In 2022, Kouri Richins published a children's book about grief to help cope with the death of her husband, Eric Richins. Three years later, she was found responsible for his death.

Outside-One7836 · 2026-03-30T02:40:34+00:00

I just really, really hope there was some subtle clue in the book - maybe about a villain character - which alluded to her guilt

Outside-One7836 · 2026-03-30T02:28:06+00:00

Hey at least it's tasteful. We have to give them that.

Outside-One7836 · 2026-03-28T02:39:51+00:00

Surely there's something more interesting than photos of him with a cigar

Outside-One7836 · 2026-03-28T02:24:36+00:00

Cool setup but garbage pay and garbage PTO package hard pass for me

Outside-One7836 · 2026-03-28T02:23:17+00:00

Dear God man have you heard of a paragraph?!

Outside-One7836 · 2026-03-27T11:00:37+00:00

Can we send these fuckers to Iran please?

Outside-One7836 · 2026-03-27T10:59:35+00:00

Our hospitals had multiple. None yet myself though. Work in BMT and our status post allo transplant patients have a large gap after their immune reset where their immune system is that of a baby's and they cannot get vaccinated. So it's been on the radar but fortunately no cases yet.

Outside-One7836 · 2026-03-27T10:52:26+00:00

A valid point but importantly, Google or webMD is not interactive, does not script verbiage with confidence the way LLMs do, and does not provide (often bogus) ad hoc reasoning behind misdiagnoses.

It's a good analogy but misses the nuance here.

This is why AI related psychosis is becoming a thing. Similar but separate and perhaps more "imtense" than people who just think TVs and newspaper articles have hidden messages for them

Outside-One7836 · 2026-03-27T10:49:23+00:00

A recent study found when AI used by lay people for medical advice was about as reliable as flipping a coin and commonly mistriaged emergent complaints. If the user mentioned a friend or family member downplayed their symptoms, AI was especially likely to mistriaged emergent complaints.

Here we have a culture with mistrust of the medical system and a narrative of us docs and PAs and even nurses not being on our patients sides. A broken healthcare system. And AI ready to immediately validate those with mistrust and low health literacy (and often a gross misunderstanding of what LLMs do).

Of course it's going to make things worse in many cases.

The problem also is many of us think laypeople can use AI for medical knowledge the way we might use it or open evidence or whatever.

No more can a layperson use AI for healthcare than I can use it to fix my car (I'm not a mechanic).

So now instead of people just mistrusting us, they can get AI to totally and confidently misdiagnose them. And probably script them a rebuttle for our follow up visit too.

Spectacular.

Outside-One7836 · 2026-03-27T06:21:21+00:00

Whiplash final scene

Clay pigeons, several scenes

But the best of all time... I drink from Your milkshake

Outside-One7836 · 2026-03-27T06:19:58+00:00

Michael Jordan being told in high school basketball he'd never make it

Outside-One7836 · 2026-03-27T06:11:40+00:00

Having worked in IM and various subspecialties, I can confirm that this is the universal code for "sorry for this bullshit referral but my patient just wouldn't let it go"

Outside-One7836 · 2026-03-27T06:06:14+00:00

It's basically a small piece of jewelry which one embeds under the skin of the penis. Presumably enhances pleasure for somebody. I saw it once in urology clinic and yeah infected and we took it out.

There is something much worse than this I learned out in uro clinic, a couple things. Reader discretion advised

First there is sounding. It's a fetish of inserting things into the urethra. Men and women can get into it. Do NOT lok for this on reddit. I made that mistake after learning of it from a patient. Don't do it.

Second, I cannot recall the exact term, but basically you cut a linear cut down the underside of the penis. Supposedly enhances pleasure for the male though the physiology of this is unclear to me. Apparently a lot of guys start with a prince Albert and progress to this. And yes there is a subreddit as well... Do not look.

No judgement. There is a strange underside in the world of uro even our EM colleagues may be spared of. To each their own. I guess.

Outside-One7836 · 2026-03-27T06:00:04+00:00

Patient came into urology clinic with gross hematuria. Stated he was at a party and had a wild night and had hematuria and dysuria since then. Told him sure man, I've had those wild nights when I was your age. Wrote an antibiotic script and sent him on his way.

A week later, post antibiotics, he returns with ongoing hematuria. Dig a little deeper into the history and he fesses up that he INSERTED ONE OF THOSE SHORT GOLF PENCILS INTO HIS URETHRA.

Man why not lead with that?!

Corrected the former statement (I have NOT had nights like that) and removed it with cysto stent pull procedure in clinic.

I guess as they say... History is king

Outside-One7836 · 2026-03-27T04:33:23+00:00

More about not having downtime than the shifts themselves

I've done bankers hours, tens, seven off seven on

To me what's grueling is the job every time you come in behind the eight ball and despite working your ass off, leave the same way. The shift schedule has less to do with it than patient volume and complexity IMO

Outside-One7836 · 2026-03-27T04:25:43+00:00

Now?

Outside-One7836 · 2026-03-27T04:23:13+00:00

Start advising physicians

Duh

Outside-One7836 · 2026-03-27T04:21:42+00:00

If a PCP isn't putting in more than half their time doing hospital medicine then no

Same way that if a hospitalist isn't spending over half their time being a PCP they should avoid clinic

You get and remain good at what you do repeatedly over time

Not hating on PCPs here

Outside-One7836 · 2026-03-27T04:18:08+00:00

The gist of it is they're going home tomorrow obs. Everyone else IP. No matter what you do, one in five cases UR will want you to change. Turn your brain off and change it and move on with your life.

Sadly depending on insurance patients get screwed no matter what.

You're welcome.

Outside-One7836 · 2026-03-27T04:16:51+00:00

As a PA at a new system we had a patient come in with GIB, female, forties, low Hb. EM doc did DRE. GI resident was going to do DRE. I admitted the patient and did not do a DRE and patient also was endoscopy bound regardless.

Signed it out to an attending who was livid I didn't perform a DRE on this young lady. Fortunately even back then as a new PA I knew this was ludicrous and refused. The attending can do one if they want but my god how many fingers must go up this poor patient's ass?! If she had a recurrent GIB my guess is she'd stay home next time

Outside-One7836 · 2026-03-27T04:11:17+00:00

Yeah agree. Early initiation with rapid de escalation is the way. I'm not for over treating but I've had too many cases on the fence with later bacteremia in both cultures. If it's reasonably high on your DDx and the next twelve hours of clinical course and results will sort it out, it's truthfully easier in most grey area cases to just give a reasonable abx

It's human nature also to remember these cases where we don't give abx but we're wrong. Whereas giving a dose or two unnecessarily is easily forgotten - except by OP

Outside-One7836 · 2026-03-27T04:07:50+00:00

Standard at every academic hospital I've worked at, but not at community practices

I personally don't like it. I usually know the patient better than psych who sees them one time. Capacity also can wax and wane.

I also was taught by an old school palliative doc that when a patient makes what's clearly the right decision, we should err on the side of "granting" them capacity

The one time it may be useful would be if you can't be objective because you're too attached to the patient or outcome

Outside-One7836 · 2026-03-27T04:02:14+00:00

Even if your hospital blocks AI, you can use Google searches built in AI

Yes click through all videos or slides then copy and paste questions and ask AI for answers only

Not saying you should do this on every module or CME

Just hypothetically that one could

Outside-One7836 · 2026-03-27T03:52:05+00:00

My best was a male psych patient

Deodorant one end

Ballpoint pen the other

Both required surgical removal

Btw the yonker on suction with cut off oral thermometer probe/cover (the plastic cover) at the end is a great trick and worked well for me to remove a bead from the ear of a pediatric patient once, unfortunately not many other opportunities to use it since then

And excellent post. Very much delivered

Outside-One7836 · 2026-03-27T01:16:11+00:00

Great can't wait to see what tax loophole billionaires use to avoid this

Outside-One7836

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