I think we can drop any pretense about the judicious use of imaging in medicine. It’s a lost cause. My radiology friends and I have a running exchange of the myriad absurd reasons for doing CTA’s (= CT angiography). It all distills down to the hypothetical clinical scenario of “itching out of proportion to dandruff.” These days a semi-skilled triage “provider” in the ER only need decide which half of the body to image. The expedient catch-all test that requires almost no skill or thought to request. Just touch the proverbial light-pen to the screen. It is the diagnostic euivalent of a hand-grenade. Something A.I. can order-up in a nanosecond, yet we are the ones supposedly being replaced. I’ve got news for you — that’s not even close to happening. I challenge A.I. to a neuroimaging duel anytime, anyplace. That’s a highly worthy discussion for another day. But soon the ER imaging options will be but three (before the performance of multiple MRI exams, that is): CTA-top half, CTA-lower half, or CTA-whole body. They literally cannot go to the cafeteria, make a phone call, or take a shit without first ordering a CTA exam.
Administrator:“Now, let’s talk about your report turn-around time (RTAT)….”
Two malignant narcissists become entangled in an international conflict. What could possibly go wrong???My buddy, agent X-98, had an even better motif!
Elegant Brown Toilet looks fantastic and it reduces cleanings to once every six months!
This post was added as a needed sorbet from posts about our oxygen-sucking idiotocratic national leadership, who continue to pile stupid upon stupid and corrupt upon corrupt.
Trumpf is presiding over the political enshittification of America.
I have to admit this singular fact. That Trumpf has been open and honest about a few specific things over what has become our interminable national nightmare. He did boast about not properly paying his taxes. And he described his technique of greeting attractive women wherein he’ll “just grab them by the pussy.” Both true and also proven in the court of law. An in so doing, he has single-handedly created a new and dubious meaning of the 1%-er = those who unflinchingly lie 99% of the time! Scientists have determined that he has a rare case of “neurocognitive cholera (NCC)” that is manifest as an unceasing logorrhea of feculent falsehoods, boasts and distortions. Prognosis is deemed “guarded to grim”… at least for those in his chaotic orbit, which we all most unfortunately are. Trumpf’s brain is like a particle accelerator, akin to the Large Hadron Collider (LHC) near Geneva, Switzerland. Though in his shit-for-brains head what smashes together are not protons or neutrons but rather ossified bits of his own stool left over from his younger, anally-retentive days. Let’s call it the Unified Trumpf Theory (UTT). “Lots of people are saying…”
DON COLOSSUS gets pumped up before attacking Iran. After dodging the Vietnam draft, this modern day Coriolanus hardened his resolve as a slumlord in NYC, in the city’s bankruptcy courts, and on the gritty set of his reality TV show “The Apprentice.” If he isn’t ready for a tough fight, then nobody is. With Pete “the Bender” Hegseth at his side, I’m feeling really good about this one! Perhaps my favorite joke of Trump 2.0 is Pete Hegseth being called a “DUI hire.” Never gets old.
From slumlord to president by way of Jerry Springer. What a heartless hack!
Right-wing journalists often use obfuscating wiggle words around Trump saying things like, “he’s the most consequential president of the modern age.” You know what’s also consequential? Cholera is consequential. And cancer. And, and… and crocodiles. Another one that Hugh Hewitt used was the sports analogy that Trump scored an historic upset win over Hillary Clinton. Yes, but with an assist from Russian intelligence (that he openly courted) and also James Comey’s idiotic meddling. Thirdly, they say, he moved the Supreme Court to the Right. True, but largely by dint of Mitch McConnell’s skullduggery followed by the untimely death of RBG and the retirement of Anthony Kennedy. To state the obvious, that only followed because of his very narrow victory. So there it is: when your ideas suck, and you constantly lie, cheat and steal, and your policies only help the rich and powerful, this is what the pundits fall back on — his hugely consequential upset victory that packed the court. Congratu-fucking-lations. It’s like winning the Masters Tournament in March. They’ve got the sharpest pencils in the game.
I’ve come to the opinion that business school mostly teaches people how to lie. And smile. Smile when they lie (and earn money on other people’s labor). And they never lie more than with their comparative statistics. Hospital administrators start off by placing a near zero productivity value on a clinician’s administrative tasks, all the while paying themselves quite handsomely for doing only administrative tasks. Next they adopt laser-focus on your billable work output, which is the metric that, to them, equates to your institutional value. These are your RVU’s (relative value units), which for a radiologist is how many CT’s and MRI’s you read over a given period. Mind you, that metric has absolutely nothing to do with quality or safety. Productivity and quality/safety, I like to say, are two entirely separate meetings that are held on different days and not even in the same building — never the twain shall meet. This is the foundational sleight of hand that drives the engine of hospital administration. Obsession with the former while paying grandiose lip-service to the latter.
But one there’s one thing I have never figured out. What is the key performance metric for these non-clinician pencil-pushers who take no call, are exposed to zero risk, don’t bill out one bloody RVU, and are difficult to find after 4:15pm? Is it “number of e-mails sent” or “meetings attended (while simultaneously texting out your fantasy football picks)” or maybe “photos posted to social media”…??? The world may never know… But, whatever the case, I hope they are at or above the 50th percentile!
One of my self-defining characteristics is an enduring love of bread products. Bagel, roll, croissant, pita, popover, naan, you name it. Having a separate, anomalous bread stomach has allowed me to consume large quantities with any meal. No butter required. So keep your Panerai, just give me Panera.
The 2026 Tesla Douche-wagon.
What our high school and college curricula need is a formal training course called “How Not To Be A Douchebag.” The Douche-Dex in America is at an all-time high, jet-fueled by the performative masculinity of Trump 2.0. I used to be of the opinion that women were generally excluded from that club. Then I observed the likes of Pam Bondi, Karoline Leavitt, and Kristi Noam who not only qualify but are prime examples of D-maxxing.
My friend JS calls it “silly season.” I’m now of the opinion that competitive endeavors should operate about at the level of non-league bowling. Because, honestly, who gives a shit what you roll or shoot or whatever? Our society is entirely too focused on score and outcomes. A “tennis ladder” ought to be those little stairs you climb to sit in the umpire chair and heckle your friends while they play using their off-hand. Lining up every two-foot putt for your Nassau bet is douchey (see above) and is ruining the game. “Good-good” is a great thing. Because at day’s end, nobody really cares. And winner buys lunch.
Let’s start the bidding at two dollars.
I’m ambivalent about this one. As above, our culture has become preoccupied with quantifiable comparison, particularly as it pertains to money. In cinema, it’s box office receipts. Awards follow but they are used, in turn, to goose the bottom line. It’s all about the ROI. In the art world, there is a hyperfocus on assigning monetary value to specific works and ranking each artist based on what they fetch at auction. One sad irony is that this value usually increases greatly after they are deceased. Vincent himself famously died poor and largely unknown. If only he could have had a bump from the Lego Van Gogh. But one might argue that any portal into art appreciation is invaluable. And while it smacks at first of commoditization, maybe it’s what’s needed to ground things again. This, however, comes at the risk of a cheapening. I feel this way about my favorite songs used in advertisements. It took seeing Sean Hayes in “Good Night, Oscar” to finally dissociate Gershwin’s “Rhapsody in Blue” from that United Airlines spot. Maybe, in the end, we each have to keep these precious things in our own unique way. Qualitatively. Block out all the noise. Forget any transactional value. And remember what it was about any given piece, or book or play or song, that moved you in the first place.
Great Exudations 