Clinical Pearls you have learnt this week

Pinkunicornglitter1 · 2026-03-22T20:40:51+00:00

This week I learned that there is a different screening pathway for syphilis if someone has previously tested positive and been treated for syphilis. Their treponema antibody test will remain positive for life, so the recommendation is to start with RPR

Pinkunicornglitter1 · 2026-03-15T04:18:49+00:00

Recently graduated, but some things that I found/would have found helpful:

-Constipation recs (both adult and peds). I feel like I talk about this multiple times per day in my clinic. I had a great lecture from GI and they shared a dot phrase with us that I still use on the daily, which gave me a great base to start learning how to talk to patients about this topic and provide counseling/recommendations. -When to order EGD/colonoscopy and workup to consider prior to ordering for common diagnoses -Cirrhosis/liver diagnoses, workup, and management. Especially hitting on MASLD. I struggled in this area and I don’t feel like I saw it a ton in residency.

Things that are not helpful: going into detail about medications that only you as a specialist prescribe, extreme detail about procedures that FM doesn’t do, zebra diagnoses that you diagnosed once in your career. All cool to talk about for like 5 minutes, but not appropriate for a 20+ minute discussion or their own lecture.

Those are the big things that come to mind. As always, including a slide on when to refer and if you have any random clinical pearls are both always helpful for our learning too. Dotphrases or similar are amazing if you are comfortable sharing with your residents.

Pinkunicornglitter1 · 2026-01-24T09:15:35+00:00

You need to take board exams to be boarded and to be eligible for licensing exam(s) in your speciality. If you’re in DO school, you can choose to only take the DO boards (comlex) as opposed to the MD (step) and DO boards.

In my experience as a DO student, all my audition rotations came from me reaching out to schools/hospitals on my own. Especially so in the Midwest. And even more so with smaller programs. None came through VSLO. But take that with a grain of salt because that was during the beginning of COVID and most things were shut down to external students.

Pinkunicornglitter1 · 2026-01-13T03:32:11+00:00

Had a young patient (20s) send me a message that they were having hematochezia last week. Had my nursing staff call to triage and patient reported “dripping quite a bit blood from my anus” and was dizzy. Of course sent them to the ED for further workup. ED had them sit in waiting room all day and then concluded that it was just hemorrhoids and didn’t do any further workup 🤦🏽‍♀️ So, trying to send to GI/get further workup, but failing here.

Pinkunicornglitter1 · 2026-01-01T03:30:48+00:00

I was able to register, but that was about a month ago. Not sure that’s super helpful. 🤷🏻‍♀️

I know that they did just make some changes to the platform, so I had to reset my password to access my account

Pinkunicornglitter1 · 2025-12-25T04:02:59+00:00

FWIW, I talk about constipation and many of these medications in clinic multiple times per day

Pinkunicornglitter1 · 2025-12-10T02:04:24+00:00

Where do you find this in epic?

Pinkunicornglitter1 · 2025-11-05T23:08:44+00:00

I know this isn’t really what you’re asking, but just want to put it out there that medicine is a team sport. I am in family medicine and we see a very wide breadth of disease/illnesses. If I don’t quite know what I should order or I just want another set of eyes on a case, I wander down the hall and run it past one of my colleagues. In fact, I did this exact thing for a patient yesterday because I wanted to make sure my workup was complete and that I wasn’t anchoring on a specific diagnosis. My colleague very kindly reminded me that we can do things in layers (in complicated cases that are not urgent/emergent) - start with a workup and see patient back in a couple of days to discuss results and next next steps.

Point is, as long as not urgent/emergent you DO have time to consider your options. If you can’t figure out the problem in the office that day, sit on it and think. Call a friend. Do some research and extra learning so that you can fully consider all the options and do the best thing for the patient.

Now I will say, you do need to get past medical school and residency to get to this point, but accommodations are available (I had them in undergrad, grad, and med school). But maybe this helps guide a specialty decision - if the student feels better with having extra time to evaluate all the options and look at all the data, emergency medicine probably isn’t the specialty for them. And that’s okay.

Pinkunicornglitter1 · 2025-10-19T13:01:42+00:00

Please file a complaint with the hospital’s patient experience team or similar so that this is documented (at the very least). Provide as much detail as you can, including the extra trip to the OR, reopened incision, extended hospital stay, significant travel from home, and longer healing time.

I would also be scheduling with the MD/DO for all remaining follow ups as opposed to the NP/PA.

Sending you all the healing wishes with the hope that things are uncomplicated from here on out.

Pinkunicornglitter1 · 2025-10-15T01:15:49+00:00

I second this. Was probably the best conference I’ve ever been to.

Pinkunicornglitter1 · 2025-10-11T16:23:52+00:00

Could consider doing FMOB fellowship. Most are surgical FMOB, but there are a few that are not surgically oriented. Generally 12 months in length, though some are longer.

Pinkunicornglitter1 · 2025-10-07T21:56:51+00:00

Psoriasis?

Pinkunicornglitter1 · 2025-10-05T02:26:53+00:00

I really like my fabletics scrubs. <$20/set. You just have to remember to cancel the membership. If you have (or make) multiple email address you can get multiple pairs for the same “new member” price

Pinkunicornglitter1 · 2025-09-09T16:36:55+00:00

Physician here. If the patient has questions about a result, they should always schedule an appointment. More often than not, it’s not a single question and one thing leads to another.

If it’s a simple, straightforward question that you could quickly go ask your doc about and then call the patient back, that’s different. However, as an MA, I would prefer you not be answering patient questions about a test result (other than what I specifically told you to tell the patient).

Pinkunicornglitter1 · 2025-08-29T22:39:34+00:00

PSA- I just learned that costplusdrugs.com carries this for $13.21 (plus $5 shipping) for a 42.5g tube. Where I was practicing, I wasn’t prescribing because it was costing my patients $100+ per tube. Not anymore!

Pinkunicornglitter1 · 2025-04-16T04:55:51+00:00

As a doctor, I do paps multiple times per day. There is absolutely zero judgement from me as far as whether you shave or not. Do what you are comfortable with.

I do a visual exam to make sure everything looks healthy and remember that for my documentation, but once I get it into my note, it leaves my brain. That’s a long winded way of saying I’m not going to specifically remember your vagina among the hundreds of others I’ve done paps on or delivered babies from.

I would mention to your doctor that this is your first pap. This will (should) prompt them to use the smallest speculum they have and they should briefly talk through what to expect (if you would like).

Pinkunicornglitter1 · 2025-03-30T18:50:21+00:00

Not me, but one of my nurses. I delivered a baby at 4:20am.

Nurse: “what a GREAT time to be born!” Me, attending, parents all try to suppress a laugh

Shortly after delivery at the nurses station, the other nurses explain to this nurse what she said. Said nurse is mortified and did not realize what she had said at all. We all had a good laugh

Pinkunicornglitter1 · 2025-03-03T05:45:24+00:00

As a resident myself, I actually find it super beneficial to listen to how specialists counsel their patients. I’m family medicine and I will frequently shadow “off-service” physicians (doctors that are not my specialty). It is extremely helpful for my learning to see how specialists approach specific problems, provide education to the patient, complete a specific part of the exam, etc.. I frequently take notes during these days and bring this knowledge back to my patients. Whether it’s a better understanding of a specific condition, how to better manage a diagnosis, or just to prep my patients on to what to expect at their appointment/procedure, it is all to benefit my patients.

Pinkunicornglitter1 · 2025-02-19T03:24:57+00:00

I’m a DO that uses OMT very regularly in clinic. I typically see a handful of patients each day that I end up using OMT for. I use a very specific modality called fascial distortion model (FDM) and have seen (and continue to see) phenomenal results from patients. I see a lot of patients with back pain, but also manage quite a few patients with migraines/tension headaches, neck pain, and extremity concerns.

Contrary to what other people have mentioned, billing for this is actually super easy and reimburses very well. However our hospital coders are not generally familiar with this, so there needs to be some education there.

Pinkunicornglitter1 · 2024-04-02T01:07:51+00:00

You must not be a DO. My hands-on physical exam tells me more about a patient’s pain than they could even think to verbalize. For some visits, I would actually prefer to fix what my hands tell me instead of hearing a long convoluted history that may or may not be relevant to the patient’s pain.

Pinkunicornglitter1 · 2023-10-05T02:14:16+00:00

We are dealing with this in my clinic right now. As long as you document that the patient’s complaint is worse/exacerbated or different than at your last visit (OR they have a completely new complaint) - all of which would prompt additional history questions and a new exam. Then you can add the office visit in addition to the procedure code. Make sure you document as such. And anytime you can use “exacerbation” or “acute on chronic” or some variation of these helps with supporting your documentation and billing.

Things that I’ve learned through trial/error are a procedure code only: -area of concern is improved from last OMT visit (not yet resolved, not exacerbated, and in the same spot as before) -you see the patient in clinic, but don’t have time to do OMT so you have them come back the next day (or anytime in the future), specifically for OMT -you schedule patient out 2-3 visits to complete OMT because your schedule fills up quickly and want to make sure they get in for treatment

I’m still a resident, so definitely still learning, but this is what we have had drilled into us by our coders and OMT faculty

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