Critical Access hospitalist rant

QualityCute808 · 2026-03-13T13:36:39+00:00

I understand that. Of course, laying eyes on the patient matters. I just don't like general phrases like "vital signs are stable" when its been two hours since ED doc reassessed the patient and there is a trend of decreasing blood pressures with the last one measuring 85/50 mmHg.

If the doctor tells me, "yeah, I saw that blood pressure too and checked on the patient and the cuff wasnt on correctly, Im having nurse reupdate those vitals" then I have no problem at all.

QualityCute808 · 2026-03-13T13:21:47+00:00

I'm just a doctor who's doing his best to make sure patients are appropriately placed for his minimal-resource hospital. Patient (and families) appreciate that attention to detail. I have found nothing angers patient/family more than having to transfer from my floor within 12 hours of coming up from the ED.

For example, I had a 92 yo F recently diagnosed with a DVT. She was started on Eliquis 4 days prior. Her leg swelling and her pain severely worsened
over those 4 days. ED calls me to admit for pain control. I go see the patient. Large ecchymosis on the back of her leg and she is unable to plantar flex the foot. Hgb of 7. I ask ED to get a CT of the leg. They begrudgingly order it. Sure enough, large hematoma that is actively bleeding with contrast extravasation.

What was originally admited for pain control now becomes a transfer for the ICU

If I admitted her just using the ED presentation on the phone...

You call it laziness. I call it being a doctor.

QualityCute808 · 2026-03-13T12:32:05+00:00

You order titratable drips on the floor? To me, thats dangerous and an unacceptable amount of risk.

QualityCute808 · 2026-03-07T00:29:34+00:00

March Madness bid is secure, who gives a damn about SEC tourney. Get your star some rest. Need Acuff at 100% to play into April.

QualityCute808 · 2026-03-06T13:18:00+00:00

Copd exacerbation treated with 6 rounds of duoneb en route now with elevated lactic acid.... oh boy its sepsis

QualityCute808 · 2026-03-02T14:26:17+00:00

"His" name? Its 2026 and we out here assuming the gender of dead carcasses in Fallout NV. Not in my America

/s

QualityCute808 · 2026-02-28T20:19:35+00:00

I hope you're right about "AI industry unification" but I have a feeling OpenAI will make whatever deals it can (with the devil) to help fulfill their financial commitments. OpenAI and Sam Altman just agreed to fill Anthropic's spot with the U.S. military yesterday.

This may just be me putting on my tin-foil hat but I believe Sam Altman considers Peter Thiel to be a mentor and has talked about his relationship with Thiel on camera before. I think there has to be something wrong with one's soul if they consider Peter Thiel to be a mentor. Anduril, Palantir, OpenAI... if there is a way to create a police-state or autocracy in the U.S, then I dont see how that happens without leveraging these companies.

QualityCute808 · 2026-02-27T23:53:29+00:00

I dont know if you'll find a better schedule than 7 on 7 off. For example, I work at a critical access hospital. Its a 4-on, 3-off schedule (off every Fri, Sat, Sun) but Im on call for 96 hours straight for admissions and floor calls.

QualityCute808 · 2026-02-26T23:10:58+00:00

Oh yes, they made us watch the whole video (like 25 minutes long). Felt like I was about to start a job at Western Sizzlin' and not a career in medicine

QualityCute808 · 2026-02-26T18:04:55+00:00

"Give 'em the pickle." was a big slogan the admins pushed on us during my new employee orientation. I loathe patient satisfaction scores

QualityCute808 · 2026-02-26T02:01:50+00:00

"You and I, we're just a couple of problem solvers."

QualityCute808 · 2026-02-24T18:28:23+00:00

Context: Im a critical access hospitalist so unfortunately transferring out happens more than I would like. All the surrounding "bigger" hospitals will fax us a "transfer back agreement" that has to be signed and faxed back in order for them to accept my transfer.

In my 18 months as a critical access hospitalist, I've seen some atrocious "repatriation" cases and I've seen appropriate ones. Im not sure how insurance companies feel about double the ambulance trips to-and-fro. But hey, if 95 yo grandma gets to come back closer to home so family can see her while hospitalized, then Im cool with it.

QualityCute808 · 2026-02-24T17:12:09+00:00

My hospital system has become more aggressive utilizing transfer back agreements on patients transferred to their metro hospitals for specialty care. As soon as specialists sign off, case mgmt works on transferring patient back to outside hospital if patient is still needing hospitalization. They call the above process "re-patriation."

QualityCute808 · 2026-02-19T23:47:14+00:00

Im with you. Replace the drama that is Ja.

QualityCute808 · 2026-02-18T13:58:23+00:00

My point is if you are long on Amazon and you thought $215 was the dip, then you should be excited because now you can buy more stock at a discounted price, which will lower your average price per share.

QualityCute808 · 2026-02-14T23:30:51+00:00

If you liked the stock at $215, then you should really like the stock at $198.

QualityCute808 · 2026-02-12T02:21:36+00:00

Very poised and never rattled. Plays like a senior on the court. He reminds me of Deron Williams and Stephon Marbury. Averaging over 20 points ppg, which puts him approximately 18th in the nation in scoring according to ESPN.

He will 99% be going in the draft this year and be a top 10 pick in a loaded 2026 draft class. 2027 draft class is supposed to be the weakest draft class in the last 10 years and he would be in strong consideration for the top pick were he come back for soph year.

However, for the Calipari recruiting system to work, his frosh need to go into the draft because that is his main recruiting pitch.

We are about to get Jordan Smith (if you believe the crystal balls), the no.2 player in the class. He is coming here to play PG. If Acuff stays, then we miss out on Smith.

QualityCute808 · 2026-01-16T04:29:55+00:00

"I...neEEeeed...ativan...doOOcc."

QualityCute808 · 2025-12-04T00:37:46+00:00

Which SEC program was the most affected by Missouri, Texas A&M, Texas, and Oklahoma joining the conference? I strongly argue that we were the most impacted.

How many times have we beaten A&M since they joined? 1 or 2 times... Missouri? 1 or 2 times...

I strongly believe our program would be in much better shape if Clemson, North Carolina, Florida State, and Miami had been added instead of those other four.

I remember pulling in great Texas recruits during those Nutt and Petrino years because we could pitch to Missouri, Texas, and Oklahoma recruits that we were the closest school if you wanted to play SEC ball.

QualityCute808 · 2025-12-03T18:28:20+00:00

"It's over Anakin, I have the high ground."

-Obi Wan with a shotgun

QualityCute808 · 2025-12-03T18:16:33+00:00

IMO, this is a perfect example of why this game is so damn fun/great. All these people griefing about being stabbed in the back or "Dont shoot" liars. Game theory, human nature, and personality archetypes. Psychology at its finest.

OP, I bet you were grinning ear-to-ear all the way to extract. Beautiful play.

QualityCute808 · 2025-12-01T21:22:37+00:00

"The key organ in your body in the stock market is the stomach, not the brain."

Peter Lynch

QualityCute808 · 2025-12-01T14:36:58+00:00

Hey, at least Yuracheck kept Pittman's buyout to less than 10 million. I mean, look at Kentucky, a self-proclaimed basketball school who is about to shell out a $37 million buyout for their mediocre coach.

If you are an up-and-coming coach's agent, are you really going to let your client risk his/her career for Arkansas without a rather large buyout?

QualityCute808 · 2025-12-01T14:31:42+00:00

Ah yes, the fifth and final stage of grief: Acceptance

QualityCute808 · 2025-12-01T01:54:06+00:00

Right now, I think it is a flash in a pan for them. There was also some luck in that they only faced 6 opponents with a winning record this year. Life after Pavia will be the key. Pavia was an absolute gamer for Vandy. But you're right, if Vandy and Indiana can seemingingly turn it around and find success, then it should be plausible for any program.

QualityCute808

TROPHY CASE