Writing from inside the collapsing medical-industrial machine.
Joined June 2025
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To a physician, a note that reads like an inventory is a sign that the writer doesn't understand the patient. To the prospective payment system it is the only kind of note that counts.
My Latest: Hate the Game
substack.galtmd.com/p/hate-t…
Everyone says you have plenty of time to have kids but having a newborn beyond your 20s is doing it on hard mode. I’m gonna teach these kids the opposite.
I am getting closer to opening my own clinic. Lots of help from friends. @noahkaufmanmd is an inspiration.
Somehow didn’t notice it with my first kid but holy shit the umbilical stump stinks just like all the diabetic PAD foot gangrene that fills the halls at work. This is not the association I want!!
Had another boy! Won’t be writing much for a few weeks.
A highlight so far, aside from my new son, is my wife after the epidural telling me that someone else was farting out of her butt.
My 1 year old son just drank the holy water from his baptism. I don’t know if that’s a good omen or a bad one.
Julian Galt, MD retweeted
AI is going to increase healthcare costs, not lower them. Already seeing it. Insurance uses AI to deny claims. Hospitals use AI to up code. Doctors use AI which tells them to order more stuff and admit more patients. Patients use AI which tells them to ask their doctor to order more stuff.
Beyond that, entire departments in the hospital are now basically AI generated and much more useless and ultimately create a lot more work. Our legal department now just sends out hedgy AI slop instead of giving straight answers. The CEOs emails to the organization are all AI generated garbage. They decided to cut nursing bonuses based on AI, which resulted in a ton of nurses quitting and now we are hiring travelers which cost way more than the bonuses did. I am certain the CEO got a “that’s on me” response from chat afterwards.
Julian Galt, MD retweeted
Me causa gracia seguir leyendo que la medicina hegemónica y el disbalance de poder y toda esa falopa, mientras que la realidad es que yo no puedo hacer que nadie haga nada que no quiera hacer, y un paciente moderadamente motivado puede arruinarme la carrera y la vida sin consecuencias.
It’s staffed entirely by social workers wearing long white coats and carrying totemistic stethoscopes and pushing around a COW. The COW batteries are still always dead but now the C stands for Claude.
It’s 2075. There is only one hospital in the entire country. It is 8 square miles in the middle of Kansas and owned by United Healthcare. Premiums are $47,000 per month. The only medications left are Ozempic and boner pills. Life expectancy is 38.
Government: “I can’t believe doctors did this to us.”
Julian Galt, MD retweeted
It’s 2075. There is only one hospital in the entire country. It is 8 square miles in the middle of Kansas and owned by United Healthcare. Premiums are $47,000 per month. The only medications left are Ozempic and boner pills. Life expectancy is 38.
Government: “I can’t believe doctors did this to us.”
Julian Galt, MD retweeted
I used to say ... the patient and the doctor were naturally aligned ~against~ the hospital "before"
The doctor was truly independent of the hospital, and the hospital *needed* the doctor's patients (and the ancillary revenue that lay behind that)
So if the doctor insisted the patient stay one more day
#1 The hospital had zero leverage to force that
-and-
#2 They were afraid of the upsetting the doctor who could admit the next patient somewhere else
Once the hospital employed the physician, that all evaporated. Now the patient has no ally when they are in the hospital
Because if the doctor breaks too many rules, they won't be working there long. And little by little, all the Hospitalists that are there are tools of administration
We can argue about whether doctors should own hospitals. There may be a conflict of interest. Maybe not.
But if the premise is that there is one ... they should have made the opposite true too
Hospitals should NOT OWN doctors.
That is not in the interest of good patient care.
Julian Galt, MD retweeted
If a thief steals from you, the recourse isn’t to go steal from some random other person who had nothing to do with the theft.
Where do you think the government is going to get the money to pay you? Don’t you see that those people are then going to be in the position you now are complaining about being in? Do you not see that you are desperately trying to avoid being done to you what you are trying to inflict on others?
If boomers were counting on us to pay for their social security they should have had at least as many kids as their parents did. The ponzi structure is starkly exposed when there are far fewer young than old.
We ought to take note and start cranking out babies.
Julian Galt, MD retweeted
I would agree to a plan to phase out social security over the next 25 years, even knowing that it means the system will end right at the moment when I would start drawing a check. If that means that my kids and grandchildren aren’t subjected to this scam for their entire lives, I’m willing to take that hit. I just can’t for the life of me understand or relate to the older people who don’t feel that way and wouldn’t be willing to make the sacrifice for the sake of their descendants. Totally foreign mentality to me. I truly find it baffling. Setting my kids up for the future is like one of the only things I care about anymore.
Ah so the AI writes the scripts and the doctors still somehow are the ones who will get sued.
Only way I’d ever take that job is if it paid a hundred million a year.
The latest conspiracy is that it’s more likely Trump has PAH than that he doesn’t know the dose of aspirin he’s on.
These people don’t even know what PAH is and they all think this is for essential hypertension.
Holy shit.
Remember after his stroke, when I told you Trump’s blood results only make sense if he is in an additional medication?
Trump claims he takes a “386” of Aspirin.
Which doesn’t exist.
But is the marking on hypertension medication.
People tried to claim he meant he takes a 325mg of aspirin daily - which is the level for severe pain treatment.
But his own health records confirm he is only on a 81mg dose.
ER patient checks in for vomiting and abdominal pain. I evaluate and tell them I want labs and a CT and they agree.
RN comes to room 3 min later to start IV and execute plan, and finds the patient naked in the shower down the hall.
This is pathognomonic for what diagnosis?
The entire liability environment of medicine has everyone more afraid of measurable numbers and failure to appear to take them seriously than they are of the many real harms that are measurable from a population standpoint but impossible to measure in an individual patient.
They really should specify persistent hypoxemia as the indication for oxygen to avoid people getting put on nasal cannula for days because they occasionally drop into the 80s while sleeping
Also, just like with asymptomatic HTN, we really need a major guideline to specifically state in large bold letters as a standalone recommendation that oxygen in non-hypoxemic patients is contraindicated due to evidence of HARM
Nurses, patients, and families should be more afraid of unnecessary oxygen therapy than they are of minor, harmless desats (and they are all extremely afraid of minor, harmless desats lmao)