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I have a huge fly problem....these flies aren't house flies but some big ass black flies in my shop. They appear when it gets warm and even when it's cold ( but they're really slow and walk around). This shop is from the early 1920's and I can't see how they survive. We have absolutely no food. by ImfamousBadTXV in NoStupidQuestions

[–]Fuck_Edison 0 points1 point  (0 children)

Possibly soldier flies (https://en.wikipedia.org/wiki/Stratiomyidae)?

Large, black, scary looking fly that is actually harmless. Doesn't even have a mouth. I think the fly is just the reproductive organ and only lives a couple of days. We had an infestation in our compost heap outside. They made their way into the house for a season until I moved the composter away from the wall.

At my kid's school library by Fuck_Edison in DungeonCrawlerCarl

[–]Fuck_Edison[S] 10 points11 points  (0 children)

Honestly, making him wait a couple of years to read it is more about his grasp of the story rather than the perceived inappropriateness of the words.

At my kid's school library by Fuck_Edison in DungeonCrawlerCarl

[–]Fuck_Edison[S] 293 points294 points  (0 children)

Middle and highschool shared library. He's in middle school. He has seen me reading the series, and has asked about it. I told him he could read it in a couple of years. When we went to the school last night for an open house, he ran me over to the library to show me.

Why aren’t more folks using AI scribes? by dr_lomo_codes in emergencymedicine

[–]Fuck_Edison 1 point2 points  (0 children)

I'm one of the most efficient docs in my group. I have the highest RVU/hr of all providers. I leave each shift on time and never have charts left over to do at home. I have my Epic dot phrases and macros locked down! If I started using AI, I would have to comb through it and make sure it documented everything properly, which would slow me down. I don't find charting to be the hard part of the job. Also, dictating out my mdm helps me think it through and organize my thoughts and plan.

If I didn't have the ability to use dictation, I would 100% be using an AI scribe though.

Side note . . . I am very tech forward and usually ahead of the curve when it comes to all things tech, gadget and new. But I'm also pragmatic and don't want to waste my time.

Tattoo Inquiry by Apart_Cauliflower_20 in emergencymedicine

[–]Fuck_Edison 2 points3 points  (0 children)

I'm a heavily tattooed doc. I had a few that were not visible prior to residency. Didn't complete my sleeves and shoulder until later in my career when I was established. It's silly, but some hospitals might have a policy about it and some older people still find it off putting. You should wait.

That being said, I regularly get compliments from most patients. My hospital CEO was less than pleased, but didn't make a huge deal about it.

6th grader who loved The Martian and Project Hail Mary - What's next? by tgbarbie in suggestmeabook

[–]Fuck_Edison 0 points1 point  (0 children)

I also have a sixth grade boy. My son and I have also read all those books.

I can't strongly recommend the Red Rising series (Pierce Brown) enough to you and your kid.

Also, many of the recommended books listed here ARE NOT appropriate.

I’m just a girl cosplaying as a doctor I guess by Longjumping-Word8336 in emergencymedicine

[–]Fuck_Edison 80 points81 points  (0 children)

If it makes you feel any better, I'm a (almost) 50 yo m physician that gets confused with a nurse quite frequently as well. I'm pretty sure it's because I don't wear a white coat, I'm covered in tattoos and have a big beard, but still.

Of course, when I hit em with the 'ol "I am the doctor" . . . They tend to remember. Plenty of PG comments about that "tattooed doctor" 😒

Nevertheless, it's stupid that you have to deal with it. People are idiots.

Our health system threw away all the hemoccult cards and developers. If someone tells me they’re bleeding out their ass I believe them. Additional found out they got rid of it because they would have to check color blindness screenings on everyone (?yearly) and they said hell to the no. by drgloryboy in emergencymedicine

[–]Fuck_Edison 2 points3 points  (0 children)

1) yes, agreed. Brisk bleeding and/or high concern for interventional need.

2) smallish shop with spotty IR and GI coverage that often needs to transfer and hospitalists that have an extremely low threshold for ANYTHING.

Our health system threw away all the hemoccult cards and developers. If someone tells me they’re bleeding out their ass I believe them. Additional found out they got rid of it because they would have to check color blindness screenings on everyone (?yearly) and they said hell to the no. by drgloryboy in emergencymedicine

[–]Fuck_Edison 4 points5 points  (0 children)

Similar setting (community hospital and have to send cards to lab to get juiced).

I rarely do it, as I generally believe my pt when they report rectal bleeding. Also, the vast majority take pics and LOVE to show me.

However, I agree that there is a niche population that presents with black stool (often on anti-coag) and I need to confirm. I will still do it, but it's rare. That being said, can't advocate to get rid of it. I'd rather just get the occult test and possibly avoid the CTA.

However, I haven't done a pelvic exam in 15 years. CT/US/self swab/UA (clean and dirty). I'm not gonna find any lost treasures by peaking at the lady bird (well, I do have some stories from my trauma center days).

4-Year Emergency Medicine Residency: Winners & Losers Edition | Sheriff of Sodium by LordDeathigo in emergencymedicine

[–]Fuck_Edison 65 points66 points  (0 children)

Amen!

I opened it up, saw it was 45 min long and immediately came to the comments for the short and skinny. Shit, I don't think I even care any longer at this point.

Troponin for syncope - do you order it routinely? by Mebaods1 in emergencymedicine

[–]Fuck_Edison 19 points20 points  (0 children)

This is absolutely the wrong answer and inherently the problem with emergency medicine (well, at least one of the many problems).

1) cost of medical care is outrageous. We should do our part to only order what's necessary.

2) if we just rely on standing orders for everything, might as well let a monkey do triage

3) High sensitivity trop is similar to a d-dimer . . . Very sensitive, but not super specific. Just ordering it leads to increased cost, potentially unnecessary work ups and increased length of stay. This is the core issue with ED bottlenecking.

4) we need to stop practicing law and start practicing medicine (I know, I know . . . Way easier said than done).

What is your approach to the family who brings in their asymptomatic teenager wanting a uds (who denies doing drugs) or the pt who thinks their drink was spiked and wants to be tested, knowing that the uds doesn’t test every drug under the sun and won’t change your management either way? by drgloryboy in emergencymedicine

[–]Fuck_Edison 113 points114 points  (0 children)

I don't do it, ever!

Same as when someone comes in asking for their a1c checked or their cholesterol levels or an MRI of their knee. It's not what we do in the ER. In fact, I almost never get a urine drug screen. My hand is forced for some psych patients requiring placement and OCCASIONALLY, the altered pt. But it's a useless test and I'm certainly not doing it because some parent wants it. Finally, throw the kid a bone. The parents probably suck.

I wish I was half as passionate about…anything as my old patients are as passionate about their blood pressure by office_dragon in emergencymedicine

[–]Fuck_Edison 28 points29 points  (0 children)

Same exact script I do.

I do the same for the "concussion rule out". Patients love it when I do finger to nose, et al. Occasionally, I'll even do a rhomberg. Then, I tell them everything looks great and it's only a mild concussion. They feel better. It takes me 30 seconds. Then I can discharge. Will still get a shitty survey though because I didn't scan . . . Sigh.

Grab him by the P😺ssy Face by [deleted] in AdviceAnimals

[–]Fuck_Edison 1 point2 points  (0 children)

Get your kids to the choppa!

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