iiinova — where your digital self keeps evolving

Dr C @drcarroll.com · 19/06/2026

How ironic is it that the war with Iran has so overwhelmingly been a negative intervention that it may actually lead to regime change... here in the US.

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Dr C @drcarroll.com · 17/06/2026

AI generated "without botox". Actually, she looks a lot better imho.

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Dr C @drcarroll.com · 12/06/2026

And they freaked out about this well, dressed, man...

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Dr C @drcarroll.com · 08/06/2026

I give you.... Foreign Pringles. Fruit Chutney is just wrong.

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Dr C @drcarroll.com · 06/06/2026

Makes me think about that influencer that was trying to get every man to expose their nutsacks and anus to the sun. Have fun buddy! Don't let any flies land on your anus!

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Dr C @drcarroll.com · 05/06/2026

English and Literature class AI summaries for the 80's and 90's.

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Dr C @drcarroll.com · 05/06/2026

Or reading one of these:

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Dr C @drcarroll.com · 27/05/2026

This picture is not right, but it's what you get when you're not paying a graphics artist. A new attraction is being added to the Washington DC skyline.

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Dr C @drcarroll.com · 27/05/2026

And here are the luxury meals being served!

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Dr C @drcarroll.com · 23/05/2026

Reminds me of the Pillars of Creation:

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Dr C @drcarroll.com · 23/05/2026

Women above men is a great position.

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Dr C @drcarroll.com · 22/05/2026

Someone needs to run a Trump Cost Clock parallel to the National Debt Clock.

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Dr C @drcarroll.com · 14/05/2026

Didn't JD Vance's team talk to him about ordering food in public? I thought they had stopped that conversation-ender.

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Dr C @drcarroll.com · 06/05/2026

There’s a weird moment in clinic when you realize: the patient is fine… and the system is still trying to make you do paperwork about how fine they are. We built a bureaucracy that bills itself as ‘care.’ That’s the post.

Text-on-image graphic: ‘CLINIC MOMENT. There’s a weird moment when you realize: the patient is fine… and the system still wants paperwork about how fine they are. Family Medicine • Phoenix.’

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Dr C @drcarroll.com · 05/05/2026

So, this likely produced 1.2 tons of CO2 into our atmosphere, but you gotta love the worldwide and humanity-based benefits of AI.

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Dr C @drcarroll.com · 04/05/2026

Sunday night thought: Medicine is still the point. The system is built to make it the exception. That’s the post.

Text-on-image graphic on a dark background: 'Sunday night thought: Medicine is still the point. The system is built to make it the exception.' Footer: 'Family Medicine • Phoenix'.

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Dr C @drcarroll.com · 03/05/2026

May 1996 → May 2026: 30 years as a physician. What changed? Less paper. More care. Now it’s portals, prior auth, and feeding the billing machine. They...just...don’t...care.

Text-on-image graphic on dark background: '30 years. May 1996 → May 2026. What changed? Less paper. More care. Now it’s: portals, prior auth, and the billing machine. A family doc’s reflection.'

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Dr C @drcarroll.com · 02/05/2026

Measles elimination isn’t a trophy you win once. It’s a condition you maintain. The Lancet: 2,280 US cases in 2025 + 910 more in the first 6 weeks of 2026. Vaccines work. www.thelancet.com/journals/lancet/a…

Bar chart titled 'USA measles resurgence: 2025 vs first 6 weeks of 2026'. Bars show 2,280 confirmed measles cases in 2025 and 910 confirmed cases in the first 6 weeks of 2026. Text box cites Lancet Correspondence (May 2026), Rt on Feb 16, 2026: 0.60 (95% CI 0.51–0.70), and that the outbreak spread to 45 states. Source URL is shown at the bottom.

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Dr C @drcarroll.com · 01/05/2026

BMJ FAST RCT (n=370): a home-based tailored program cut the rate of falls after stroke by 33% (IRR 0.67; P=0.02), even though the % who fell didn’t change. pubmed.ncbi.nlm.nih.gov/41876122 Fewer falls matters.

Bar chart titled 'FAST trial (BMJ 2026): falls rate over 12 months.' Two bars: usual care set to 1.0; tailored home-based intervention at 0.67 (33% lower). Annotation: primary outcome incidence rate ratio 0.67 (95% CI 0.48–0.94); P=0.02. Source: https://pubmed.ncbi.nlm.nih.gov/41876122/

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Dr C @drcarroll.com · 01/05/2026

MYTH: antibiotics help most colds. FACT: in 6 RCTs (n=1,147), no benefit vs placebo (RR 0.83) + more adverse effects (RR 1.8). pubmed.ncbi.nlm.nih.gov/41277585 This is why stewardship matters.

Split-panel infographic. Left (MYTH): 'Antibiotics help most colds.' Right (FACT): For the common cold, antibiotics showed no benefit vs placebo (RR 0.83; 6 trials; n=1,147) and increased adverse effects (RR 1.8). Source: https://pubmed.ncbi.nlm.nih.gov/41277585/

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Dr C @drcarroll.com · 30/04/2026

Medicare’s 2026 cost-sharing jumps again: Part A inpatient deductible $1,736 (was $1,676). Part B premium $202.90 (was $185). Part B deductible $283 (was $257). www.cms.gov/newsroom/fact-sheets/20… Costs rise. Paperwork stays.

Bar chart comparing Medicare cost-sharing amounts for 2025 vs 2026: Part A inpatient hospital deductible $1,676→$1,736; Part B standard monthly premium $185.00→$202.90; Part B annual deductible $257→$283. Source: CMS fact sheet https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles

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Dr C @drcarroll.com · 30/04/2026

NEJM Kawasaki RCT: adding prednisolone to standard care didn’t cut coronary lesions at 1 month (16.0% vs 13.8%; ARD +1.1%; P=0.31). More meds isn’t always better. pubmed.ncbi.nlm.nih.gov/41985133

Bar chart titled 'Kawasaki disease RCT (NEJM, 2026): primary outcome.' Two bars show coronary-artery lesions at 1 month: 16.0% with prednisolone plus standard care vs 13.8% with standard care alone. Caption: adjusted risk difference +1.1% (95% CI -1.0 to +3.4); P=0.31. Source: PubMed PMID 41985133 / doi:10.1056/NEJMoa2511478.

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Dr C @drcarroll.com · 30/04/2026

In the category of ‘No shit’… a positive urine culture isn’t automatically a UTI. IDSA: don’t treat asymptomatic bacteriuria (exceptions: pregnancy + invasive urologic procedures). www.idsociety.org/practice-guidelin…

Split-panel infographic titled 'URINE CULTURE MYTH'. Left panel (MYTH): “Bacteria in urine = UTI, so treat it.” Right panel (FACT): No urinary symptoms? Usually do NOT treat asymptomatic bacteriuria. Bullets: Antibiotics don’t help most people; they can cause harm: C. difficile, side effects, resistance. Source note: IDSA guideline (2019).

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Dr C @drcarroll.com · 29/04/2026

CMS is finally putting clocks and standards on drug prior auth: FHIR + ePA APIs, and decisions measured in hours—not weeks. Fact sheet: www.cms.gov/newsroom/fact-sheets/20… Make payers play by the rules.

Infographic summarizing CMS-0062-P (Apr 10, 2026) proposals: HL7 FHIR standards for HIPAA prior authorization transactions (24 months after final rule; 36 months for small plans); Oct 1, 2027 go-live for electronic prior auth for drugs via Prior Authorization API plus NCPDP SCRIPT/Formulary & Benefit/Real-Time Prescription Benefit for pharmacy-benefit drugs; and Oct 1, 2027 decision clocks: Medicaid/CHIP ≤24 hours; QHPs on FFEs ≤72 hours standard and ≤24 hours expedited. Source URL shown: cms.gov fact sheet.

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Dr C @drcarroll.com · 29/04/2026

Family doc take: integrated primary-care models (collaborative care/stepped care) move depression scores a bit, but they move them. Meta-analysis: SMD −0.25 (95% CI −0.43 to −0.06). Primary care works when we’re allowed to do it. doi.org/10.1136/bmjmed-2025-002400 That’s the post.

Chart showing small improvements in depression symptom scores from integrated primary-care interventions: organizational interventions SMD −0.25 (95% CI −0.43 to −0.06) and collaborative care subgroup at 18–24 months SMD −0.30 (95% CI −0.50 to −0.22). Source: BMJ Medicine DOI 10.1136/bmjmed-2025-002400.

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Dr C @drcarroll.com · 29/04/2026

In the category of “No shit”… uncomplicated low back pain usually doesn’t need an MRI. Routine imaging doesn’t improve pain or function, and “abnormal” discs show up in up to 97% of people without symptoms. pmc.ncbi.nlm.nih.gov/articles/PMC80…

Split-panel infographic labeled MYTH vs FACT. Myth: ‘If I have low back pain, I need an MRI (or X-ray) right away.’ Fact: ‘For most uncomplicated low back pain, imaging doesn’t improve pain or function — and it can lead to more downstream care.’ Callout: ‘Up to 97% of asymptomatic people have disc abnormalities on imaging.’ Source shown: https://pmc.ncbi.nlm.nih.gov/articles/PMC8023332/

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Dr C @drcarroll.com · 28/04/2026

CMS proposes public reporting for drug prior auth: approval/denial rates, appeal outcomes, decision timeframes. www.cms.gov/newsroom/press-releases… Stop the formulary game. Now enforce it.

Simple bar-style infographic listing three metrics CMS says plans would publicly report for drug prior authorization: approval/denial rates, appeal outcomes, and decision timeframes. Source: CMS press release (Apr 10, 2026).

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Dr C @drcarroll.com · 28/04/2026

If the US is truly able to flip both the House and Senate, please vow to not only impeach the seat but also, if he decides to resign to save himself embarrassment, the ascendant VP as well. Because they are both the biggest Executive Branch jokes of all time.

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Dr C @drcarroll.com · 28/04/2026

Annals: 11 ambient AI scribes vs 18 clinicians on 5 standardized primary care visits. Biggest gap: acute low back pain note quality 43.8/50 (human) vs 20.3/50 (AI), Δ -23.5. AI is a draft, not a clinician. pubmed.ncbi.nlm.nih.gov/41996184

Bar chart titled 'Ambient AI scribes vs humans' for a standardized primary care visit (acute low back pain) from Annals of Internal Medicine 2026. Two bars show modified PDQI-9 documentation quality scores (0–50): human note 43.8 vs AI scribe note 20.3. Caption notes the difference is -23.5 points (95% CI -29.2 to -17.9) and cites PubMed PMID 41996184 / doi:10.7326/ANNALS-25-02772.

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Dr C @drcarroll.com · 28/04/2026

In the category of “No shit”… antibiotics for acute bronchitis rarely change the outcome. Cochrane: no overall clinical improvement; cough ≈0.5 day shorter; harms higher (NNTH 24). www.cochrane.org/evidence/CD000245_…

Split-panel graphic labeled MYTH vs FACT. Myth: ‘Antibiotics help most cases of "acute bronchitis."’ Fact: ‘Most improve without antibiotics. Cochrane: no overall clinical improvement; cough ≈0.5 day shorter; harms higher (NNTH 24).’ Source note: Cochrane CD000245 (2017).

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Dr C @drcarroll.com · 27/04/2026

CMS wants drug prior auth to look less like fax warfare: ePA + FHIR, with decision clocks (QHP: 72h standard/24h expedited; CHIP FFS: 24h). Proposed Oct 1, 2027. www.cms.gov/newsroom/fact-sheets/20… Now enforce it.

Bar chart of proposed drug prior authorization decision timeframes from CMS-0062-P fact sheet: CHIP fee-for-service (24 hours); Qualified Health Plans (QHP) standard (72 hours); QHP expedited (24 hours). Proposed compliance date: Oct 1, 2027. Source: CMS fact sheet (Apr 10, 2026).

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Dr C @drcarroll.com · 27/04/2026

JAMA IM cluster RCT: a patient+GP deprescribing intervention doubled the odds of big PPI cutbacks—≥50% dose reduction in 14.9% vs 7.0% at 1 year (aAD 6.9%). This is what primary care systems work looks like. jamanetwork.com/journals/jamaintern…

Bar chart titled 'PPI deprescribing in primary care (JAMA IM 2026)'. Two bars show patients with ≥50% PPI dose reduction at 1 year: intervention 14.9% (n=11,442) vs usual care 7.0% (n=11,732). Caption: adjusted absolute difference 6.9% (95% CI 5.7–8.3).

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Dr C @drcarroll.com · 27/04/2026

In primary care, continuity is the real intervention. It’s also the one thing the insurance-and-industry complex can’t prior-auth, deny, or carve out. That’s why they keep trying.

Dark blue text graphic with the quote: 'The most powerful medication in primary care is continuity.' Below: 'Also: it’s the one thing the insurance-and-industry complex can’t bill a CPT code for.'

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Dr C @drcarroll.com · 27/04/2026

Aspirin for primary prevention: the ‘take one daily’ myth is outdated. USPSTF: 40–59 w/ ≥10% 10y CVD risk = individual decision (C). Age 60+ = don’t start (D). www.uspreventiveservicestaskforce.o…

Infographic titled ‘Aspirin for primary prevention’. Left red panel labeled MYTH: ‘An aspirin a day is still a good idea for most adults.’ Right green panel labeled FACT: ‘USPSTF: 40–59 with ≥10% 10-year CVD risk: individual decision (Grade C). Age 60+: recommend against starting for primary prevention (Grade D). Bleeding risk is the point.’ Footer notes source: uspreventiveservicestaskforce.org (Apr 2022).

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Dr C @drcarroll.com · 26/04/2026

CMS+FDA built a fast lane around Medicare’s coverage bottleneck: RAPID. CMS: proposed NCD the same day FDA authorizes an eligible device. About time. www.cms.gov/newsroom/press-releases…

Bar chart comparing time from FDA authorization to Medicare coverage/payment: current pathway ~12 months vs RAPID pathway ~2 months. Source: CMS press release (Apr 23, 2026).

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Dr C @drcarroll.com · 26/04/2026

Pontiac Aztek comes pretty close.

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Dr C @drcarroll.com · 26/04/2026

JAMA TOBRA trial: adding intrawound tobramycin to vancomycin didn’t lower deep SSI after high-risk tibial fracture fixation (7.4% vs 6.6% at 182d). Local antibiotic powder isn’t magic. jamanetwork.com/journals/jama/fulla…

Bar chart titled 'TOBRA trial (JAMA 2026): deep SSI rates'. Two bars: Tobramycin+vancomycin 7.4% (n=753) and vancomycin-only 6.6% (n=775). Note: no statistically significant difference reported.

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Dr C @drcarroll.com · 26/04/2026

Saturday night test: if a TV doc orders labs the way no real clinic can, I still flinch. Then I remember: it’s not trying to be accurate. It’s trying to be a story. Reality is messier. Stories still matter.

Text-on-image graphic. Title: 'Physician brain, Saturday night'. Body: 'I still catch myself watching TV medicine and thinking: “Nobody would order it like that.” Then I remember: it’s not trying to be accurate. It’s trying to be a story.' Footer: 'Reality is messier. Stories still matter.'

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Dr C @drcarroll.com · 26/04/2026

In the category of “No shit”… taking vitamin C daily doesn’t prevent colds for most people (RR 0.97). But it does shorten them a bit (≈8% adults, 14% kids). The “immune boost” myth is mostly marketing. www.cochrane.org/evidence/CD000980_…

Split-panel infographic titled "VITAMIN C & COLDS". Left panel (MYTH): "Taking vitamin C daily prevents colds." Right panel (FACT): "For most people, it doesn't prevent colds (RR 0.97). It can shorten duration a bit: ≈8% adults, 14% kids." Footer cites Cochrane Review CD000980 and DOI 10.1002/14651858.CD000980.pub4.

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Dr C @drcarroll.com · 25/04/2026

CMS cut the Star Ratings measure set: 11 admin measures out; a Depression Screening + Follow-Up measure in (2027 measurement year → 2029 Stars). Stop optimizing paperwork. Start measuring care. www.cms.gov/newsroom/fact-sheets/co…

Bar chart showing CMS Star Ratings measure set changes in the Contract Year 2027 Medicare Advantage/Part D final rule: 11 measures removed and 1 measure added (Part C Depression Screening and Follow-Up). Source: CMS fact sheet (Apr 2, 2026).

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Dr C @drcarroll.com · 25/04/2026

Long COVID RCT (Ann Intern Med): 8-week recovery was 63.6% with metformin vs 68.2% with ursodiol vs 68.2% with placebo. Two weeks of either med didn’t move the needle. That’s the post. pubmed.ncbi.nlm.nih.gov/41771135

Bar chart of 8-week recovery rates in a long COVID randomized trial: metformin 63.6%, ursodiol (UDCA) 68.2%, placebo 68.2%.

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Dr C @drcarroll.com · 25/04/2026

Dept. Q has the right detail: trauma is paperwork. Mandatory therapy is scheduling. Recovery is boring repetition.\n\nTV makes it look like a montage. It’s mostly work.

Text-on-image graphic reading: 'Dept. Q' and 'Mandatory therapy after trauma (on TV) looks like work. In real life, it is.'

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Dr C @drcarroll.com · 25/04/2026

In the category of “No shit”… PSA screening isn’t “just a blood test.” USPSTF: don’t screen unless the person wants it (55–69); recommend against PSA screening at 70+. www.uspreventiveservicestaskforce.o…

Split-panel graphic labeled MYTH vs FACT. Myth: ‘PSA screening is always just a blood test.’ Fact: ‘It’s preference-sensitive. USPSTF: don’t screen unless the person wants it (55–69). USPSTF: recommend against PSA screening at age 70+.’

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Dr C @drcarroll.com · 24/04/2026

CMS wants drug prior auth to function like infrastructure: ePA + APIs, denial reasons, and tighter clocks. Proposed: QHPs on FFEs 72h standard/24h expedited; Medicaid 7d/72h. Less fax theater; more accountability. #HealthPolicy — Dr. Andrew Carroll

Bar chart comparing proposed maximum drug prior authorization decision times: QHPs on federally facilitated exchanges at 72 hours standard and 24 hours expedited; Medicaid/CHIP (fee-for-service and managed care) at 7 days standard and 72 hours expedited. Source: CMS fact sheet (Apr 10, 2026).

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