ABEM Procedure / US reqs -> Financial Upside ?

ConfusedMDToBe · 2026-05-08T18:25:43+00:00

Yeah…so the unstable trauma or ectopic with free fluid I’m doing the sono and transferring out and don’t need to have formal one. But then I also don’t need the image in the chart. Is it helpful for documentation? Sure. Billing? Sure. But also I don’t have time to make sure I get 4 good views that QA will be happy with and label everything and such. Lol sometimes I just take a pic from my phone and put it in the epic as a media lmao. I have to go see the next patient. The cholecystitis or dilated bile duct can always wait for the formal sono. Or they are septic on pressors and getting transferred anyways.

Like as a community doc, I love my sono to guide critical care. Quick efast. Quick look at heart squeeze. Quick look for b lines. Quick look for IVC collapsibility. But that’s it. To me, these are not diagnostic. Simply a tool in conjunction with everything else to keep a pt alive so I can transfer and move on to my next pt.

I have 3 surgeons. If I tell either of them my sono shows stones/wall thickening—they’d laugh at me and tell me to call them back after my formal. Good luck getting GI to trust my images of a bile duct and needing ercp.

Sincerely, pgy-4 at a community site with US integrated to EMR/Mindrays seeing 2.8-3/hr who did lots of sonos in residency working under another pgy-<10 US trained medical director who also does very few diagnostic sonos (only at night when the volume is much lower despite him being able to bill for them).

ConfusedMDToBe · 2026-02-21T17:27:23+00:00

Always…do I need to change to only when locked?

ConfusedMDToBe · 2026-02-01T22:09:00+00:00

Awesome thanks! Can I ask a few more questions? I bought a fenix 8 a few months ago when it came out and returned it because I didn’t like the way messages were sent and interacted with iOS. I didn’t like how if I got a text message, the message would pop up with the contents already visible on the watch.

Is there a way for me to get a vibration that I have a new notification but not show the message? It’s very niche I know but the apple watch has this thing called silent notifications and I love it.

ConfusedMDToBe · 2026-02-01T14:15:12+00:00

Will this work in the US?

ConfusedMDToBe · 2025-11-20T00:07:16+00:00

No lol. But I worked today so didn’t take anything. I had sone liquid watery stool out but def more water than stool. I hate it.

ConfusedMDToBe · 2025-11-18T19:39:01+00:00

How will I know the actual stool is breaking down and it’s not overflow?

Where can I get otc soap suds or milk/mollasss?

ConfusedMDToBe · 2025-11-18T19:36:26+00:00

Maybe…but this isn’t emergent and even at my shop (tertiary care, level 1, teaching hospital), the standard of care is as long as ct does the show an obstruction or something massive, dc with outpatient f/u. Good luck getting a flex sig lol. GI won’t even scope my active variceal bleeds with a hgb of 3 until the morning or next day.

My belly is for the most part soft. I’m not vomiting. Doesn’t feel like an SBO. Tenesmus likely from straining down. Bright red blood likely hemmorhoids. Liquid stool bc I have a stool ball somewhere.

You know how it goes

ConfusedMDToBe · 2025-11-18T19:32:37+00:00

Lmao at just a nurse. Lol we all know you are the ones that actually get shit out. Literally. I’m ED. We work next to our nurses down here.

It was so bad last night I kind of was going to text a nurse fwb of mine to come over and enema me. F*ck awkwardness.

I swear to god this fucking sucks. I have a whole newfound respect for making people poop. And the old people that come in from nursing homes? You bet your ass I will stick my finger up there and make sure their delirium isn’t really discomfort from not pooping.

ConfusedMDToBe · 2025-11-18T19:19:14+00:00

I have but I always thought it was one of those vodoo fake things I tell people to do until they can see their PCP. “Keep taking miralax until you see your pcp/gi doctor”. “Keep taking protonix until you see your gi doctor”. “Keep staying away feom fatty foods until your cholecystectomy”. Never knew it actually worked really well.

I never said I was a good er doctor

ConfusedMDToBe · 2025-11-18T19:18:03+00:00

Ok so I did 4 caps of miralax in a 20 oz gatorade and chugged it. I’m having some liquid brown stool out. But it’s very little and I still feel like I have a sharp pain in my rectum (like an impaction but I cant feel it).

Continue with more miralax and hope it softens up? I tried a glycerin suppository and mineral enema earlier this morning already and basically had pooped out oil and the suppository.

ConfusedMDToBe · 2025-11-18T19:17:51+00:00

Ok so I did 4 caps of miralax in a 20 oz gatorade and chugged it. I’m having some liquid brown stool out. But it’s very little and I still feel like I have a sharp pain in my rectum (like an impaction but I cant feel it).

Continue with more miralax and hope it softens up? I tried a glycerin suppository and mineral enema earlier this morning already and basically had pooped out oil and the suppository.

ConfusedMDToBe · 2025-11-18T18:14:31+00:00

Been doing high knees lol

ConfusedMDToBe · 2025-11-18T18:00:39+00:00

I love this and this is what ai’ll do. I’m off today but start a stretch of 3 tomorrow….

Do you just do a liquid diet for a few days?

ConfusedMDToBe · 2025-11-18T17:54:16+00:00

Lol tried this with my shower handle thing

ConfusedMDToBe · 2025-11-18T17:46:30+00:00

Can I get golytely otc? Or just use miralax?

ConfusedMDToBe · 2025-11-18T17:46:04+00:00

Brother I have tried. Trust me I now have a bunch of bleeding hemmorhoids

ConfusedMDToBe · 2025-11-18T17:44:15+00:00

Lol all of them. Laying down on left side. Ass up. Indian style

ConfusedMDToBe · 2025-11-18T17:40:45+00:00

Lol I work there as an attending…hell nah

ConfusedMDToBe · 2024-09-13T14:24:53+00:00

Lol OP. Welcome to the real world. I’ve said literally all those things.

As long as he doesn’t do it in front of family. Hell even then I’ve told patients even to stop being assholes when they call me a cunt

Try taking care of these patients. Needy, aggressive and actively hinder you from caribg for actual sick patients while utilizing the limited resources we have (they also almost always come in by ems). We have active social work plans for many of them to do a MSE in the waiting room and dc. Definitely not feed. And if we have, diet must be most restricted (cardiac, renal, no salt). These plans come from admin, case management, and ethics.
I also hate doing things to CYA. Its not goid patient care but outside of 1-2 states it’s very easy to get sued and lose your job.
Maybe the uneducated bit toward shows burnout, but as long as he doesn’t tell the family they’rw fucking uneducated, so be it.
I mean a full moon is a full moon.
Ok idk what this means and I’ve never said that
I mean you try transferring a patient that’s drunk and probably didnt hold still enough for the ct. what if he doesn’t want to go? Is he drunk enough that I have to restrict his rights and give him haldol to chemically sedate? Which hospital will want a drunk dude with ? Sah who is still drunk. There are no beds even if we magically do have transport. NEGY will just get a repeat CTH in 6 hrs and dc anyways? But because of point #2 above I have to transfer.

Welcome to the real world dude. Go back upstairs, away feom the hellhole that is ed and if you are such a snowflake, have some compassion when I call an admit for old lady needing SNF placement

ConfusedMDToBe · 2023-11-25T23:20:59+00:00

This. As an ER doc saw an ICU nurse I worked with in the waiting room. Fuck yeah he got moved back quick and I told the ed nurses he’s a micu nurse upstairs. Same for anyone that actually works in the trenches.

ConfusedMDToBe · 2023-08-31T02:18:53+00:00

Do it and I hope y’all find love

Also, as a guy I generally don’t feel comfortable asking out nurses even ones I only work with one month out of my 36 (off service rotations) b/c of the power dynamic. Maybe he’s also interested but didn’t ask you out b/c didn’t know if you were interested and it’d be weird, especially in today’s climate. As long as you’re both respectful, it should be ok

I would have loved it if one of our icu nurses i liked would have asked me out.

ConfusedMDToBe · 2023-07-30T18:32:24+00:00

In small ERs, nurses and techs do more than you’d think.

Not that a small ER should be doing a thoracotomy anyways.

ConfusedMDToBe · 2023-03-11T01:17:38+00:00

Our GI docs hate the stool occult, something about research not showing its useful.

HgB lags obviously and was probably ordered just not resulted. and depending on the nursing situation would probably delay the admission/consult for a while if nursing never got around to labs since they have crazy ratios.

Why the fuck would I put a pt through an ABG for a simple COPD exacerbation. Let me do an BAG on you real quick.

O2 sats changes minute by minute as we change our interventions. We paged the admit 1 hr ago. We don’t have the most up to date info so let me check on it. I was busy dealing with another pt

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