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September 1st, 2021- Circle it on your calendar, folks:

www.texaspolicy.com

TPPF: Texas Leading the Way on Health Care Price Transparency - Texas Public Policy Foundation

The Texas Public Policy Foundation celebrated a unanimous vote in the Texas Senate for reform that requires hospitals to disclose negotiated rates. The bill, SB 1137, is a huge step forward in creating a transparent market for health care that obligates providers to tell patients what treatments...
www.texaspolicy.com www.texaspolicy.com
 
Drew's comments should come as no surprise given his acerbic online persona. But more than that, they should come as no surprise in the growing culture of treating adults like dependent children and coddling them in an unnatural fantasy world where personal responsibility no longer exists.

The rebuttal to Drew that it's actually medically an important question is needed. But so is the politically incorrect rebuttal that drives at the heart of his smug virtue signaling. When you make bad decisions in life, it's no longer on you to suffer consequences and learn from those choices. We all deserve equal outcomes in life, and the right to not be offended (and definitely not judged) is the only right that matters, and as Drew demonstrates, there is no better way to signal your moral superiority to the world than by screaming how non-offensive and non-judgmental you are while ironically cancelling those who disagree with you.

Can we even say that being fat is dangerous to your health anymore? I mean we obviously can't say that being fat makes you unattractive (because objective reality hurts feelings and no matter what we can't have hurt feelings). But we're now living in a world where doctors asking about smoking history in lung cancer patients is considered offensive. Just take a second and think about that.

I don't remember the ABR tip-toeing around my feelings when I wanted to identify as a board certified radiation oncologist without having to take a bunch of exams and memorize a bunch of useless facts that offend me by making me realize that some people are smarter and work harder than me. I should be able to have the same outcome as people who studied more without having my feelings hurt, right? I mean, they already have removed grades from college, med school became pass fail, and now USMLE step 1 scores are gone. When will the woke anti-reality thinking finally trickle down to the ABR and cancel the boards and #MeToo the sexist dinosaurs at the ABR? Can we at least get that silver lining as the everybody-gets-a-trophy snowflake generation of children from the 90s slowly take over the world?

Excuse my rant.
 
Turaco said:
Drew's comments should come as no surprise given his acerbic online persona. But more than that, they should come as no surprise in the growing culture of treating adults like dependent children and coddling them in an unnatural fantasy world where personal responsibility no longer exists.

The rebuttal to Drew that it's actually medically an important question is needed. But so is the politically incorrect rebuttal that drives at the heart of his smug virtue signaling. When you make bad decisions in life, it's no longer on you to suffer consequences and learn from those choices. We all deserve equal outcomes in life, and the right to not be offended (and definitely not judged) is the only right that matters, and as Drew demonstrates, there is no better way to signal your moral superiority to the world than by screaming how non-offensive and non-judgmental you are while ironically cancelling those who disagree with you.

Can we even say that being fat is dangerous to your health anymore? I mean we obviously can't say that being fat makes you unattractive (because objective reality hurts feelings and no matter what we can't have hurt feelings). But we're now living in a world where doctors asking about smoking history in lung cancer patients is considered offensive. Just take a second and think about that.

I don't remember the ABR tip-toeing around my feelings when I wanted to identify as a board certified radiation oncologist without having to take a bunch of exams and memorize a bunch of useless facts that offend me by making me realize that some people are smarter and work harder than me. I should be able to have the same outcome as people who studied more without having my feelings hurt, right? I mean, they already have removed grades from bunny training, Easter basket became pass fail, and now USMLE step 1 scores are gone. When will the woke anti-reality thinking finally trickle down to the ABR and cancel the boards and #MeToo the sexist dinosaurs at the ABR? Can we at least get that silver lining as the everybody-gets-a-trophy snowflake generation of children from the 90s slowly take over the world?

Excuse my rant.
Click to expand...
When people ask if I'm against smoking bc im a cancer doctor I offer to buy em a pack, and tell them I know lots of people who will be ready to help.
 
I always ask my patients if they have smoked and when the question pops up "Is that why I got cancer?", I inform them that very likely their lung/throat/esophageal/bladder cancer appeared because of that.
I don‘t really understand what‘s offensive about that. Stigmatisation often pops up, but the question „why me?“ is probably the most common one for cancer patients. What Drew is proposing is to not ask a question, so that when the mostly inevitable question "Is that why I got cancer?" pops up, one should not let the patient feel guilty. But in that way, we are pretty much allowing us to leave the patient in the dark (almost lie to them), since we all know that the question "Why me?" is one most patients want to ask.
I also see it a bit as a service to the public, since this message (smoking—>cancer) may be passed by the patients to family snd friends, and who knows maybe someone will finally quit smoking. Cessation of smoking during treatment for cancer patients is also important, we know that.

Besides training, I think how you approach these issues has to do with your life experiences.
My dad died from advanced lung cancer and before that he had a myocardial infarction and early bladder cancer. He was fully aware that it all likely happened because of his accumulated >50 pack years of smoking and turned into a anti-smoker after his heart attack for the last quarter of his life.
He proudly told everyone who he saw smoking, they should quit smoking or risk experiencing the same. Seeing his older brother (also a heavy smoker) being consumed by SCLC and dying within 6 weeks from diagnosis surely shaped his opinion (and mine) too.
 
Last edited:
Palex80 said:
I always ask my patients if they have smoked and when they say yes, I inform them that their lung/throat/esophageal/bladder cancer very likely appeared because of that.
I don‘t really understand what‘s offensive about that. Stigmatisation is often pops up, but the question „why me?“ is probably the most common one for cancer patients. I also see it a bit as a service to the public, since this message (smoking—>cancer) may be bypassed by the patients to family snd friends, and who knows maybe someone will finally quit smoking. Cessation of smoking during treatment is also important, we know that.

Besides training, I think how you approach these issues has to do with your life experiences.
My dad died from advanced lung cancer and before that he had a myocardial infarction and early bladder cancer. He was fully aware that it all likely happened because of his accumulated >50 pack years of smoking and turned into a anti-smoker after his heart attack for the last quarter of his life.
He proudly told everyone who he saw smoking, they should quit smoking or risk experiencing the same. Seeing his older brother (also a heavy smoker) being consumed by SCLC and dying within 6 weeks from diagnosis surely shaped his opinion (and mine) too.
Click to expand...
I 100% agree with you and do the same. Any time a patient has high-risk behavior, we discuss it, in a kind and non-judgmental way. But this is the way that Drew Moghanaki does his virtue signaling. Someone should talk to him about his drinking and risk of liver disease.
 
Turaco said:
Drew's comments should come as no surprise given his acerbic online persona. But more than that, they should come as no surprise in the growing culture of treating adults like dependent children and coddling them in an unnatural fantasy world where personal responsibility no longer exists.

The rebuttal to Drew that it's actually medically an important question is needed. But so is the politically incorrect rebuttal that drives at the heart of his smug virtue signaling. When you make bad decisions in life, it's no longer on you to suffer consequences and learn from those choices. We all deserve equal outcomes in life, and the right to not be offended (and definitely not judged) is the only right that matters, and as Drew demonstrates, there is no better way to signal your moral superiority to the world than by screaming how non-offensive and non-judgmental you are while ironically cancelling those who disagree with you.

Can we even say that being fat is dangerous to your health anymore? I mean we obviously can't say that being fat makes you unattractive (because objective reality hurts feelings and no matter what we can't have hurt feelings). But we're now living in a world where doctors asking about smoking history in lung cancer patients is considered offensive. Just take a second and think about that.

I don't remember the ABR tip-toeing around my feelings when I wanted to identify as a board certified radiation oncologist without having to take a bunch of exams and memorize a bunch of useless facts that offend me by making me realize that some people are smarter and work harder than me. I should be able to have the same outcome as people who studied more without having my feelings hurt, right? I mean, they already have removed grades from bunny training, Easter basket became pass fail, and now USMLE step 1 scores are gone. When will the woke anti-reality thinking finally trickle down to the ABR and cancel the boards and #MeToo the sexist dinosaurs at the ABR? Can we at least get that silver lining as the everybody-gets-a-trophy snowflake generation of children from the 90s slowly take over the world?

Excuse my rant.
Click to expand...
Drew misses the point that ongoing tobacco abuse can increase toxicity and reduce response to tx so it should absolutely be brought up.

But i guess when you're used to being a putz, the science falls by the wayside
 
Turaco said:
Drew's comments should come as no surprise given his acerbic online persona. But more than that, they should come as no surprise in the growing culture of treating adults like dependent children and coddling them in an unnatural fantasy world where personal responsibility no longer exists.

The rebuttal to Drew that it's actually medically an important question is needed. But so is the politically incorrect rebuttal that drives at the heart of his smug virtue signaling. When you make bad decisions in life, it's no longer on you to suffer consequences and learn from those choices. We all deserve equal outcomes in life, and the right to not be offended (and definitely not judged) is the only right that matters, and as Drew demonstrates, there is no better way to signal your moral superiority to the world than by screaming how non-offensive and non-judgmental you are while ironically cancelling those who disagree with you.

Can we even say that being fat is dangerous to your health anymore? I mean we obviously can't say that being fat makes you unattractive (because objective reality hurts feelings and no matter what we can't have hurt feelings). But we're now living in a world where doctors asking about smoking history in lung cancer patients is considered offensive. Just take a second and think about that.

I don't remember the ABR tip-toeing around my feelings when I wanted to identify as a board certified radiation oncologist without having to take a bunch of exams and memorize a bunch of useless facts that offend me by making me realize that some people are smarter and work harder than me. I should be able to have the same outcome as people who studied more without having my feelings hurt, right? I mean, they already have removed grades from bunny training, Easter basket became pass fail, and now USMLE step 1 scores are gone. When will the woke anti-reality thinking finally trickle down to the ABR and cancel the boards and #MeToo the sexist dinosaurs at the ABR? Can we at least get that silver lining as the everybody-gets-a-trophy snowflake generation of children from the 90s slowly take over the world?

Excuse my rant.
Click to expand...
HURTING PEOPLE'S FEELINGS OVER SMOKING MAY BE GONE IN A GENERATION, EXPERTS PREDICT

s0pNl2i.png
 
Drew was wrong and Jeff and Mudit were correct.
But this is the way Drew works: asking a controversial question to stir the pot.
Then he lure ppl in to "shoot at them."

- Asking Social Hx question (smoking Hx, drinking Hx, iv drug abuse Hx, sexual function etc.) is an important aspect of overall quality care. It is more than the organ that we were asked to treat.
- What Drew was looking at is a monkey looking at a banana. Give me a T1-T2 and I will do SBRT, and turn the care back to PCP. He does not care if the pt continues to smoke. Probably a VA culture, idk.

- As others said above, I always ask these questions politely and in a non-judgmental way...This is how I normally phrase these questions..."I understand ppl have asked you before but I just want to know if you still smoke, the reason is that I want to help you".
- A smoking Hx is important in many ways:
1. I need to tell the pt to stop smoking ASAP to prevent another lung or other cancer.
2. I need to tell the pt to stop smoking ASAP to reduce cardiac and other health issues from smoking.
3. I need to tell the pt to stop smoking ASAP to prevent health issues to those family members he lives with.
4. In every F/U visit, if I smell smoke in pt's clothing, I ask again whether this is a prostate ca pt or breast ca pt.
It is our moral duty to ask and help. Pts know which MDs care about them and which do not. Pts are very smart!
 
Not asking a lung or bladder or (X) cancer patient about their current smoking habits when it is well proven to have an impact on their treatment outcomes is malpractice. Sure most patients will continue to smoke, but a patient who would otherwise be amenable to quitting or reducing their tobacco use could easily (and not unreasonably) have assumed that they already have cancer, so no point in giving up the cigarettes now.

Of course it can be done poorly or judgmentally, but the fact that some doctors suck doesn't mean we shouldn't take a history.
 
DoctwoB said:
Not asking a lung or bladder or (X) cancer patient about their current smoking habits when it is well proven to have an impact on their treatment outcomes is malpractice. Sure most patients will continue to smoke, but a patient who would otherwise be amenable to quitting or reducing their tobacco use could easily (and not unreasonably) have assumed that they already have cancer, so no point in giving up the cigarettes now.

Of course it can be done poorly or judgmentally, but the fact that some doctors suck doesn't mean we shouldn't take a history.
Click to expand...
Almost makes me call into question Drew M's competence as a rad onc.... Guess it wasn't just an EQ deficiency after all
 
DoctwoB said:
Not asking a lung or bladder or (X) cancer patient about their current smoking habits when it is well proven to have an impact on their treatment outcomes is malpractice. Sure most patients will continue to smoke, but a patient who would otherwise be amenable to quitting or reducing their tobacco use could easily (and not unreasonably) have assumed that they already have cancer, so no point in giving up the cigarettes now.

Of course it can be done poorly or judgmentally, but the fact that some doctors suck doesn't mean we shouldn't take a history.
Click to expand...
There should be zero debate about this. Screening for tobacco use and smoking cessation is a quality metric according to Medicare.

MACRA created the QPP, which uses screening for tobacco use and smoking cessation as a component of quality of care.

From the AMERICAN LUNG ASSOCIATION itself:
Medicare Access and CHIP Reauthorization Act (MACRA)vi • The Medicare Access and CHIP Reauthorization Act (MACRA) is a 2015 law that enacted a new payment framework and Quality Payment Program (QPP) focused on quality and value-based care. Medicare payments are adjusted based on the amount of data submitted and how well providers did on certain performance measures. • Tobacco Use: Screening and Cessation Intervention, National Quality Forum Performance Measure #0028 is one of the QPP performance quality measures and assesses the percentage of adult patients screened for tobacco use and for those identified as a tobacco user, the percentage who received cessation counseling or referred to a more intensive cessation intervention."


Every oncology practice needs to have a tobacco screening and cessation program. Important part of providing quality care.
 
When i ask my patients about smoking i ask all sort of details:

1) you smoke ah? So what do you smoke? (Little wink)
2) ok so you smoke cigs. Do you smoke menthols? Cloves? regular ones? Long ones? Skinny ones?
3) ok so you smoke cigarillos, my bad bud. Whats your fav flavour of black and mild?
4) what do you drink when you smoke?

i like to get to know my patients.

Speaking of bad things, I totally agree the ABR and our “leaders” should be cancelled because they absolutely suck.

have a good easter. Hope you see a bunny!
 
fiji128 said:
View attachment 334327
At least we can count on our premiere rad onc Twitter troll @lemmiwinks to chime in.
Click to expand...

Lemmiwinks is consistent if nothing else.

Given the job crunch, maybe not the best time for a new EM residency in Gainesville, GA, with a population of 40,000, less than 1 hour from Atlanta, GA. 36 resident complement right off the bat. But maybe this discussion is better served for the EM forum.
 
evilbooyaa said:
Lemmiwinks is consistent if nothing else.

Given the job crunch, maybe not the best time for a new EM residency in Gainesville, GA, with a population of 40,000, less than 1 hour from Atlanta, GA. 36 resident complement right off the bat. But maybe this discussion is better served for the EM forum.
Click to expand...
When the southern states picked city names, did they have like 75 total to choose from? Soooooo many repeats. Not just names like Lincoln or Washington or Franklin (though do we really need two like an hour apart in KY and TN), but stuff like Gainesville and Bowling Green and Nashville and Fayetteville and Talledega and Lynchburg, etc...

What's the deal?
 
Mandelin Rain said:
When the southern states picked city names, did they have like 75 total to choose from? Soooooo many repeats. Not just names like Lincoln or Washington or Franklin (though do we really need two like an hour apart in KY and TN), but stuff like Gainesville and Bowling Green and Nashville and Fayetteville and Talledega and Lynchburg, etc...

What's the deal?
Click to expand...

I was going to say Gainesville, GA, better known as the second best Gainesville, until I did a google search and discovered there is a Gainesville in 11 states in just the USA. All in the south. In states that abut one another.

Cities named Gainesville. How many places are named Gainesville?

How many places are named Gainesville? There are 11 places in the world named Gainesville! Number of places named Gainesville per country:
geotargit.com geotargit.com

Who was Gaines, and why does he have so many cities named after him in not only the deep south, but even in Missouri and Texas (but not in the Carolinas??)
 
Ok, you made me curious so I took a wiki dive:

Alabama: Haven't found any info yet
Arkansas: in 1840 the county seat was moved to the location. Was called "Gainesville" because it gained a county seat.
Florida: Named after Edmund P. Gaines. Army officer.
Georgia: Edmund P. Gaines strikes again.
Missouri: Named after Gainesville, Georgia, from where many of the townfolk originated
New York: Our guy Edmund P. Gaines expands his reach
Texas: Being sympathetic to the Texas Revolution gained (see what I did there?) Edmund yet another town.
Virginia: Named after Thomas Brawner Gaines, who brought the railroad through the town.

Thank you for coming to my TED talk.
 
OTN said:
Ok, you made me curious so I took a wiki dive:

Alabama: Haven't found any info yet
Arkansas: in 1840 the county seat was moved to the location. Was called "Gainesville" because it gained a county seat.
Florida: Named after Edmund P. Gaines. Army officer.
Georgia: Edmund P. Gaines strikes again.
Missouri: Named after Gainesville, Georgia, from where many of the townfolk originated
New York: Our guy Edmund P. Gaines expands his reach
Texas: Being sympathetic to the Texas Revolution gained (see what I did there?) Edmund yet another town.
Virginia: Named after Thomas Brawner Gaines, who brought the railroad through the town.

Thank you for coming to my TED talk.
Click to expand...
This is what happens when we hypofractionate and have residents doing all our work! Either way, I’ve learned a lot, thank you!
 
RadOncDoc21 said:
This is what happens when we hypofractionate and have residents doing all our work! Either way, I’ve learned a lot, thank you!
Click to expand...

No residents for me- residents should slow an attending down, as teaching should take up a lot of time. Should being the operative word there.

Have to do something while I'm eating lunch!
 
OTN said:
No residents for me- residents should slow an attending down, as teaching should take up a lot of time. Should being the operative word there.

Have to do something while I'm eating lunch!
Click to expand...
That’s why we need to train more residents so that we will start having attendings with a “team” of docs and maybe we can start doing “rounds” soon!
 
OTN said:
Ok, you made me curious so I took a wiki dive:

Alabama: Haven't found any info yet
Arkansas: in 1840 the county seat was moved to the location. Was called "Gainesville" because it gained a county seat.
Florida: Named after Edmund P. Gaines. Army officer.
Georgia: Edmund P. Gaines strikes again.
Missouri: Named after Gainesville, Georgia, from where many of the townfolk originated
New York: Our guy Edmund P. Gaines expands his reach
Texas: Being sympathetic to the Texas Revolution gained (see what I did there?) Edmund yet another town.
Virginia: Named after Thomas Brawner Gaines, who brought the railroad through the town.

Thank you for coming to my TED talk.
Click to expand...

Today I learned somethings.

Useless trivia, but hey, something is better than nothing!
 

it seems some centers may actually increasing some prices more than others to benefit technology/style of practice, at least when it comes to mri linacs/ethos
 
Meanwhile, in other specialties who don't want to self-destruct:

1618075063699.png


www.emra.org

Designing the Workforce of the Future

EMRA President RJ Sontag releases a statement regarding the new Emergency Medicine Physician Workforce: Projections for 2030 study. The findings present a complex picture of the changing workforce, where healthcare trends and external forces are reshaping our specialty.
www.emra.org

It took ASTRO almost a decade after alarms started to ring (and 3 consecutive years of medical student disinterest) before they finally started to recognize oversupply issues.

Cool.
 
elementaryschooleconomics said:
Meanwhile, in other specialties who don't want to self-destruct:

View attachment 334521

www.emra.org

Designing the Workforce of the Future

EMRA President RJ Sontag releases a statement regarding the new Emergency Medicine Physician Workforce: Projections for 2030 study. The findings present a complex picture of the changing workforce, where healthcare trends and external forces are reshaping our specialty.
www.emra.org

It took ASTRO almost a decade after alarms started to ring (and 3 consecutive years of medical student disinterest) before they finally started to recognize oversupply issues.

Cool.
Click to expand...

And not a single mention of anti trust concerns. Hmm
 
BobbyHeenan said:
And not a single mention of anti trust concerns. Hmm
Click to expand...

ASTRO are cowards

No surprise given how much emphasis placed on knowing RTOG 1950s data down to .1 decimal

Ridiculous that field gave VVPN a standing ovation for literally talking about a "potential issue" while 0 changes were actually made
 
ROforbetterorworse said:
ASTRO are cowards

No surprise given how much emphasis placed on knowing RTOG 1950s data down to .1 decimal

Ridiculous that field gave VVPN a standing ovation for literally talking about a "potential issue" while 0 changes were actually made
Click to expand...
I've got to be honest, I've re-read this EM Tweet (and several others) and...I'm just so disappointed in us.

"Heartbroken" is probably overly dramatic, but with all the hand-wringing denialism of our "leaders" for YEARS, to watch another specialty just jump up and pay attention to similar issues...wow.

In Ed Halperin's piece about why there aren't more RadOnc Deans/Presidents, the criticisms he faced from other specialties as he interviewed for various jobs just ring true. There are some up-and-coming folks in the field that I'm somewhat optimistic about, but until the crew that has driven us into the ground are retired and silent...it's going to get worse, before it gets better.
 
ROforbetterorworse said:
ASTRO are cowards

No surprise given how much emphasis placed on knowing RTOG 1950s data down to .1 decimal

Ridiculous that field gave VVPN a standing ovation for literally talking about a "potential issue" while 0 changes were actually made
Click to expand...
A cowardly stance I think is better than the realistic alternative (spoiler: they don’t want to reduce spots at all and are not afraid of anti trust, they’re just using it as a tool).
 
elementaryschooleconomics said:
I've got to be honest, I've re-read this EM Tweet (and several others) and...I'm just so disappointed in us.

"Heartbroken" is probably overly dramatic, but with all the hand-wringing denialism of our "leaders" for YEARS, to watch another specialty just jump up and pay attention to similar issues...wow.

In Ed Halperin's piece about why there aren't more RadOnc Deans/Presidents, the criticisms he faced from other specialties as he interviewed for various jobs just ring true. There are some up-and-coming folks in the field that I'm somewhat optimistic about, but until the crew that has driven us into the ground are retired and silent...it's going to get worse, before it gets better.
Click to expand...

@elementaryschooleconomics - Very accurate capture of how many of us feel

Better than I could have put into words. Thank you for this
 
medgator said:
Spratt 💕💕 fest on Twitter today

Click to expand...

I'm so rooting for this! Just walked the campus of Case & University Hospital a few weeks ago; very nice integrated feel; and you can walk to Cleveland Clinic from UH in 15-20 minutes as well. Lots of potential for clinical/academic growth. The city has had some faster growth and change ahead of it's 'industrial north' partners; cost of living is low. Three sport town... and the Browns didn't look too bad for once 😛

And, if you're part of this vanguard group supported by someone who is both academically/social media/SDN savvy; not a bad place to position yourself...

I told Dan if I wasn't already settled in with family; and that they didn't already have someone far better than me in GI already; I would be knocking on the door!
 
GI_RadOnc said:
I'm so rooting for this! Just walked the campus of Case & University Hospital a few weeks ago; very nice integrated feel; and you can walk to Cleveland Clinic from UH in 15-20 minutes as well. Lots of potential for clinical/academic growth. The city has had some faster growth and change ahead of it's 'industrial north' partners; cost of living is low. Three sport town... and the Browns didn't look too bad for once 😛

And, if you're part of this vanguard group supported by someone who is both academically/social media/SDN savvy; not a bad place to position yourself...

I told Dan if I wasn't already settled in with family; and that they didn't already have someone far better than me in GI already; I would be knocking on the door!
Click to expand...

How is walking from your employer, Case, to your non-employer and direct competitor, Cleveland Clinic, a pro?
 
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