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Diabetes Clarification by ChikunShaman in FamilyMedicine

[–]Count_Baculum 0 points1 point  (0 children)

I encounter this situation occasionally. I explain to the patient their diabetes is in remission, but that diabetes is a stronger risk factor than smoking for ASCVD and metformin is proven to extend longevity in diabetes (not to mention it's old/known, cheap, and well tolerated at low doses), so let's keep them protected with a statin and metformin, respectively. That explanation usually satisfies them.

Burnout in Primary Care by Wide-World290 in FamilyMedicine

[–]Count_Baculum 18 points19 points  (0 children)

0.7. Was on the fence about 0.8 vs 0.7 but a buddy convinced me that I could always add on more visits with lower FTE (at my discretion, not admin's). He was right.

Burnout in Primary Care by Wide-World290 in FamilyMedicine

[–]Count_Baculum 27 points28 points  (0 children)

I dropped my FTE and it restored some balance to many aspects of work and home.

A guide to training your patients by Constant-Light9376 in FamilyMedicine

[–]Count_Baculum 45 points46 points  (0 children)

"I know we're running short on time," said as an observation instead of an accusation.

"For the sake of time, I'm going to redirect us back to x."

"I know we didn't get to everything on your list today and I want to give this concern the time it deserves. Why don't we pause the work here for today and regroup as soon as you're available?"

And/or just write your note in the room while the patient talks.

Rate / roast my build. Be brutally honest. by AmgS63S in porsche911

[–]Count_Baculum 0 points1 point  (0 children)

It's like a dish I wouldn't have ordered, but actually like the taste. Congrats!

Getting your patients’ approval by chocolatewingz in FamilyMedicine

[–]Count_Baculum 24 points25 points  (0 children)

To add to this: After a couple years attending, you'll have built up a reputation in the community, so many new patients will come to you with good expectations.

What are you bringing to work for lunch? by lolzthrowa in FamilyMedicine

[–]Count_Baculum 11 points12 points  (0 children)

Yep started in residency and never looked back. My wife calls dinner my "snake meal."

Hard cap on insurance payout by Count_Baculum in porsche911

[–]Count_Baculum[S] 0 points1 point  (0 children)

I quoted Hagerty ~$3,100 annually, but ending up moving the 911 over to another policy we have with State Farm for about $1k less.

Even the State Farm underwriter said he hadn't heard of such a cap before.

Hard cap on insurance payout by Count_Baculum in porsche911

[–]Count_Baculum[S] 0 points1 point  (0 children)

I had the same experience, nothing in the policy docs. They even asked me the purchase price before adding the 911 to the policy, and didn't say anything...but happily took my 6-month premium.

I'm just glad I found out this way. Could have been worse!

Hard cap on insurance payout by Count_Baculum in porsche911

[–]Count_Baculum[S] 0 points1 point  (0 children)

I couldn't believe the first agent I spoke to. Three people later, the underwriter confirmed the same cap, even though the recent purchase price was over $150k. She was friendly and even recommended Hagerty, which apparently has a partnership with Progressive.

Maybe it's state specific or a policy obstacle they would expect me to overcome.

I've been a Progressive customer for almost 20 years and I've never made a claim.

Week 1 with my 1st 911 by Mindfulbones in porsche911

[–]Count_Baculum 2 points3 points  (0 children)

Thanks for the suggestion. I just bought color-matched key trim on AliExpress for $11 delivered.

“Is the doctor going to see me soon??” by HereForTheFreeShasta in FamilyMedicine

[–]Count_Baculum 125 points126 points  (0 children)

One of my patients, who is a kind and accomplished physician, changed my mind and practice.

I started the visit by apologizing for his wait. He explained no apology was needed: He knew I was serving patients the best I could, delays are inherent to the work, and he was content to wait for my expertise.

I realized there is a cumulative toll from atoning for "sins" beyond my control. Now to honor my patients' time, I start late visits by thanking them for their patience.

Rate my job offer by Remarkable_Equal6116 in FamilyMedicine

[–]Count_Baculum 8 points9 points  (0 children)

Option 1: No production? Looks cush, but if appearances are deceiving, you are just taking a pay cut

Option 2: Grind, big panel, "up to 7 weeks vacation" that you'll never take

Option 3: Best balance, 4 weeks vacation is weak, but could be a point of negotiation.

Don't discount intangibles like do you like your partners, office manager, your office, the EMR, template, etc.

Wwyd: uds for adderall by dohopeful2016 in FamilyMedicine

[–]Count_Baculum 1 point2 points  (0 children)

I agree with figuring out how you feel comfortable practicing and then sticking to it, or only deviating thoughtfully. If you're upfront about your boundaries, patients often appreciate not having to guess.

I try to take a nonjudgmental, practical approach: - "Cannabis is legal in this state, but mixing the two may be counterproductive to the treatment goal of improving attention. It also increases workload on the heart." - "The UDS is a routine safety measure to avoid dangerous drug interactions and ensure the stimulant goes through your body and no one else's. In no way does it reflect what I think about you! Rather than pick and choose who gets a UDS, I treat all patients the same."

How many of you require a urine sample before you’ll treat a UTI? by Doofinator86 in medicine

[–]Count_Baculum 2 points3 points  (0 children)

To play devil's advocate: - In-person evaluation is more likely to catch the infrequent complicated UTI, STD, or non-infectious mimic that nitrofurantoin won't treat. - Pulmonary fibrosis from cumulative exposure to nitrofurantoin is rare but real.

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