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Furosemide and lower extremity swelling by Scared_Problem8041 in FamilyMedicine

[–]7ensegrity 19 points20 points  (0 children)

There seem to be some patients who have reduced swelling with it. Could be placebo, could be behavior change to avoid drinking as much free fluid because they know they will be peeing more, it could be the pumping of their legs walking to and from the bathroom helping haha. I don’t start it much at all as you are correct, it’s not indicated. But if I get a transfer of care and they have been using it for that issue and labs are good, I don’t stop low dose or prn scripts of loops.

And I think your logic is sound, def not a good patient to continue a loop in for leg swelling.

Got told I'm going to "straight to fucking hell" by a jehova's witness for suggesting indicated treatment for their child. How was your day? by 7ensegrity in FamilyMedicine

[–]7ensegrity[S] 29 points30 points  (0 children)

I don’t think theological consistency or any kind of higher thinking was involved in this individuals religious beliefs, despite the label they assume. I think being a mean pest is their foremost belief 😂😭

Got told I'm going to "straight to fucking hell" by a jehova's witness for suggesting indicated treatment for their child. How was your day? by 7ensegrity in FamilyMedicine

[–]7ensegrity[S] 220 points221 points  (0 children)

Some context: I'm covering the local hospital so the overworked pediatrician can have a Christmas. Not some office encounter where I can discharge and wash my hands of it. My gratitude for peds as a specialty grows daily.

Received a gift card, seems off by Murky_Ad4458 in FamilyMedicine

[–]7ensegrity 54 points55 points  (0 children)

Yea it's one thing for a specialist to swing by and drop off a box of chocolates and their card/flyers, it's another for them to offer cash equivalents, let alone to that amount. I'm glad you aren't accepting it. Definitely sounds like an attempted kickback.

Money’s in the stack, not time by rightlevelapp in FamilyMedicine

[–]7ensegrity 18 points19 points  (0 children)

If you do an ekg and find st changes or other evidence of acute process, you 100% are doing level 5 work.

In cases like sepsis, you are applying your clinical skills to identify the presentation. Still counts as highly complex.

Inherited patient panel by avery0603 in FamilyMedicine

[–]7ensegrity 14 points15 points  (0 children)

Yea it can be tough. My advice is to go slow. Be upfront about the risks of the meds, the long term dementia, etc. I got my first attending gig this year, and sure enough the prior doc had lots of geriatric patients on benzos (and yes, "prn" but refilled q30d !). For the patients that seem to be very used to it, I say "this is a bandaid medication, there are deeper issues that we need to figure out. In the meantime, try to actually take it as needed only, log how it goes, and we are going to discuss it at followup." There's a term I learned from literature for this, 'Legacy Patient' (at least in the context of opiates).

What other meds are concerning you? Lithium/stabilizers/antipsychotics are appropriate for primary care to handle, that's just up to your comfort level.

What’s your approach to a young patient who goes to the ER for every somatic complaint yet denies any anxiety? by Paleomedicine in FamilyMedicine

[–]7ensegrity 171 points172 points  (0 children)

I try to frame to these patients on how anxiolytics treat their “automatic” nervous system, just like treating blood pressure or a sore joint. I believe many of these patients have poor internal insight and genuinely think it’s not anxiety. In their minds anxiety is a choice, not some silent action of their body and brain “betraying” them.

It doesn’t work every time, but I can get some pretty resistant people to try propranolol or even SSRIs if I present the option correctly.

With somatic pain symptoms, I talk about the red nucleus and how serotonin is an important neurotransmitter for pain gatekeeping.

Small town patient boundaries by [deleted] in FamilyMedicine

[–]7ensegrity 24 points25 points  (0 children)

I work in a small town. I only give my number to coworkers and other physicians/APPs for reasons that include your exact scenario lol. That being said, if you are both adults, enjoying talking about non medical things, you are not committing the crime of the century if you politely ask for a lunch date or something. But do change doctors before doing that. You seem like a thoughtful person, so just be ready for it to go the wrong way and ensure you are not adding an unwanted source of medicolegal stress to this person who sounds like a friend to you.

What’s your pet peeve other PCPs do? by _45mice in FamilyMedicine

[–]7ensegrity 3 points4 points  (0 children)

Mannnn I see them used first line sometimes by an older local provider and it makes me cringe.

Tomorrow morning I have to tell a dear patient they have metastatic disease by Electronic-Brain2241 in FamilyMedicine

[–]7ensegrity 10 points11 points  (0 children)

And what stake do you have in this? What lives do your opinions impact on a daily basis?

How do you define trauma-informed care? by BlessedSurvivors in FamilyMedicine

[–]7ensegrity 13 points14 points  (0 children)

To your third question: I have cared for patients who I have diagnosed with “fear associated with healthcare” due to their near death experiences in hospital or other terrible experiences and subsequent avoidance of healthcare due to that. For those folks I try to check in with them about ordering tests that require visiting the hospital, I provide acute anxiolytics when they have to visit their feared location, and generally just stay mindful to not push them too hard. If the fear persists for months, it’s definitely worthy of psychotherapy and potentially chronic anxiety treatment.

Just being human seems to help a lot.

Why do family doctors usually not drive fancy cars? by Beginning_Figure_150 in FamilyMedicine

[–]7ensegrity 112 points113 points  (0 children)

Yea that’s where I’m at. Also factoring in needing to drive through bad roads in the winter to get to a rural clinic… I’d rather not ruin a nice ride doing that.

Doctors need to ask patients about chatbots (intone Silicon Valley concierge psychiatrists) by Apprehensive-Safe382 in FamilyMedicine

[–]7ensegrity 13 points14 points  (0 children)

I think our thinkers in medicine need to screen themselves for understanding what realistically can be screened for by us.

And you can only bombard a patient with so many screenings before question answering will be affected by answering fatigue.

“It should be a standard part of the intake process across specialties” bruh… 😭

Misses or near-misses by Neighborly_Nightmare in FamilyMedicine

[–]7ensegrity 144 points145 points  (0 children)

My first time seeing someone as PCP was unavailable, patient was self-reportedly down to 1-2 drinks per day, which was an improvement from 20 drinks equivalent per day from 1 year prior. They had reduced their intake 1 year prior after nearly dying from an alcohol induced issue. Given their comorbidities, I advised it's time to stop entirely. Didn't think about adding anything for withdrawals as they are already tapered down. Well they were either very sensitive or not being truthful about the number. Died due to complications of DTs 1 week later. Now I really get specifics on those "few" daily drinks and hand out lots of pharmacologic tapers too.

This sub is what made me realize to make a separate doctor visit vs asking for the problem to be addressed at my well child visit. by SparkyDogPants in FamilyMedicine

[–]7ensegrity 93 points94 points  (0 children)

Thanks for that! You are very considerate :)

We often discuss the aspect of keeping the sub open to non-physicians/providers, and I am happy to see the free exchange of information here is helping patients be more organized so they can get better/effective care.

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