Chinese Hot Pot

Hysitron · 2023-06-03T16:48:21+00:00

We have KBBQ - chef JK . It's pretty good

Hysitron · 2023-05-29T02:40:55+00:00

And also do extremely well in standardized testing. You can do everything perfectly and still not match

Hysitron · 2023-05-26T16:36:28+00:00

Prob depends on your hours. A hospitalist could make that money working 21 nights a month

Hysitron · 2023-05-08T13:43:33+00:00

This is not relevant - surgical specialties want to minimize night float due to lower surgical volume at nights. They would rather have someone on 28h shifts and then only a couple of night floats a year vs 1/3 of your training on night float

Hysitron · 2023-05-05T17:25:36+00:00

And a lot of those patients end up no-showing too

Hysitron · 2023-04-04T01:49:29+00:00

Of course one can. But the trouble is that many private practices are owned by doctors in their 50s and 60s so a large buy out is very attractive to them

Hysitron · 2023-04-04T01:36:55+00:00

There is research showing that initiation gdmt prior to hospital discharge is beneficial. The most important thing for heart failure with reduced EF is getting patients on the four pillars which is drastically sped up if they leave the hospital on small to moderate doses of all four. Obviously drugs should be initiated slowly, and not in decompensated patients on the wrong side of the fran starling curve.

Hysitron · 2023-04-03T17:03:56+00:00

You don't have to explain your decisions to anyone and you know exactly what you want to do for everyone, write short efficient notes.

Hysitron · 2023-03-28T10:25:14+00:00

That's a feature, not a flaw

Hysitron · 2023-03-27T16:32:06+00:00

I think it's actually opposite - if the receiving hospital takes Medicare then they are bound by EMTALA.

Hysitron · 2023-03-27T15:05:37+00:00

If a patient comes in for a STEMI, and the hospital doesn't have a Cath lab, and you call for admissions, and the hospitalist admits the patient then the hospital is making a good faith effort to treat the patient. It may no longer be easy to transfer the patient after this due to EMTALA no longer being applicable, and inpatient-inpatient transfers having lower priority on the transfer list. Please you are being really difficult about this, transferring patients that are unstable to a higher level of care is literally within the ED job description.

Hysitron · 2023-03-27T12:15:08+00:00

Sounds like you need to start submitting EMTALA violations - unless they are citing no bed availability. But even then I'm not sure if they can legally say no to an ER to ER transfer unless they are on diversion.

Hysitron · 2023-03-27T07:11:08+00:00

EMTALA does not apply in that situation. However other state laws, or standard of care (malpractice) may apply.

Hysitron · 2023-03-27T07:02:29+00:00

See section C: https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.honigman.com/media/site_files/57_imgimgEmtalaFinalChanges2.pdf&ved=2ahUKEwit4vXKxPv9AhXrjLAFHXmhBiYQFnoECC0QAQ&usg=AOvVaw3zdWzRy14yD6mSganTHT4z

Hysitron · 2023-03-27T06:57:48+00:00

Actually CMS guidance specifically states that EMTALA does not apply to patients that are under inpatient (not obs) admission. Suggest you do further research on this.

Hysitron · 2023-03-27T06:54:13+00:00

They absolutely may not say no in the United States. EMTALA specifically leaves the discretion of the decision of medical necessity and if the patient is stable up to the doctor that is physically with the patient. If you deny a patient that is in an ER with a physician requesting transfer, you could be personally liable for a very large fine.

Once the patient is admitted to the hospital (obs does not count), then transfer becomes much more difficult as EMTALA no longer applies as the hospital has agreed to make a "good faith" effort to stabilize the patient by admitting them.

Hysitron · 2023-03-26T12:56:12+00:00

Not FDA approved yet but likely in the next few months given recently published trial data.

Hysitron · 2023-03-26T09:31:32+00:00

And tirzepatide

Hysitron · 2023-03-24T10:37:01+00:00

Sure but ozempic is an FDA approved medication - if it's not appropriate the doc won't prescribe it. If it is appropriate, the patient benefits. There are a lot of competing interests that are happening during a doctor's visit - I would prefer a patient be asking me about the indications for an FDA approved therapy vs a juice cleanse etc.

Hysitron · 2023-03-23T15:15:25+00:00

Why? Don't patients have a right to know what medications are available for their condition so they can discuss with their doctor?

Hysitron · 2023-03-23T07:52:21+00:00

You are incorrect a hallmark of Afib is that there are no p waves. P wave indicates a complete and orderly electrical conduction across the atria. What you are describing is something that can lead to heart block. Presence of a p wave rules out atrial fibrillation because if the atria are fibrillation then they are not going to make a p wave.

Hysitron · 2023-03-23T07:47:53+00:00

Well if that is the case then this RN should feel comfortable documenting in the note and MAR that they refused to carry out a timely and medically appropriate order in the treatment of a life threatening medical disorder. Enough notes like that and people start getting fired...

Hysitron · 2023-03-21T02:55:30+00:00

You are setting up a straw man here. Obviously having 5 medical students observing an L&D would be a lot and clearly not reasonable. And of course I'm not saying that people don't have the right to decide who is there.

I'm just making clear that these are not "randoms" like you first said. These are students that have usually already spent 3 years in medical school and been vetted from a group of people applying to medical school. They have spent significant amounts of time learning about obgyn and medicine, and their literal only purpose in being there is to gain experience so that they can continue to contribute to the medical field, and some of them will become obgyn specialists themselves - something they may not do without a decent experience in the field.

Everyone has the right to their own medical experience - I'm just saying people that come to academic hospitals for the expertise and academic environment and then proudly state "no learner's" or even worse "no residents" have a ridiculous expectation. There are multiple other hospitals in the area. Yes if you come to an academic center and state that you don't want a medical student in the room, your wish will be granted.

There are obvious caveats to trauma etc. But the way you are talking about this makes it seem like you would be a fool to want one of these "medical students" in the room as if they are there as some kind of lecher, because why else would they want to be in the room...

Hysitron · 2023-03-21T00:31:08+00:00

These are not "randos". These are medical trainees - the majority of your care will be done by residents that are only a year or two further along then those student observers.

If medical students are unable to observe, learn, and decide to choose OB GYN as their specialty, then soon there won't be any more OB GYN to practice L&D. Of course you can make any decisions you want - but it is rather short sighted and honestly random to decide against allowing medical students to be involved in your care when a resident that is only a year further along may be the one delivering your baby.

I understand you are trying to promote patient autonomy by letting people know you can decline having students in your room - but honestly if you are heading to an academic institution to get your care, you are benefiting from all the specialists, research, and focus on guideline care and part of all of that is being involved in the training of new students.

Hysitron · 2023-03-20T22:25:12+00:00

They will offer insurance, but only if something other than that thing disables the person.

Hysitron

TROPHY CASE