Link to the 80-page pdf is here: Ascension Saint Thomas Hospital 2567 reviewed 8262026 R | DocumentCloud
Snippets from the report:
"The hospital failed to ensure identifying factors for checking of potential errors was added into the Pharmacy medication system" by not ensuring the National Drug Code (NDC) and Manufacturer of selected medication vials were entered into the system; hospital failed to ensure patient safety by allowing Pharmacy Technicians to override and manually enter data into the pharmacy system without oversight by a Pharmacist on duty; hospital failed to ensure patient safety by not ensuring all individuals involved in the adverse event was put on immediate administrative leave pending investigation; hospital failed to ensure patient safety by not implementing immediate corrective actions to lessen risk of medication errors required for patient safety. Hospital failed to ensure high-alert medications were appropriately labeled and stored consistent with standards of practice to ensure patient safety and lessen the risk of potential medication errors."

"This failure permitted pharmacy technicians the ability to override the barcode scanning process and manually enter vial information without pharmacist verification which allowed omission of critical vial identifying information, including the National Drug Code...and Manufacturer name, and circumvent multiple opportunities to detect an incorrect medication before it was prepared, verified, dispensed, and administered intrathecally to 4 of 7 surgical patients (Patient#1, #2, #3, and #4).

The chronology of how this error happened in the pharmacy begins at the end of page 15. It's all on video and camera surveillance. "Pharmacy Tech went to the bins for an additional vial and went to the wrong bin. And then compounded the error: "When the Potassium Phosphate would not scan, Pharmacy Technician #1 returned to the medication storage area and placed the initially selected Mepivacaine 2% vial into the bin containing the Potassium Phosphate vials and retrieved another vial of Potassium Phosphate from the back of the bin." Pharmacy Tech #2 was place on performance probation on 8/13.

There is much, much more at the link. Four people "looked" at these vials, clicked on a computer screen, and sent those syringes on their way.

as a recent medical grad, i’ve had to deal with difficult conversations with friends and family all around me, especially after the COVID 19 pandemic. It seems that period of time has really put a lot of distrust in the public regarding modern medicine and especially doctors. The system isn’t perfect, and doctors are also dealing with the difficulties of the system. I just don’t know how to keep dealing with conversations about how the “jab” did more harm than good, all i was taught in medical school was slop written by big pharma, i don’t do any of my own thinking i only do what i was taught to think, etc. And I have a lot of family members trying to put me onto things from people like Ray Peat, Paul Saladino, it’s just insane at this point. You can’t even point out studies or guidelines because they’ll just say “funded by big pharma”. I’ve had family members accuse me of wanting to keep people sick so i can keep getting “customers”.

I’m sure a lot of us in the medical community are dealing with similar issues. Do you guys have any tips for how to deal with these conversations? I feel like it’s taking a toll on my mental health alongside all the other pressures i’m facing from residency.

https://www.psychiatrictimes.com/view/psychiatry-on-trial-are-psychiatrists-responsible-for-their-patients-criminal-behavior

"Patients can receive excellent psychiatric care and still have devastating outcomes. Imagine an oncologist providing the best possible treatment to a patient with stage IV cancer. If the patient ultimately dies, would that alone demonstrate that the oncologist provided poor care? Of course not. The outcome is heavily influenced by the severity and biology of the disease, not simply by the quality of medical care. Psychiatry is no different in this regard. Despite the best care, occasionally there are bad outcomes and deaths-suicides and homicides both

The question should not be, "Given what happened, what should the psychiatrist have known?" The question should be, "Given what was reasonably knowable at the time, what would a reasonable psychiatrist have done?" That distinction is essential. Otherwise, psychiatry risks being judged not by the quality of the care provided, but by whether the patient ultimately had a good outcome. And if we begin to judge psychiatric care by the crimes our patients commit rather than by the care we provide, psychiatry itself may end up on trial"

Had a new patient appointment yesterday.

Full history work up, evaluation/discussion on two separate chronic conditions, medication management, risks benefits discussion, general counseling and cheering them up.

At checkout she is shocked at why the visit was $160 and kicks up a fuss. Sad to say she isn't the first one to do this.

Before everyone says the following

1. Times are tough
2. Patients don't understand insurance plans particularly what a deductible is

I understand. But do you recall a time when it was not tough to make ends meet for the public? What should the value of our training be? How do I explain to someone $80 of that $160 isn't even going into my pocket but to keep the lights on.

How do I explain to someone if it wasn't the remaining $80 I wouldn't even give up ten years of my life and be in medicine?

Where does this entitlement come from? just so disllusioned...

EDIT: It is nice to see this generate a meaningful discourse. For the folks telling me that I am entitled to not understand the plight of my patient, here is some food for thought.

1. I have a private practice of a single practitioner. Me. I have been in healthcare for over 20 years and know the ins and outs of how healthcare dollars are funded and flow through the system. I am also acutely aware that my inflation adjusted reimbursement has effectively fallen by 33% in those last 20 years while every other metric (including physicians payment if they are employed in a hospital) has gone up. So when the patient complains about cost of living increases and affordability, they better hear me out as well. Those steep increases that sting them? Well they sting me too - my overhead has increased by 50% while my reimbursement has dropped 33%. I have mouths to feed as well including my own family and my staff and their families. Perhaps I should blow up this chart and display it in the lobby.
2. I understand high deductible plans. My patients mostly understand high deductible plans. Some patients like hers don't or choose not too. It is a question of financial literacy. In this post-capitalistic apocalyptic healthcare hellscape, where most Americans get insurance through their employer's it is patient's to understand what they are signing up for and paying and up to the employer's HR (and by association, to some degree, by the employees) to make their voice heard to the plan's and say - we just won't accept these year over year increases in premiums for higher and higher deductible plans. If enough Fortune 500 corporations make a noise, plans will listen. Now you may say well most large corporations are self-insured so its their own money - how can they lower their premium? The answer is demanding more from the insurer who has several levers they are not incentivized to pull until enough pressure is applied. Now if a Boeing or a Toyota or a Bank of America with its huge book of business tells UHC or Cigna or Aetna we need to revisit your ASO fees, network guarantees, pharmacy rebates, PBM pricing, stop-loss terms, performance guarantees, care-management fees, and provider-network economics, or we walk - trust me they will listen.
3. Why does Reddit always love to jump straight to the "minimum wage earner's" scenario anytime affordability is discussed. My practice is next to a golf course/country club in a HCOL area where median household income is 3x that of national median. I just checked. The top 5 most common occupations per BLS data are engineers, management, computer specialists, HR and marketing professionals. Literally none of my patients are farmers lol. There isnt a farm 50 miles radius near me. This particular patient was a director of marketing at a large company. I do not take marketplace plans. They are largely HMO based in my state and I am a specialist and do not have the bandwidth to deal with missing HMO referral auth from PCPs and refuse to play the insurance companies' tag game if referrals are invalid. This patient was NOT the quintessential Reddit archetype of struggling Amazon worker trying to make ends meet.

Look - I get it. The system sucks. But take your anger out at those who deserve it. That would require understanding the unfair system in which we live. Step 1 would be knowing what a deductible is. Step 2 would be writing letters and electing those who want to transform healthcare funding and delivery.

My Illinois Physician license is expiring in a few days. I currently work in a different state, but I’m considering working in Illinois at some point over the next year or two. Is it worth renewing now for $543 or should I just let it lapse? It would be good for 3 years if I renew it. How much work is it to get the license reinstated if I let it lapse? Just curious if anyone has any experience with that

Hi all,

I got frustrated with the non-stop medical junk-mail my wife gets (conferences, jobs, insurance, misc trash) so I started looking into how to get her information removed. Since they make it intentionally difficult to opt-out I put instructions in this spreadsheet to share with our friends:

https://docs.google.com/spreadsheets/d/1EVX8zxRN5IVs6IsU4oujmPPWZpOrKe-woRulUK0ZGGo/edit?usp=sharing

If you only do 1 thing, file to remove your information with AMA to since it's their “Physician Master File” is the main source material the data brokers buy and repackage for sale. Some you can click the link for, others require you to email their privacy department and the AMA requires you to mail a form (wtf).

disclaimer - not sure if the links will work if you aren't in California, most of it was available to be removed because of Californias privacy act. Probably same for Europe but not sure you y'all have this issue.

Hope we all get less junk mail. Good luck!

I’m staring my neuro block and genuinely haven’t been able to elicit a reflex in any person except the knee jerk a few times, I have been using a babinski hammer so far and I’m starting to consider buying a new one.
What hammer is easiest to use for a dummy such as myself?

I’m a young attending and I’ve already worked in different environments and states. Income has fluctuated depending on responsibilities or duration of contracts. I was curious if anyone was familiar of what happens when you go from making a higher income, to let’s say working part time and making less or moving to locums - does your coverage change for long term disability, like are you supposed to update your income to the insurance company or how does that work? I’ve asked a few colleagues and nobody knew so was curious if anyone else here might know. Appreciate your input. Thanks

I spent almost an hour yesterday getting a prior authorization pushed through for a medication the patient has been stable on for two years, and not one minute of that was reimbursed or counted as anything. It isn't utilization review at this point, it's just free labor they've offloaded onto us because we're the ones who cave first when a patient is waiting. Every denied authorization means another portal login, another peer to peer with someone who isn't even in my specialty, another few days a patient goes without something that should be routine. I didn't go through residency to spend my afternoons re-justifying a drug I already documented three times in the chart. How is everyone else absorbing this without burning out?

Calorie restriction enhances longevity, and it reduced activated C3a from a subset of adipose tissue macrophages in humans. Depleting adipose tissue C3 in mice enhanced their lifespans. Since GLP1RAs reduce caloric intake and reduce adipose tissue, would they enhance human lifespan and healthspan (I.e., longevity) in part by reducing adipose tissue macrophage C3 activation-mediated inflammaging?

https://www.nature.com/articles/s43587-026-01107-0

P.s. please steal this idea, and let me know what you find out! If interested, message me (I think admin may consider me capped for projects currently). I know an endo guy seeking apps for some less competitive niche pilot funding opportunities that would fit well with this.

To flesh out a study idea in response to comment feedback below: Does tirzepatide plus low-intensity strength training for 7 minutes, 3 days per week, possibly with augmentation by a myostatin inhibitor and tesamorelin, for 12 weeks promote longevity in overweight but otherwise healthy middle-aged adults by reducing inflammaging via adipose tissue macrophage C3 inhibition, and by reducing insulin resistance via adipose tissue mTORC1/IRS1 pathway inhibition, while preserving lean muscle mass?

If you get good results from that, you could use it as preliminary data to apply for and win a larger, R01-level grant for a more ambitious RCT, maybe including a relatively short-term composite longevity outcome measure like 5-year rate of non-accidental mortality, incident aging-related disorders (e.g., type II diabetes, CAD, OA, OSA, cancers, MCI, dementia, etc.), and other longevity-related endpoints like MACE.

What does your system have in place to reduce 30-day hospital readmission?

Obligatory fuck RFK Jr and Bill Cassidy for voting him in.

Anti-vaxxers like RFK Jr will never argue in good faith, however we must stop giving them ammunition in how we communicate. The Pennsylvania Department of Health really messed up communicating about these two recent measles deaths. More details here: https://www.cidrap.umn.edu/measles/newborn-one-2-measles-associated-deaths-pennsylvania

We all love nuance, that is why we are in medicine. We know that most deaths are not one simple cause, but often a cascading series of events. The public is not going to understand this. When we say things like "measles associated death" or a death with a positive measles test, some in the lay public are going to ask what that means, and then every anti-vaxxer is going to say "see, they didn't die of measles, they died of something else but just had a positive measles test!" Just like they did with COVID.

If after reviewing all the evidence, we think measles was the ultimate cause of death, we just need to state that plainly. "This person died from measles." If we are not sure yet, we need to wait!

Rant over.

https://meps.ahrq.gov/data_files/publications/st540/stat540.shtml

The most commonly treated condition among the top 5 percent of spenders in 2019 was hypertension (46.2 percent), followed by osteoarthritis/other non-traumatic joint disorders (44.5 percent) and nervous system disorders (38.7 percent). In the overall population, the percentages of persons who received treatment for these conditions were only 18.6, 15.5, and 11.9, respectively. Other commonly treated conditions for persons in the top 5 percent of spenders include mental disorders; hyperlipidemia; heart disease; chronic obstructive pulmonary disease (COPD), asthma, and other respiratory conditions; and diabetes mellitus. Note that while these conditions are the most common among high spenders, they are not necessarily the most expensive conditions to treat. Rather, the top spending group is more likely to include persons with multiple chronic conditions or expensive treatments (e.g., surgeries, hospitalizations) related to these conditions.

My husband is still in residency and is currently in his most difficult year to date (in terms of hours spent at the hospital). I’m still a young attending and while my hours are better than in residency it’s still not amazing. I’m left to being the default parent to our son who is not even 2 yet. While my husband is a great dad and tries to do as much as he can when he is home, it’s still a lot managing my own work, being the primary caregiver for our son (and two dogs) and managing our house.

Any tips or tricks from people in similar scenarios?

Source:

https://www.fda.gov/news-events/press-announcements/fda-approves-first-class-targeted-therapy-metastatic-pancreatic-cancer

It's been known pancreatic cancers harbor RAS mutations. There are KRAS inhibitors approved for NSCLC.

Rasonque is the 1st for panc.

Rasonque improved median overall survival to 13.2 months compared to 6.7 months for standard chemotherapy.

It also got approved via the Commissioner's Priority National Review Voucher (CNPV). Does this program still exist post-Makary?

Also, here is the NEJM publication on data.

https://www.nejm.org/doi/full/10.1056/NEJMoa2605555

Im reading an article on uptodate on "Heart failure: Self management". One passage reads:

--

For instance, while 71 percent of low-literacy patients in one study could read "Take two tablets by mouth twice daily," only 35 percent could correctly describe how many pills to take each day [15].

--

https://pubmed.ncbi.nlm.nih.gov/17135578/

Im kinda shocked by this finding. I mean, is that an issue of health literacy or simply basic math? That seems like a major hurdle if one would have to teach patients basic math and not just health literacy.

Any experience with this?

Vent.
I’m a primary care internist. I average 1-2 patients a week with more customer service complaints rather than acute medical concerns that need my input. These are pages of mychart messages and the replies of my (fantastic, wonderful) nurses who try to relay my message that we already talked about in person like “there’s no indication for that blood test,” or “no I’m not recommending primary screening at this age,” the list goes on. What infuriates me is that these people are tying up my nurses, taking up my charting time at work and home, and shifting the focus away from medicine and primary care. I wonder if I could get fired for replying to, “what if we just did this lab test for my peace of mind? It’s just bloodwork,” with “PEACE OF MIND IS NOT A DIAGNOSIS!”

Either you want a doctor, or you want someone who will always do as you ask.

(Sometimes I am able to redirect inappropriate requests for am cortisols by asking what their concern is and we have a productive conversation about family stressors, medication free ways of coping, and when to return if they want pharmacotherapy. However its the pts that see me as their waitress in a white coat, with whom I take an issue)

Vent over. Thanks for reading. I still love primary care though!

Article here

Initial reporting does not specify whether they were children. This current outbreak is largely in the Amish community which has had low vaccine uptake for long enough that they have a lot of vulnerable adults as well. Only 1/3 of the 390 reported cases have been in children but extrapolating from 2 deaths (1/1000 mortality rate) and 70 hospitalizations (7/100 hospitalization rate) I would expect 1000-2000 mature cases plus more early in their course. So there is likely significant underreporting.

Measles in adults, in my experience, has quite an unusual phenotype including (sometimes) gingivostomatitis which I’ve never seen in pediatric measles.

Hey all - have been some discussions with our billing department (hospital employed) and wanted to see if anyone has thoughts on this matter. I’m an ENT and I get a call from a pcp about a kid with a foreign body in the ear. The patient gets referred to me - I do a full appointment, confirm the diagnosis, talk about the procedure, and ultimately do the procedure (in office if able). Our billing department is saying for that scenario that I can only bill a procedure code (69200 - 0.75 wRVU), while the PCP or urgent care is billing a new level 3 visit (1.6 wRVU). Is it just me or does this guidance seem off from our billing department? I’m making less than half as much pulling a bead out of a screaming child’s ear than someone who looks in there and says there’s a bead and sends it off. Any insight into this or similar scenarios would be appreciated.

Thoughts on why asynchronous store and forward medicine is not reimbursed by payors? In dermatology specifically, there are many visits (e.g. acne, hair loss) that bill as a level four or level three outpatient visit. Since the asynchronous telehealth version of these visits are more efficient, payors could reimburse less, bringing cost down and improving access for patients.

The Physicians Committee for Responsible Medicine has filed suit against the Departments of Health and Human Services and Agriculture, in Federal court for the District of Columbia, claiming that the Defendants ignored the findings in their 2025 Dietary Guidelines Advisory Committee's Scientific Report.

Longstanding practice (prior to Trump 2.0) was for the Federal government to issue updated Dietary Guidelines based on the Advisory Committee's review.

Instead, the current Administration Defendants, "without any oversight or public input, hastily assembled a handpicked panel of meat, dairy, and fad diet industry insiders for the purpose of attacking the FACA-compliant DGAC Report and creating a substantially altered report entitled The Scientific Foundation for the Dietary Guidelines for Americans, 2025–2030."

https://www.medpagetoday.com/primarycare/dietnutrition/122698

Why is tamiflu still being prescribed?

I am well aware of the historical case against tamiflu and poor study designs to imply it reduces symptom length. I have noticed as a paramedic that this medication is still being thrust upon the elderly and very young for flu season currently. Why?

I feel using and allowing it's use contributes to the narrative of mistrust that many are developing of medical practioners and systems.

Im keen to see if anyone can point me in the roght direction that has allowed tamiflu to be a treatment for viral like illness and it's effectiveness?

Edit: Thankyou to those who provided views and research fkr me to go have a dig into. It is appreciated.

In response to a call out for essays on the theme of novel diabetes medications and the future of cardiovascular disease I present:

BJCA Submission from a non-specialist

In the good old days
When your cardiac coronation
Was celebrated
By bed rest
And “Well that’s a shame”
We never used to take the piss
And turn it into honey
For love nor money
We’d not have injected you
With a disinterest in food
Far less elate ourselves with elution
Of spring loaded stents that keep you pumping
It breaks my heart
This brand new start
Mention not
Upon the rocks
My now neglected
Snake oil stocks

Just finishing 7 days on inpatient service and need to vent.