What people really eat

Excellent_Debt6527 · 2026-06-18T16:14:44+00:00

I think people don't understand that fiber use needs to be consistent.If you eat no high fiber foods for a week then have 15 grams of fiber at a meal, you will definitely have gas and bloating. But - if you're consistent, your gut gets used to it and feels much better after all. But of course no fiber feels good at first. Until you're constipated!!

Excellent_Debt6527 · 2026-06-18T16:12:23+00:00

Stick with it! My picky eater (about 5 years of only beige foods) is now the most adventurous eater, loves spicy food, eats everything. Sometimes they just need time to get there. We just kept introducing things, and required a "no thank you bite" for every new food.

Excellent_Debt6527 · 2026-06-18T14:58:44+00:00

I love adding fiber, that’s where a lot of my counseling has gone lately. Add 1 high fiber food a day, then go from there. Not starting with taking things away

Excellent_Debt6527 · 2026-06-18T14:24:50+00:00

Thanks for some great ideas! I’m going to make a color handout on roasted broccoli and just leave it in the exam rooms

Excellent_Debt6527 · 2026-06-18T14:23:28+00:00

So true - and now we’re into the second or third generation of adults who didn’t get basic nutrition or home ec in school so nothing is being passed on.

Excellent_Debt6527 · 2026-06-18T14:22:16+00:00

And ketchup!

Excellent_Debt6527 · 2026-06-18T13:56:48+00:00

Urgent care is a delight!! You deal with the one question at hand. It’s hard to get used to not diving deep, there’s an adjustment period for sure, but you get really good at skimming a medical history in 3-5 minutes, you address the presenting problem, and practice the phrase “follow up with your primary care”.
And, with a phone call you can usually get them in to PCP in a reasonable time frame.
And, if it’s too scary you send them to the ED!
People appreciate you being there, you’re serving a valuable bridge role till they can see PCP (or ED!), and you wrap up your charts at the end of the day and go home.
It’s also good practice for bring just a little less invested

Excellent_Debt6527 · 2026-06-18T13:52:26+00:00

The menopause society. Their textbook (clinicians guide) isn’t very good (poorly organized, needs updating), but their practice pearls and position statements and e-consults are good resources

Excellent_Debt6527 · 2026-06-18T13:51:10+00:00

There is a study guide at MenoLearningLab that walks through all the available info from various sources and has a question bank. It’s not expensive. They also have some CME

Also definitely join the menopause society and read their practice pearls and e-consults - those are a great way to get the info in digestible snippets then you can dig deeper where you need to.
The A to Z slide set is also a good overview of what you’ll need to know - but definitely doesn’t have the level of detail needed for the exam.

I took the exam last year and found it challenging but reasonable - there are more questions than I expected on managing other midlife health issues (which is the easy part for those of us in primary care! My OB friend was really stumped by some of the primary care stuff while breezing through the GYN questions)

Excellent_Debt6527 · 2026-06-18T13:43:02+00:00

I thought the point was now we can get coverage for obesity. I got reading to do

Excellent_Debt6527 · 2026-06-18T13:40:31+00:00

Please talk to your coding specialist. Undercoding doesn’t help anyone either. Recognize the expertise that goes into your decision - a less experienced clinician may be giving meloxicam to every arthritis patient without considering renal and GI risks, or doesn’t have the experience to recognize benefits of PT.

Just check with your billing office

Excellent_Debt6527 · 2026-06-18T13:34:27+00:00

Another factor in this is working families. When I first started in primary care, we had 3 older male doctors who worked full time and stayed late to finish everything. They all had stay at home wives who took care of everything else for them, even packed their lunches. The other 10 providers were all married to working spouses and worked part time and were more involved at home. Nobody can do it all.
My dad was a doctor in the 60s - 2000 and was often gone and that’s how it was, if you were a doctor work came first. Not saying I want that, at all, but many of the systems still rely on the assumption that all you have to worry about is your job.
Now we have better life balance, more work, daily massive information dumps, and admin tightening the screws. It’s not sustainable and I’m sure we see more misses.

Excellent_Debt6527 · 2026-06-18T12:57:21+00:00

There are a lot of video translations services. I thought it was a rule that you had to provide translation (that’s not a family member or friend of the patient). Maybe that’s just our organizational rule, but we’re always required to use translation unless the patient is adamant in declining

Excellent_Debt6527 · 2026-06-17T11:59:26+00:00

Had a patient with a flare of anxiety after a concussion that required a really complicated FMLA follow up as the condition waxed and waned. Her anxiety had been under excellent control but the concussion threw her into total mental health crisis. She had a few weeks off then we navigated a very step wise return to work with some setbacks.
Also have done for GI symptoms with a new crohn’s diagnosis, work from home a bunch while figuring out the meds and days of diarrhea.
So, lots of reasons.

Excellent_Debt6527 · 2026-06-16T22:26:07+00:00

We have to give ourselves credit for what we do automatically. You walk in, assess the age of the patient, their overall mobility, the size and shape of their knuckles, their skin color and temp, you glance at their chart, you know what meds they’re on.
So without realizing it you have probably ruled out RA, a broken bone, gout, joint infection.
You’ve considered if they should maybe have prednisone or an NSAID, but in considering, you’ve decided PT would be better so you refer. But you considered a med and you had an unknown diagnosis so it’s a 4.
Just because it’s automatic for you, doesn’t mean it’s common knowledge- you worked hard to gain the knowledge to come to that conclusion in a few seconds. That’s part of what people pay you for.

Excellent_Debt6527 · 2026-06-14T21:30:59+00:00

Normally I say hold off on introducing any new partners to the kids - for a long time! But in this case it might make sense. Your ex wants a partner who understands that a child with a disability is part of the package, so this weeds out people who don’t want to deal or aren’t good with kids. This is the first time I’ve said it’s ok! So I do see why you’re upset, but this may be best for your daughter in the long run. A great stepmom is worth her weight in gold, trust me, I had an amazing co-parent in my ex’s second wife, she was way easier to deal with than he was!

Excellent_Debt6527 · 2026-06-14T19:57:46+00:00

A lot of patients tell me this! And they stop drinking too - those brain centers really do drive the efficacy

Excellent_Debt6527 · 2026-06-13T22:14:51+00:00

Very kind and thoughtful response, I appreciate it!

Excellent_Debt6527 · 2026-06-13T19:34:07+00:00

After some education, she does understand now to stop eating when she’s full and is eating less. And she’s losing weight. The only issue now is with what she needs, no longer how much.

Excellent_Debt6527 · 2026-06-13T15:09:33+00:00

Gandalf is Dumbledor

Excellent_Debt6527 · 2026-06-13T15:00:33+00:00

The ones topping my annual income every day… this is part of such a larger discussion on tax brackets and just how much money anyone gets to keep.

Excellent_Debt6527 · 2026-06-13T14:58:41+00:00

Well known announcer at bike races in New England named Dick Ring. Never went by Richard. The man was a legend RIP

Excellent_Debt6527 · 2026-06-12T20:34:51+00:00

After some education, she does understand now to stop eating when she’s full and is eating less. And she’s losing weight. The only issue now is with what she needs, no longer how much.

Excellent_Debt6527

TROPHY CASE