Microsoft Nuance DAX, which transcribes your notes on the fly as you speak to patients, seems very intriguing. They also have a few competitors such as Ambience: https://www.ambiencehealthcare.com/

How did DAX improve your flow (or make it worse)? Also, do the notes seem as robotic as the demo shows them to be? (which I believe will make notes less and less useful as they basically become standard legalese language)

Any concerns about the encounter audio recordings for malpractice (I don't know if they even keep them)?

My shop previously used fioricet for headache in SAH pts. Had a pt post IR coil and embolization for ruptured wide neck aneurysm. Pt developed hydrocephalus and then had an EVD placed. Pt had a good amount of CSF drained, usually 150 to 200 ccs every 24 hrs. 16 days later the EVD had been clamped for nearly 24 hrs, no drainage and ICPs had been 3 to 15 mmHg. Drain was likely going to be removed with no shunt required. TCDs have been negative since they were initiated.

We recently totally changed our providers to a completely new neurosurgical service . They are absolutely against using Fioricet due to it being implicated in causing vasospasm. I had looked up the paper and indeed it seemed highly likely to contribute to vasospasm in SAH pts.

Pt had severe headaches that were refractory to other meds, so Fioricet was ordered and then advanced to 2 tabs Q4 right before the incident. Pt was GCS 15 and NIH of 0 at 0600 when I gave Fioricet and Nimodipine. At 0630 pt could not move LUE and had left facial droop. They were still AAOx4 and had no other deficits and normal sensation. NIH increased from 0 to 5 - no effort against gravity, lethargic but arousable with repeated stimulation, and minor facial paralysis.pt could slightly move fingers off and on. Stat CT showed no new bleeds and they were taken to IR for treatment of vasospasm.

Has anyone had experience with Fioricet causing vasospasm? Pt was pretty stable throughout stay except for periods of moderate lethargy. Is anyone else using Fioricet for headaches in SAH pts, or is it not commonplace in other shops? Thanks

https://tennesseelookout.com/2024/03/26/house-gop-votes-to-end-flu-whooping-cough-vaccine-rules-for-foster-and-adoptive-families/

GOP votes to eliminate vaccine requirements for adoptive parents of "medically fragile kids" under the ruse of allowing more families to adopt.

Huge slippery slope.

I do not know the specifics of this, but my boss at the VA said that one cannot bill anywhere outside of the VA if it is within tour of duty hours or maybe the same calendar day? Not sure if this is for Medicare only or if commercial is included. Does anyone know?

Prescription medicine is almost exclusively metric (SI). OTC (Over-the-Counter) medication varies in this approach. Although we have seen recent changes in dosing directions for liquid medicine (mL only dosing), the fill bottle itself is in dual units (at least the label is). The reason for this is a requirement from the FPLA (Fair Packaging and Labeling Act) of 1992 requiring dual units. An amendment has been in the works for the last 10 years to allow metric-only labels as well as dual unit labels. Proctor & Gamble, Pfizer, Johnson & Johnson all support this. Do you support this amendment, or possibly going a step further and requiring metric only labels on all medicine?

Note: Prescription medication is fully exempt from the FPLA.

I'm cash poor due to the Change hack. I haven't received any CMS payment in over a month. We have submitted red form claims, and supposedly have claims filtering through Office Ally, but I can't get an answer on if we are pending money actually coming back.

I am applying for the CHOPD accelerated payment, but I wanted to see how long the turn around was. Payroll is looming.

Does anyone have recommendations for an affordable at-home BLS & ACLS certification that can be verified by AHA?

I am happy to do the online classes, and have the course instructors mail me a mannequin to do a skills test virtually over video. Thanks in advance!

Recently, I got to teach what Throckmorton sign was to someone.

It made me wonder- what other humorous signs/symptoms/diagnoses exist? Bonus points for increasing amounts of esotericism, and if they're actually clinically useful.

Ant fellow radiologists here? how are you keeping it up with your career?

What do I do? I’ve been a radiologist for almost 12 years, I’ve been working in a very modern environment as resident in a university hospital and I’ve been helping out in some R&D projects with animals. For 10% my time is invested in a company. I have a stable marriage and lovely kids. I’m not overloaded with work as something I’m glad to help out colleagues or family.

Now my is issue is that I don’t really have a big motivation anymore, it seems like I’ve seen and done it all. Money isn’t a problem, nor something else.

How do you guys keep up with the job and hassle around it after so many years?

I'm working Locums at a small hospital within a faith-based system and this particular hospital does their multi-disciplinary rounds in a way I haven't seen before. It's bedside rounding and it seems very poorly conceived with respect to efficiency. MD, pharmacist, CM, RN are expected to enter each room and the RN (some very fresh grads) are expected to present the case basics, then MD, etc.. weighs in on their portions. However, the hospital president (young & very fidgety almost to a cocainey level) insists on coming in the room and basically wants to direct the whole discussion. Also there is always a parade of additional people who follow this painful death march but they all say out in hall like a gaggle of geese which is a congestion issue.

The president likes to direct the rounds discussion like he's a Maestro and it's very odd, the obvious underlying concern (only concern IMO) is the GMLOS and how close are we to DC so we don't lose money. He likes to ask lots of questions dragging this discussion out much longer than it need be and at times I feel like an intern having to present my plan and justify my decisions but he does seem to be careful about not pushing too hard when I assert my plan.

I am only Locums and not interested in getting deeply involved or I would already be having meetings with the admins but I was curious if any others had been seeing this sort of process?

Self explanatory but how to switch specialities in canada, willing to retrain in States.

is anyone billing this code? if so, only if you use a chaperone or would you still bill it of patient refused chaperone?

I've been a Nurse Practitioner with my clinic for 5 years. When I started, it was a fantastic Ryan White clinic, focused exclusively on HIV (my dream job!) and PrEP. Within a year, we became a FQHC and the physician/CMO I trained under retired. As new physicians joined and a new CMO started, new policies took effect.

A year ago, it was mandated that the practice will write no controlled substances except testosterone for gender affirming care. In my state, gabapentin is a scheduled med. The policy change was spurred by one of the new docs whose stance is "there's never a reason to write a controlled substance." Granted, gabapentin was probably overutilized at times and sometimes TCAs or duloxetine can do the trick, but not always. Nor are those always best when considering Rx interactions...

Anywho, we serve a specialty patient population, many of whom have HIV induced neuropathy stemming from a 20-30 year history of the disease and l'm having to stop this medication. I'm talking 300mg QD, not 800 TID... ther docs are equally frustrated at this policy and are angered that they, as physicians, are being told "no" to prescribing something they think is appropriate and indicated based on guidelines.

The CMO maintains that the policy is staying. Also, our CMO doesn't see patients, so they get to avoid having these conversations altogether, but that's another question for another day.

My question is - is it typical for CMOs to dictate policies such as this and for other practicing physicians to be reprimanded if they write a controlled rx when it's indicated and other options have failed?

**TLDR - Is it normal for a CMO to dictate a "no controlled meds" (which includes gabapentin) and reprimand the MDs or NPs if they prescribe it? Specifically treating many older patients with HIV induced neuropathy.

The most ridiculous thing I heard in my last job was when someone claimed that one of the girls we cared for was a psychopath because she “talked to herself.” I am certain this came from TikTok.

From observation, there is a lot of medical misinformation on TikTok. However is it worse than other social media sites? I’ve gone back and forth on this. What are your thoughts?

Nursing school teaches the importance of auscultating bowel sounds. I can’t find good literature to support (or discontinue) this practice. The limited studies I found showed low to moderate positive predictive value for SBO and post-op ileus.

Is auscultating bowel sounds an outdated practice?

Should it only be used post-op? Do you have good data to support or d/c this practice going forward? Hoping to hear from GI and surgery!

References (not APA, random order, don’t @ me)

1. Ching SS, Tan YK. 2012. Spectral analysis of bowel sounds in intestinal obstruction using an electronic stethoscope. World J Gastroenterol.
2. Baid H. 2009. A critical review of auscultating bowel sounds. Br J Nurs.
3. Gu Y, et al. 2010. How useful are bowel sounds in assessing the abdomen? Dig Surg.
4. Felder S, et al. 2014. Usefulness of bowel sound auscultation: a prospective evaluation. J Surg Educ.
5. Breum BM, et al. 2015. Accuracy of abdominal auscultation for bowel obstruction. World J Gastroenterol.
6. Read TE, et al. 2017. Bowel sounds are not associated with flatus, bowel movement, or tolerance of oral intake after major abdominal surgery. Dis Colon Rectum.
7. van bree S, et al. 2018. Auscultation for bowel sounds in patients with ileus: An outdated practice in the ICU? Neth J Crit Care.

I'm a PA starting to train in cardiac surgery and hoping to poll the crowds on favorite brands/features for loupes? All recommendations welcome.

I feel like I'm going insane and I need to know if this is all clinics or just this one. Apologies as this is kind of a rant. I've worked in the ER, 911, and at a plasma donation center before starting as medical assistant at this autoimmune clinic and I'm all for basic hygiene. Handwashing before gloves, gloves on before Pt contact, face shields for blood draws, etc. But this clinic I just started at is so laxxed on their regulations and it's concerning.

On my 3rd day the person who was training me asked me why I put on gloves before taking vitals. I was taken aback as this woman had been a nurse for 20+ years. I told her it's just basic hygiene and keeps the Pt and us safe. She said it was disingenuous to not physically touch the Pt and have gloves on for that. I didn't even know what the hell to say. She then asked the PA what she does and apparently she never uses gloves either, even for physicals. WTFFFF am I crazy?? Are all clinics this unhygienic? One of the rooms doesn't even have a sink. This is an AUTOIMMUNE clinic, our Pts are on biologics and have suppressed immune systems most of the time, they're at such high risk and this is the norm? We don't even have face shields for blood draws and some of our Pts have forms of hepatitis. Not to mention there was no form or anything saying I'd have or they'd give me a Hep B shot so they clearly don't care about that either. We don't wipe down chairs or the pulse Ox. Hell we don't even have disposable tourniquets for blood draws and we use the same one every time.

Someone please tell me I'm not crazy. I want to speak up but the complete and systemic lack of care is concerning. I know I'm only 20 and inexperienced but this can't possibly be regular for most clinics, right?

Edit: Thanks for all the replies. I appreciate everyone sharing what they know as I only started working in the medical field once covid started, so PPE for everything was my normal, and I'd never seen it any other way. I apologize if this post came off as criticism in any way as I definitely came across as a bit frantic as I reread this lol. Thanks again for all the input, it's nice to see other perspectives on the whole glove thing!

I'm an ER clinician (hourly contract) and I've hit a rough patch. Every shift, I'm staying back 30+ minutes for sign-outs and patient transitions, but this extra time isn't reflected in my paycheck. After doing this for years, the unpaid hours are really adding up, and it's becoming a financial and mental burden.

When I brought this up with my admin, their response was basically, "That's the ER life. If it bothers you, maybe this isn't the place for you." That left me feeling pretty stuck.

I'm turning to you all for some perspective:

1. Is this the norm in healthcare settings? Are we expected to just accept unpaid overtime?
2. If I push back or leave on time (while maintaining patient safety) and get fired, is that a legal battle worth fighting?

I'm not gunning for a legal showdown. I just want to do my job and get fair compensation. Is anyone else dealing with this? How do you handle it?

Thanks for any advice or shared experiences!

Given the recent reports of fusobacterium associated with colon cancer, is there a concern that the near ubiquitous usage of PPI’s may allow the bacteria to survive the upper GI system and wind up in the colon? Could this be the reason of the higher cancer rates in the younger?

I'm junior faculty at a university hospital in the States. Have grants, publish frequently, etc., and I was just asked to join one of Wiley's journal's editorial board (Impact factor ~6) where I'd review reviewer comments, make editorial decisions, promote for the journal, and perform QC for the journal's publication. They offered an annual honorarium of $1,000.

Listen. I didn't go into academics to make the big bucks, but it is outrageous that these companies are making billions in revenue (Wiley did $1.8 billion last year) while their business model relies on academics volunteering their time for this industry. So, this is my PSA that the academics of r/medicine stop accepting these incredibly low paying positions. The publishers have the funding to pay proper stipends for these positions, and if they were made to, they would in order to preserve their business models. It's astounding to me that they've gotten away so long without having to pay reviewers for their time. Somehow they convinced us all that our integrity would be out the window if we were paid for our time. /rant

I'm a doctor from South America, and since I was a med student every old doctor I met didn't trust in this website. Is this happening also in USA?

Found this in the news.

Patient presented to the ER sick. Got a lot sicker.

Abdominal pain, hx of cancer for which he is being treated. Tachycardia, hypoxia, fever, rash, shallow/rapid breathing. Septic.

No discussion of treatment provided in hospital. No information on treatment provided pre arrest by transferring ambulance

No ALS units available for transfer. No discussion of using a critical care transport (ground or air).

Patient was sent BLS, which given presentation is pretty damning.

<I have serious questions on why the ambulance service did not flat out refuse. Are they contracted to do the transport no matter what? Did the EMTs not have enough experience to tell the physician no. Were they lied to about patient condition and didn’t have the medical experience/ training to understand?>

En route child codes. Article says bls crew made several intubation attempts. <this sounds incorrect, as intubation is a paramedic level skill. I wonder if it was failed rescue airways? Like a King or Igel)>

When patient coded 911 unit was called, and patient taken to a closer hospital with a pediatric icu <unknown why patient was transferred there in the first place>.

EMS (unclear if the bls transfer crew or the responding 911 agency) was able to resuscitate the child, but damage was terminal and family ultimately withdrew life support.

I’ll be really interested in this mad mal case.

https://www.jems.com/patient-care/family-files-lawsuit-after-ct-boy-with-cancer-dies-after-ambulance-transport/

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.