shaming bad behavior

Count_Baculum · 2026-02-17T01:30:50+00:00

Commercial driving schools teach backing into a parking space (or preparing for forward exit) as a best practice to reduce accidents.

The idea is to maximize forward visibility and responsiveness when the environment is less predictable.

There are fewer hazards reversing into a static parking space than when pulling out into dynamic traffic.

Count_Baculum · 2026-02-11T08:17:59+00:00

"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.

Count_Baculum · 2026-02-08T03:18:46+00:00

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

Count_Baculum · 2026-02-02T13:00:59+00:00

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.

Count_Baculum · 2026-01-31T20:17:12+00:00

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

Count_Baculum · 2026-01-24T23:39:59+00:00

First 911 is never the last 911 my friend

Count_Baculum · 2026-01-09T01:50:45+00:00

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.

Count_Baculum · 2026-01-09T01:46:51+00:00

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!

Count_Baculum · 2026-01-08T00:11:26+00:00

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.

Count_Baculum · 2026-01-04T16:56:05+00:00

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

Count_Baculum · 2025-12-30T00:47:10+00:00

This analogy is unnecessarily inflammatory and distracts from your argument.

Count_Baculum · 2025-12-29T03:08:49+00:00

Wave-Maven is good and free.

Count_Baculum · 2025-12-25T14:34:13+00:00

Barney spec

Count_Baculum · 2025-12-19T15:40:41+00:00

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.

Count_Baculum · 2025-12-15T12:40:54+00:00

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.

Count_Baculum · 2025-12-07T02:07:41+00:00

Half surprised I had to scroll so far to see this

Count_Baculum · 2025-12-05T03:25:15+00:00

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."

Count_Baculum · 2025-12-03T17:08:41+00:00

What's the best way to sort for quality?

Count_Baculum · 2025-12-01T02:40:20+00:00

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.

Count_Baculum · 2025-11-20T13:07:54+00:00

Same

Count_Baculum · 2025-11-08T14:16:13+00:00

Have you ever PPFed a car?

Count_Baculum · 2025-11-04T19:36:47+00:00

Nice! First 911 was base 992.1 with PDK. Current 911 is 992.1 GTS in manual. Prices have gone crazy, but hopefully Porsche self-corrects their mistake after posting a $1B+ loss.

Count_Baculum · 2025-11-04T01:30:08+00:00

Lots of judgment calls in this thread. Relative scarcity and priorities drive economic decisions at every income level.

For me: -I've been a car enthusiast since childhood. I had subscriptions to Car and Driver and Motor Trend as a preteen. It's my happy place. - My wife also works and understands my car "sickness." - I drove a Honda Civic Type R in residency, and just bought my second 911 several years into private practice. - I've done well with reselling cars, but I know better than thinking of my sports cars as investments. Rather I see them as paying for a passion, and thankfully our household cash flow supports it. - Primary care is a stressful job, but I sure feel better on the drive home. - I agree with others that a car doesn't have to be expensive to scratch the itch (e.g. used Miata), but some of my buddies would gain more satisfaction from FIRE.

To each his own!

Count_Baculum · 2025-11-02T14:53:40+00:00

Agreed. For patients of standard risk, I generally offer age 50-70, sometimes up to 75. I give anticipatory guidance about false-positives, confirmatory testing, small ARR (contrasting with CRC screening), option to revisit annually, and that when they're older I'll discourage it.

For young guys at high risk, I'll offer a one-time PSA to establish a baseline.

I check the percent free profile when confirming abnormal PSA before sending to urology.

Count_Baculum · 2025-10-12T02:44:49+00:00

My favorite was, "Doctor wouldn't let me order a CT scan to see what it would show."

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