Saw the oversight committee released this.. anyone else over the bs and can’t wait for the new clown car with Dr Oz to make this mess even worse?

https://oversight.house.gov/release/final-report-covid-select-concludes-2-year-investigation-issues-500-page-final-report-on-lessons-learned-and-the-path-forward/

Hello everyone,

Wanted to post about a topic that I havent seen covered on this subreddit. If you frequently prescribe flomax please be aware that it can make routine eye surgeries much more complicated by creating floppy iris syndrome.

Floppy iris syndrome is a condition where the iris loses its muscle tone, usually a result of taking alpha 1 antagonists. This change causes the iris to minimally dilate and/or lose dilation quickly during surgery. The iris will become very floppy and flaccid so that it flies around the eye during surgery. There is also the possibility of the iris repeatedly prolapsing out of the eye through the incisions made during surgery. Patients tend not to like the cosmetic effects of losing iris pigment when that happens or the subsequent intraocular inflammation that causes pain, light sensitivity and macular edema.

Light colored irises are particularly difficult when combined with flomax. Certain adaptations can be made during surgery, but they include manually dilating the iris. This can involve making five or six extra corneal incisions and then pulling the iris into dilation with hooks, or placing a dilating ring that can cause tears or dialysis of the iris and bleeding.

Please consider asking older patients if they have had cataract surgery yet and send them for an eye exam if they haven't before starting flomax. Stopping flomax unfortunately does nothing to reverse floppy iris syndrome. Even if the patient only took it for a few months.

Thank you for listening!

One of the popular cliche phrases, it came to my mind - it is just a twofold increase of accountability, two instead of one being responsible/considerate. Just to make it sound great made up 200%…

Hi all, FM PGY-3 here hoping to develop some skills with POCUS prior to embarking on a sports medicine fellowship this coming academic year. Seeing that PCSM is POCUS-intensive and most of the fellowship programs will lend you a Butterfly or similar device, is there any utility to picking up a “cheap” or used device for practice now and, if so, can anyone recommend an affordably-priced machine?

I’m hoping to practice broad-spectrum primary and sports medicine +/- a hospital component and therefore would like to develop my skills beyond MSK US.

Thanks so much!

Anyone else facing this issue? New to practice management and this local clinic seem to get some downtime from no-shows

Hi everybody, title pretty much sums it up but I wanted to elaborate.

I myself am from a central european country and a third year in med-school right now, so I have been exposed to a lot of medicine-themed social media content over the last few years since my algorithm has caught on. Over this time period I have been bombarded primarily with influencers from the US, talking about their experience during school, training etc., but recently I feel like most of the content I see is not only about the topic per se, but the people involved in making the content are basing their whole personality on their career choice, be that nursing or medicine. Obviously in my home country people are happy to talk about their career choice as well and do so quite vocally, but for some reason I get a very different and much more hardcore vibe from most US people I interact with online.

Is this just a skewed social media thing or do you have any experience with this phenomenon? I would greatly appreciate any input, maybe someone even has studied/worked in the field outside and within the US and can share their experiences!

This is observation is based on my very personal social media experience so please take all of this with a grain of salt, I am just genuinely curious.

I'm aware it's not a protected title, but I find it very interesting how the term is used in this sub.

In Aus/UK there seems to be an understanding that a physician is a clinician that holds a FRACP or MRCP, that is specialised in internal medicine or a "medical" speciality (cardiology, endocrinology, haematology, gastroenterology, etc). You'd hear the term "emergency physician" or "sports physician" but I don't think those clinicians would describe themselves as "a physician". (Nb I met a cardiothoracic surgeon who non ironically told me they described themselves as a "physician who operates" but that's another story).

Anyway, on this what I assume is a mostly US based sub, everyone is a physician. Surgeons are physicians. Family medicine docs are physicians. Non specialist training doctors are physicians. What do you call classical physicians then?

I don't think there's anything necessarily wrong with either, but I am confused by the difference in terminology.

I work at a teaching hospital with residents, and, as a rule, they are hard-working, smart, kind, and all-around amazing people.

However, there have been a few events lately that have inspired some yucky feelings in me. I've found and had to question some poorly thought out orders, such as:
-dual nsaid therapy on a surgical ckd patient(unfortunately I didn't catch that one prior to the predictable outcome and I feel real rough about it)
-d2 blocker anti-emetics on a parkinsons patient (bonus - that patient also had one of the d agonists for their restless leg syndrome, fortunately i did catch that one prior to harm).

These orders, placed by residents, allegedly reviewed by attendings, and allegedly reviewed by pharm (again - kind, competent, hard-working people) have caused harm, and it makes me have very big feelings, usually fury.

So - how do yall do it. How do yall resolve those feelings and keep them from spoiling your time away from the hospital? How do you regain trust in someone knowing that they've fried someone's beans, and treat them in a manner that facilitates the growth of their confidence?

Eta - also, any advice between being appropriately thorough on chart check and not developing an anxiety disorder would be welcome

Suppose you have a test that is ~90% sensitive and ~90% specific for a disease which has a prevalence of 1%. If you have a patient who gets a positive test result, what is the probability that they have the disease? The answer is explained in this short video by 3blue1brown: https://youtube.com/shorts/xIMlJUwB1m8?si=w3cwVaBaOI6KtnaO

The medical test paradox is that a very accurate test does not necessarily imply that it is a predictive test. If you’re interested in learning more, the longer video this is clipped from is very good, though a bit on the mathy side, and gives a great overview of Bayesian statistics and how to understand and resolve the paradox.

New medical graduate i know this comes with experience but how do you deal with the sheer terror of making a mistake , the constant second guessing my decisions , the waiting for the patient to show signs of improving , the stabilizing and then immediately searching and reading material to validate my decision. Back in med school I had residents I could rely on and call at any hour but now it's terrifying . Any advice

Edit: thank you for the reassurance, I’m glad to know I’m not the only one who feels this way regardless of level, I’ll make sure to keep this cautious nature and be more open to asking for help even if it isn’t immediately available, also the comment about learning when to do nothing really struck a chord and also reminded about that one episode of scrubs about drug fever. Again thank you all for the advice and reassurance.

Patient having US for evaluation gallbladder polyps with incidental note of splenomegaly. What is your threshold for further evaluation? Do you work up EVERY incidental splenomegaly finding?

I feel like this particular phrasing is used so frequently online and by people I meet irl, and I am finding it irksome. Sure, there is some elitism in medicine, as there is in many professions, but the term feels so exclusive to medicine and very dismissive.

Signed - an MS4 who is worried about responding to this sentiment moving forward

I practiced as a pediatrician for 20 years, and am now pivoting to adult mental health care. I have a (non-clinical) Master's in Depth Psychology (Jungian and Archetypal Studies), as well as years of volunteer experience running informal group therapy on the side. I have no interest in doing the thousands of hours of supervision required to become a fully-licensed therapist. I make it clear to clients that I'm not a licensed therapist, and I don't work with insurance companies. But I seriously cannot find information about whether I'm technically using my MD, since I'm working with people, or whether I'm supposed to completely divorce myself from my MD, in order to be ethical. Does anyone know people in this situation? Who could I consult about what my MD license actually covers? I don't even know what flavor of lawyer might be helpful--not the malpractice ones, lol!

Hi all, I got a great job offer to work the VA and have been seriously considering it, but I can’t help but be worried about all of the politics going on and Elon Musk’s plan to eliminate big chunks of the federal workforce. How stable are VA physician jobs in this climate? Are those of you working in the VA worried at all?

I am interested in understanding the perspectives of physicians practicing in Texas regarding the current abortion legislation. Given the significant legal and ethical challenges presented by these laws, I am curious about the factors influencing your decision to continue practicing in the state.

• What considerations have led you to remain in Texas despite these challenges?
• Have these laws affected your professional satisfaction or prompted considerations of relocation?
• If you agree with the current legislation, how do you reconcile these laws with your commitment to patient autonomy and evidence-based care?
• For those who have thought about leaving but decided to stay, what resources or support systems have influenced your choice?
• Are you seeing any changes in patient trust or the doctor-patient relationship as a result of these policies?

One of my friends who is an Emerge resident told me that they recently called push back from General Surgery when they called about a SBO that was diagnosed by Emerge via a POCUS.

Having done a few off service general surgery rotations, I can completely understand why that’s the case. POCUS quality varies entirely with the level of expertise of the practitioner, isn’t the gold standard for SBO, and at our particular centre the ED doesn’t save any POCUS scans so no one (radiology, gen surg) can even review the image.

At the time we were speaking, I also was under the impression that POCUS was a bad test for SBO. Was looking more into it and saw that there is some recent research of decent quality that shows it to be sensitive and specific (not as much as a CT, but not as terrible as imagined).

Curious as a rads resident if at any of your centres, you use POCUS for SBO and if you’re able to consult a surgical service with just a POCUS!

I will preface this by saying that I have absolutely no research or data to back this up. But my gestalt is that in the past ~2 years I have seen many reports of medical malpractice payouts with figures that are incredibly high, like more than $100M. How does such a value get determined?

Can anybody provide some insight into this. My younger brother was accepted to medical school this week but is worried about his future ability to practice as a physician due to having taken a leave of absence for mental health reasons in undergrad. He has been told by a physician he has worked under as a scribe that when credentialing committe see that his start and end dates for undergrad are 6 years apart this could impact his ability to work as a physician. Any info would be appreciated!

Dear meddit, with this image I propose to you a new radiological sign. The so called [Darth Vader Sign] (https://imgur.com/a/ORGaMJQ). It is a finding in the crural veins in B-Mode Ultrasound that has a high positive predictive value for a high count in Midi-chlorians in the patient.

Silliness aside, I would love to see some interesting or funny looking radiological findings and/or medical images that you guys have collected over the years. Of course you are open to propose a name for your radiological signs or images!

Disclaimer up front, this is just a rant.

I get it that some patients are more high-maintenance than others, and they come in all the time for trivial complaints like 3 days of an intermittent runny nose, ear was ringing last week, balance feels "a little off", throat is kinda sore...well not really sore, but it just doesn't feel right.

What's grinding my gears lately is getting these patients referred to me, often as stat/same-day/urgent referrals, because their PCP is tired of reassuring them and they want somebody else to tell them there's nothing wrong. I get it, and I'm happy to do it, and these patients are often very appreciative to receive specialist reassurance. But, at the same time, I've got patients with fungating head and neck tumors that have to wait 3 months for a new patient appointment because I'm booked solid seeing colds and sniffles that are not even remotely surgical candidates. (Obviously there are some system admin changes needed that would hopefully triage the more time-sensitive referrals to the front of the line, but my gripe remains that the reason for the long wait times is the deluge of meaningless referrals).

We've done enough bitching about inpatient consults recently, so I thought I'd get the community's take on outpatient referrals.

Hi all,

I’m writing this post here because this seems like the best place on Reddit to pool experience and advice from my fellow medical professionals—particularly physicians, but I’m interested in insight from all healthcare workers, too.

Long story short, I’m an attending physician in a patient-facing role and deep down I’m a huge introvert. I know I chose the wrong career, however I did so when I was in my early 20s and much more idealistic about what I could handle. That said, the cat’s out of the bag, and I’ve accepted this career path and have made peace with that.

I’m 3 years post-fellowship, and spent 5 years in residency + fellowship, so I’ve been mostly seeing patients on my own for about 8 years now. I work in an exclusively outpatient setting with low acuity patients. I see patients for 32-36 hours weekly.

Here’s the thing: I’m quite nimble when it comes to interacting with patients and staff—I can shape-shift and be the extroverted-appearing, sociable, highly communicative and empathetic physician that I believe my patients and staff want and need. While I’m in clinic, my energy levels feel decently well managed and I get through most days just fine. I mostly enjoy patient care.

The “problem” happens after I leave work. I feel zero desire to do anything social, sometimes little desire to even leave the house. The weekends are not enough time to recharge my batteries. I’m not pursuing friendships or hobbies like I’d hoped, because I’m so drained from patient care and the high energy hustle-and-bustle of the clinic, my ever exploding Inbasket, fielding patient calls simultaneously, etc.

Some said this would get better with time and it hasn’t. Being an attending has gotten much easier after the first 2-3 years, but this piece hasn’t budged. I worry I’m sacrificing my personal life to this job.

Any advice from my fellow introverts in patient-facing roles?

Thanks in advance.

(PS this is 100% not a pity post, I’m genuinely looking for advice, as I fully intend to stay in this career and want to find better strategies to have a life outside of work).

Title. After 5 years I'm now getting random rejections from the coders stating "medicaid pay for only one professional service per day". So you can't bill 99396 (annual) + 99214 (acute) despite proper documentation?! (annual + diabetics for example, easy 99214).

Can someone confirm with any proof? I have asked 5 different "admins" and nobody will respond. This is a practice changing if so...cries in so much free work

Edit: we are a very large community institution but not FQHC, these are straight medicaid, yes using modifier -25, these are all reviewed by coding so they add in any additional modifiers if the documentation is up to date but they won't upcode if you undercode for obvious reasons. i do the same billing for all patients regardless of insurance and it's only medicaid that I get kick back from and only from one coder. Our institution actively encourages acute issues on annuals, so now it's a big problem...

There is much discussion on unnecessary imaging these days, the "medical CT Head" is a frequently visited topic. Most vocal have been radiologists and neurologists who point out that the diagnostic yield for acute, actionable findings (ie. subacute/acute infarct, bleed, hydrocephalus, mass, mass effect) is relatively low (ie. ~10-15%). And overall leads to more unnecessary work and over utilization.

That said, 10% does not seem to be a particularly low number to find something acute in the head that could change management. Would you aspirin load and anticoagulate granny who had an unwitnessed syncopal episode sitting at the dinner table from an NSTEMI without a head CT? Also wouldn’t looking at the amount of cortical atrophy, chronic lacunar infarcts, silent cortical/frontal strokes help characterize the burden of vascular pathology that predispose them to become altered from relatively mild insults? 

Some references I have for diagnostic yield of CTH in the medical setting. Other suggestions are welcome:

Use of Computed Tomography of the Head in Patients With Acute Atraumatic Altered Mental Status: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022

A new clinical score for cranial CT in ED non-trauma patients: Definition and first validation. Am J Emerg Med. 2019

Altered Mental Status in ICU Patients: Diagnostic Yield of Noncontrast Head CT for Abnormal and Communicable Findings. Crit Care Med. 2016

Would like to hear what people think.

Edit: To everyone who keeps questioning where I got the number 10% from PLEASE SKIM THE 3 ARTICLES I POSTED

Questions about medicine as a career, about which specialty to go into, or from practicing physicians wondering about changing specialty or location of practice are welcome here.

Posts of this sort that are posted outside of the weekly careers thread will continue to be removed.

https://www.kob.com/new-mexico/rio-rancho-man-awarded-400m-in-medical-malpractice-lawsuit/

What a giant mess. Not a proud moment for PAs here in NM. Moreover, that award amount should be alarming to all clinicians.

Chill out on Flexing your salary on public forums

I feel like constantly flexing and showing off your salaries on public forums like r/salary is a shitty idea. General public already have perceptions as doctors as rich or greedy and flexing your 750k salary as a radiologist or whatever other high paying salary specialty isn’t a good look. Especially in this economy where people are already hurting and seeing healthcare as super expensive and they can easily see us the rich scapegoat. You will find public will have very little sympathy when we complain about pay cuts if all they see are these salaries.

I get it, your ego feels good when you post it. But lots of people don’t see the years of work, sacrifice, student debt, etc behind the salary. They just see the high salary. We already don’t have the best perception.

I’m all for salary transparency among colleagues and residents so they’re aware of the market but showing off in public like that doesn’t help anyone.

Lower paying specialties rarely post on public forums so people are all thinking doctors are all making 500k+. I guess, just be mindful folks.

https://nyunews.com/news/2024/11/27/home-depot-donation-ten-million/

Mountain Dew Camacho doesn't seem so far-fetched anymore. Just a reminder, the ER had a super-secret exclusive ER room for Home depot founder Kenneth Langone, at the Langone medical center.

Any other examples of Robber Barons being whimsical with their health systems.?

I had this happen in clinic and was wondering what your response might be. Pls reply in the exact words you’d say to her? TIA.

https://www.bbc.com/news/articles/cvg4yxmmg1zo

What is the best way to get patients that are enrolled in a research study to return as needed for the study?

-money -food -taxi?

The area would be inner big city, so lots of poor that will need care.