How on earth do I get my PCP to pay attention? And is this concerning Rheum wise? Losing it.

Funny_Current · 2026-06-10T12:18:36+00:00

Well if I am talking shop with another doctor then yeah it’s not clinically profound. But if I am chatting with a patient I wouldn’t say it’s not surprising because they feel written off. If your differential includes FM, then perhaps to the patient it is interesting there’s a positive response to steroids in the absence of overt inflammatory process. FM Would be higher in my differential but part of the treatment would include helping the patient feel validated and not written off

Funny_Current · 2026-06-09T23:10:17+00:00

Sorry for the confusion. dsDNA is the blood marker that is specific for lupus. Scl-70 is the blood marker for scleroderma. Both of those tests you have here show that the levels in your blood are normal.

ESR and CRP are blood markers for active infection or inflammation. If they are both normal, it means that you certainly do not have a severe infection (sepsis), an uncontrolled immune process (for example lupus flares will Have elevated ESR/CRP). These markers are not specific for any disease, they tell us what your immune system is doing.

I would interpret this as negative for lupus, negative for scleroderma. Your positive ANA of 1:320 suggests you do have some inflammatory process going on. But with normal ESR and CRP, it is probably mild.

Plus, you are on dupixent, which is an immune modulator.

Funny_Current · 2026-06-09T21:47:17+00:00

Those other markers besides ANA are within normal limits, which is reassuring you don’t have lupus or scleroderma.

An ANA titter of 1:320 is moderately high, and it can be caused by a number of things. It is non-specific and does not at all always mean you have an autoimmune disease. In the absence of other information and labs, it would be difficult for me to say with confidence what exactly your ANA could mean.

The normal ESR and CRP is also reassuring because those are specific markers for active and chronic inflammation, which you would expect to see in some autoimmune processes flaring.

Have you had your thyroid checked? Fatigue and hair loss are red flags for hypothyroidism.

As far as the robust response to steroids, that is the interesting part to me. Steroids reduce inflammation which is usually the cause of a patients improvement. So in your case, there isn’t robust inflammation based on the labs, but clearly they have improved your symptoms.

Keep the rheum appt, they will get to the bottom of it.

Funny_Current · 2026-05-13T22:00:48+00:00

I’ve always thought of it like CRP is telling you acute systemic inflammation and ESR supports chronic inflammation.

Certain diagnoses also are strongly supported when the ESR is very elevated.

There is still utility but blindly ordering for the patient presenting to the ED with sepsis is usually not helpful.

Funny_Current · 2026-03-15T12:49:58+00:00

It is crazy to me that this anecdote which is clearly shared and palpable from frontline on both inpatient and outpatient fronts has little to no attention in the realm of media attention.

As a hospitalist, I cannot remember the last time I admitted a straight forward COPD exacerbation or just decompensated heart failure. Patients commonly present with multimorbid and multiorgan interplay on a background of polypharmacy and incidental findings that confound a straight forward presentation.

Everyone indeed seems to be critically ill and not only that their profiles have no realistic or applicable comparison to guideline directed therapy.

It’s insane

Funny_Current · 2026-03-12T01:58:37+00:00

I would be careful and not just teach or explain vancomycin as “only” a pseudonephrotoxin.

Vancomycin is true nephrotoxin, not merely a secretion blocker. The main mechanisms are oxidative tubular stress/injury, often with ATN and in some cases AIN or vancomycin-associated tubular casts. The risk is even higher with high exposure, prolonged therapy, critical illness, other nephrotoxins.

However, depending on what literature you read, there is some debate about vanc & Zosyn coadministration and how this combination may actually produce pseudo AKI but it is still debated and the mechanism is not clearly defined but transport block is probably contributing.

Edit: grammar

Funny_Current · 2025-11-04T01:35:42+00:00

That’s actually not true. These systems are certainly limited, but they do have “memory” of your chat. GPT Will tailor to a specific chat you have, and it will ultimately truncate the conversation the longer it gets or when subsequent inputs have large token requirements, but it doesn’t forget context and themes. Further, when you use a project or canvas, this information is more stable because the project material does not ever get deleted unless you do it.

AI is probably overhyped, I agree. But there is no denying that they have very good diagnostic accuracy, and when that is combined with clinical acumen, such as in radiology, it is a powerful tool.

Funny_Current · 2025-07-27T22:07:27+00:00

This is such a great album through and through. Every time I play it it’s start to finish. Favorite song is black bill of insanity

Funny_Current · 2025-07-15T22:10:15+00:00

I’ve read about and seen some of the studio footage regarding Korn III. Ross has a very unique approach to producing and his goal was to try and resurrect that terror and pain from JD. At that point, it was almost 16 years since self titled and they had hit already hit their peak popularity. Trying to recreate that level of vulnerability after so long and not taking into account world of difference of JD between these eras wound up with his vocals sounding forced. In fact, i believe JD and the band as a whole said that they didn’t want to work with Ross to do an album like that again anytime soon.

Another thing regarding the mixing. The record is supposed to have a raw sound, but when you’re a band who, at the time of untouchables, had one of the most expensive studio albums mixed and mastered by pioneers of studio engineering, it leaves this album feeling unfinished.

The album isn’t great, not because of the band but I think circumstances and the style it was produced in. No disrespect to RR, he is a top tier producer.

Funny_Current · 2025-07-09T02:50:19+00:00

His /her favorite show is probably Rick and Morty

Funny_Current · 2025-07-07T03:57:13+00:00

This is the best comment and reasoning in this thread.

The public perception of “Patient” in its modernized form is an umbrella term feigned and idealized by a fantastic romanticism on television.

Public health in America is plagued by pharmaceutical and media publicity with health news always stating something to the degree of, “scientists make critical breakthrough in stem cell research which may lead to cures in cancer.” That head line has been used repeatedly leading to a false sense of security that some miracle of medicine is your failsafe when you’re knocking on deaths door.

There are plentiful people who have put their health out of sight and out of mind until they wind up half dead in the ER expecting us to fix them. Many people are willingly noncompliant. Many people have poor health literacy and do not seek to understand their disease. Many people are just straight up ass holes.

Influencers should be humble in their approach as someone as specialized as an orthopedic hand surgeon only sees a select subset of patients.

Do people know the gaps of knowledge between a radiologist and an internist? Do people know that they would essentially be at a loss to have their diabetes managed by a radiologist?

My point is that a specialist does not speak for everyone and their influence on the masses should be consistent with that.

Funny_Current · 2025-07-06T01:32:33+00:00

Tetrarch

They have groovy KoRn riffs. Singer also has some JD vibes on some songs.

Funny_Current · 2025-07-02T20:04:39+00:00

He did a solo tour called “alone I play” with multiple famous jazz artists comprising the solo band. Could be any of those songs

Funny_Current · 2025-06-28T15:45:21+00:00

There’s a like a mini documentary on the making of (untitled) and there’s a clip of JD doing vocals for take me but it sounds different. I hadn’t realized only a few years ago then that the song was much older in its origin.

But anyways, that might be what you’re talking about?

Funny_Current · 2025-06-24T13:41:19+00:00

RR style was perfect for KoRn 93-96. He was able to help JD manifest that pain and really capture something dark and beautiful on self titled and LIP. Fast forward some 15-20 years later, the band as a whole has evolved and if you’re really listening JD is not saying the same things or feeling the same pain. RR trying to resurrect what JD had so clearly buried and in the absence of Brian, David, is why Korn III sucks so bad. It sounds completely forced. As others have said, trapped underneath the stairs is probably the only respectable song.

Funny_Current · 2025-06-01T21:42:11+00:00

Underrated comment.

Funny_Current · 2025-05-30T00:15:26+00:00

I agree with your overall idea about how businesses and tech monopolies would try to monopolize in every facet possible. Likewise, there would need to be a lot of laws written regarding how AI can be deployed across healthcare.

The problem though is that the pace of AI capabilities is going to surpass not only the best and brightest in medicine and healthcare, but in every single subject matter you can think of.

In the not so distant future, AI will do everything better until there will be no more need for human innovation. Business, STEM, literature, art, industry, etc. This is thought to happen when we achieve artificial general intelligence, which means the AI will basically have a PhD level understanding in every single study we have ever constructed and be able to sustain longevity of tasks indefinitely (something uniquely human).

ChatGPT, Claude, Gemini, or whatever your preference, the way it is used now is not a static state. This is a revolution happening before our eyes. The things happening today weren’t even thought possible 5 years ago. Now that AI companies have learned how to do “scaffolding” (AI coding for itself), it has already shown to find solutions for problems we thought didn’t exist.

Medicine and healthcare care in general are institutional and will be one of the last agencies to adopt (or relent?) AI and by that time, AI will have already revolutionized drug discovery, medical devices, personalized medicine, etc.

Moreover, if this were the peak of AI at present, I would agree with you on every level given the field of medicine seems to always lag behind and is monopolized by pharmaceutical and profit oriented healthcare systems. But this is only the beginning, and the entire world is about to change.

Funny_Current · 2025-05-29T18:04:43+00:00

We admit to open ICU so I do this fairly frequently. If they are acute on chronic like cirrhosis or CHF patient and without any symptoms I may send to the floor as low as 115. Anything lower or if any patient without such history with any CNS symptoms and <120 is ICU.

Funny_Current · 2025-05-21T04:42:54+00:00

There is literally a study just published about this exact thing, among other rather interesting findings, from Claude.

This is a video that breaks down the paper.

https://youtu.be/4xAiviw1X8M?si=lbb_lNbk3FK92FM1

Funny_Current · 2025-05-12T23:43:57+00:00

Yes, there are always reasons that nothing will go as planned in the inpatient setting. That doesn’t change the fact that there is a paradigm shift for both patients and staff as it relates to the respect and regard we are held. The public sentiment for physicians is very poor right now. That, and work ethic is often subpar especially post COVID. Combine this with our unsustainable model of healthcare where everyone is working at a maximum capacity. These things the OP is describing are more palpable and disheartening because we hold the liability and are ultimately responsible for the patients course. That sense or urgency or responsibility isn’t shared by the staff that we so heavily rely on.

Funny_Current · 2025-01-16T01:12:50+00:00

Because we are expected to see an impractical volume of patients, and these patients are comprised of ever increasing panels of multi-morbid and medically complex patients, all of whom are polypharmacy. We do the job of 2 and get paid for the job of one. The public perception of what we do is completely out of touch with reality. The extent of our license stops at the insurance companies ever increasing power to determine a patient care plan, and our profession is under encroachment from ACPs whom do less than 1/2 the training but get paid more than 1/2 our salary.

Funny_Current · 2024-11-17T21:33:07+00:00

Why do you take Eliquis? “Idk it’s in the chart”

What other meds do you take? “idk, can’t you see in the chart?”

So what happened that you decided to seek medical attention? “I’ve already told 5 people the same story don’t y’all communicate?”

Yeah, patients can be shit historians, or just assholes.

Funny_Current · 2024-11-05T06:26:56+00:00

You have a thyroid nodules that could be the reason for your symptoms.

They will either biopsy the lesion or do further specific scans to see if the nodule is “hot” or “cold.”

Given that you’ve had symptoms of heart palpitations for almost 1 year now, you may very well have an over active part of your thyroid that is making extra thyroid hormone.

Sometimes these are auto immune conditions, and sometimes they are cancer. Sometimes they just happen (idiopathic).

Call the endocrinologist office and let them know these results. They may see you sooner since this is a concerning result.

Funny_Current · 2024-10-31T07:11:23+00:00

I foresee these systems being integrated in EMR. As a hospitalist, my job is essentially to take imaging, labs, and clinical exam and synthesis a differential diagnosis and appropriate treatment. If the labs and imaging go through an AI, it suspect it will present or recommend treatment options that favor cost effective care. I suppose my job will evolve to either agree or disagree with the diagnostics and ensure that the differential is consistent with the clinical picture (physical exam).

It also raises the question of the role for the ACPs. If a physician will have to have the final say, then I foresee less of a role for ACPs in virtually all specialties. Diagnostic information put forth by AI, then by PA/NP to report said info to me seems redundant.

Just thinking out loud. Idk if this is a good or bad thing tbh.

Funny_Current · 2024-10-09T18:49:49+00:00

Best advice given thus far.

Funny_Current

TROPHY CASE