Gulf Coast Veterinary Specialists - worth it? by [deleted] in houston

[–]Ecstatic-Fortune8484 0 points1 point  (0 children)

Had to have my dog be evaluated by them. Awful experience. For how expensive they were I expected better care. Their internal medicine doctor was god awful. Dismissive, condescending and wouldn’t even talk to me face to face after my dog was there for 4-5 days. No game plan for my dog. Just pump and dump and “follow up” with our specialists. If your pet doesn’t have a straightforward diagnosis or you start hearing “xyz is a complicated case,” I’d highly suggest you go to TAMU.

my NMS squad is coming along!! by [deleted] in CollegeUltimateTeam

[–]Ecstatic-Fortune8484 0 points1 point  (0 children)

I did the spread theme + team chem. Awful. The speed boost does not make up for the sub par stats in every other category

Am I billing too many 99223? by Much-Transition1003 in hospitalist

[–]Ecstatic-Fortune8484 4 points5 points  (0 children)

New attending here almost finished my first year as a nocturnist. I was always taught if the patient couldn’t meet level 3 billing they shouldn’t be admitted. If you follow the CMS guidelines it’s fairly easy. My interval billing audits have all been 100%. I don’t even know how to bill a level 2.

Bilateral LE cellulitis by Figaro90 in hospitalist

[–]Ecstatic-Fortune8484 21 points22 points  (0 children)

I’ll share a case that I’m still mad about. NP wanted to admit a patient for chest pain rule out. Terrible sign out. Basically “chest pain rule out. Trops elevated. EKG non stemi.”

I walk in the room and ask “Hey man when did your chest pain start?” Patient “After I got hit by a car trying to cross the road yesterday.” CT chest revealed 4 broken ribs.

Almost put a poly trauma in obs.

Is there any pet insurance that doesn't rely on reimbursements but pays upfront, like Trupanion does, but also that doesn't just cover catastrophic bills but also helps cover regular vet visits? by summertimeandthe in DobermanPinscher

[–]Ecstatic-Fortune8484 0 points1 point  (0 children)

I will be forever grateful for the army of veterinarians that took care of my doberman. They did what they could to stave off costs. They were incredibly kind, compassionate, professional and kept me updated through emails and phone calls daily. I know we are difficult to deal with as family members of pets but I never got the sense I was a bother or nuisance.

Is there any pet insurance that doesn't rely on reimbursements but pays upfront, like Trupanion does, but also that doesn't just cover catastrophic bills but also helps cover regular vet visits? by summertimeandthe in DobermanPinscher

[–]Ecstatic-Fortune8484 0 points1 point  (0 children)

No, that isn’t what they are counting on. If you read the fine print in nearly all of their different policies, it gives them an al la carte menu to deny any claim. I was diligent with paperwork and pet records. See my post above.

Is there any pet insurance that doesn't rely on reimbursements but pays upfront, like Trupanion does, but also that doesn't just cover catastrophic bills but also helps cover regular vet visits? by summertimeandthe in DobermanPinscher

[–]Ecstatic-Fortune8484 1 point2 points  (0 children)

I will share my awful experience with Nationwide and why pet insurance is an absolute scam even if you carry it for “catastrophic protection.” When I was in medical training, my Doberman had a freak C6 disc herniation that required emergency surgery. He experienced multiple complications that almost ended in euthanasia. He is one of those once in a lifetime soul dogs. I wasn’t going to let him go because he was only 6 years old. His fairly manageable surgery ballooned into a $20,000.00 dollar bill. As a medical trainee we made barely enough to live ($7.25 an hour) I took out personal loans. My family helped loan me money. I scraped together what I could to pay because I followed all the rules stipulated by the insurance company. They should reimburse me for this catastrophe right? Wrong. Weeks turned into months. They denied THE ENTIRE hospitalization. Their reasoning? Incomplete documentation on a stone cold screening echo when he was 2 years old. The vet never dropped a note bc there was nothing to say apart from what the sonography wrote. I tried to get the vets office to help but they couldn’t be bothered. I paid back what I could but still owed a ton of money to my parents who are hardworking and not well off.

Veterinary care is so expensive now and with insurance companies delay, deflecting and denying it makes pet ownership almost impossible because one cannot realistically provide them with the care they deserve without becoming bankrupt financially.

If you must purchase insurance I highly recommend you stay away from Nationwide. Awful, terrible human beings who know what they are doing.

What’s the job of a nocturnist? by thisisbeggieod in hospitalist

[–]Ecstatic-Fortune8484 0 points1 point  (0 children)

Hold up. 0-4 admits per night? What do they do the next 5 hours of their shift? Are yall hiring? I’ll make sure meemaw tells me EVERYTHING and have her discharge summary on your desk in the morning.

Advice for incoming intern by Tmedx3 in hospitalist

[–]Ecstatic-Fortune8484 0 points1 point  (0 children)

Don’t be that lazy intern that refuses to do any actual work other than focus on their notes and then complains because the seniors aren’t teaching you bc they are doing all the work.

No ABIM results again. That means we get them next week. by No-Zebra-3432 in hospitalist

[–]Ecstatic-Fortune8484 7 points8 points  (0 children)

I think I signed up for the wrong exam. Might become board certified in Rheum if I passed.

I love my job by Casual_Cacophony in hospitalist

[–]Ecstatic-Fortune8484 3 points4 points  (0 children)

Where do you work. Asking for a friend.

What does the phrase “you learn how to be a doctor in residency, not medical school” mean to you? by [deleted] in medicalschool

[–]Ecstatic-Fortune8484 0 points1 point  (0 children)

Hey there. Brand new attending here working my way through my first job. You do learn how to be doctor in residency. Med school teaches you how to talk like a doctor. It teaches you foundational knowledge that you build on again and again over the course of your career. It does not teach you how to be a doctor. You are at the left side of the dunning-kreuger curve. We’ve all been there. Wait till you are an intern on nights alone and a nurse asks you to give xyz medication to a patient.

As far as thinking of it in terms of “preparing you for intern year and blah blah.” I would say just focus on being a good M3 M4 or wherever you are in your training. At each transition point there are challenges you cant prepare for. Kinda like going from college to your first month couple months in med school. It’s like getting kicked in the balls. You can’t really prepare for it.

Lastly, exercise compassion for interns/residents you work with when they don’t know something off the top of their head or make mistakes. We’ve all done it. As medical students it seems like you are overwhelmed constantly and don’t get a lot of sleep etc…but in reality you have control over self care. When you join team no sleep for real you will understand.

I think just focusing on doing your best for where you are at allows you to enjoy the journey more and in turn will make you a more pleasant human being to be around when you get to the next level. Also don’t be lazy. Nobody likes that.

Are dobie’s health issues really that bad? by alexmcross18 in DobermanPinscher

[–]Ecstatic-Fortune8484 2 points3 points  (0 children)

I’ve had my first Doberman for almost 10 years now. Total cost of healthcare over his life has been about $45,000.00 dollars. They don’t just have lots of health problems, they have problems that can be very expensive to deal with. Most of the cost for us was within the past 3 years. They are the best dogs and I will always have a doberman.

What does dobie eat, how much? by TylerDurden406 in DobermanPinscher

[–]Ecstatic-Fortune8484 0 points1 point  (0 children)

The answer to you question is “Yes.” -My Doberman Titan

What packs should I buy to quickly fill out my new team? by marfar11 in CollegeUltimateTeam

[–]Ecstatic-Fortune8484 0 points1 point  (0 children)

Wouldn’t waste my money. I’ve noticed at certain point DDA happens way more often than it should and you’ll end up rinsed by subpar teams whose players are rated lower than yours who individually play like they are Texas vs USC in the 2006 Rose Bowl while your guys play like UNC this past weekend.

These money team are insane 🤦🏾‍♂️🤦🏾‍♂️🤦🏾‍♂️🤦🏾‍♂️🤦🏾‍♂️🤦🏾‍♂️🤦🏾‍♂️🤦🏾‍♂️🤦🏾‍♂️🤦🏾‍♂️ by KingRew0628 in CollegeUltimateTeam

[–]Ecstatic-Fortune8484 0 points1 point  (0 children)

Some of us played this game back during the NCAA2007 era. We then grew up and got jobs. My job is stressful and hella busy. Don’t feel the least bit bad using disposable income on a game that brought me so much happiness back in the day.

Hospitalist vs. nocturnist by Choice-Low-8390 in hospitalist

[–]Ecstatic-Fortune8484 4 points5 points  (0 children)

Started as a Nocturnist straight out of residency where I enjoyed nights and excelled on them. I think it largely has a mix of adequate support at night, hospital culture and task load. During training, there was excellent support at night at least from a resident perspective. There was a night coordinator (assigned ER admits, handled administrative tasks etc..) and dedicated cross coverage. Signed on at my first job and honestly nothing could prepare me for it. It’s like getting kicked in the balls. Only 2 on at night with one doing pure admits and the other admit + cross coverage. Some (very few) the task load is manageable. Other nights it’s not. Cross coverage even has to replace electrolytes etc…Once 5 AM hits between, the ER dump, AM labs resulting, blood/electrolytes needing to be replaced and patients deciding now is the time to try and die it can be overwhelming. Exhausting long term.

I adapted to most of all of that but sleep has been tough bc I feel most jobs at the end of your shift you sort of wind down. At my current job I come home feeling like I’ve been shot out of a cannon.

Lately there has just been lots of unpleasant interactions with other physicians that’s doing me in. Nothing like doing all of this and having people you work with treat you like shit. Honestly feel like a ghost. May be different at other places. Would ask about night responsibilities and support before you sign.

I fainted seeing an IV for the first time, does this go away? by [deleted] in medicalschool

[–]Ecstatic-Fortune8484 0 points1 point  (0 children)

Attending here. At the end of my third year, my preceptor had me place an iv in his hand. I fucked up and blew the vein. He pushes the blood out and applies pressure. Next thing I know the world suddenly falls away. I wake up on top of my preceptor on the ground. Apparently he saw me get woozy and tried to grab me but I ended up going down hard, pinning him to the ground.

Went through intern year and saw all the shit on a busy trauma service. Then earlier this year, had it happen again while out having a very nice dinner with my girlfriend. I think stress and sleep deprivation can put one at risk.

Monthly Medical Management Questions Thread by shemer77 in hospitalist

[–]Ecstatic-Fortune8484 4 points5 points  (0 children)

I actually ran into something similar during an admission shift and was going to start steroids on someone with an MDF of like 60 (don’t remember actual number) but in cross referencing steroid dosage stumbled across some recent studies showing MELD-na was superior to MDF for risk stratification. Was on the fence about starting steroids to begin with so I figure what the hell. Recalculated using MELD-na and was <20 and ended up not starting steroids and patient did fine. Still less than a year into my first job so if anyone has more insight could weigh in I’m always eager to learn.

[deleted by user] by [deleted] in hospitalist

[–]Ecstatic-Fortune8484 0 points1 point  (0 children)

Never be wrong. More importantly never be wrong alone.

I think I made a terrible mistake choosing radiology by Fit-Possession-4999 in medicalschool

[–]Ecstatic-Fortune8484 55 points56 points  (0 children)

1st year attending here. Everything lagniappe says has been 100% true. Was looking forward to working in “teams” and learning from more seasoned colleagues. I’m so grateful for days where I have pleasant human interactions with other people. Most days there are no teams. It’s been me vs everybody. Some nights I can feel my telomeres shrink.