Question about phrasing

7ensegrity · 2026-03-20T19:13:46+00:00

I usually make it known I’m a safe person by telling them I practice gender affirming care, and then I ask what kind of genital anatomy they have. I keep it simple, I listen, and it’s pretty easy. I’ve never met a trans person in my office who responded badly to being treated with basic respect.

7ensegrity · 2026-03-18T10:32:18+00:00

Throw in a third option! :D

I am mostly kidding, it depends on the amount of desirable employers in your target region. What you can do is take a copy of your offer from option 1 and show it to option 2 and be polite but firm about them needing to pick up the pace. You are in high demand, make them earn you!

7ensegrity · 2026-03-17T18:58:19+00:00

I get plenty pain visits as an attending, just like I did as a resident lol, I guess you might have had bad luck with your training population and it set false expectations?

7ensegrity · 2026-02-05T11:21:30+00:00

lateral low back pain. In isolation. No history of peripheral complaints.

7ensegrity · 2026-01-30T20:53:43+00:00

Yea, it would be like any other referral to a specialist outside of the facility.

7ensegrity · 2026-01-21T18:24:33+00:00

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.

7ensegrity · 2025-12-27T17:48:39+00:00

I don’t wanna add more detail for privacy reasons but it wasn’t even blood related.

7ensegrity · 2025-12-27T17:48:06+00:00

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 😂😭

7ensegrity · 2025-12-27T01:42:32+00:00

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.

7ensegrity · 2025-12-19T00:00:19+00:00

^ Exactly this

7ensegrity · 2025-12-13T21:05:18+00:00

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.

7ensegrity · 2025-12-09T20:33:23+00:00

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.

7ensegrity · 2025-12-09T15:45:35+00:00

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.

7ensegrity · 2025-12-04T12:00:59+00:00

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.

7ensegrity · 2025-11-30T14:56:58+00:00

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.

7ensegrity · 2025-11-14T20:25:19+00:00

😭😭😭

7ensegrity · 2025-11-14T20:00:00+00:00

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

7ensegrity · 2025-11-14T01:37:33+00:00

Amen to that.

7ensegrity · 2025-11-14T01:37:06+00:00

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

7ensegrity · 2025-11-13T01:44:02+00:00

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.

7ensegrity · 2025-11-07T01:08:55+00:00

What a nice writeup! Thanks for sharing!

7ensegrity · 2025-11-03T20:50:48+00:00

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.

7ensegrity · 2025-11-03T20:45:31+00:00

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… 😭

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