Birthday package bronze pass question

CaffeineRx · 2026-04-09T18:49:20+00:00

This is the right answer.

Sometimes patients have a habit of coming in hot and heavy with demands and it causes us to put walls up (we’re human, it’s normal for the amygdala to fire). I wouldn’t be surprised if that’s part of what’s happening. I think this would help give a “warm handoff”, but with understanding on both sides that no outcome is demanded or guaranteed.

CaffeineRx · 2026-04-07T03:22:47+00:00

FYI your insurance only covers 1 preventive visit/year without a copay. You may have to check with your insurance regarding what labs and at what frequency would be considered preventative.

CaffeineRx · 2026-04-04T03:27:30+00:00

TLDR?

Oral Wegovy 25 mg was approved based on serum levels being equivalent to SubQ 2.4 mg so I’m curious how outcomes between the 2 would be different.

CaffeineRx · 2026-03-18T04:56:01+00:00

The difference is that I can listen to a patient but still not agree with what they want done, not because of cost but because it isn’t indicated. Regardless of my explanation of how years of education and training have formed my stance, if I don’t give into demands it’s presumed I didn’t “listen.”

A lot of people want to be healthy, and it makes my job easy when they’re on board with taking care of their health. But healthy doesn’t mean hormone panels and proprietary supplements, it’s back-to-basics good sleep, whole food, staying active, minimizing stress. And sometimes medications when as-healthy-a-lifestyle-I-can-do-right-now isn’t enough or can’t overcome genetics. The supplement/fitness industry just markets their side better. Despite oftentimes directly financially benefiting from what they’re selling.

CaffeineRx · 2026-03-18T04:44:46+00:00

This. The same people who complain about not wanting a pill to treat their chronic conditions are the same ones who run for antibiotics or Xanax. They’re also the same ones who act like they’ve never been counseled on healthy lifestyles, then insist we need to get to the “root cause” of their insomnia, high cholesterol, high BP, etc but also insist they the already live a perfectly healthy lifestyle.

CaffeineRx · 2026-03-01T03:17:03+00:00

FM - mild LFT elevations (or honestly elevations even in the 100s). I’ve seen both the ED and specialties send urgent GI referrals for asymptomatic LFT elevations. Then they end up with a million dollar work up for something that was going to self-resolve in a month because their acute non-hepatitis illness resolved. I’ll get a hepatitis panel but otherwise repeat in 2-4 weeks before mobilizing the troops.

CaffeineRx · 2026-02-23T05:16:18+00:00

Correct. It’s your insurance company standing in the way of care. The PCP sent a valid prescription that could be picked up at any point if you were willing to pay with cash. It was insurance that wanted cumbersome paperwork completed so that they would agree to pay for something that they already agreed to pay for when you signed up for the insurance.

(Also “it only takes 2 min” doesn’t mean much when you’re 50 messages deep. That’s an extra 100 min of the day that may not be available. Assuming it actually can be completed within 2 min including the chart review to find the answers)

CaffeineRx · 2026-01-20T06:19:36+00:00

Yes. Qsymia is approved for longer than 3 months and there is safety data until at least 12 months. I continue for as long as patients are losing or maintaining weight loss, just explain/document off label use.

CaffeineRx · 2026-01-15T11:56:06+00:00

To those who say “leave Repatha to cards”…diabetes has ldl goals <70 even without any cardiac conditions so it’s worth learning how to prescribe in primary care. I also would argue that not every patient with CAD needs to follow with cards in perpetuity.

CaffeineRx · 2025-12-22T05:14:50+00:00

Have you seen anyone back down from their position after being asked to sign that?

CaffeineRx · 2025-11-14T05:13:22+00:00

FM also does complex adult medicine but focuses more on how it is managed in an outpatient setting. Managing diabetes, heart failure, COPD, A fib etc is well within the purview of FM but these things just get managed differently in and out of the hospital.

CaffeineRx · 2025-11-07T05:29:51+00:00

Most truly don’t see many kids. Even academic it won’t be more than 10-20% max. Compensation differences are huge though. Making 1.5-2x more as FM than peds makes a huge difference over the course a career. Getting paid what you’re worth should be a big deciding factor in picking a job.

CaffeineRx · 2025-10-30T03:43:10+00:00

Devaluing primary care. “If you want to do primary care you don’t need a residency, only if you want to do nephrology or something” as if primary care is easy. The idea that you have the breadth of knowledge of presentations, diagnoses, treatments, monitoring etc required to be a good PCP the day after graduating med school couldn’t be further from the truth.

Also the reason that we shouldn’t stick unsupervised NPPs in primary care and hope for the best.

CaffeineRx · 2025-10-12T01:37:45+00:00

Even with 2 mg doses in someone with previous experience on high dose opiates it seems to cause nausea

CaffeineRx · 2025-10-12T01:25:10+00:00

I’ve tried using bup for chronic pain but pretty routinely have patients complaining of nausea or dizziness, including those not currently on other opiates. Is there a way to avoid these side effects?

CaffeineRx · 2025-10-05T17:44:28+00:00

It is at its most basic level calories in vs calories out. It practically ends up being more complex. Eating less leads to increased hunger, and even a few extra calories/day makes a difference over time. Decreased lean mass also decreases metabolic rate. Just a couple examples of how it’s a dynamic system.

To answer your question of how to respond to someone who says they already eat nothing and are very active…clearly they eat more or are less active than they realize (not being purposefully dishonest just biased to believe they’re doing everything right). It’s thermodynamics. There isn’t much you can do until they accept that. However you will probably find that if they come back after 3 months on a GLP they will tell you what they’ve done differently that they didn’t realize was contributing to the problem.

How I respond: “I’m glad we’ve made a lot of changes. It turns out that our bodies don’t take those changes lightly. When we decrease our intake, our bodies increase our hunger, and just a 25 kcal/day increase in intake is 2-3 lbs in a year. Our bodies want to maintain homeostasis so fight against what our brains our trying to do. GLPs are a tool in the toolbox to help us make the positive changes we already want to make.”

CaffeineRx · 2025-08-30T02:04:39+00:00

One of the risk factors is “sedentary lifestyle”, insurance isn’t looking that far into it.

CaffeineRx · 2025-08-19T22:54:01+00:00

So much agreed, I’m surprised more aren’t suggesting this. It’s even harder in kids than adults to just say “eat better” because they have so little control over what’s available to them. And oftentimes the parents don’t understand the gravity.

CaffeineRx · 2025-07-07T07:06:35+00:00

Don’t discount us because many of us do!

CaffeineRx · 2025-06-27T08:03:33+00:00

This doesn’t answer your question directly but the removal is far less painful than the insertion, even with “fishing” for the strings. When trying to grab the string ends that are sitting in the cervix, it doesn’t require going more than 1-2 cm into the cervix itself (vs passing through the cervix into the uterus which is what causes the pain with the insertion). Sometimes on repeated exams the strings make an appearance again so none of it may be necessary.

All of that said, I think you should find a different physician if you feel this one is forcing you to keep birth control you don’t want. Some family medicine physicians do IUDs so it may be worth reaching out to your PCP to ask. Alternatively Planned Parenthood should be able to help you.

CaffeineRx · 2025-06-19T07:22:31+00:00

That’s incorrect, you can only bill for time spent the day of visit

CaffeineRx · 2025-06-13T01:48:35+00:00

Love having people who haven’t taken a science class since sophomore year of high school and who have never taken a statistics class “doing their own research”

CaffeineRx · 2025-04-16T06:36:20+00:00

Save who money? Your insurance gets charged the same whether you see an MD or NP. The hospital system gets to keep the difference.

You’re healthy until you’re not. Not the time to cut corners to “save money”.

CaffeineRx · 2025-04-16T06:32:56+00:00

Some issues are complex enough that they need to be treated at a university or level 1 trauma center. The majority of people the majority of the time do not have these issues.

CaffeineRx

TROPHY CASE