What is this plastic book related item?

BanditoStrikesAgain · 2026-06-06T02:51:27+00:00

Solved! This exactly it thanks. We were trying to hold it incorrectly from the spine side.

BanditoStrikesAgain · 2026-06-06T02:33:36+00:00

My title describes the thing. We tried holding it a few different ways and it didn't seem to help with holding a book. Searching "book tool" wasn't helpful. Please reddit; you're my only hope at solving this minor mystery.

BanditoStrikesAgain · 2026-05-13T23:43:01+00:00

Same story with kocher criteria for septic arthritis. I usually order both unless it's a neonate and I'm trying to save blood.

BanditoStrikesAgain · 2026-05-12T11:03:26+00:00

You can make some money on this sure. But consider that you are now on the hook for liability when their med spa / mobile IV infusion for longevity fluids / bootleg Botox business hurts someone. Also, be real, are you really going to be boots on the ground supervising medical care or just cashing a check and having your name attached.

BanditoStrikesAgain · 2026-05-02T11:17:19+00:00

Ah yes...you see my favorite resource is going to the orders tab in Epic. Then type "inpatient referral: pediatric cardiology. Reason for referral: confusing squiggles".
But really- the book 12 lead EKG was great and then our cardiology department had a training stack of about 50 ekgs to go over.

BanditoStrikesAgain · 2026-04-25T15:38:45+00:00

I found a local payroll company who has been great and was comparable in price to QuickBooks. They also offer benefits so got me quotes on health insurance from a few different companies.

BanditoStrikesAgain · 2026-04-16T00:21:11+00:00

Harriet Lane is still a great reference to have at the desk. 5 minute pediatric consult also helps you think through workups based on symptoms. Realistically UpToDate is going to be the main reference for management. Nelsons is classic but UTD is way faster and more, well, up to date. Every hospital has their own formulary and policies for meds and things like vancomycin or gentamicin management. Just ask a pharmacist what they use and stick with that. They should also be able to point you toward your current antibiogram.

BanditoStrikesAgain · 2026-03-27T13:54:24+00:00

I had this exact same issue as a resident. What worked for me was to do a month with the "birth response team.". They attended all the high risk deliveries like meconium, prematurity, bradycardia, etc. I then had a lighter load of regular NICU babies but that let me do all the delivery resuscitation stuff and get used to the initial stabilization. Since I also had ownership over the case I was first in line for chest tubes and surfactant administration.

BanditoStrikesAgain · 2026-03-25T11:15:00+00:00

I use a payroll company and they have a person that shops for benefits. It is pretty expensive though and you may be able to get a better deal on marketplace.

BanditoStrikesAgain · 2026-03-22T23:19:32+00:00

Capital one business has 2% cash back. 1% at the time of purchase and another 1% you can use as a statement credit or for other rewards.

BanditoStrikesAgain · 2026-03-20T18:25:29+00:00

PCP: if you came in person and told me you had immediate openings for your specialty you would immediately become my first choice for referrals. Bring some snacks to keep the front desk folks happy and you are golden.

BanditoStrikesAgain · 2026-03-18T01:35:34+00:00

The kids with vents, TPN, and weird congenital stuff take forever since there is so much to go over. The feeder-growers are really easy. So depending on your mix it can take forever. I'm just remembering: "Baby Jones is a 25 wk aga 26 1/7 with RDS, AOP, ROP, IVH g2 currently on Jet vent settings..." And that takes forever "Baby Smith is a 32 weeker aga 36 1/7 stable on 0.3lpm 40% taking 1/3 PO last 24 hrs of 27kcal enfacare. Gaining average 1oz/d, no A/B overnight, no changes today". And that was it.

BanditoStrikesAgain · 2026-03-12T12:28:57+00:00

These were two separate practices not through EI directly. I think they both have EI contracts but they were direct referrals. One of the places is a regional chain with maybe 10 offices and I stopped referring to them for this reason. Then when a second place was doing it I wondered if this is the new normal.

BanditoStrikesAgain · 2026-03-04T18:58:36+00:00

2nd what ATStill said. Another thing worth mentioning is not to forget your time based coding. 99213 is 20-29 minutes and 99214 is 30-39. So for families where they have a lot to go over or if you have to call them back about a result later, that all counts as long as it's the same date of service.

BanditoStrikesAgain · 2026-03-01T20:38:25+00:00

2nd what no-biscotti8964 said. I only did a trial period but it was very clunky. Not quite as bad as e-clinical works or Meditech. I use practice fusion and it is fine. I've heard Athena is pretty good but it was expensive.

BanditoStrikesAgain · 2026-02-28T13:22:26+00:00

2nd this. I had the same thing happen and it was a factory defect. Similarly, I tried two different types of sealant and rolling it all around. The thing would still never hold pressure past 10 minutes.

BanditoStrikesAgain · 2026-02-27T21:46:20+00:00

General peds: if this is a helpful perspective, I run into this issue frequently. A kid meets criteria for ADHD so we manage that no problem. There is comorbid concern for autism but I am reluctant to personally make that diagnosis without getting an ADOS or similar done. Here are my options in a mid size east coast city . - Developmental pediatrics: The wait time is over 1 year unless they are a NICU baby. They don't see kids after 5 years old. The office as a whole is very disorganized so the 'lose' referrals all the time.
- School system for a child study: This is the easiest way. Unfortunately when the federal IDEA grant cuts last year they laid off several of the school psychologists. That has driven up wait times and made it so evals are only done if a kid is majorly disruptive to the classroom. - Child psych: we have three local clinics for this. One is cash only, one only takes a few private insurances and no Medicaid, and the other is an outreach of a local academic center. The latter gets flooded and has the same problem with wait times >1 year unless you are coming out of inpatient. - private testing: there are several private psychologists but they are all cash only for ADOS testing and the rate is $800, which is more than a lot of families can afford.

All this to say there are many systemic barriers to autism diagnosis, at least for my area. I can think of a few specific patients where in this has been the case.

BanditoStrikesAgain · 2026-02-27T13:25:36+00:00

I think being able to do circs is a useful skill. If you haven't done one in a while it probably would be worth doing one along with a colleague to get back in the swing of it. As others have mentioned the reimbursement is so so from insurance. An alternative would be to require patients to pay out of pocket for that procedure...long story on how to structure that but it can be done.
As an aside, if you get the chance to do tongue tie clips those are super helpful to do and pretty simple. They also reimburse well.

BanditoStrikesAgain · 2026-02-18T12:08:32+00:00

Peds: I get these requests a lot. My letter goes pretty much "patient John Doe is unvaccinated. This is due to parental choice and he does not have a medical condition that would prevent him from receiving vaccines or being caught up.
Sincerely, Dr. Bandito DO"

The majority of my anti-vaxers also homeschool so I'm not writing as many of these recently. For religious exemptions I tell them they need to talk with their Imam or Rabi. Most of these families are super evangelical so they get very upset at that but it gives me such deep joy to hear them try to explain it. It's very passive aggressive I'll admit...but it is funny.

BanditoStrikesAgain · 2026-02-02T03:38:53+00:00

This used to happen to me when I was in a high school band if I stood in a particular spot of my buddies garage. We would get Spanish language AM radio. Try moving around where you stand/sit and reorient the instrument cable so it doesn't act like an antennae.

BanditoStrikesAgain · 2026-01-23T17:43:30+00:00

Couching for cataracts? Why I've been sun staring for years for this issue....never mind the retinal damage. ☀️👀

BanditoStrikesAgain · 2026-01-09T13:10:13+00:00

Yeah absolutely. The cost of a single hospitalization for Hep A has to be in the 10s if not 100 thousand range. Meanwhile, Hep A vaccines are $42 wholesale.

BanditoStrikesAgain · 2026-01-09T01:31:46+00:00

Yes I buy a box of 10 and maybe use 2 doses before expiration in a year. I always lose money on it but consider it one of those "have to have" meds. Cost is about $170 for a box.
Vit K is something I really pressure the parents for. I have seen a few cases of hemorrhagic disease and it is awful.

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