According to the AMA Code of Ethics, "In exceptional circumstances of unjust laws, ethical responsibilities should supersede legal duties." Current anti-abortion laws in some states put women at disproportionate risk and thus easily clear the bar of being unjust. This is before even considering the fact that pregnant women are medically vulnerable even without laws preventing them from receiving proper care. Combined with the absolute ignorance of medicine on display in laws controlling the practice of medicine, this situation is firmly in the territory of "exceptional."

As such, it is incumbent on practitioners in states with such laws to provide proper care to their female patients regardless of said laws. The ethical principles which must guide the practice of medicine allow for no other option. The death of a single woman due to allowing fear of legal repercussions to override ethical behavior leaves an indelible stain on the medical profession as a whole. Unfortunately, that stain already exists, but it must not be allowed to grow further.

I want to make it clear I understand what I am asking of practitioners in those states. I understand how much physical and emotional strain many of you are already under. This is not a place to list all the difficulties of a life practicing medicine, but anyone who needs to be reading this already knows them. It is not fair for this burden to be placed on your shoulders.

Unfortunately, that is where it is.

I just learned that a brilliant, dedicated, hard-working woman that I went to med school with has died, succumbed to major refractory depression.

She was a good clinician even while struggling.

I'm numb. When is this going to turn around?

Lab tech here with a question for the MDs. I know these questions might be better suited for a nephrology sub or something lol but I figured I’d start here:

When we’re running serial blood and/or urine osmolality tests Q1h/2h/4h/etc. on an inpatient hospital pt for several days in a row… why? Like what’s the clinical indication(s) for ordering these so frequently?

Also, how much can an osmolality result really tell you about the pts health? And how useful is a blood osmolality without a simultaneous urine osmo (or vice versa)?

These are just some things I’m genuinely curious about, hopefully this post doesn’t come off as sarcastic or an attack or anything. Obviously down here in the lab, we understand that osmolality testing is used to help gauge fluid/electrolyte balance, but a lot of us don’t know too much more than that lol. I’m always interested in learning more about the what and why behind the tests we perform but I obviously don’t want to bother providers with these types of questions at work.

Thanks! And thanks for all you do!

So I have a bad habit of seeing patient injuries and going "that is interesting". I have had people tell me to avoid saying that which is fine and I agree and get it. I am just asking for some help to either phrase it a different way or just say something else. For context, I am currently shadowing so that I can become an OT. I dig medicine and find the way the body works fascinating and just want a better way of not insulting the patient and yet letting the person that I am shadowing know that I am: 1) appreciateive for them explaining to be what is going on, but also 2) being sensitive to the patient. Thank you for your time and energy.

Edit: This is easily the fastest and most productive reddit post I have ever had. A lot of great advice. Thank you.

Just unsuccessfully coded a young man who arrested very unexpectedly after a routine surgery and then had to notify both of his parents that he had died. Most of my patients are older and it’s a spouse or a child I’m telling when this happens, not a parent. The whole thing was confusing (still not sure what happened), awful, and just fucking brutal. The sound of his mom keening won’t leave me any time soon.

Medicine is hard sometimes y’all.

I have seen a good number of physicians (usually male) who are hell bent on practicing until the day they die.

What are the most common factors that eventually lead to these doctors retiring (forced or voluntary)? Is there a final “straw”? Please share any stats or stories you might have.

I’m sure you’ve all seen it before during work ups for issues like anemia, dementia, or even neuropathy. Someone sends a vitamin B12 level and instead of it being low, the level is >2000 pg/mL.

The question I wonder is: what does it mean? Is there any additional information that would be helpful in determining what the source of the lab abnormality is for those not on active supplementation? Particularly among those with otherwise normal blood counts, cell diff, kidney function, & hepatic function on routine lab work. Or is it something we just universally ignore without a second thought?

I saw the following article which makes me wonder if we are being as thorough as we need to be when this finding arises, albeit an isolated laboratory finding:

https://pubmed.ncbi.nlm.nih.gov/34172805/

What was your experience? Would you recommend it/do it again? What were the most unexpected things people don't take into account? I know the language requirement can be an issue, but what else? Perspectives from volunteering with other similar organizations also welcome, but looking for more long term projects than just a 1-2 week trip

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.

Looking for some advice on what to do with a needed relocation for partner’s work (I do not have a new job yet)

End of year bonus is coming up, more than 10% of my total take home for the year. In the bonus language it is noted that even though it is based on past performance, it is designed to incentivize future performance, therefore one must be employed to receive the bonus. I have a sneaking suspicion if I give notice I won’t be getting the bonus even though I will be employed past the payout date.

The problem is if I give 3 months notice, which is not in my contract but was listed as an “expectation” in the Offer Letter I received it will be before bonus pay out.

Again, I don’t have another hospitalist job lined up yet. I have gone through the documents I have an see nothing about clawbacks or anything.

Options as I see them:

1. Give 3 months notice and separate as normal, probably without the bonus.

2. Get paid out and immediately give notice, giving about a month and a half of warning

3. Get paid out and offer to come back for a week a month for two months to get to the proper quit date. I would work half my shifts all in a row as the schedule is set up.. There’s no way I can do two weeks of shifts though.

FWIW I would expect my shifts to get picked up for moonlighting when I leave. Obviously this is somewhat delicate with not having new job lined up yet because I don’t particularly want my employer contacted yet.

Thanks

I work in a cardiology office where we started administering Leqvio. I'm new to the office and was under the impression that besides setting up an account and the actual ordering of the medication, the office already had their ducks in a row and I was just coming on board to do pharmacist stuff (I monitor patients taking other cardiology meds and really only talk to Leqvio patients after they've been started on therapy). Turns out no one knows what they're doing and I'm having to coordinate everything. We have another office in the system that has been administering Leqvio for a few years and we've been referring to them a lot for the logistics. I'm getting a bit frustrated because there appears to be a lack of communication and misunderstanding in expectations. I feel my office was expecting me to implement everything for everyone of all job titles while I was expecting everyone to already have all of this done and I would just be doing my duties as a pharmacist.

ANYWAY, for those who do administer Leqvio or other injectables in office, what is your protocol? If it's scheduled as a nursing visit, do you check vitals like a regular office visit? Or do you just verbally confirm patient feels healthy enough for the dose and proceed with administration? We've been documenting verbal consent and checking blood pressure prior to administration but now the prescribers are getting irritated that nursing is reaching out to them when BP is high. We're a cardiology office, so of course some patient's blood pressure will run high (also if they're "sick" enough for Leqvio they most likely have other health conditions going on too). Legally speaking as well, is the office at risk if a patient goes to the ED for something unrelated and had their Leqvio injection same day and vitals weren't checked? These are all questions I'd like to defer to the nursing manager because these all feel like nursing/managerial tasks, but the current one is dealing with some health issues and likely stepping down soon and since I know more about the Leqvio protocol than the rest of the office everything is falling on me.

NMR lipoprofile and apoB testing…could someone explain the purpose of these tests and when/how they would be used? I’m IM primary care and I see these done or patients will bring it up, but I don’t really understand how to use the tests and if they’d really be more useful than a normal lipid panel??

Just to preface this query by saying I’m obviously a Big advocate for covid vaccines and how they rapidly mitigated the pandemic.

However I’m less sure as to the benefit in young adults of getting repeated annual boosters such as advised in many jurisdictions for healthcare workers.

There is a definite risk of myocarditis from each covid vaccine and I acknowledge a definite increased risk of severe covid (and myocarditis) if not in receipt of vaccine boosters. Both risks are low. Is there any compelling data looking specifically at boosters that shows the benefit of boosting this cohort outweighs the risk at this stage in the endemic with the illness becoming less severe?

Edit: I think it’s concerning that no one was yet shown any study or evidence to support that repeated annual boosters for healthy young people is more beneficial to them versus the risk. This needs to be looked at urgently as if the risk outweighs the benefit, the antivax brigade will have significant ammunition and it will bring the recommendations from bodies like the CDC into disrepute which would shatter confidence.

I would struggle to recommend a vaccine to a cohort of people where there is no clear evidence that the benefit outweighs the risk to them. Thankfully I’m a geriatrician!

Hello!

I'm about to start work at a large telemed organization, working as a 1099 physician. I'm a sole proprietor with essentially no overhead and few business expenses of my own: basically just my preexisting computer, webcam, and microphone.

I'm curious if anyone has any pointers to useful software for tracking personal productivity, income, time spent with patients, case logs, and other similar metrics. I'm more doing this for my own curiosity, since the compensation at this organization is panel-based, not time-, or case-based, and I just want to make sure that my true hourly rate is reasonable. I don't need practice-management software or anything similarly heavy duty, just some trackers to monitor my own output.

I could always fire up a Google doc, but if there are useful utilities that are already out there, I'd be curious to explore those first.

Pt wanted to be delivered at 35 weeks, I told her, no we have to wait till at least 39

She said jokingly "why do you hate me?!"

I said "I don't hate you, I love you!"

then quickly realized how awful this sounded and corrected to "I-WE... love all our patients! and their babies! that's why we need to deliver at 39 weeks etc etc..."

i wanted to melt, this is one of those moments that keeps you up at 2am replaying it in your head

I'm getting harassing email because I'm 2 weeks late on what I feel is a stupid test. Someone convince me that this is for the good of my patients and maybe I won't think of admin being as stupid as they act.

https://www.economist.com/united-states/2024/10/27/the-data-hinted-at-racism-among-white-doctors-then-scholars-looked-again

Case here: https://expertwitness.substack.com/p/stroke-after-warfarin-held-for-hematuria

tl;dr

Elderly man seen in ED for hematuria, on warfarin for a fib and with previous strokes.

ED doc talks to urologist to get quick follow-up.

Patient told to stop warfarin for 3 days.

Has posterior circulation stroke and dies.

Defense argued it was atherothrombotic stroke, not cardioembolic, so warfarin wouldn’t have changed outcome.

Plaintiff drops the case, not settlement paid.

I signed up for OIG email newsletter out of curiosity. It's wild how much fraud there is. And the dollar amounts are just as wild. Some examples from just today. And there's multiple emails a week each with multimillion dollar schemes featured. What have you seen?

If you want to sign up and become more cynical come on in, it's terrible.

Touch, smell, appearance, sound, or taste. So - what are you showing us?

had a cards fellow mention it before but completely forgot i need the name a website that lets you upload all of your templates. we cover multiple hospitals with different EMRs. it can't be an app/onedrive/googledrive because many of the hospitals don't let you access personal email addresses or storage drives--hence the need for a website based one. you'd just log into the site and it let's you copy/paste. i think this was designed for physicians/medical field, just cant remember or find the name

I like how everyone on the healthcare team has a role and purpose for being there and I like expalining my specific role to patients because I feel like it takes away fear associated with visiting a hospital. I also like that since I room the patients, I can shadow doctors. I've noticed that the online picture of what a hospital is like is way more negative than being there. For example the doctors are attending, the nps and pas are very much a part of the team and don't over step. The residents are responsive and friendly. There's conflict but we work through it. It's my first hospital job and I hope my next place isn't toxic. Fingers crossed.

I'm a medical student from the US, and as we all know, the healthcare system here is fundamentally broken for the average person. From routine checkups to specialist care, it's a struggle, to put it mildly. But what's equally concerning is that medical professionals are getting the short end of the stick too, often unable to fulfill the basic purpose of healthcare: treating people in the best possible way based on their conditions. Of course, resources play a part in this, but here, it feels like the system is twisted and heading downhill fast.

Recently, I've also been learning about the toxic conditions in India's healthcare system and how many other countries face similar issues. Amid all this doom and gloom, I’m curious: Is there any country or healthcare system that serves as a beacon of hope? A place where patients receive timely and affordable care, medical professionals are respected and fairly compensated, and the workload is manageable? And, of course, where all the other elements that contribute to a strong healthcare system are in place?

I know no system is perfect, but are there any that come close? I’m asking because this community is international, and we might be able to learn something valuable about how healthcare can be done right from those who experience it firsthand!

Are there any transcutaneous C02 monitors/sensors that can be used at home for patient w/ hx of hypercapnia? Thx

Mods this is NOT a personal post/personal question.

https://thorax.bmj.com/content/74/2/157

https://www.sciencedirect.com/topics/medicine-and-dentistry/transcutaneous-carbon-dioxide-monitoring

https://www.aastweb.org/Portals/0/Docs/Resources/Guidelines/Transcutaneous%20CO2%20Monitoring-1.pdf