internist - primary care - associate professor | - (Salary 233k + RVU bonus) - no other COI
Joined June 2009
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Living thread of lessons learned after attempting primary care academic medicine since 2013--🧵
"This randomisation ratio was chosen to address participating centres’ financial concerns about reduced revenue from ablation procedures and patients’ and physicians’ concerns about deferring guideline-recommended catheter ablation during the blinded follow-up period"
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I’m not as confident in the MA (adding old studies right?)
Just old biases creeping in.
If it is lower BP fine, but don’t want to add yet another agent without confirming it’s this specific drug.
Why is everyone dismissing this?
Consistent reduction in mortality seems important IMO
Is this just effect of BP control? Seems more than that
Not easiest drugs to take, especially hydralazine
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Easier to encourage the slop than implement the actual answer—teach appraisal.
The amount of serious discourse I seem to have kicked off the last couple days is pretty wild. Nobody is banning med student research. Come on people. Clearly compulsory med student research is a big problem though. Should it be illegal, resulting in jail time? No, 3 days on the vascular surgery service should suffice.
Btw, the jail thing was a joke. I hate clarifying jokes, but I’m genuinely concerned about the well being of some of my biggest PhD haters.
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Caspian Kuma Folmsbee MD retweeted
This #JGIM #BottomLineSummary by @FolmsbeeMD showed that continuing aspirin use for chronic coronary heart disease can be harmful when used with other blood thinners
🆓 full-text ⬇️:
rdcu.be/fo9eF
Woof. And then recommending an LLM to translate it to Spanish for your patient. What are we even doing anymore?
A new Clinical Practice article summarizes the classification, evaluation, risk stratification, and management of syncope. History, examination, electrocardiography, and orthostatic blood-pressure measurement identify the cause in most patients.
Read “Syncope” by Rose Anne Kenny, MD, DSc: nej.md/4cjFuVU
Ask AI Companion to provide a summary of this article for your patient. In Spanish.
ALT A flowchart from the Clinical Practice article "Syncope" by Rose Anne Kenny, M.D., D.Sc., that shows the general principles for initial evaluation of all patients after an episode of syncope. The chart includes steps such as suspected syncope, evaluation, history taking, and an ECG. It categorizes causes of syncope as certain or uncertain, leading to risk assessment and further evaluation or treatment.
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This actually reflects poorly on the teacher and not the students.
A Brown professor gave his students a take-home midterm exam. After suspecting many cheated using AI, he made the final in-person. The orange dots are the midterm scores and the gray dots are the final scores. Looks like all but 3 cheated on the midterm.
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The fact he took the time to read what I wrote is one of my proudest moments. RIP
This truly nails it. Shared decision making is a mirage without shared understanding and a relational context.
I gave up believing it possible until the arrival of generative AI. The BMJ triadic care Analysis articles explain how it might be achievable. @crblease
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“Not caring about their health” is such a superficial understanding of how complex we all are, not to mention a system stacked against them.
This is a poignant reminder about patient motivation.
Even *a literal heart attack* is not enough to get most patients to care about their health, and these aren't particularly hard targets to reach!
I bet if this chart added obesity, it would look even worse.
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Caspian Kuma Folmsbee MD retweeted
2018 vs 2026 Lipid guidelines compared.
The visually striking thing is the number of recommendations made in 2026 vs. 2018 : more than 4x as many recommendations, and observational-evidence recommendations replaced RCTs as the foundation.
The COI story is interesting🧵
AI is making us worse. Repeated bullet points. CAC point talks about meds? Do we even care what we share anymore?
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More nuanced and low value. Perfect for AI.
I genuinely disagree with this.
More and more nuanced management flow charts mean that we are getting closer and closer to the ideals of precision medicine: matching the right patient to the right treatment.
It means our understanding of disease and risk mitigation is getting more nuanced. (Caveats here about evidence tiers for some recommendations.)
Is it a pain? Sure. But that's the job.
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Why does everyone assume brainstorming with an LLM is helpful? Wouldn’t it just feed you other people’s ideas and limit your own creativity?
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Caspian Kuma Folmsbee MD retweeted
To statin or not to statin
unrelentingebm.substack.com/… via @KumaFolmsbee
Took a deeper dive into LIBERATE-D after listening to your episode. Less practice changing and more guideline nudging?
@adamcifu @drjohnm
open.substack.com/pub/unrele…
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Is #NEPHJC going to cover LIBERATE-D? Or do you think we already know the answer (less is more).
@kidney_boy @hswapnil
open.substack.com/pub/unrele…
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