. We’re talking not thematically related driving simulators, a car, basketball arcades…etc.
Some had expensive setups but were somewhat more justifiable - eg one drug was extra with the plush carpet but it was eye catching and the VR headsets were educational for me and by extension patients. Another had a neat house set about detecting bronchiectasis.
I know they’re doing it to attract doctors to sell their products. But is their evidence that somehow a driving simulator is going to sway a prescriber more so than an educational VR headset?
Like keep the 12ft dragon but maybe drop the giant tree and use that budget for coupons to give patients discounts on their products?
And secondarily…this conference specifically mentioned trying to reduce their carbon footprint. Can conferences tell companies in their exhibit halls to tone it down?
https://www.medpagetoday.com/washington-watch/washington-watch/121375
Drs. John Wong, MD and Esa Davis, MD, MPH were terminated on May 11, but also reinvited to apply for membership with a deadline of May 23, 2026. Kennedy said he "directed a review of current USPSTF appointments [to] ensure clarity, continuity, and confidence in the Department's exercise of its appointment and supervisory responsibilities and to protect the integrity of the Task Force's work. ... [The action] is administrative in nature and is unrelated to your performance or many years of dedicated service to the Task Force. ... Your continued participation would be highly valued." 50% (8 of 16) of the USPSTF is currently vacant.
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Modus operandi of RFK Jr.: break first and replace without transparency or independent review. I'm sure he's going to put Big Wellness and Big Supplement in charge of determining which preventive services are supported.
I tried 1 last year. It was okay, but the amount of editing that I was having to do did not really help me out at all. So I've gone back to simply dictating my notes, but it takes me a long time to get done, like an hour and a half. So my last patient got finished at 05:30, and then I will say that it was about a 20 minute drive home, so an hour and a half of documenting. I'm willing to try just about anything to make this better.
But last year, no more efficient at all.
I am on Eclinicalworks.
I’m a speech therapist and work in outpatient rehab. All my jobs have been paid hourly, so when things get busy and I’m seeing a bunch of patients, I get paid overtime if I need to chart late or census is high. Granted, they didn’t like paying me time and a half so they would try to keep the schedule manageable. I barely had to work overtime.
I am starting a new job that is paid salary, but bonuses will be given for productivity based on RVUs billed per quarter. So my thought process is that instead of getting compensated via overtime during busy times it’ll be paid via the bonus. This is an entirely new system to me. I’m a little worried I’ll be working over 40 hours a ton due to being salaried. Don’t get me wrong, I love the idea of a bonus for productivity but I also value a work life balance too.
Looking for suggestions on how to set boundaries or red flags to look out for in this type of set up? I’d like to start strong rather than have to back track if shit gets overwhelming. My hackles are a tiny bit raised because this clinic is a corporate chain type vibe so I’m worried about the drive for profit. I took the job because the pay is good, benefits are better than I’ve ever had and they are providing me a hefty moving bonus (was going to be moving to that town regardless of what job I got). It’s also a special multidisciplinary clinic quite unique for speech therapists.
Thanks!
I have been talking to a friend of mine who is a lawyer who had a lot of luck ( 120usd / hour ) with some of these AI training companies. He's obviously working in his own field and quite frankly I was a bit surprised on the amount of money some of these companies are willing to pay.
I just wanted to ask here, if someone is doing the same and if so what are your thought about the whole ordeal ? do you think its ethical and could it ever reach a point where it actually replaces doctors or affects this field negatively ?
I personally am in the Computing science field and I think it might be a sailing ship for us, I would love to know how other fields are thinking about this change.
https://www.usf.edu/health/public-health/news/2025/steph.aspx
https://www.hhs.gov/about/leadership/stephanie-haridopolos.html
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As of now, there is no permanent and voted-upon surgeon general. She is married to US Representative Mike Haridopolos (R-FL-8). Some of the quotes I've seen in the articles about what Haridopolos stands for:
No comment from her I've seen from vaccines.
https://fingfx.thomsonreuters.com/gfx/legaldocs/lbpgyelqepq/05192026doe.pdf
The final rule published on May 1, 2026 excludes certain healthcare staff including PAs, APRNs, PT, OT, and SLP from higher loan caps because they are graduate degrees rather than professional degress (which includes MD, DO, JD, podiatry, and theology). I am neutral on this, but lifetime loan caps inhibit a lot of lower income folks from getting an education to become part of the healthcare system.
I saw patient today for follow up who all I did was get him to the correct provider to confirm and treat the right diagnosis. They were grateful to finally be diagnosed correctly and to have been referred to a provider who treated them so well. Despite their gratitude, I cannot think of the road ahead for someone with a progressive neurological illness. I know I got them to the right team with the right resources for now and down the road, and I really wish this was a case when I was wrong and it was psych and I had more ways to be helpful. How do you take care of your self care in when you cannot stop thinking about a patient and their circumstances?
Is there a way to find myself a medical scribe job from outside the US? I am an egyptian medical student in my final year and I’ve been doing cold calling next to uni for like 3 years now but I want to switch to another job that feels more relevant to my studies.
And anyone here interested that I’d do this job for them,I’d happily help.