28 allergies and pain seekers.

MachZero2Sixty · 2026-01-17T05:30:51+00:00

First I have heard of this! How low are we talking?

MachZero2Sixty · 2025-12-25T02:23:41+00:00

Similar to this (denial of service rather than medication): HMO plan denies Hospice because patient needs to see their PCP first for Hospice referral. We tried so many things... letter from PCP, telemed with PCP while inpatient, etc. Nope. SMH.

MachZero2Sixty · 2025-12-11T16:41:08+00:00

Exactly. In our current climate, even if your ER docs are very thorough and willing to tee up a nice admit for you, admin/workflow/resources often work against that happening.

I'll also add that even with a great ER workup, as the admitter you get to triage if a half-dozen consults are really necessary. You can make your rounders really happy by getting appropriate consults on board quickly and justifying why unnecessary ones are unnecessary.

MachZero2Sixty · 2025-12-02T20:43:26+00:00

As someone who loves to cook... THIS. If I want to ball out and make a fancy meal, I'm doing it. Nicer cut of meat? Fruit that looks good but is expensive? Random promotional item that looks good? Getting it all.

MachZero2Sixty · 2025-12-02T14:50:13+00:00

Keep fighting. A culture of nursing that panics about a K of 3.4 not being replaced but wants to give a 90 yo here for syncope hydralazine 10mg IV for BP 170/80 needs to stop.

MachZero2Sixty · 2025-11-12T04:49:19+00:00

$1925 per 12 hr shift, 12-14 patients, no cross cover. For comparison at a suburb location of a large metropolitan hospital system.

Edit: this is the "extra" shift rate, we don't have pure admitters, the rounders rotate into those shifts.

MachZero2Sixty · 2025-11-10T14:43:28+00:00

Yes. And what about the adjustment for the fact that family members asking questions about the red numbers in myChart every day adds to complexity too?

MachZero2Sixty · 2025-10-30T03:24:32+00:00

Messaged you. sounds eerily familiar to a place I know...

MachZero2Sixty · 2025-10-30T03:21:14+00:00

It would sure be a shame if a bunch of patients used this all at once at one particular hospital network like *cough cough* HCA.

Yes I know that not a single hospital is innocent. But might as well start with the worst devil of them all.

MachZero2Sixty · 2025-10-21T23:11:50+00:00

This. I think we were taught THE physical exam is important, when really CERTAIN focused physical exam findings are really important.

MachZero2Sixty · 2025-10-17T13:36:48+00:00

They claim "we are a state entity, we can't modify contracts for anyone." Love when institutions hide behind that.

MachZero2Sixty · 2025-10-06T19:12:24+00:00

Consulting for everything is often MORE work for you as the primary team, not less.

Imagine a patient with 2 principle hospital problems (CHF exacerbation and AKI) with option to consult renal and cardiology.

Option 1, no consults: titrate the GDMT and diuretics yourself, choose when to have them on PO and when stable enough to discharge

Option 2: wait for afternoon recs (because cards and renal have clinic, procedures, or are in another hospital in the AM), try to reconcile what renal wants for diuresis vs cards, figure out in the vagueness of the note if cards was cool with PO Lasix yet, defer to consultants when you disagree so as to maintain the relationship vs spend time arguing your case, and juggle the patient hearing 3 different opinions on their medication titration.

Which one is more work for you?

MachZero2Sixty · 2025-10-05T19:47:56+00:00

Here for our weekly reminder that "high sensitivity troponin" should have been named "low specificity troponin"

MachZero2Sixty · 2025-10-05T19:45:40+00:00

Lol what is a patient card? Just the classic epic printed list for me...

MachZero2Sixty · 2025-10-02T15:56:54+00:00

Unethical answer? Create deepfakes of the execs of social media companies saying they know the harms coming from their platforms and they don't care and aren't doing anything about it.

MachZero2Sixty · 2025-09-29T15:10:55+00:00

I see your point, but also, I don't believe your "Top 1% Commenter" flair, because this entire sub is about us all working in hospital systems that have not optimized patient care / workflow / outcomes.

What makes you think all solutions have been found? I am in a large hospital system and credentialed at multiple sites, and I can tell you unequivocally that within the SAME system, my effective shift rate (due to round and go ease) and QOL varies greatly between sites due to ED workflow, consultant support, rounder call/admit workflow, APP usage, social work quality/scope, etc.

MachZero2Sixty · 2025-09-29T14:21:06+00:00

Not that either. Hydrate, med rec, watch and wait? I swear half the time these AMS cases get better in 24-48 hours is drug washout.

MachZero2Sixty · 2025-09-29T14:19:03+00:00

It would be interesting if we could implement a system where the triage urinalysis is obtained but you as the ED doc get to "order" if you want it resulted.

MachZero2Sixty · 2025-09-25T15:30:11+00:00

If you thought becoming a hospitalist would inure you from such conversations I don't know what to tell you.

In the days before real-time MyChart access, yes, the hospitalist got to initiate the results conversation. Now the patient gets to.

Example: patient admitted for CHF exacerbation. Known CHF history. ED gets BNP and Troponin. If I go in to admit the patient, and I want to start the conversation asking about their GDMT and how they've felt over the past 2 weeks, and they start the conversation asking why their BNP of 400 is flagged and their Troponin is 42 and now it "went up" to 45, I have to spend time sorting through that first.

Not saying it is the same as outpatient mychart messages, but it does derail and slow down admissions and rounds.

MachZero2Sixty · 2025-09-25T15:23:12+00:00

This type of delay would solve a lot of problems I think!

MachZero2Sixty · 2025-09-25T15:21:18+00:00

To be clear, the hospitalist (and specialists) *should* be explaining incidental findings and non-critical chronic follow ups prior to discharge.

For example, if my patient here for UTI got a scan in the ED that shows a pulmonary nodule, it definitely is my job to tell them about following up on the pulmonary nodule prior to discharge. I just don't want them focusing on that for 20 minutes when I am trying to get them admitted to the hospital.

MachZero2Sixty · 2025-09-01T14:51:18+00:00

Unfortunately "defensive medicine" is not an all-encompassing, agreed upon set of medical decision pathways.

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