FACEP FACEM AFAIDH. Emergency Medicine & Informatics. @AnnalsofEM Podcast & Journal Club. Columnist @ACEPNow. Speaker, writer, dad. @Stanford '00. 🇺🇸 in 🇳🇿
Joined June 2011
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How precarious is the valuation of OpenEvidence – when anyone can get better performance out of a general-purpose LLM, or even the much-maligned generative search result in Google?
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Do you like using bicarbonate in cardiac arrest? Couldn't hurt!
Do you hate using bicarbonate in cardiac arrest? Waste of time!
You're both right; never change.
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The beguiling suggestion viral testing will reduce antibiotic use (or other investigations) doesn't quite pan out as expected – positive testing does, indeed, diminish prescribing, but negative testing increases.
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There's absolutely a role for well-made educational games –
– the case is better made for them when the intervention is compared to an active control, however, rather than intellectual famine.
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Will this be the study that finally puts a dent in outpatient prescribing of azithromycin?
Oh, of course not.
But, still, a nice example of "clearing bacteria" doesn't change the course of the acute illness.
#FOAMed
evidencetriage.com/p/enough-…
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What is the diagnostic frequency of those "killer" outcomes for patients presenting with chest pain?
Some you'll see every couple shifts – some you might see once or never across an entire career.
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If you're waiting for the frontier models to navigate your EHR and complete physician-level tasks – don't hold your breath.
But, that dawn is just over the horizon.
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Yes, a Google symptom checker embedded into the FitBit platform generated some valid differential diagnoses.
Beyond that, the data is messy enough as to limit many conclusions.
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Ivermectin
Is for scabies
nejm.org/doi/10.1056/NEJMoa2…
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The media hype has decreed: emergency medicine is a dead specialty, and your Friendly Neighborhood LLM is ready to replace you.
Just another challenger bringing the disrespect to our specialty ....
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Don’t follow/subscribe to convicted sexual predators.
Apr 22
I'll be darned.
*That* David Newman is back, and writing about medicine.
"Fallen from grace" indeed.
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If you're prescribing Paxlovid to prevent serious complications, the population in whom that might be a valid consideration is shrinking rapidly.
If you're chasing theoretical advantages to viral load and symptom resolution, well, good luck.
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Tired: amoxicillin-clavulanic acid for acute sinusitis
Wired: no antibiotics
Baby steps: amoxicillin
Amazing how we can spend our whole lives talking about antibiotic stewardship and see little, if any, progress ....
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Yes, AI scribe note quality has limitations – amplified when a consult occurs in a noisy environment, or the human comparators know they're writing a note for a head-to-head evaluation.
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Come on over and contribute to the discussion – thinking about how to mitigate performance impact on ambient scribes: roon.com/doctors/rounds/how-…
Apr 14
Today we welcome a new group of founding physicians to Roon!
This group reflects a mix of private practice, academic medicine, research, and education, all approaching similar questions from different angles and in unique environments. That diversity is important.
One of our main goals at Roon is to make those differences more visible and easier to learn from. We don’t just want to know what the “right” answer is, but how people are thinking through it in practice.
We are very proud to have this group join our community and contribute to these important conversations.
@hboucher3, @DrAnil001, @sarawinndong, @Keith_S_Kaye, @DMohottige, @amalmattu, @emlitofnote, @long_brit, @chungk1031, @MercedesCastie4, @AnnaGaddy, @GitaPensaMD, Dimitrios Papanagnou MD, EdD, MPH, Teresa Y. Smith-Bellille, MD MSEd FACEP, Stephen Wolf, MD
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Ryan Radecki, MD MS retweeted
Apr 14
Today we welcome a new group of founding physicians to Roon!
This group reflects a mix of private practice, academic medicine, research, and education, all approaching similar questions from different angles and in unique environments. That diversity is important.
One of our main goals at Roon is to make those differences more visible and easier to learn from. We don’t just want to know what the “right” answer is, but how people are thinking through it in practice.
We are very proud to have this group join our community and contribute to these important conversations.
@hboucher3, @DrAnil001, @sarawinndong, @Keith_S_Kaye, @DMohottige, @amalmattu, @emlitofnote, @long_brit, @chungk1031, @MercedesCastie4, @AnnaGaddy, @GitaPensaMD, Dimitrios Papanagnou MD, EdD, MPH, Teresa Y. Smith-Bellille, MD MSEd FACEP, Stephen Wolf, MD
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Ever thought about the effect of your local environment on ambient scribe output?
Babies, OK. Toddlers, right out.
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Don't forget you can use 8.4% NaHCO3 instead of 3% NaCl for many cases of severe hyponatremia requiring rapid correction.
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Ryan Radecki, MD MS retweeted
Apr 1
This is an extremely important potential explanation by @emlitofnote of the otherwise surprising finding that procalcitonin saves lives: sick patients with low PCT may have prompted consideration of diagnoses other than sepsis, leading to appropriate resuscitation
#PatientsWithoutSepsisDontDieOfSepsis
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These data incompletely explain the nuance of physician behavioral change when provided with procalcitonin results, but – somehow – mortality decreased from 16% to 13%.
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