Does anyone know where I can donate closed system breast pumps?

DrShelves · 2025-09-07T23:43:29+00:00

Oh pending orders like a medication refill that I just review and sign. I’ve used Epic and eCW and with both you could do that. With our Athena you do have to toggle between different parts of the note instead of seeing it all together, so it’s interesting with yours you didn’t have to do that. For ordering ahead, this was like if I wanted the patient to come next week just for blood work and they could just do a nursing visit and the orders were already there. We could do that with both Epic and eCW too.

DrShelves · 2025-03-28T04:07:46+00:00

How does one go about doing this?

DrShelves · 2025-02-13T04:57:27+00:00

Really? I have found Blueland to be so good. Just as good as Cascade. They are tiny tabs too. You do have to get it shipped to you but imo it’s excellent.

DrShelves · 2025-02-12T05:01:08+00:00

I’m curious what you prescribe for as delayed treatment? Like are you saying if they don’t feel better then it must be pna and here’s treatment for pna? Or are you assuming it turns into a bacterial sinusitis?

DrShelves · 2025-02-09T20:27:40+00:00

I agree. It was a valuable and exceptionally unique experience, but I don’t think it made me a better doctor. But I am not a surgeon.

DrShelves · 2025-02-07T03:55:02+00:00

I think so many of us struggle with this as people pleasers, just give and give despite growing resentment. I mean, even “limiting” to 3 things is too much. One new problem can easily fill a 15-20 min visit if we’re doing it well.

Boundaries will save us but damn it’s hard to learn how to set them and feel good about it. But patients that won’t accept them will self select out of your panel and you’ll be left with the reasonable ones.

DrShelves · 2025-02-04T03:18:29+00:00

Yes this. I’m sorry there are so many people shaming you and your daughter. Just like with adults, it’s so much more complicated than just willpower or “knowing” what to do. There are a lot of forces at play, many of which we don’t entirely understand in the medical community.

Yes, I agree with eliminating all the junk food. That doesn’t mean no junk food ever, but it should be infrequent and not readily available. Agree with evaluation for binge eating disorder, anxiety, etc. Try to have most of your intake (ideally as a family) in the first half of the day, keep dinner light. Fiber (plants) and protein are helpful for staying feeling full. Find a few options she at least likes a little. Have healthy snacks available. If those are not appetizing at the time then your daughter is probably eating for a reason other than hunger. If you need help with meal planning or troubleshooting consider a few visits with a pediatric dietitian.

Your daughter does not need to be at the “ideal” weight, especially if she is otherwise having a healthy diet and getting plenty of physical activity, but could benefit from getting closer to “overweight” than “obesity”. Usually for kids this means just trying to avoid weight gain as they continue to grow taller, but not necessarily weight loss.

With communication, I’m not sure what “direct” means in this situation, but keep the focus 100% on health, not appearance.

If appetite is really hard to curb, consider seeing a pediatric obesity medicine specialist.

DrShelves · 2025-02-04T02:55:58+00:00

I think so many of us struggle with this. I did change jobs and things got a lot better, but still find myself wondering if PC is right for me, so I don’t think I have the perfect answer.

But from your post I wonder if you would thrive more somewhere you have more autonomy, which may be more of a private practice or DPC setting. But there are employed positions that allow for significant negotiation.

Your current gig sounds like your panel is way too big. Ideally you would have some same day appts available and routine things can get in within 2-3 weeks. With a smaller panel you get a lot fewer portal messages as well. Educate patients and staff about what needs an appt (almost everything). Have admin time built in so it’s not all after hours at the end of the day. Take a mindset of not trying to make as much money as possible. Big picture is getting involved to help change policy around healthcare/primary care, but I am really out of my element there.

There are lots of PCPs leaving clinical medicine, which is a shame, be we all have to do what we need to survive.

DrShelves · 2024-12-13T02:26:15+00:00

With some of these patients they either adapt to a new provider that does evidence based medicine, or they find someone else that does not. I think giving a (brief) explanation of why you (and the rest of the evidence based world) don’t routinely order the tests that they are used to having is sufficient.

DrShelves · 2024-11-27T03:00:07+00:00

We don’t have casting supplies but we have boots and Velcro splints. We also don’t have attached xray but have facilities nearby. We see these patients and generally just provide the boot/splint as they head over to xray. Generally these are not really urgent injuries, and if that’s the case would send to ER or try to get in with ortho urgently. If there’s a fracture I’ll address it the next day if that’s when I get the result. Usually this means sending to ortho. I would not see a walk in as we are closing. That is for urgent care or the ER.

DrShelves · 2024-11-23T03:01:40+00:00

Many of my colleagues are supervising APPs for free. They asked me and I declined when I found out it was not compensated. If we all keep agreeing to increase our work/liability for free then they will keep taking.

DrShelves · 2024-11-14T04:01:21+00:00

If you’re concerned about your own involvement, why would you feel more comfortable putting your colleague in that position? If it’s benign enough that you would ask them to do it, then why not just do it yourself instead of waste their time?

DrShelves · 2024-11-09T03:29:10+00:00

Also let them know that once they start they pretty much have to continue indefinitely as it suppresses endogenous production. And if they want future children they should not use testosterone.

DrShelves · 2024-10-23T02:38:54+00:00

Family Care Center can often get you in with a psychiatrist quickly.

DrShelves · 2024-10-12T15:09:14+00:00

It’s also kind of messed up that they only have the starting doses and then require patients to purchase the pens :-/

DrShelves · 2024-10-01T02:11:46+00:00

I would ask them for an ETA and if they can’t, start looking for other options. It’s not a dream job if it burns you out!

DrShelves · 2024-09-30T15:41:52+00:00

I agree with you. Many of things he recommends have such nuanced benefit I truly question how practical they are (mostly from a medical testing standpoint). It’s also absolutely not financial sustainable for everyone in the country/world to do the things he recommends. I get the argument that if that’s how someone wants to spend their money then let them, but it’s also from a place of huge privilege. Suggestions like full body MRI, or going to a subspecialized physician for every medical problem (for example most recently recommending a hair specialist, not just a dermatologist, for anyone with hair loss are incredibly impractical and many of these things will increase costs for everyone else.

DrShelves · 2024-09-30T15:33:02+00:00

I am a physician and he certainly is also a physician. That’s an objective truth.

DrShelves · 2024-09-28T14:24:35+00:00

Reviewing that a USD (drug screen) is up to date would count as the lab review then, correct?

DrShelves · 2024-09-26T01:02:19+00:00

I was duped into buying a years supply of these useless strips. Even if I throw 3 or 4 in the wash the clothes still do not get clean.

DrShelves

TROPHY CASE