I am not sure we can teach these students compassion or empathy. As an older internal medicine doc, I could never do this to a patient of mine. I hope when my next student comes to do their internal medicine rotation I can hope I get through to them about being more human and to have good listening skills. They need to stop rushing and listen. I will share this great article with them as well. Thank you
I want to applaud you for writing something hilarious; and, in part, I do so applaud. But, it also doesn't seem terribly far-fetched, which is enormously disturbing.
Nice job throwing Vinay and John under the bus, by the way!
I have read about half the comments. If we were living in a virtuous society, I would opine that your writing was an excellent presentation of hyperbole. But given the changes that have occurred since my first day in clinical practice (1973), I would with eyes wide open say this is no more preposterous than the American electorate having voted into office a criminal president whose emulous is to grab power a la Adolf or Vladimir.
Being board-certified in medical oncology and internal medicine & board-eligible in hematology, I would never have dreamed it would take me 4 months to see a colleague after I was diagnosed with light chain amyloidosis (AL) in 2018. And then, when I moved to Oregon from California, it was unthinkable that I would:
• need to wait 6 months to get a gatekeeper medical officer (should be there official title: GMO)
• then at the awaited first meeting with the GMO have all of 30 minutes to review my case and examine me.
• wait another 4 months to see the hematologist/oncologist
• have the HemOnc tell me she has never seen a case of light chain amyloidosis but she can order a CBC, chem panel, etc.
So the Dystopian Future that Dr. Cifu portrayed me be fiction today, but it is conceivable that it is reality tomorrow.
On a present-day note, I am not in total agreement with Doc Cifu about screening tests being a waste. Any man with a PSA of > 1.0 ng/ml has some pathological process going on in the prostate. Careful serial testing with PSA kinetics such as PSA doubling time (PSADT) and PSAV (PSA velocity) can discern very well if this is benign prostatic hyperplasia (BPH) vs. prostate cancer vs. prostatitis. Of course, if the patient's context is that he has far-advanced disease of any kind, screening makes no sense.
I also disagree with the reaction of many towards artificial intelligence (AI). We have been using AI-like programs to enhance diagnosis and evaluation for well over 30 years starting with nomograms, and then artificial neural nets (ANNs). Human beings cannot process a combination of variables and we need software tools to do so. I observed a world of change (for the better) with the above and am already noting the same with artificial intelligence (AI) and machine learning (ML). The basic concept involved in any biological system is to recognize the interplay of systems. I call this SAIN medicine with SAIN (Systems Analysis & Integrity Networking) being the foundation block.
Such analyses lead to a more accurate assessment of STATUS of a biological system (human, planet, ocean, air, etc) and that information is invaluable.
In the case of my life-threatenng illness, no one diagnosed me for over 5 years (so much for that concierge MD), but an AI software program (free) called Symptoma had light chain amyloidosis in the top 6 of a differential diagnosis. An earlier diagnosis of AL would have been life changing.
It is obvious you like “socialized” medicine politically,
But prefer non-government health care personally.
Can someone say “Obama-care”? Ie backdoor socialize medicine ??? 💊
Free advise, no charge ( Briben,”No joke”)
Stop drinking the CNN, MSLSD Demerol, quetiapine, haloperidol cocktail 🍸….. and probably refrain from THC for 90 days. The world will come into clarity.
You have no concept of socialism. You have no experience with the USSR or Russia--I would bet. There is nothing in my post above that is relevant to your BS criticisms. I cannot imagine an MD that prefers Fox "News" or prefers a criminal that became POTUS, or a GOP so rife with lunatics that kiss the "ring" at the far end of the GI tract, or a SCOTUS that is clearly out to lunch. The only thing we have in common is I am an old salt and right now would love to have my ship back to sail away from the lunatics that are populating this country.
I can see you are a Socialist WINGNUT that has no ability to think for one self and need to stay in the N. west with all of the blue hairs who think men can be women and vice versa.
Obviously you do not read anything that contradicts your own view point to determine if what you think is correct or, just maybe you were lied to by the propaganda media like what happened in Germany in the 1930’s.
You just repeat the “party’s “ statements even when they have been proven false for years.
So tell me…. How long has Briben had dementia ???
I have been writing about it for 5 years.
It appears that he has some form of dementia AFTER ALL…. But the media has said he has not been sharper just 2 weeks ago.
But you being the famed heme-onc doc from blue hair land …. Always knew … since two weeks ago when the media started telling you what to say.
Good lord they are still doing Whipples in 2040?? That “27th Covid vaccine” line was just mean - having had abdominal surgery yesterday and laughing out loud hurts! But I got to coughing and that helped clear some gunk! I need a Tylenol, hopefully that’s covered.
With one exception.. due to DIE the physician is non-white, never took an entrance exam, could not fail med school or be kicked out of the year and a half residency because that would be racist.
Dr. Google is their go-to text book and they seek advise from the nurse practitioner.
I forgot to mention …. This IS happening TODAY !!!!!!!
Lol I’m old enough to have seen terminator 1 and 2 as first run theatrical releases. And the “Mandrola laws” going live sounds a lot like Skynet acquiring self-awareness.
If the rads who perform and bill all these “screening MRI” had some skin in the game (ie fiscal responsibility for unnecessary downstream medical costs) maybe they won’t be so quick to taken the money of the suckers who pay for these things.
I’m truly terrified of the impending interference of AI. Had it been used in the past decade, it would have destroyed my life with living forcing me to continue to live with 16 of the 22 possible symptoms of hyperparathyroidism, endured three to four total surgeries, and I would have died at least 10 years earlier because of the inaccurate diagnosis and treatment recommendations by doctors only trained in following one-size-fits-all standard guidelines and not using their own critical thinking skills. Their nonsense would have fed an AI, and boy did they get it all wrong. In the end I had to use my own critical thinking skills and save my own life.
A few years back I had a surgery to remove three parathyroid tumors. The currently followed diagnostic criteria is very faulty and out of date. I had been living miserably for 6-8 years with symptoms that destroy quality of life. I had to fight with specialists and surgeons in my area for well over a year to accurately diagnose me, continuously dodging their persistent premature prescribing of osteoporosis medication for my subsequent severe advanced osteoporosis that is rarely seen in anyone my age, 30 years too young for my scores. Even the endocrinologists were shocked my scores were so low for my age. Tests and scans were misread, blood tests were reported inaccurately, and it would have been very bad had they injected me with that osteo medication when the real problem was hyperpsrathyroidism. As it was, only one tumor actually showed on the scan, but they wrote it off as a fatty cyst or something. I kept researching and pushing and found the best experts on hyperparathyroidism in the world and flew to see them. (We do not have the means to afford this, but I was desperate and we sacrificed a LOT to be able to see them.) They clearly saw the scan was misread and I had a parathyroid tumor. But scans only find 50% of them. I then flew back two weeks later for surgery and they didn’t remove just one, but three! Big ones. The surgeons around me would have left two of them in me while I continued to suffer the symptoms, and then expose me to more surgeries when/if one of the others showed on a scan.
A couple months after my surgery I fired every doctor connected with the hospitals around me, and switched to a low carb diet. I sit here today two years later a new creation at age 59. Healthier than I’ve been in 30 years, energy of a 20-yr old, vibrant, clear skin, and I lost 55 lbs. I’m very active at a gym for the first time since my 20s.
Had AI controlled my care, my horrible symptoms of 8 years would have continued and I would have died much earlier while suffering from the many diseases untreated hyperparathyroidism can cause. That’s what is waiting for the masses of AI is relied upon.
So many of the maladies plaguing people today are due to the mega corporate hijacking our food supply. Insulin resistance is rampant and not just in obese diabetics. Ever since Framingham started the AHA has its head up its *** and stopped looking at biochemistry of where very dense LDL arise from in the diet. The Pharmaceutical industry have actively suppressed so much dietary and naturopathic information to stop problems from arising in favor of popping a pill with numerous adverse effects for which there is another pill. Common sense metabolic biochemistry of how the body uses what we shove down our throats has been shoved to the wayside. As long as we continue to focus on treating diseases (Band Aide at best) and ignore trying to ameliorate the causes underlying these chronic diseases, the insurances and governments of the world will increase curtailment of services.
"Insulin resistance" is the cells way of limiting damage to excess blood glucose entering the cell(via Glut4)..Its also a mental construct as we cannot measure "insulin resistance"The problem is excess glucose levels..which cause the dysfunction of insulin responses/levels etc..then we have 2 problems..glucose/insulin....
Hey, let’s look on the bright side. At least with only six clinic sessions, Dr. McGraw managed to diagnose reactive airway disease and avoid handing over a needless script for Levaquin (lol).
Also, I completely lost it at the Apple Pay suggestion 😂
Having only been on Medicare for a year, I was shocked when bills for my colonoscopy kept coming in. I had a positive test for fecal blood on a routine exam (no gross blood, no complaints; was told the test was not routinely repeated when I balked at colonoscopy). Who knew that your colonoscopy is free only when you don’t need it!? Screening/routine colonoscopy is fully covered. But if you have one due to actual concern, NOT fully covered. Who makes these rules?
Yes. Crazy. Like the annual "Wellness" or "Well" visits. An ICD-10 primary diagnosis code is assigned to your visit for billing purposes. I once went for an annual "Wellness" visit that was reportedly covered with no co-pay by my insurance. Why? Well, they want us to be seen annually to remain Well! Alas, I received a bill as the diagnoses assigned showed that I was not "Well" and the ordered blood work was denied. Fought that one successfully but the additional stress did not help with my Wellness. The system wants you to be "Well" or else you may incur a bill.
At my last PCP exam I learned that "Primary Insomnia" was my primary diagnosis. Well (again, no pun intended), I told the truth when my then PCP asked how I was sleeping. What nearly 60 y.o. person doesn't have trouble sleeping from time to time in this day and age? My PCP had to give me a diagnosis at my "Well" visit and that's what he came up with.
I am not sure we can teach these students compassion or empathy. As an older internal medicine doc, I could never do this to a patient of mine. I hope when my next student comes to do their internal medicine rotation I can hope I get through to them about being more human and to have good listening skills. They need to stop rushing and listen. I will share this great article with them as well. Thank you
Forgot to mention DEI graduate
I hope before we reach there our
Students get talk on listening skills ,compassion ,and empathy training
And also understanding of treat thy neighbour.
But definitely appludable /hilarious read.
Let’s wake up team of medical community !!!
I want to applaud you for writing something hilarious; and, in part, I do so applaud. But, it also doesn't seem terribly far-fetched, which is enormously disturbing.
Nice job throwing Vinay and John under the bus, by the way!
I have read about half the comments. If we were living in a virtuous society, I would opine that your writing was an excellent presentation of hyperbole. But given the changes that have occurred since my first day in clinical practice (1973), I would with eyes wide open say this is no more preposterous than the American electorate having voted into office a criminal president whose emulous is to grab power a la Adolf or Vladimir.
Being board-certified in medical oncology and internal medicine & board-eligible in hematology, I would never have dreamed it would take me 4 months to see a colleague after I was diagnosed with light chain amyloidosis (AL) in 2018. And then, when I moved to Oregon from California, it was unthinkable that I would:
• need to wait 6 months to get a gatekeeper medical officer (should be there official title: GMO)
• then at the awaited first meeting with the GMO have all of 30 minutes to review my case and examine me.
• wait another 4 months to see the hematologist/oncologist
• have the HemOnc tell me she has never seen a case of light chain amyloidosis but she can order a CBC, chem panel, etc.
So the Dystopian Future that Dr. Cifu portrayed me be fiction today, but it is conceivable that it is reality tomorrow.
On a present-day note, I am not in total agreement with Doc Cifu about screening tests being a waste. Any man with a PSA of > 1.0 ng/ml has some pathological process going on in the prostate. Careful serial testing with PSA kinetics such as PSA doubling time (PSADT) and PSAV (PSA velocity) can discern very well if this is benign prostatic hyperplasia (BPH) vs. prostate cancer vs. prostatitis. Of course, if the patient's context is that he has far-advanced disease of any kind, screening makes no sense.
I also disagree with the reaction of many towards artificial intelligence (AI). We have been using AI-like programs to enhance diagnosis and evaluation for well over 30 years starting with nomograms, and then artificial neural nets (ANNs). Human beings cannot process a combination of variables and we need software tools to do so. I observed a world of change (for the better) with the above and am already noting the same with artificial intelligence (AI) and machine learning (ML). The basic concept involved in any biological system is to recognize the interplay of systems. I call this SAIN medicine with SAIN (Systems Analysis & Integrity Networking) being the foundation block.
Such analyses lead to a more accurate assessment of STATUS of a biological system (human, planet, ocean, air, etc) and that information is invaluable.
In the case of my life-threatenng illness, no one diagnosed me for over 5 years (so much for that concierge MD), but an AI software program (free) called Symptoma had light chain amyloidosis in the top 6 of a differential diagnosis. An earlier diagnosis of AL would have been life changing.
https://www.symptoma.com/
Stephen B. Strum, MD, FACP
WTF!!!!
Stay in Commune Oregon!!!
It is obvious you like “socialized” medicine politically,
But prefer non-government health care personally.
Can someone say “Obama-care”? Ie backdoor socialize medicine ??? 💊
Free advise, no charge ( Briben,”No joke”)
Stop drinking the CNN, MSLSD Demerol, quetiapine, haloperidol cocktail 🍸….. and probably refrain from THC for 90 days. The world will come into clarity.
You have no concept of socialism. You have no experience with the USSR or Russia--I would bet. There is nothing in my post above that is relevant to your BS criticisms. I cannot imagine an MD that prefers Fox "News" or prefers a criminal that became POTUS, or a GOP so rife with lunatics that kiss the "ring" at the far end of the GI tract, or a SCOTUS that is clearly out to lunch. The only thing we have in common is I am an old salt and right now would love to have my ship back to sail away from the lunatics that are populating this country.
Actually you are incorrect on many counts.
I am extremely familiar with socialized medicine.
I can see you are a Socialist WINGNUT that has no ability to think for one self and need to stay in the N. west with all of the blue hairs who think men can be women and vice versa.
Obviously you do not read anything that contradicts your own view point to determine if what you think is correct or, just maybe you were lied to by the propaganda media like what happened in Germany in the 1930’s.
You just repeat the “party’s “ statements even when they have been proven false for years.
So tell me…. How long has Briben had dementia ???
I have been writing about it for 5 years.
It appears that he has some form of dementia AFTER ALL…. But the media has said he has not been sharper just 2 weeks ago.
But you being the famed heme-onc doc from blue hair land …. Always knew … since two weeks ago when the media started telling you what to say.
Hmmmm ..
you are funny. 😆
Listend to this using the audio option lol
Good lord they are still doing Whipples in 2040?? That “27th Covid vaccine” line was just mean - having had abdominal surgery yesterday and laughing out loud hurts! But I got to coughing and that helped clear some gunk! I need a Tylenol, hopefully that’s covered.
Very creative/satirical! I think Dr AI is coming soon to a hospital near you. Sabrinalabow.substack.com
This is spot on!!!!
With one exception.. due to DIE the physician is non-white, never took an entrance exam, could not fail med school or be kicked out of the year and a half residency because that would be racist.
Dr. Google is their go-to text book and they seek advise from the nurse practitioner.
I forgot to mention …. This IS happening TODAY !!!!!!!
You mean DEI...right? Perhaps DIE is a Freudian slip?
No, DIE (no matter which way you like your letters how about IDE or EDI …. )
Which means:
Discrimination
Intimidation
Exclusion
Lol I’m old enough to have seen terminator 1 and 2 as first run theatrical releases. And the “Mandrola laws” going live sounds a lot like Skynet acquiring self-awareness.
If the rads who perform and bill all these “screening MRI” had some skin in the game (ie fiscal responsibility for unnecessary downstream medical costs) maybe they won’t be so quick to taken the money of the suckers who pay for these things.
I’m truly terrified of the impending interference of AI. Had it been used in the past decade, it would have destroyed my life with living forcing me to continue to live with 16 of the 22 possible symptoms of hyperparathyroidism, endured three to four total surgeries, and I would have died at least 10 years earlier because of the inaccurate diagnosis and treatment recommendations by doctors only trained in following one-size-fits-all standard guidelines and not using their own critical thinking skills. Their nonsense would have fed an AI, and boy did they get it all wrong. In the end I had to use my own critical thinking skills and save my own life.
A few years back I had a surgery to remove three parathyroid tumors. The currently followed diagnostic criteria is very faulty and out of date. I had been living miserably for 6-8 years with symptoms that destroy quality of life. I had to fight with specialists and surgeons in my area for well over a year to accurately diagnose me, continuously dodging their persistent premature prescribing of osteoporosis medication for my subsequent severe advanced osteoporosis that is rarely seen in anyone my age, 30 years too young for my scores. Even the endocrinologists were shocked my scores were so low for my age. Tests and scans were misread, blood tests were reported inaccurately, and it would have been very bad had they injected me with that osteo medication when the real problem was hyperpsrathyroidism. As it was, only one tumor actually showed on the scan, but they wrote it off as a fatty cyst or something. I kept researching and pushing and found the best experts on hyperparathyroidism in the world and flew to see them. (We do not have the means to afford this, but I was desperate and we sacrificed a LOT to be able to see them.) They clearly saw the scan was misread and I had a parathyroid tumor. But scans only find 50% of them. I then flew back two weeks later for surgery and they didn’t remove just one, but three! Big ones. The surgeons around me would have left two of them in me while I continued to suffer the symptoms, and then expose me to more surgeries when/if one of the others showed on a scan.
A couple months after my surgery I fired every doctor connected with the hospitals around me, and switched to a low carb diet. I sit here today two years later a new creation at age 59. Healthier than I’ve been in 30 years, energy of a 20-yr old, vibrant, clear skin, and I lost 55 lbs. I’m very active at a gym for the first time since my 20s.
Had AI controlled my care, my horrible symptoms of 8 years would have continued and I would have died much earlier while suffering from the many diseases untreated hyperparathyroidism can cause. That’s what is waiting for the masses of AI is relied upon.
So many of the maladies plaguing people today are due to the mega corporate hijacking our food supply. Insulin resistance is rampant and not just in obese diabetics. Ever since Framingham started the AHA has its head up its *** and stopped looking at biochemistry of where very dense LDL arise from in the diet. The Pharmaceutical industry have actively suppressed so much dietary and naturopathic information to stop problems from arising in favor of popping a pill with numerous adverse effects for which there is another pill. Common sense metabolic biochemistry of how the body uses what we shove down our throats has been shoved to the wayside. As long as we continue to focus on treating diseases (Band Aide at best) and ignore trying to ameliorate the causes underlying these chronic diseases, the insurances and governments of the world will increase curtailment of services.
"Insulin resistance" is the cells way of limiting damage to excess blood glucose entering the cell(via Glut4)..Its also a mental construct as we cannot measure "insulin resistance"The problem is excess glucose levels..which cause the dysfunction of insulin responses/levels etc..then we have 2 problems..glucose/insulin....
Hey, let’s look on the bright side. At least with only six clinic sessions, Dr. McGraw managed to diagnose reactive airway disease and avoid handing over a needless script for Levaquin (lol).
Also, I completely lost it at the Apple Pay suggestion 😂
i love comical snark…and fiction?
It reads all too true… I suspect that this or a similar pathway is in our not too distant future…
Having only been on Medicare for a year, I was shocked when bills for my colonoscopy kept coming in. I had a positive test for fecal blood on a routine exam (no gross blood, no complaints; was told the test was not routinely repeated when I balked at colonoscopy). Who knew that your colonoscopy is free only when you don’t need it!? Screening/routine colonoscopy is fully covered. But if you have one due to actual concern, NOT fully covered. Who makes these rules?
Yes. Crazy. Like the annual "Wellness" or "Well" visits. An ICD-10 primary diagnosis code is assigned to your visit for billing purposes. I once went for an annual "Wellness" visit that was reportedly covered with no co-pay by my insurance. Why? Well, they want us to be seen annually to remain Well! Alas, I received a bill as the diagnoses assigned showed that I was not "Well" and the ordered blood work was denied. Fought that one successfully but the additional stress did not help with my Wellness. The system wants you to be "Well" or else you may incur a bill.
At my last PCP exam I learned that "Primary Insomnia" was my primary diagnosis. Well (again, no pun intended), I told the truth when my then PCP asked how I was sleeping. What nearly 60 y.o. person doesn't have trouble sleeping from time to time in this day and age? My PCP had to give me a diagnosis at my "Well" visit and that's what he came up with.