iiinova — where your digital self keeps evolving

Residents: see as many patients as you can during training, and see them attentively. An encounter examined closely early in training teaches lessons that later require many routine encounters to acquire. Early, attentive experience has disproportionate educational yield.

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Orthopaedic surgeons increasingly answer for the consequences of decisions they don’t control. “Causal legibility” means transparently mapping out the decision process from inception to execution. This helps surgeons negotiate commensurate decision rights for their stewardship.

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Kids hate reading reams of discharge paperwork, so I have transitioned to employing the majesty of song:

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If you want me to show you how to use AI whilst I subtly mock it: join our convo tomorrow at 5pm Arizona time. What time zone is that for you? Nobody knows and there is no way to figure it out. us.list-manage.com/4E6fQvtyAhC?...

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When you ask AI it says “flex nails” but I say plate. Read below to hear an old man yell at a cloud.

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There are probably exceptions, but the admittedly deterministic heuristic “don’t send out a kid who can’t walk from the ER at least until you know why” has never steered me wrong.

Haters will probably say this is AI instead of unimpeachable evidence of my surgical prowess and judgement.

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The doorman fallacy is a category error in which a complex human role is reduced to a function, leading to the assumption that it can be replaced with an automated substitute without loss of value, with decision-makers failing to understand the indirect, intangible, non-visible value they provide.

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dave @davembmd.bsky.social · 24/09/2026

The main thing that makes hospital care veer toward low-quality in 2026 is the institutional idea of embracing physician and nursing team turnover in favor of service line member interchangeability.

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Medical students and residents should see as many patients as possible.

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dave @davembmd.bsky.social · 23/09/2026

On Amazon we have the least expensive pediatric orthopaedic textbooks by a good margin. They are as cheap as Amazon allows.

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dave @davembmd.bsky.social · 22/09/2026

Great article in @jbjs looking at the art of just using all available resources to examine our own practice through the lens of intellectual courage and epistemic humility. @robertlparisien

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Reposted by dave

Tivadar Danka @tivadardanka.bsky.social · 21/09/2026

No assumption should be set in stone. I’m not afraid to challenge them. You shouldn’t be afraid either.

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Reposted by dave

Digital Brain @yourdigitalbrain.bsky.social · 21/09/2026

Paraplegic walking for the first time in 10 years with help from an exoskeleton

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dave @davembmd.bsky.social · 21/09/2026

Tomorrow restores you to the saddle of your dependable cubicle, a remarkably pauciloquent beast whose entire philosophy consists of remaining square, holding your laptop, and permitting absolutely no dromomania.

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Reposted by dave

Daniel Abraham @abraham.bsky.social · 16/09/2026

Recursive self-improvement seems like making a photocopier that adds more detail than the original image.

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Reposted by dave

Daniel Abraham @abraham.bsky.social · 18/09/2026

As we approach 100 sessions in, Ty and I have gone from brainstorming, outlining, writing the first draft, and halfway through the first rewrite pass with occasional asides for Q&As and life getting in the way. If you ever wondered how the sausage gets made... www.patreon.com/c/JamesSACor...

patreon.com

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dave @davembmd.bsky.social · 18/09/2026

This was my first boss & he is one of the people who encouraged us to keep in direct contact w/our post ops. Saved my patients from complications more times than I can count. Smash cut to now when we are forced to use portals which add many unnecessary layers of difficulty between us and patients.

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Reposted by dave

Digital Brain @yourdigitalbrain.bsky.social · 16/09/2026

Sculptor Transforms Scrap into Moving Metal Figures

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Reposted by dave

Wanda Monroe @wandamocats.bsky.social · 16/09/2026

Pain care is structurally suicide prevention. With an estimated 20 million people globally dying in unrelieved pain annually, forcing stabilized patients off legacy full-agonist therapies destroys lives, families, & careers.

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Reposted by dave

Digital Brain @yourdigitalbrain.bsky.social · 16/09/2026

Single-leg squat: the level of strength and balance few achieve

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dave @davembmd.bsky.social · 16/09/2026

One major criticism I have of David Epstein’s “think inside the box” concept is that that kind of thinking in part lead to this weird “averaging to the mediocre phenomenon”. “Convergent evolution” is a joking descriptor, but several mechanisms together explain this image.

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dave @davembmd.bsky.social · 16/09/2026

When people ask what magic I use instead of crushing the bone with a lobster claw that doesn’t require so much strength to get a difficult reduction…

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dave @davembmd.bsky.social · 16/09/2026

"Well planned is half done"

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dave @davembmd.bsky.social · 15/09/2026

You may not have heard of him but you have probably heard of his daughter … Ghislaine.

dave @davembmd.bsky.social · 14/09/2026

When they take away my second room

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dave @davembmd.bsky.social · 14/09/2026

Medicine often has an underdetermined and epistemically pluralistic solutions to a given problem, which makes competence harder to infer than in mathematics. Even when an apodictic endpoint exists, equifinality permits multiple defensible routes to the same correct answer. So it may not be best.

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dave @davembmd.bsky.social · 14/09/2026

This may invite some eristic pushback, but telehealth clinics have tightened my clinical workflow and cut down on otiose follow-up visits and after-hours results phone calls that added little.

dave @davembmd.bsky.social · 13/09/2026

Very excited to get to team up with Jaime Denning, Keith Baldwin, Bryan Menapace and Romie Gibly @GiblyMd in helping Peter F. Armstrong and Dave Bailey with OrthoPediatrics to help with the POST curriculum workbook! Thanks to the Armstrong Children's Orthopedic Alliance

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dave @davembmd.bsky.social · 13/09/2026

Residents who come to a case appear without having made a plan or at least thought about the case beforehand appear far more desultory than they realize during the case.