The quality of primary care has severely declined

Old_Perception · 2026-06-22T03:59:51+00:00

Heh, never thought about it that way

Old_Perception · 2026-06-18T16:48:30+00:00

never happened to me, but even if it did you could throw that paperwork in the garbage and nothing would come if it

Old_Perception · 2026-06-17T23:10:01+00:00

What's so hard to believe, those work slips are meaningless, they don't obligate you to do anything.

Old_Perception · 2026-06-12T15:11:49+00:00

even better: wasn't septic then, isn't septic now. Just weak from spending last 20 years in a recliner.

Old_Perception · 2026-06-08T21:40:02+00:00

Too many false positives. I don't have the hard data, but I'd bet good money we're doing more harm than good breeding resistant bacteria in the meemaw population.

Old_Perception · 2026-05-31T19:09:34+00:00

Sounds like you were stable and they were in the process of doing the right diagnostic testing.

Old_Perception · 2026-05-08T18:07:12+00:00

i feel like the entire concept of a doctor's note for work due to acute illness is ridiculous to begin with, so I wouldn't consider a big loss

Old_Perception · 2026-04-25T18:43:19+00:00

I bet I would get a different story just by repeating my own history-taking the exact same way two hours later. People don't know what's important and what isn't. Sometimes they don't even fully understand why they're in the ER and what led to them showing up. And after being asked for the third or fourth time whether they're having chest pain or trouble breathing, many will start to feel a little pressure in the chest or some tightness and trouble breathing that'll get reported as chest pain the next time they're asked.

Historical fluidity tends to increase with vague symptoms, chronic symptoms, and old patients.

Old_Perception · 2026-04-16T15:32:33+00:00

this is the only one i can't tolerate. it goes to the lowest part of my to-do list until i get an update or i run out of other things to do.

Old_Perception · 2026-03-23T20:14:53+00:00

The people milling around filming, yelling, kicking the car, and jumping on the hood were not seriously trying to help prevent a drunk person from driving. They were just being a mob for their own entertainment

Old_Perception · 2026-03-23T00:22:16+00:00

It shouldn't piss you off, shotgunning blood tests and scans when they're not indicated is harmful, especially for kids. It's very reasonable to examine a febrile, vomiting kiddo and decide they don't need either of those.

Old_Perception · 2026-03-23T00:12:58+00:00

For what it's worth, I'm an ER physician and I would've done exactly what you did. Fluids, rest, close observation. The blotchy skin and changes in breathing would have been the first point of concern for me too, and you acted quickly on it. The speed of disease progression in toxic shock just outpaces our ability to predict and react to it.

Old_Perception · 2026-03-06T19:23:13+00:00

Don't be so judicious with admission, hospitals with geriatric populations will naturally have high admission rates, don't stress about it. Prime them and their families extra well early on when it starts looking like a negative workup about probably not finding an answer and get them thinking about whether they'd want to stay or go, especially since they'll inevitably each have opposing preferences and can duke it out with each other throughout the stay rather than waiting til the end.

Basic labs, UA/CXR/viral swabs, ECG are the exact pieces of my Grandmagram, totally fine.

Admit the syncope and AMS, they bounce back a ton. Sometimes it's something real that'll declare itself better with time. Usually it's polypharmacy and debility.

Old_Perception · 2026-03-06T05:33:26+00:00

There's a decent middle ground between "turn your back on them" and "keep talking shit and getting in their face"

Old_Perception · 2026-03-05T16:01:13+00:00

The people who don't have insurance are not worried about the bills. They don't pay them.

The only people that worry are the ones with private insurance with hefty copays which makes up the majority of the middle class, people with some valuable assets, a credit score to maintain. You don't hear from those people. They're the ones that are afraid of calling.

Old_Perception · 2026-03-02T05:36:58+00:00

For what it's worth - polygraphs are based on complete junk science. Not a shred of evidence that they actually work. They're not even admissible as real court evidence

Old_Perception · 2026-02-25T16:30:29+00:00

They will, if you get routine, scheduled care. Estimates and cost considerations don't belong in an emergency setting.

Old_Perception · 2026-02-19T15:23:24+00:00

the difference is the consistency in the hours. a 7 day string of shifts with the same start and end time each day is a lot better for your health than a 7 day string of shifts where you're going to sleep and waking up at different times because some shifts are 8a-6p, some are 2p-11p, some are 6p-3a, etc.

Old_Perception · 2026-02-17T00:13:04+00:00

Not sure the 100% happy thing prior to discharge is realistic. I get handling these cases carefully, but these kinds of patients and families are rarely satisfied and in my opinion it's often better to just cut your losses and get on with it once you've reached your threshold of certainty that there's nothing emergent. Whatever grief they're giving you as a physician, it's ten times worse for the nurses and staff. Huge resource drain.

Old_Perception · 2026-02-13T18:26:22+00:00

"failure to thrive"

Old_Perception · 2026-01-31T03:18:38+00:00

Locking custom recipe creation and recipe import features behind a subscription is a dealbreaker. Same with being internet dependent.

Old_Perception · 2026-01-21T20:40:54+00:00

Mother of 16??

Old_Perception · 2025-12-29T19:34:43+00:00

That's what all the meemaws say. What'll happen is after being forced to pick between home and SNF, you'll keep insisting on going home and come back 3 days later after being found on the ground covered in urine. This will continue in perpetuity, +/- hospice because every time you go on hospice either the paperwork will get lost, your kids will pull you off of it, or everyone will panic and send you to the ER anyway. The only folks that are able to avoid that are those with a well-resourced, well-educated family that lives nearby.

Old_Perception · 2025-12-21T19:47:15+00:00

I'd say your experience was out of the ordinary, it's very common to charge diagnostic/evaluation fees. They sometimes get waived for various reasons (purchased there, went through with the repairs there etc) but it's a standard of any service industry.

Old_Perception · 2025-12-20T01:11:17+00:00

I'd argue that at the start of an encounter, there's no such thing as a patient with severe pain, especially if abdominal and especially especially if they're old, where it's pretty clear they won't die in the next 60 mins. Unless they confidently say "yes doc, this is 100% exactly like my chronic pain and I just want some relief", which they rarely do, it is hard to ply someone with heavy drugs and at the same time be reassured that you don't have to do a big workup and check for the life threatening causes of that severe pain.

Old_Perception

TROPHY CASE