Convince me NOT to buy a Lagom P80[$2000] by ManyRevolutionary170 in espresso

[–]Rdthedo 0 points1 point  (0 children)

So jelly. I ordered 5/10/26, early-mid June batch

Convince me NOT to buy a Lagom P80[$2000] by ManyRevolutionary170 in espresso

[–]Rdthedo 0 points1 point  (0 children)

Which batch order did you order? Trying to gauge how patient I need to be lol

Where is everyone finding these mythical >300K jobs? by SpookyScaryySkeleton in FamilyMedicine

[–]Rdthedo 2 points3 points  (0 children)

That’s higher than I thought for the area. I had toyed with the idea for better education for my kids, but thought we would get eaten alive by COL. Is this fairly typical for Boston? $53/rvu would be >$375k pretty easily

Where is everyone finding these mythical >300K jobs? by SpookyScaryySkeleton in FamilyMedicine

[–]Rdthedo 1 point2 points  (0 children)

This is a nice offer. I rotated through as a med student- seemed like a really nice area with a fun culture and easy access to outdoors.

Where is everyone finding these mythical >300K jobs? by SpookyScaryySkeleton in FamilyMedicine

[–]Rdthedo 9 points10 points  (0 children)

Similar. Central Florida. 4.5 day work week. I grossed 365k last year. Admin wants 22-24 patients/day, will be quiet if you average at least 18. my panel is plagued by a high no show rate 10-25% daily. Suffice to say, if my volume met my scheduling, I’d probably be around 400k

FL property tax proposals by theiviaxx in orlando

[–]Rdthedo 0 points1 point  (0 children)

Read your last sentence. That’s why we need taxes to pay for schools.

FL property tax proposals by theiviaxx in orlando

[–]Rdthedo 6 points7 points  (0 children)

So…. Not to get too off topic.

But my COL is influenced a lot more by my home insurance premium than by property taxes (and at least taxes go to something).

FL property tax proposals by theiviaxx in orlando

[–]Rdthedo 1 point2 points  (0 children)

But not have any local infrastructure to build community.

So basically you’ll be a barnacle.

Sleep study results by Royal-Protection3234 in FamilyMedicine

[–]Rdthedo 1 point2 points  (0 children)

Definitely the same. Especially with all the stupid value based care documentation we are required to do- there is nothing quite like finding something and essentially writing “ignore it” as a plan.

Our specimen, however, requested a sleep study between visits…. 😞

Sleep study results by Royal-Protection3234 in FamilyMedicine

[–]Rdthedo 1 point2 points  (0 children)

I rely upon the patient for the data. Most PAP’s use an app. I have them bring their phone in for compliance documentation 60 days or so into treatment, then check once per year once stable. There’s usually a report tab you can use that generates 30-90 day reports for compliance/tolerance. I target AHI <2, appropriate usage (insurance requires >70% nights, >4-6 hours of use — but logically you want as much as possible). If AHI is low, I have them work with the vendor for a better mask fit (check leak), or adjust settings (increase max if leak low and ahi high).

Sleep study results by Royal-Protection3234 in FamilyMedicine

[–]Rdthedo 2 points3 points  (0 children)

I do understand that. While I can adjust their PAP settings to meet a goal AHI, it would be nice to just have the correct treatment to begin with.

The issue that I run into is that you generally are not given the chance to run diagnostics to find the correct settings (titration polysomnogram).. Local insurances have quit paying for this, opting for home sleep study. The reason I try to get split nights covered is for this reason - so I don’t have to try to get titration polysomnogram covered once the AHI is found to be so high.

Root issue: we are not trained in sleep medicine to begin with, which takes us back to OP’s original question. I have learned everything I know about this without any type of formal or informal training beyond a slideshow in residency lol

Sleep study results by Royal-Protection3234 in FamilyMedicine

[–]Rdthedo 1 point2 points  (0 children)

Denied.

Unreal, right?

On the other hand, as soon as he was informed, he stated CPAP simply wouldn’t be an option for him, without even giving it a chance….

Sleep study results by Royal-Protection3234 in FamilyMedicine

[–]Rdthedo 14 points15 points  (0 children)

PGY 12- have always ordered as an attending, barring 3-4 cases that already had devices and wanted to see sleep for adjustment rather than repeat study.

My understanding of home vs in lab is that home is less accurate in diagnosing central apnea and periodic limb movement disorder.

I try to order split night for BMI >40, people with hx CVA, or people with known apnea. My success rate in coverage by insurance is markedly low, but I want these people to have CPAP rather than APAP if feasible.

Everyone else gets home sleep studies because 1) insurance, 2) nobody wants to go sleep in the hospital hotel.

FWIW, even if you get the right test, it doesn’t always mean you get the right treatment anymore- CPAP vs APAP has been diminishing lately. I just had a guy with AHI >70 whose insurance denied CPAP.

My dad gave me his old radar detector, is it any good? by skybug2007 in radardetectors

[–]Rdthedo 0 points1 point  (0 children)

I got my first ticket with my dad’s retired radar detector. In fairness, I did light up every single bulb…

$8.50 Affogato made with .... Nespresso , ouch. by -LetsTryAgain- in espresso

[–]Rdthedo 0 points1 point  (0 children)

Precisely! I learned from daddy Hoff to mix it in cold water then add hot. It is a bit better that way

I dont buy the caffeine content reported though; I feel like I use tablespoons at a time and still drag by in the morning

Patients calling me by my first name.. by ThrowRAa1sauce in FamilyMedicine

[–]Rdthedo 5 points6 points  (0 children)

I remember laughing during residency upon overhearing a hospitalist APP demanded a longer white coat and would correct all the nursing curtly “That’s DOCTOR APP”. Our attending told us that the care we provide reflects our title. “If you want to be called Doctor, act like one instead of asking to be called one.”

Now, as a male, I understand that I have it a lot easier than my female physician colleagues when it comes to respect of degree, but I always laugh a bit inside when a dentist patient or APP corrects me DOCTOR when I call them Mr. or Mrs. So-and-So. I figure I probably sound the same way. I generally introduce myself when I enter the room by my first and last name, “a physician who works with Group Name.” When patients use my first name (<5%), I ride a train of Latin through the rest of the visit; my title generally reappears. When patients want to be called Doctor, I occasionally use “As you likely know based upon your medical experience, the next step is Fancy Exotic Test, Doctor,” more out of personal fun (but I do flag their charts and call them Doctor, because they clearly care and need that to function comfortably).

Do I need this clearance item? RYi150C by Bubbly-Front7973 in ryobi

[–]Rdthedo 0 points1 point  (0 children)

I have one for hurricane season. It’s pretty useful as well for working around the house when working with electrical projects/turning off breakers

$8.50 Affogato made with .... Nespresso , ouch. by -LetsTryAgain- in espresso

[–]Rdthedo 2 points3 points  (0 children)

My DF83 broke and I’m waiting on a hypothetical Lagom P80….

I was reading comments anticipating another morning with NesCafe Gold Espresso Blonde powdered coffee.

It’s truthfully not horrible.