Imagine an ER Physician's Response to Elon Musk's Email

Welcome back to On/Offcall!

Dear Elon,

Here are 22 things I did last week in 1 shift:

1. Told a patient they have cancer
2. Stitched up a four-year-old's head
3. Evaluated a woman for miscarriage
4. Popped a broken ankle back into place that had lost blood flow
5. Consulted with cardiologists about a patient having a heart attack
6. Diagnosed appendicitis
7. Saw an elderly patient with dizziness
8. Saw an elderly patient with dizziness
9. Saw an elderly patient with dizziness
10. Saw an elderly patient with dizziness
11. Saw an elderly patient with dizziness
12. Resolved a migraine in patient with two days of a constant headache
13. Reassured parents of a child with a febrile seizure
14. Updated a patient's tetanus vaccine
15. Sewed up a calf laceration from a broken wine bottle
16. Reversed the blood thinners of a patient with internal bleeding
17. Provided pain relief to a patient with metastatic ovarian cancer
18. Removed a 2cm piece of glass from a woman's hand
19. Drained an abscess in the mouth
20. Performed a spinal tap on a patient with meningitis
21. Diagnosed a pulmonary embolism
22. Spoke with poison control about a suicide attempt

Thanks,
Graham

By now, you’ve surely heard about Elon Musk’s infamous “pulse-check” email asking federal employees to either share what they accomplished in the past week or be fired. The whole incident got my wheels turning: How would an ER doctor respond to such an email? I started jotting down a list, but I quickly realized it would be far too long for an email (or this newsletter) — because this was all the stuff that happened in the first several hours of my shift on Monday alone! Thoughts? What would be on your list? What did you get accomplished this week? 😂 Reply with your top five items or add them directly in the comments!

Graham Walker, MD, Emergency Physician
Co-founder, Offcall

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How To Think About AI As a Physician

his week on How I Doctor, Graham talked to Dr. Spencer Dorn, a gastroenterologist, informatics physician, and professor at UNC, who is an expert in how AI is shaping medicine. The episode is a crash course on AI – what’s already happening, where things are heading, and how physicians should think about AI’s expanding role. Graham and Spencer also separate fact from fiction: What are the bright spots as well as the biggest misconceptions about AI’s impact? Trust us, this is not an episode you want to miss.

Some of our favorite community reactions:

@Eric Arzubi: “This is a profound reminder that healing is more than data and diagnostics. Human connection will always be medicine’s greatest tool.”

@Shane Speirs: “ It's fascinating to consider the unique role of human empathy in healthcare. The ability to emotionally connect and genuinely understand someone's pain is irreplaceably human.”

@Julie Rennecker: “Great to see/hear the two of you in one session! Keep up the good work.”

@Joshua Liu: “Love that quote - true empathy cannot be machinized (that the right word?)”

@Steven Rauchman: “The false dichotomy of comparing humans to AI , is without intellectual foundation.”

@Jeffrey Millstein: “So well said!”

Listen to the episode →

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Violence Against Healthcare Workers Is Unacceptable →

From Graham on social media: As incidents of violence against healthcare workers surge, where is the zero-tolerance policy for threats in hospitals? How can we be expected to save lives when our own are at risk?

3 Things to Read This Week

Why We Don’t Trust Doctors Like We Used To → (WSJ)
It’s like the WSJ was reading Graham’s mind. In the TikTok era, why do patients increasingly feel ignored and complain about their care?

LLMs are Vulnerable to Poisoning Attacks → (Nature Medicine)
Today, in something you didn’t want to read: LLMs are susceptible to spreading medical misinformation like wildfire.

Where the Physician Shortage Is Headed, and What It Means → (Medscape)
Physicians are in short supply across the board, and the problem isn’t going away. What should we do?

Are You Negotiating a Physician Contract? Let Us Know!

Are you currently a resident who’s receiving and comparing offers or are you in the midst of negotiating an employment contract for yourself or for your physician group? We want to hear from you!

We’ve now collected thousands of compensation data points, so using our custom Salary Tool, we can run customized reports giving you accurate compensation data about your employer, speciality, and practice setting. This could be a powerful way to compare offers and fuel your negotiation. We’re interested in helping any physician who's actively comparing offers or negotiating a contract. Reply or forward this email directly if this could be helpful to you or a colleague.

Highlights From Our Community

Each week, we celebrate career milestones, launches, & other goings-on in the physician community. Have something to promote? Reply and we’ll feature you.

🎉 Congrats, XPC Games Winners!
Earlier this month, Offcall was proud to sponsor the XPC Chart Biopsy Games led by X = Primary Care and Dr. Paulius Mui. The 48-hour virtual event was a huge success, and we’re excited to acknowledge the winners: Dr. Morris Aguilar, Dr. Sam Huang, Dr. Ben Tran, and Dr. Syed Akbar. Congratulations! Learn more here.

⚕️Come Find Me at HIMSS, Graham Walker!
So many friends and physician colleagues will be at HIMSS in Las Vegas starting this weekend, including Graham (speaking Monday!), Matt Sakumoto, Bronwyn Harris, Neri Cohen, Ed Lee, JD Tyler, and many more. Be sure to say hi to Graham, see you there!

🎉 Big News, Eve Cunningham
Dr. Eve Cunningham joins the health tech world as the new Chief Medical Officer of Cadence, the leading remote monitoring company in the U.S. Watch her announcement video and learn more about her new role here. Congrats!

🩺 Great Commentary, Terence Tan
Some spot on analysis about the 6 inalienable truths in healthcare from Dr. Terence Tan. Great insights!

🎙️Go go go, Justin Norden
Dr. Justin Norden launched a new Stanford AI in Healthcare series, alongside Dr. Matthew Lungren. See the first episode with Troy Tazbaz here.

🎉 Bravo, Niharika Goparaju
Dr. Niharika Goparaju was featured by Dell Medical School at the University of Texas at Austin and published in Annals of Emergency Medicine for her work on AI-driven medical communication with text-to-image models! Learn more here.

🎈Let’s Gooo, Anwar Jebran
Dr. Anwar Jebran will serve as a member at the Health Informatics National Committee at American College of Physicians. Congrats! Learn more here.

🎙️Hot Podcast Alert, Tina Shah
Dr. Tina Shah is everywhere! Don’t miss her new podcast appearance with Anwar Jebran and Matt Sakumoto on ACP + Innovation here.

🎙️Give it a listen, Hansa Bhargava
Dr. Hansa Bhargava recorded a new episode for the Physicianary podcast with Dr. Austin Lee Chiang. Coming soon, bookmark it here!

📚 Add it to your reading list, Uché Blackstock
Graham reviewed Dr. Uché Blackstock’s new book Legacy, which he called “a deep sternal rub for all of us to question our medical culture and our medical upbringing.” Read the review here!

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