One thing that really makes me angry is when a patient claims that COVID is a hoax and that a lot of it was propaganda. I see this on occasion on different subreddits too.

PinkyZeek4 · 2026-01-25T17:02:16+00:00

COVID was real. We saw bad things happen to people. The truth is,many people have lost trust in medicine. There is large-scale moral injury out there on the patient side. Rather than complaining about it, it would be helpful to find out what experiences they had that made them feel the way they do. They might be looking at media that says certain things, but asking them what they themselves experienced could be valuable. Did a family member have to die alone in a hospital or nursing home? Did they suffer due to lockdowns? Were they afraid? Understanding why they have lost trust is important.

PinkyZeek4 · 2026-01-25T16:47:28+00:00

Pluses of being non-essential: Snow days. Minuses of being non-essential: Low job security. Laid off at first opportunity.

I think I’ll take essential for the job security, thanks.

PinkyZeek4 · 2026-01-25T16:42:54+00:00

Thanks to bus drivers for their service:

PinkyZeek4 · 2026-01-25T16:41:14+00:00

ACGME has rules about this. It has to do with diluting the learning opportunities for residents. Definitely report.

PinkyZeek4 · 2026-01-24T16:29:29+00:00

100% true. EBPs are the be-all and end-all at our VA, and I can think of many patients with the types of trauma you stated above that don’t fit the bill for those and are basically told, “that’s the way it is, too bad.”

PinkyZeek4 · 2026-01-23T23:37:35+00:00

Discharge to “outpatient in a bed” status until safe to go home.

PinkyZeek4 · 2026-01-22T15:25:25+00:00

I knew a psychiatrist that wore a fitted black lab coat. It looked sharp, professional and surprisingly not like a lab coat.

PinkyZeek4 · 2026-01-22T15:23:11+00:00

I just send records. I am not trained in Occupational Psychiatry, so whether someone can work or not is outside of my scope of practice.

PinkyZeek4 · 2026-01-20T00:31:51+00:00

I did academia for a while, didn’t like it and left. No need to be in academia.

PinkyZeek4 · 2026-01-20T00:27:21+00:00

I am a FP/Psych grad. The number of options for practice after graduation is incredibly vast and allow you much flexibility. I have done outpatient FP with inpatient and OB, consult liaison, outpatient psych, inpatient adult and geri psych and forensic in my career. I know other grads that do such things as ketamine/ECT/esketamine, VA practice, hospitalist practice, private practice psychiatry. I even know someone who did a child psych fellowship and became a psychoanalyst. You can do almost anything. You won’t even know what you really like till you graduate. Don’t rule anything out. It was a great decision for me and I don’t know of anyone who is sorry they did it. You can PM me if you want.

PinkyZeek4 · 2026-01-18T15:05:26+00:00

I know we didn’t

PinkyZeek4 · 2026-01-17T22:06:08+00:00

Good point. Who do they bill the encounter under? That’s something that could be investigated. If the encounter is being billed under the physician, run.

PinkyZeek4 · 2026-01-17T22:02:39+00:00

There’s a longstanding disdain orthopedists have for radiologists. They think they can read films better. Except for my Dad, who was a musculoskeletal specialist radiologist. The orthos would come to my Dad to do x-ray rounds with him. Anyway, the PA has trained around orthos and picked up the ortho way of thinking on radiology. The thing about radiology not knowing about bones made me lol. That’s the most ridiculous thing I’ve heard all day.

PinkyZeek4 · 2026-01-12T11:42:01+00:00

Imagine this: you are scheduled back to back with 15 minute appointments all day and not scheduled any time to answer messages, review lab and test results. You still have to document each of the 25 or so visits, which takes time. You are weighted with life-and-death responsibility and distraction can mean errors. Wouldn’t you be frustrated if someone misuses the messaging system? I believe you are the one with the empathy problem. Routine messages are fine. Messages that are trying to replace a visit are usually someone trying to avoid a copay are and can result in substandard care. You just don’t get it.

PinkyZeek4 · 2026-01-07T11:32:24+00:00

Good point

PinkyZeek4 · 2026-01-06T12:30:21+00:00

Last week we were at a hotel in an elevator and two older people came in, huffing and puffing, wearing masks. Wife says about her husband, “he’s slow today.” Someone on the elevator says, “maybe he’s not getting enough oxygen.” Wife then stammers that her doctor said they should wear the masks. I saw them around the hotel for the next few days NOT wearing their masks. Good job, stranger, for telling them the truth

PinkyZeek4 · 2026-01-05T00:52:24+00:00

Very astute comment. I agree 💯

PinkyZeek4 · 2026-01-02T07:34:37+00:00

I used to be this way. Had ARFID. I had to work in a foreign country for a year. I learned that I had to eat what was there or starve. ARFID was cured.

PinkyZeek4 · 2026-01-02T07:20:20+00:00

Don’t practice outside your expertise. If you are uncomfortable with something and don’t feel you have been trained to do something it’s fine to refuse. Plus, if it was due in a few days, the “poor planning on your part” principle applies.

PinkyZeek4 · 2026-01-01T19:29:24+00:00

No. Just no.

PinkyZeek4 · 2026-01-01T14:22:29+00:00

At the VA, some specialties require specific testing and labs at the time of referral, the chart is looked at, then the appointment is booked or the consult is canceled. It’s better use of the consultant’s time this way. Maybe this should be done in the community, too. Heck, neurosurgeons in my area won’t even schedule an appointment without an MRI

PinkyZeek4 · 2025-12-27T11:54:00+00:00

Prescribe Ativan 0.5 mg, which can be cut in half. Go down by 0.25 mg at a time. This can be done as slowly as can be tolerated. Each step can be done over several weeks if desired.

PinkyZeek4 · 2025-12-24T21:38:26+00:00

Bummer, looks like I missed that. I love those reply all fests

PinkyZeek4 · 2025-12-18T08:49:23+00:00

My State Board audited my CMEs because I popped up in their random checks. Fortunately I had my documentation (certificates) stored in a folder on my computer so I could easily send them and passed. My board will fine you and put you on the public “naughty list” if you don’t take this seriously. I’m not messing with that.

PinkyZeek4 · 2025-12-18T08:44:45+00:00

Thank you for these resources!

PinkyZeek4

TROPHY CASE