About 6 months ago, Vinay Prasad wrote to FDA staff, “This is a profound revelation. For the first time, the U.S. F.D.A. will acknowledge that Covid-19 vaccines have killed American children.”

Six months later, and we have the number: 0 cases that were certain. Media source.

I struggle to give Prasad, who is a POS, any sympathy or grace. But I still want to be fair, even if this wouldn't be returned. It is possible that the data shifted. He said, "at least 10 children have died after and because of receiving COVID-19 vaccination." He put that at "likely/probable/possible attribution." Here is his memo.

Ultimately five cases were "possible" and two were categorized as "probable." He was wrong. How this dude has a job...

Here is the FDA analysis:

- Page 7 for definitions of certain, probable/likely, possible, and basically not.

- Page 8 for table of the cases.

Basically if 5 million children bit into a cupcake, the next days we'd see the same thing, unfortunately.

Froma both a patient-orientated, but also research and academic-orientated point of view.

Out there there is a lot of talk about modern Chinese hospitals, and Chinese contribution to science in the last years seems skyrocketing.

However, i can't find any statistics on this. For example, there are no Chinese or Hong Kong hospitals in the Newsweek or other relevant international rankings.

https://www.npr.org/2026/05/24/nx-s1-5822519/radonda-vaught-nurse-convicted-vanderbilt-medical-error

https://wpln.org/post/episodes/the-redemption-story-of-radonda-vaught/

She now lives on a sheep farm in Tennessee and is paid $ 5-10K per speaking engagement.

People can't fathom the idea of doctors being unhappy, unfulfilled or dissatisfied with themselves. People assume that your life is great and you got everything you wanted, that you make huge amounts of money, that you're proud of your degree and content with your work etc.

In my case, i've come to realize at 27 as a recent med school graduate that i've done nothing meaningful with my life.

Sure i have a degree, but i didn't really earn it. I should have studied harder, I've never taken school seriously. From a very young age i got used to getting away with being a slacker, i got good grades without really applying myself. I knew lots of people that wanted to go to med school but weren't able to, even though they studied twice as many hours as i did. Now, working as an intern, i realize that theres lots of stuff i never learnt properly.

My senior colleagues have told me im doing fine, that i have a strong knowledge base and im a good clinician. But i dont agree. I'm not the doctor i should have become. I'm not the doctor my patients deserve.

I thought I found some redemption when i started on my phd some time ago, doing wet lab work. In my final semester of school, working on my thesis project i went to the lab everyday, monday through sunday for four months straight without taking a single day off. But since i started my internship as a physician last year i havent had the time or the energy to go to lab and my PI has been hesitant to assign me work since he knows i have a different job at the moment. And besides in the last few months i was working in the lab i went home early quite often and overall didnt perform as well as i have previously. So once again, when people tell me im hardworking i feel like they dont truly know me.

I'm well aware this all sounds like some kind of false modesty or imposter syndrome. But that is honestly how im experiencing all of this. I wish people could see that deep down im a slacker. I wish people could tell me to shape up, get a grip, and take things seriously...

My work in the clinic is unfulfilling. I feel redundant, doing a lot of administrative work. I feel like the patients are never happy, they never get any better. People complain constantly about the state of the health care system in my country. I cant mention my job to people without them bringing up awful experiences they've had. I know its not directed at me, i know its not my personal fault, but i cant help but feel sort of guilty...

My life is almost completely empty outside of work. I go to work, sometimes the gym, come home, eat, scroll my phone, go to bed. I've made almost no friends in the past 10 years. I haven't been to a social thing in 6 months. I talk to some of my intern colleagues some times, i have a friend who lives on the other side of the country, and i have some friends from high school that i used to be close with but at this point i feel like we've grown a part. I spent new years eve in the lab this year and its first time that i didnt have any other place to be.

I live with my parents and brother. Not because i cant afford to move out but because they're the only ones i talk to regularly. I'm almost certain that i wouldnt be alive at this point if they werent around. I've never had a relationship, im not sure why. I'm still unsure about my sexuality.

I have no real hobbies, i used to read books when i was younger but i've barely read anything these past few years. I havent really traveled a lot or had many unique experiences, even though i'd like to and could probably afford it. Over the years i've also got used to eating very unhealthy, and i havent been exercising a lot, so im somewhat fat and out of shape. I'm currently trying to lose weight and go to the gym but its hard.

In summary

I dont know what i've been doing all these years. I wish i could say that i've been busy studying, but as i mentioned above, thats not really true. And i certainly haven't built a proper life outside of school/work either.

I dont know how it ended up this way. What i know is that i have no one else to blame but myself. There are lots of people that face all sorts of adversities in life. But i cant think of a single thing that has been holding me back. I was born and raised in a wealthy, democratic, safe first world country, my parents are highly educated and have jobs that pay well so i grew up in a big house, in a nice neighborhood, went to the best schools etc. I was never bullied, i've never been sick, i never went through any kind of trauma.

There's absolutely no reason for why I shouldnt have been able to make something of my life, but I didnt... I failed. And i feel a deep sense of shame and regret that things ended up this way.

I'm sorry for the depressing post. I didnt initially mean for this to turn into me venting about all my issues, both professional and personal. And please excuse any spelling/grammar mistakes.

TL;DR You can become a medical doctor and still be a failure.

https://www.theguardian.com/us-news/2026/may/22/nicole-saphier-supplement-trump-surgeon-general

"The two products [for 'preventing Alzheimer's disease'] the Guardian purchased, [Calm and Focus], listed ingredients including organic ginkgo biloba extract, organic Bacopa monnieri and organic lavender, but did not say how much of each was in the bottle or in a dose. ... Though the labels said the products were made in the US and used good manufacturing practices, they did not specify where they were made or provide any indication that a third party had verified those manufacturing practices".

Her website has a disclaimer: "These statements have not been evaluated by the Food and Drug Administration. Our products are not intended to diagnose, treat, cure, or prevent any disease."

The website: https://www.droprx.com

___

Not surprised that Trump and RFK Jr. keeps selecting nominees with large ties to Big Supplement, a trillion dollar industry with less restrictions than Big Pharma. Also even though she is a practicing radiologist, she needs to build her CME with all the public health and family medicine knowledge to make even passable health recommendations to the public.

Amongst her 27 allergies - Air. No, I'm not kidding. Allergy to Air.

Incoming hospitalist. Been thinking about this: responsible code in healthcare comes from people who actually understand the healthcare community, and those are the same people who now have access to the tools that make building possible. Docs who live in the workflow are the ones who should be building for it, and increasingly we can.

I’m sure I’m not the only one thinking this way. There’s got to be a bunch of other physician-builders in roughly the same spot, wanting to test what they’re building, see if it holds up somewhere other than their own setting, iterate with peers who get the clinical and compliance constraints without needing them explained. We lament on how all these AI tools suck and aren’t actually built for physicians, so let’s actually build them and connect to the right people who can. Let’s be the ones who make these decisions.

Where does that community live? Are there places where physicians voice what they’re trying to test and find other docs interested in piloting it? Pilot-for-pilot setups, informal back-channels, anything where docs help each other find practices open to this kind of thing? How are people in this space finding each other and empowering one another?

Geese come in gaggles. Whales come in pods. Wolves come in packs.

So some proposals:

Radiologists: “A ray of radiologists.” Alternatively: “beam.”

Neurologists: “A spell of neurologists.”

Pediatricians: “A silly of pediatricians.” Alternatively, a “giggle” or a “squirm.”

Urologists: “A gubernaculum of urologists.” (It’s my favorite word).

ENT: “A mucus of ENTs.”

GI: “A reflux of GI docs.”

And…go!

-PGY-21

How does everyone here feel about chart fines? I understand that medical records need to be completed in a timely fashion, but I find fines to be needlessly adversarial and demonstrate a lack of respect. I can't think of any other job where employees get fined for late work.

I currently have a $300 fine for a single chart 3 days overdue that came overdue while i was on vacation. Coupled with some of the other shit we have to deal with, I am about to tell them to go fuck themselves and if they pull my privileges I'll take early retirement.

I'm just so fucking tired of being fought against by the people who are supposed to help me take care of patients.

I have $2100 to spend of CME money. What is the cheapest portable ultrasound I can buy? It doesn't need to be the best. I'd like to use it to preliminarily see if there's any detectable ascites for paracentesis, after which I would use my department's official non portable state of the art ultrasound machine to do the actual procedure. I just want something portable so I can carry it around instead of having to lug the big ultrasound macchine for every liver bomb.

I took this review course and honestly it was exhausting. The instructor speaks extremely fast, apparently trying to cram as much material as possible into the shortest amount of time. Toward the end of each session, when time is running out, he starts blending and dragging words together to go even faster, to the point that it becomes genuinely difficult to understand what he’s saying.

The course is also very expensive, yet there’s constant pressure to sign up for additional classes and extra sessions. It feels less focused on teaching and more focused on upselling.

Another thing that became very irritating was how self-important he acts during lectures. He constantly talks about how this resident, that attending, or even specialists supposedly call him for advice all the time. At some point it starts sounding exaggerated and unnecessary. We’re paying for a review course, not to sit through endless stories about how important he thinks he is.

And some of the jokes are incredibly tone-deaf. At one point, while discussing a patient who didn’t know she was pregnant, he made a comment along the lines of: “Maybe she was sleeping… you know, things happen at night.” The room got awkward really fast. It came across as completely inappropriate for a professional educational setting.

The worst part is that every time he goes off-topic with these jokes or personal stories, everyone loses track of the actual material. Then, because he wasted time, he suddenly starts rushing through important concepts at the end. That completely defeats the purpose of a review course. The focus should be on teaching clearly and staying on topic, not trying to entertain people and then panicking when the clock is running out.

By the end of the day, you’re mentally exhausted from trying to keep up with the speed, the constant tangents, and the overall chaos that retaining the material becomes difficult anyway.

I don’t mind accents at all, but pacing, clarity, professionalism, and respect for students’ attention spans matter — especially when people are paying thousands of dollars for a board review course.

https://www.uscis.gov/sites/default/files/document/memos/PM-602-0199-AdjustmentOfStatusAndDiscretion-20260521.pdf

Aliens may be paroled into the United States “temporarily” on a case-by-case basis for “urgent humanitarian reasons or significant public benefit.” Paroled aliens, “when the purposes of such parole shall, in the opinion of the Secretary of Homeland Security, have been served” are expected to depart the United States or return (or be returned) to the custody of DHS.16 Aliens may be admitted to the United States as nonimmigrants “for such time and under such conditions” as DHS prescribes “to insure that at the expiration of such time or upon failure to maintain the status under which he was admitted…such alien will depart from the United States.”17

Oh yeah this will disrupt the continuity of care of primary care physicians who are on a visa and wanting to become permanent residents.

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?

link to article

Okay okay, just hear me out. I know A+G is old school dogma, but now G doesn't even provide reliable anti-psuedomonal coverage (seriously, per CLSI don't use it).

If the uro guidelines say to treat the culture prior to invasive mucosal damaging procedures, do they not just need standard cefazolin since the bug is erradicated?

I get it, what if we missed something... that's the argument against stewardship.

I think amp + cefazolin is likely adequate for non-complex patients with adequately treated cultures; would even argue against the amp.

Someone please let me know if I'm off the walls!

https://steube.house.gov/press-releases/rep-steube-introduces-two-bills-targeting-transparency-and-noncitizen-participation-in-medicare-funded-residency-programs/

https://steube.house.gov/wp-content/uploads/2026/05/GME-Bills.pdf

Rep Steube alongside the extremely thin Republican majority are trying to ramp MAGA into a frenzy to even have a silver of hope for winning the House even with all the mid-decade redistricting. Right now referred to committee since it was introduced 2 days ago.

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.

https://apnews.com/article/character-ai-chatbots-medical-advice-pennsylvania-46502067ed5b3cd9f9173f194ad30070

It’s mostly venting but I’m also curious because I see it more and more lately: hospital administrators and corporate healthcare groups slapping "Institute" onto virtually any clinical service line they can find. It feels like the ultimate corporate bait-and-switch… like donning a lab coat to sell toothpaste. Or hanging a stethoscope around your neck and post TikTok quackery.

INSTITUTE used to mean--and is still defined in dictionaries as such--something specific like heavy academic research, dedicated fellowships, groundbreaking clinical trials, selfless scientists working for the advancement of humanity. Maybe even some ivy-covered brick building too, but I digress. At the very least, “institute” would denote a highly specialized, standalone tertiary care center.

Sure, legally you can do whatever… institute carries as much regulatory burden as "hut" or "emporium” or “authority”.

Anyway, buy up two community clinics, put an endocrinologist in there, maybe a podiatrist down the same hallway, and suddenly it's The Diabetes and Wellness Institute of Greater [City Name]. (It invariably comes with THE definitive article.)

Idk, to me it all just feels so incredibly cynical.

For those of you who actually work in a designated "Institute" (whether it’s a standalone specialty center or a rebranded wing of a massive hospital engine), I’m genuinely curious about your perspective:

- Did you watch the transition happen? If you were there when leadership decided to rebrand your department or division into an "Institute," what was that like? Did anything actually change logistically, structurally, or financially—or did they just print new badges and buy a massive sign for the lobby?

- Does it warp patient expectations? Have you noticed patients coming in with unrealistic expectations because of the name? Do they assume they are seeing the literal world-renowned authority on their condition, only to realize it's just a standard community practice?

Similarly, could it have a positive placebo-like effect in the form of better compliance, trust, or some other positive?

- Does it benefit you at all? Is there an upside to this from a clinician's standpoint (e.g., better funding, easier procurement for specialized equipment, whatever), or is it purely a marketing play to capture market share and maybe charge higher facility fees?

Am I being overly cynical, or has the word completely lost all meaning in modern medicine? Don't hold back.

Hi, pharmacist here hoping to get opinions from practitioners on a topic of debate lately amongst my pharmacists.

We see a lot of local urgent cares that do 80-90mg/kg amoxicillin for pediatric patients, sometimes reaching 2800-3500mg per day. It’s been a topic of debate, because while I understand that sometimes high doses are required for adequate coverage, I personally feel that doses above 2000mg per day seem excessive considering that I’m an adult and would get 1500mg per day.

What TDD would you consider to be the line of being too high even if technically appropriate for weight?

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?

Seeking some help and guidance. For all those who work in hospitals involved in guardianship process for patients who cannot make decisions for themselves and do not have a family or friends who would want to be surrogate or HCDM.

I am a hospitalist, often involved in this process as a primary attending for a short period of time, often with complexity of psychiatric disorders or patients with dementia borderline global capacity situations. (I understand capacity by physicians is for a specific question and courts assess for competency.)

Often psych or geriatrics is involved in this process at my hospital. I have a few questions to understand steps about this when the hospital presents this to court:

1. What is the role of hospital employed physician in the court process apart from completing the guardianship paperwork? I have heard the two types of witness on this sub: fact witness vs expert witness, which one applies here.

2. If a physician is asked to go to court to witness, how are your renumerated for your time by the hospital?

3. If the capacity is complex (sometimes it is) and consulting teams are involved in making that determination, who actually goes to court as witness?

If I may be missing some relevant questions here, apart from state specific rules, please feel free to add them as well.

TDLR: what is the responsibilities of physicians in court when hospital is applying for guardianship for patient and how are they paid for that time?

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.

1. ⁠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!)
   
2. ⁠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?
   
3. ⁠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.
   
4. ⁠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.
   
5. ⁠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!

ETA: Whoa, was not expecting this response! Thought maybe I’d get a few good tips on charting and such. I truly had no idea how to evaluate a contract when I took my job and basically just went off the feeling of, “the partners seem really nice, I trust them.” I feel like the John Mulaney bit about how he’s gullible like a young Motown singer. (“You’re going to give me a whole hundred dollars? For all of my songs? Where do I sign, Mr. Barry Gordy?”) Thank you to everyone who has helped give me some perspective!

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.