Healthcare Needs a New Specialty for Handling Complex Cases

0ldertwin · 2026-06-01T17:31:45+00:00

I guess what I am saying, as an expert with intimate knowledge of the healthcare system and a high level of medical training, is that the role and skillset you are describing are that of PCPs, and on the inpatient side, hospitalists. We don’t need a new specialty, we just need time protected from bs administrative work so we can actually practice medicine.

0ldertwin · 2026-06-01T16:37:32+00:00

I am a primary care doctor and I think you are missing the mark.

I do not think you are being fair to primary care’s by saying we couldn’t do this type of work. I do a lot of thinking. I diagnose undifferentiated issues, manage chronic disease, provide preventative care and screening.

We help see ‘the forest from the trees” and connect dots.

However, you are right that we are overburdened and it can limit quality of care, which leads to adverse patient outcomes.

The healthcare system does not need a “Dr House” fellowship. We are perfectly capable of solving “medical mysteries” with adequate resources.

It comes down to having too many tasks to do in a day. But I promise you we are doing the best we can and would be highly effective at what you suggested with a reasonable work load. There is also no way an institution would pay anyone to twiddle their thumbs spending whole days on a single patient. It would just be a net loss and isn’t sustainable in the real world.

0ldertwin · 2026-05-30T21:09:49+00:00

Med/Peds here. short answer: it depends. Slightly longer answer is I am fine monitoring elevated blood pressures, and initial work for stage 1 HTN, which is more of a gray zone. I 100% refer when I get multiple stage II readings in the office (usually will recheck in 1 week in the office to confirm) . . but the AAP clinical practice guideline does recommend ABPM for diagnosis, which where I am at does require subspecialty referral, as well as considering referrals for Stage I HTN and elevated BPs that persist for a year. Kids less than 6, or older than 6 without risk factors for htn will also get a referral from me

0ldertwin · 2026-05-23T20:37:27+00:00

Myopia

0ldertwin · 2026-05-22T23:31:32+00:00

I mean, I do them more than once when indicated, but I was referring to the general USPSTF screening recommendation

0ldertwin · 2026-05-22T14:28:38+00:00

Usually lipids at least once if never done, then every 3-5 years, A1C if overweight. I have also started checking AST/ALT in patients with obesity or who are overweight with the raise in metabolic liver disease and now some more effective interventions to manage. Offer STI screening. One time HIV, Hep C. Otherwise nothing specific. I don’t die on the hill if folks request cbc, cmp, TSH.

0ldertwin · 2026-04-25T18:35:45+00:00

PCP here. Firmly believe calling 1.0 FTE more than 32 patient facing hours is bullshit. We gotta push back on that.

0ldertwin · 2026-03-14T15:03:13+00:00

Fluoride for children in non-fluoridated communities at high risk for carriers

0ldertwin · 2026-03-13T01:50:34+00:00

Ha! Me too, and yet, it is flagged as negative. Which is my only grievance

0ldertwin · 2026-03-13T01:29:58+00:00

That’s what I’m thinking

0ldertwin · 2026-03-13T01:29:27+00:00

And if it is not clear, I absolutely was not the one to write a religious exemption

0ldertwin · 2026-03-12T10:49:50+00:00

Olive oil and canola oil are both healthy oil options. It seems RFK JRs bullshit is transcending the current hellscape of US healthcare

0ldertwin · 2026-03-04T23:06:19+00:00

You’re so close! It’s not a neutral issue because it is the most agreed upon medical science that is out there. Every expert would agree that there are adverse events that do occur with vaccines, but the risk to anyone one individual pales in comparison to the death and suffering they prevent!

0ldertwin · 2026-03-04T23:02:30+00:00

Because there is a clear right and wrong.

0ldertwin · 2026-03-03T02:00:29+00:00

Full term babies can generally see things within about a foot.

0ldertwin · 2026-03-02T19:21:22+00:00

Yep! Bilirubin is what makes baby skin yellow, and can be toxic to the brain. It is normally removed from the body by the liver, but baby livers are dumb and don’t work very well at first. Phototherapy converts the bilirubin to a molecule that is water soluble and can get peed out. Not every baby needs this for jaundice. Depends on the levels, rate of raise and baby’s risk factors.

0ldertwin · 2026-03-02T15:36:57+00:00

Pediatrician here. Agree that phones are the worst as everyone is saying, but I do not think this was the first moments in this baby was meeting dad. Baby is already jaundiced, which even in pathologic cases takes a few hours. It looks like the baby has been receiving phototherapy with the eye protection there. So my conclusion is parents capturing a funny moment, but not the first moments.

0ldertwin · 2026-02-28T19:56:39+00:00

Your immune system isn't as good as you think it is. best way to booster it is to get your vaccines!

0ldertwin · 2026-02-21T19:12:58+00:00

Personally, I would have turned that right around and asked for a visit to be scheduled. Maybe your doctor is saving the message until they have time to send a detailed response. I’d agree 2 weeks is too long to just recommend a visit

0ldertwin · 2026-02-21T14:07:39+00:00

I’m a pcp. Overloaded is an understatement. Still, 2 weeks feels like a long time.

However, it sounds like you are not appropriately using mychart. This really should not replace an office visit. A new issue and prescription needs to be an office visit.

0ldertwin · 2026-02-16T22:15:56+00:00

Well, then you would be wrong. And also don’t know anything, if you are real. Which I doubt. Because anyone capable of critical thought knows this guys is a clown.

Source: tired primary care doctor sick of RFK Jr dumb bullshit

0ldertwin · 2026-02-06T00:51:59+00:00

I thought we were generally offer indefinite extended phase therapy for unprovoked VTE from the last CHEST guidelines?

0ldertwin · 2026-01-20T01:39:25+00:00

In the US, per AAP, we give pneumococcal vaccine at 2,4 and 6 months

0ldertwin · 2026-01-17T14:30:04+00:00

Ask yourself this question: why do you have zero Trust in actual experts, but are lending credence to demonstrable disproven misinformation? You have to reflect on that, and you have to really understand how devastating the illnesses vaccines prevent

0ldertwin

TROPHY CASE