henry ford once said “failure is simply the opportunity to begin again, this time more intelligently” Designed to Fail? the Future of Primary Care Journal of General Internal Medicine (2020) Access to primary care has been shown to improve patient outcomes and lower cost although outcomes are debated the cost is not- its because we can be the jack of all or the referral of all. neither is wrong the authors in this paper analyzed the 2019 “in-basket” activity of our clinical faculty at the University of Michigan to determine the average weekly activity by category of EMR tasks. A full-time primary care faculty member had a total of 390 in-basket tasks per week or 17,542 in-basket tasks per year. they surveyed 56 clinicians, and asked how much time, to the nearest minute, they spent on in-basket tasks: and a median time of 1199 min (~ 20 h) per week on these tasks many task require further steps- like addressing lab work, or ordering follow up imaging, or doing a prior authorization ALL of which are unpaid. essentially PCP see patients full time then have another part time job they do for free in answering inbox messages and we wonder why pcp is a dying speciality that no one wants to go into. a change is needed onto the next article I have said many times that I love an article that answers a simple question The Journal of Sexual Medicine Are We Overstating the Risk of Priapism With Oral Phosphodiesterase Type 5 Inhibitors? J Sex Med 2020 Jul 01;[EPub Ahead of Print], ME Rezaee, MS Gross Viagra and cialis have the famous saying on their commericial to consult a dr. if you have an erection lasting longer than 4 hours. Well in this study they looked to answer the question how often does this actually occur! They evaluated all cases of priapism reported to the FDA since 1998 which happens to be when viagra hit the market and they were able to identify a total of 411 cases due to Phosphodiesterase Type 5 Inhibitors Now it is hard to get exact or precise numbers on number of viagra and cialis prescriptions out there but In the first year and a half of marketing in the United States, more than 15.6 million prescriptions of Viagra had been filled. So even if there was not another single script of Viagra written for and we just went based on the first year and a half and we assumed each prescription was for only 3 pills then the rate of priapism would be 411/46.8million which in % terms comes out to 0.0008%-- basically nothing!! And that is just the first year scripts, obviously the numbers are much larger and we are over exaggerating the evidence. Although PDE5i-induced priapism does occur, it appears less common than once suspected. When counseling patients, this should be considered. Dean martin once said “Everybody loves somebody sometime” well it appread in medicine Everyone wants to treat subclinical hypothyroidism sometime – Clearly seen in this paper -- https://jamanetwork.com/journals/jama/fullarticle/2768464?guestAccessKey=cafa97b4-33a8-49f3-9c5c-df1ebf349f84&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=etoc&utm_term=072120 Effect of Levothyroxine on Left Ventricular Ejection Fraction in Patients With Subclinical Hypothyroidism and Acute Myocardial InfarctionA Randomized Clinical Trial Where they sought to find if levothyroxine treatment improved left ventricular function in patients with subclinical hypothyroidism presenting with acute myocardial infarction? A double-blind, randomized clinical trial took 95 participants with subclinical hypothyroidism and acute myocardial infarction, treatment with levothyroxine, compared with placebo Levothyroxine treatment (n = 46) started at 25 µg titrated to aim for a TSH levels between 0.4 and 2.5 mU/L And after 52 weeks-the authors nailed it when they say- “treatment with levothyroxine, compared with placebo, did not significantly improve left (continued)