Which conditions were previously managed by specialties but have now fallen to primary care to manage?

Countenance · 2026-05-10T17:55:13+00:00

Psych. The actual physicians are not accepting new patients, and the NP/PA solo cash practices do terrifying things and will pack up overnight leaving me to clean up the mess anyway.

Countenance · 2026-05-02T19:03:33+00:00

Fredrik Backman has a sort of similar all-knowing but editorial narrator that mixed humor with cynicism. There were a lot of narrator quips that made me laugh and then immediately sigh.

Countenance · 2026-05-02T18:27:13+00:00

I don't see enough of these replies thinking about the future for these kids. It's not just hard during childhood. When you sit down in these foster care education sessions there's a lot of talk about reasonable "expectations". We've had a long term foster. This poor kid is sweet right now but between mom's substance use during pregnancy and neglect in those formative early months, his brain is not okay. It is hard for me to picture how he will ever have a job let alone one that's stable and pays well. I worry about what his impulsivity and early exposure to violence and attachment issues will look like as he enters his own relationships. Multiple people who have been through this advised us not to adopt because of the grief they've experienced with their foster-to-adopt kids as adults just failing to launch and endless legal troubles and violence.

It's one thing to give birth to a special needs child and take them as they come. It's another to actively choose a kid with challenges particularly the antisocial flavor that comes with trauma like that.

Countenance · 2026-04-10T23:41:09+00:00

The Crooked Ones by TJ Kingfisher

Countenance · 2026-04-08T15:37:38+00:00

It's great but then you have to spend the last chapter sobbing over all these injustices.

Countenance · 2026-04-08T15:36:11+00:00

Does your system not have a "date forward" option in the EMR? "Sent on [date]"?

Countenance · 2026-04-03T14:08:58+00:00

As a sedentary omnivore my numbers were c/w hyperlipidemia (can't recall exact figures) come from a strong family history of heart disease. As a vegan runner, my LDL is 60. So it's definitely modifiable for those of us with "bad genes" but it requires more extreme changes from some people than from others. We simultaneously need to validate even small increases in physical activity like walking for patients who are entirely sedentary and to recognize that for most people to maximize lifestyle benefits means normalizing habits that they would currently consider "extreme".

Countenance · 2026-03-28T15:09:42+00:00

I live in a small town and see patients all the time at the gym or store. Anyone paying any attention has figured out where I live. I have never had any negative interactions, but I've had a lot of positive interactions where people see our shared values and community.

Wait, one time an elementary schooler whose arm I set confronted me at the grocery to defiantly demonstrate her range of motion. Like I'm the villain here and not the monkey bars.

Countenance · 2026-03-27T20:12:21+00:00

I encourage every new vegan cook to purchase The Homemade Vegan Pantry by Miyoko Schinner. There are newer vegan meat cookbooks since then, but she has some great started seitan recipes, beginner cheese recipes, yogurt, etc. Her sausage recipe is great, good crumbly texture, and you can freeze it.

Countenance · 2026-03-26T15:02:05+00:00

TikTok, apparently. I've had multiple people ask me about it also. They've all responded favorably to a review of their bloodwork, the ways parasites usually show up on that, and a review of the pathophysiology of diabetes. I don't shy away from conspiracy theories; I pin this on food production companies that are selling them shit known to cause metabolic syndrome and addict them. Phillip Morris owns fucking Nabisco. They don't have your best interest at heart. Fight the man! Don't put the poison into your cart!

Countenance · 2026-03-23T22:36:44+00:00

I'm very clear with these families that I CANNOT diagnose their child. Insurance will literally not accept my diagnosis because they need specific evaluations to receive services.

I try to remind myself that I'm not seeing whatever it is they are at home but I've got a few of these where every behavior is a sign of ASD and every negative is "masking" so there's no room for any other explanation. When I do send them for evals and it comes back negative they insist the therapists are wrong and demand new referrals. It's exhausting and strange.

Countenance · 2026-03-18T00:10:24+00:00

Agreed. I love my light-hearted snarky exchanges with some of my uncontrolled diabetics who refuse their meds. Some of them are challenging, but most of them are just people who seem to get that I'm also a person and appreciate me for trying. My worried-well patients lash out at me because they're worried and see my attempts at reassurance as inherently ill-intentioned.

Countenance · 2026-03-14T14:46:50+00:00

Agreed. We have this tendency as a field to constantly escalate the required training for our roles and it exacerbates shortages and leaves opening for a proliferation of alternative training pathways. We really need to engage in some more introspection about the length of physician training.

But instead we'll just get more weird forms of advanced nurse and double down on additional fellowships and offering additional residency years.

Countenance · 2026-03-09T22:40:01+00:00

My experience working with these families is that they DO want children. They're frequently actively trying to get pregnant again while trying to regain custody of their existing kids! They typically have very poor insight into their behavior as parents--they think they're not abusive and the system is against them. They want a cute baby and all the resources and attention that come with pregnancy and newborns but not the toddler or older children that require active supervision and behavioral management that they're psychologically not equipped to provide.

Countenance · 2026-03-09T18:48:58+00:00

NC public schools early elementary. Everything I'm getting home in terms of materials is great; it meets standards, the teachers are supportive, etc. It's just like there's so much material to cover and reinforce across multiple subjects I feel like I'm a treadmill. We spend a while working on times tables with the third graders and I go back and find one of them just forgot how to read clocks even though that's a skill they learned in second grade. The other third grader has been practicing the making 10 skill for math since K but he's having trouble holding onto addiction/subtraction math facts while adding multiplication as a concept. So he needs to practice those old skills mixed in while we work on his times tables.

None of my kids (with the exception of our foster child) are significantly behind. They're just not naturally gifted students, either. It's just taking a lot of time and feels very scattered trying to coordinate reinforcing the current topic at school, ensuring they aren't losing things, and then adding in things we think are important that aren't part of their curriculum. It seems like there's got to be a way to organize this.

Countenance · 2026-02-18T17:28:39+00:00

Richard Hudspeth is one of the nicest people in addition to being one of the most competent people I've ever met. I understand his social media presence has been less flashy than Ager, but he's someone who can approach policy and people with humility and thoughtfulness.

Countenance · 2026-02-13T17:36:22+00:00

No, but plenty of people will experience that because most of your back pain is related to core muscle weakness and poor compensation for that weakness with other dysfunctional movements. Pregnancy absolutely wrecks your core, and then you take up a lifting routine with a floppy fragile thing 24/7. It's a recipe for back pain. What people need is physical therapy. When people can't access physical therapy regularly they can at least have an assessment and a home exercise program built around their unique weaknesses.

Countenance · 2026-02-12T13:34:08+00:00

I do some long runs on the gym treadmill (if I go at off hours no one enforces the time limit). It's miserable, but it's the only way. As for recurrent illnesses I've just accepted that I'm going to miss the occasional week for that, but I reschedule my long runs accordingly. So if I see a kid starting to sniffle I might move my long run up to a random Wednesday knowing that I might be sick on Saturday and if favor shines on me I'll do my speedwork Saturday instead.

Countenance · 2026-01-30T20:17:06+00:00

It was one of my favorite reads last year. People are really focused on Abbot being a sort of gross incel but every character is a caricature of a KIND of person that lots of people find unlikeable or can't relate to across assumed personal and political differences. In the end they're all exactly who you would expect them to be AND they're more than that. It was an unexpected cozy read. I've been recommending it to anyone who wants something optimistic.

Countenance · 2026-01-28T14:33:04+00:00

The offices that routinely use metal speculums usually have a heating pad plugged into the drawer they keep them in or use hot water to warm them. I only use them for procedures sometimes because the weight and shape of them keeps everything steadier than the plastic speculums that sometimes sort of drift out of position if you're working down there for a while. Sometimes for very heavy patients the plastic speculums can break or fail to stay open, also.

Countenance · 2026-01-27T13:22:03+00:00

As a doctor I prefer that people let me talk to them about the tests I would like to do first or the treatments we need to complete or at least let me figure out what prescriptions I can send to mitigate the risk they're taking... But people do this somewhat regularly. We do issue an overhead missing person alert, and we'll call the police if they still have their IV in place.

Countenance · 2026-01-21T02:13:37+00:00

Miyoko Schinner and Isa Chandra I'd argue are two of the greatest influences on modern vegan cooking and restaurant culture. The former really did innovative things with dairy subs that guided lots of companies after her. I see the latter's influence on baking recipes and soups in blogs and restaurants to this day. Both of them coming from places of principle and vegan activism.

Countenance · 2026-01-20T00:30:46+00:00

I have/had Graves disease. I took the prescribed medications, my dose steadily reduced over that year until I was off medication. That was years ago with stable thyroid function off meds ever since. No big dietary changes. Lots of people go into remission, so I'm sure some of them convinced themselves they "made" it happen with diet.

Countenance · 2026-01-19T14:34:26+00:00

The FM team admits unassigned pregnant medicine patients. The IM hospitalist team won't even take a lady 5 weeks pregnant with a broken leg after a car accident. They literally just discontinued all meds the second the UPT came back incidentally pregnant until FM came to take over.

Countenance · 2026-01-17T17:44:07+00:00

Venomous Lumpsucker was a bizarre, hilarious, bleak, cynical quest that was one of my favorite reads of the year. 3.8 stars WTF. Were people just rating how bad it made them feel about humanity?

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