iiinova — where your digital self keeps evolving

Wael Hussein @waelhussein.bsky.social · 19/09/2026

Let’s be clear. The machine only rewards physicians for wRVUs. No meaningful recognition for self audit, quality improvement, teaching, or any deviation from the **see more bill more system**. Painful 😣

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Wael Hussein @waelhussein.bsky.social · 17/09/2026

Weighing scale app: need access to my full health info and now adding a monthly subscription. Vizio external speakers now has something with Walmart and requesting a subscription for god knows what. Stop the madness!

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Wael Hussein @waelhussein.bsky.social · 11/09/2026

Let me charge you more for the doctor visit you scheduled last minute. No other doctors available? Higher bill then. Oh, you want to sit? Extra fee. Let’s start with all those in the airlines business/ hotels/ apartment rentals. Who else wants this? #dynamic_pricing greed!

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Wael Hussein @waelhussein.bsky.social · 11/09/2026

Billing! Tell me your BP didn't go up! Some surveys estimate a physician spends more than 7 hrs/wk on billing. A 2018 JAMA article: 5 mins/ inpt visit. I'd rather spend that time on teaching, learning something new, or improving the service.

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Wael Hussein @waelhussein.bsky.social · 02/09/2026

I swear to God if EHR designers, healthcare admins, and policy makers were seeing patients, these systems would not be as crappy. Nothing is optimized for a streamlined physician experience. Can’t wait for new systems to shake their control.

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Wael Hussein @waelhussein.bsky.social · 30/08/2026

Patient with CKD, eGFR 7, declines dialysis. Let’s see what her kidney function has been doing… eGFR ranging between 5 and 8 since late 2023! Way to go, kidneys!

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Wael Hussein @waelhussein.bsky.social · 06/05/2026

40. Sickle. Lupus. ESKD on HD. Avascular necrosis, multiple joint replacements, recurrent infections. Many patients have it tough. Life can be brutal. Count your blessings.

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Wael Hussein @waelhussein.bsky.social · 23/04/2026

Help me out here. Why on earth do we have these two conditions when the second encapsulates the first? Can you have 3 events in 12 month without 2 of them being within a span of 6 months??!! #askrenal

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Wael Hussein @waelhussein.bsky.social · 03/04/2026

Why? Just why? When the main difference is the K, who decided this labeling?! #FreseniusPureFlow

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Wael Hussein @waelhussein.bsky.social · 26/03/2026

A visit to the emergency room. Sit before you look at this:

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Wael Hussein @waelhussein.bsky.social · 01/03/2026

Do you check labs after starting SGLT2i in CKD patients? What % of pts drop eGFR >30% after starting SGLT2i? What are the usual causes if that happens? Do you know of any studies that specifically looked at that? @askrenal.bsky.social #flozinators

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Wael Hussein @waelhussein.bsky.social · 22/01/2026

- y do u want to put me on januvia after my pcp stopped it? - It'll slow down ur dis.. (explaining and discussing) - yeah, but my pcp stopped it because of my kidney numbers. - Yes, and I'm ur kidney specialist (another round of explaining). - but my pcp said it was bad for my kidneys.. Me: 😭

media.tenor.com

a man is carrying a suitcase through a living room in a house .

ALT: a man is carrying a suitcase through a living room in a house .

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Wael Hussein @waelhussein.bsky.social · 15/01/2026

Patient was told to reduce his work hours so his lower income qualifies him for savings on health insurance. Ends up with more money if he works less. How ironic! Not a US-only problem. Seen it in Europe too.

media.tenor.com

a bald man wearing a plaid shirt and a black vest

ALT: a bald man wearing a plaid shirt and a black vest

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Wael Hussein @waelhussein.bsky.social · 11/01/2026

Noise or signal? eGFR fluctuating from 42 - 33 mL/min over a few weeks in a *stable* 57-yo man (Cr ~2.0): biological noise or reason to worry? 🧵⬇️

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Joel Topf @kidneyboy.bsky.social · 24/10/2025

Sing it brother!

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Wael Hussein @waelhussein.bsky.social · 02/10/2025

Humans: - Taking my job? ----- I hate AI!😡 - Helping me get rid of another human when doing something? ----- I love AI!🥰 We are doomed!! www.msn.com/en-us/health...

msn.com

MSN

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Wael Hussein @waelhussein.bsky.social · 28/09/2025

A fascinating story about prevention of scurvy shows how it can take CENTURIES between discovery and practice. Meanwhile, there will be winners and losers. Here is the story and some valuable lessons. A thread 🧵 below. doi.org/10.1001/jama...

doi.org

Disseminating Innovations in Health Care

Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly—if at all. Diffusion of innovations is a m...

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Wael Hussein @waelhussein.bsky.social · 03/09/2025

15 L interdialytic wt gain. Record? Pt was trying to beat nausea with chips and water.

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Wael Hussein @waelhussein.bsky.social · 02/09/2025

How are our patients dealing with these tremendous costs? Do you have ppl in ur clinic to help pts obtain these medicines at an affordable cost? Source: Primer on Diabetes Management www.vumedi.com/video/primer...

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American Journal of Kidney Diseases @ajkd.bsky.social · 03/08/2025

In case you missed it on the #AJKDBlog: AJKDBlog Interviews Editor Timothy Yau caught up with Dr. Subhash Chander to discuss if urea is effective for managing SIADH-induced hyponatremia. bit.ly/ChanderBlog25 (FREE)

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Wael Hussein @waelhussein.bsky.social · 25/07/2025

Do u have a local policy for picc- and mid-lines for pts with renal impairment? 🧭 Any simple algorithm that can be shared with other specialties? ⛔️ “Has to be discussed with nephrology” is a battle- we r the bad people who r inconsiderate of realities of the pt’s (immediate) care! #askrenal

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Wael Hussein @waelhussein.bsky.social · 22/07/2025

⚠️ Calciphylaxis is a debilitating and painful condition that is hard to treat. ▶️ Do you use daily dialysis as part of treatment? If so, what criteria do you use? #askrenal pubmed.ncbi.nlm.nih.gov/21872378/ doi.org/10.1093/ndt/...

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Wael Hussein @waelhussein.bsky.social · 16/07/2025

Is it just me or is it really awkward? ".. and they are all known as non-steroidal anti-inflammatory drugs, or NSAIDs". I am sure I lose patients at "non-ster.."! How do you tell ur pts about them?

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Wael Hussein @waelhussein.bsky.social · 15/07/2025

“Does not smoke, drink, or work” Made my day 😂

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Wael Hussein @waelhussein.bsky.social · 15/07/2025

Will AI tools make your job as a doctor more enjoyable? Think twice! Imagine investors developing tools to help builders. Their real focus would not be to improve job quality, but rather to boost productivity = ⬆️ ROI💰 Here’s how the game unfolds: open.substack.com/pub/sensible...

open.substack.com

When AI Listens In: How Conversational Data Could Disrupt Medicine

When I began practicing medicine, use of the Internet or a smartphone could not have been imagined because neither existed.

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Christos Argyropoulos MD, PhD, FASN 🇺🇸 0kale/acc @christosargyrop.bsky.social · 06/07/2025

#Vibecoding a #Perl interface to a #C library - Part 2 chrisarg.github.io/Killing-It-w... Conclusions: > #AI requires substantial subject matter expertise to deliver > Constant vigilance for hallucinations, omissions and biases is required! > They will not make a God out of a novice

chrisarg.github.io

Vibe coding a Perl interface to a foreign library - Part 2

Of makefiles and alienfiles

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Joel Topf @kidneyboy.bsky.social · 02/07/2025

My patients live at the margins of society. They don’t have much. Just getting to dialysis three times a week is a big ask. Taking from them to fund tax breaks for the rich is just cruel. I want to be outraged but I just feel like crying.

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JAMA @jama.com · 25/06/2025

Viewpoint: Delegating Medicare Advantage coverage and payment decisions to a third party could limit claim denials and improve access to care. ja.ma/3HZuPnm

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Wael Hussein @waelhussein.bsky.social · 22/06/2025

@askrenal.bsky.social @asnkidney.bsky.social Why do we not have a course, say on Coursera, that’s available for new fellows that covers the essentials of starting on the specialty?

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Kathleen Bachynski @bachynski.bsky.social · 19/06/2025

“If international medical graduates can’t start their medical residencies on time on July 1, the ramifications are so far-reaching that it is really unconscionable,” said Kimberly Pierce Burke, executive director of the Alliance of Independent Academic Medical Centers.”

nytimes.com

Trump Travel Restrictions Bar Residents Needed at U.S. Hospitals

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Wael Hussein @waelhussein.bsky.social · 18/06/2025

Quality of online time is an “admixture of content and quantity”, and is “not without cost”. Texting the AI boy/girlfriend is a new one!

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American Journal of Kidney Diseases @ajkd.bsky.social · 18/06/2025

From the Special Collection on Diabetes & Kidney Disease: Urine Albumin-Creatinine Ratio Variability in People With Type 2 Diabetes: Clinical and Research Implications bit.ly/4asLbxT (temp free) #VisualAbstract

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Wael Hussein @waelhussein.bsky.social · 17/06/2025

Doximity dialer and text messaging services are GREAT! I love that I can call from the app or from the browser on my computer. My calls show the office number. The texts are secure. It's very rare to see something as well done! Thx, @doximity.bsky.social ! 5/5 stars!

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Wael Hussein @waelhussein.bsky.social · 17/06/2025

Seems good, but what does "un-ionized" mean? 😵‍💫 "Resident physicians secure the first *unionized* contract at MGH.." www.wgbh.org/news/health/...

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Wael Hussein @waelhussein.bsky.social · 16/06/2025

Please don't do this! This figure stuffs a lot of information in one graph: outcome, program size, comparator, length of follow up, and type of assistance. Comprehensive, but so hard to read => wasteful. journals.lww.com/cjasn/abstra...

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Joel Topf @kidneyboy.bsky.social · 09/06/2025

Do you live in SE Michigan? Are you an incoming nephrology fellow or a nephro curious resident? Join us for the second annual Nephrology Fellow Bootcamp on July 27 in Ann Arbor. www.nephjc.com/bootcamp-2025

nephjc.com

Bootcamp 2025 — NephJC

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Wael Hussein @waelhussein.bsky.social · 08/06/2025

Ha! Surprise Question has been used outside medicine! What a surprise! “What do you think is the probability of a catastrophic stock market crash in the U. S. ... in the next six months.. ?” @grahamabra.bsky.social www.marketwatch.com/story/most-i...

marketwatch.com

Most investors now expect the U.S. stock market to crash like it did in October 1987 — why that’s good news

Widespread investor pessimism is a contrarian indicator, writes Mark Hulbert.

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ASN Publications @asnpublications.bsky.social · 29/05/2025

Perspective article discusses medical and surgical treatments for obesity in kidney transplant candidates seeking to lose weight to qualify for transplantation and/or improve obesity-related comorbidities. bit.ly/KID0813 #ASNKidney360

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Wael Hussein @waelhussein.bsky.social · 29/05/2025

Huge car. Almost crushed me while walking in the staff car park. I followed it. It parked at [chief of neurosurgery]. Ah, ok! Makes sense! 😂

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Wael Hussein @waelhussein.bsky.social · 22/05/2025

- Why is the patient on IV fluids? - Oh, just "maintenance fluids"! A common false belief is that everybody needs "maintenance fluids", particularly when they are NPO. Start with simple:

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Wael Hussein @waelhussein.bsky.social · 20/05/2025

#askrenal Why is serum bicarbonate reported as "CO2" in biochemistry results?

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American Journal of Kidney Diseases @ajkd.bsky.social · 14/05/2025

Urea to Treat Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Systematic Review and Meta-Analysis bit.ly/3XM0b53

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Wael Hussein @waelhussein.bsky.social · 13/05/2025

Want to impress but feel it’s too hard? Don’t stress! Just lower the bar. Let everyone panic and s### themselves. Then step up with the minimum and brag about how awesome you are! 😟

media.tenor.com

a cartoon baby in a suit and tie is sitting at a table .

ALT: a cartoon baby in a suit and tie is sitting at a table .

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Wael Hussein @waelhussein.bsky.social · 11/05/2025

Patient with multiple kidney stones. Drinks 3 L water a day religiously + other liquids. On chlorthalidone (also for BP) and K-citrate. Lab calls: K = 2.4 mEq/L. #SuperCompliance!! Every once in a while, I see a pt taking medical advice to the extreme.

media.tenor.com

a large body of water is coming down a dam wall

ALT: a large body of water is coming down a dam wall

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