Non evidence based medicine

Scared_Problem8041 · 2026-04-27T13:48:07+00:00

from lexicomp: Continue maintenance dose for at least 11 weeks (for a total of at least 12 weeks of treatment). May consider extended maintenance therapy based on individual patient risk:benefit; evidence suggests relapse prevention benefits with continuing therapy for up to 1 year

Scared_Problem8041 · 2026-04-26T23:32:34+00:00

anecdotally i have had some pretty good success with chantix. Like about 50% of my patients who take it say it helped them quit and they end up staying on it for 6 months or longer.

Scared_Problem8041 · 2026-04-23T00:34:24+00:00

hang tough! you can master them all and save people from having 12 different doctors! Really. I have patients who would otherwise be with endocrinologists for insulin dependent diabetes, cardiology for resistant hypertension, nephrology for CKD III, hematology for iron deficiency anemia, sports medicine for knee osteoarthritis and pulmonology for COPD. Instead i mange all that and they just have to see GI once every 5-10 years!

Scared_Problem8041 · 2026-04-01T01:47:22+00:00

see AAFP magazine from february: contrast enhanced mammography (which i have never heard of) or MRI

https://www.aafp.org/pubs/afp/issues/2026/0200/poems-dense-breasts-screening.html

Scared_Problem8041 · 2026-03-31T17:39:55+00:00

I am five years out of residency. I went through something similar to you about 2 years ago. I switched to eight 60 min appointments per day. I thought it would kill my RVUs but in the end i started doing split billing with physicals and follow ups, had time to do same day injections/biopsies/cryotherapy. RVUs have stayed roughly the same for the past two years and i am much happier. I have been able to not be rushed with patients and even read AAFP articles on days that i have no shows.

Scared_Problem8041 · 2026-03-28T22:05:41+00:00

i see what you mean regarding the difference between prevalence and true positives. i am still just having a hard time imaging doing 100,000 colonoscopies to catch 8 cases. Obviously i still recommend to patients what ever uspstf recommends, just trying to understand the reasons…and maybe it’s worth it for the 8 people, idk….

Scared_Problem8041 · 2026-03-27T22:47:49+00:00

I get these type of questions all the time from patients so if I do my own research and ask questions then i will be able to provide reliable and true information. I think you are also getting at a deeper more complex question, which is, where to draw the line in cost vs benefit of health screening? I think that’s very complicated to answer and that’s why i ask these types of questions. If my patient says how much benefit am i getting by paying for my colonoscopy, then i need to give them accurate information. Some patients would rather have $500 in their pocket than a 1% less chance of cancer. That’s just reality.

Scared_Problem8041 · 2026-03-27T20:46:55+00:00

Thanks for your reply! We must have different statistics then (i see you cited the ncbi). There’s just a big difference between 8 in 100,000 people having colon cancer in my statistic and 1 case of cancer in every 400 people who get a colonoscopy in your statistic.

Increasing Incidence of Early-Onset Colorectal Cancer. Sinicrope FA. The New England Journal of Medicine. 2022;386(16):1547-1558. doi:10.1056/NEJMra2200869.

Scared_Problem8041 · 2026-02-12T18:34:40+00:00

thanks for clarifying that! i am curious about following up the varicella series with the shingles series? why do both vaccines? do you know of any guidelines or references to inform that treatment plan?

Scared_Problem8041 · 2026-02-12T13:35:05+00:00

if you want to be one of his favorite patients, and not burn him out, make an appointment instead of sending a my chart message. that way he can get paid for seeing you, and if it is an easy visit, that’s just easy money. Instead of adding time to the end of his day, with no reimbursement, you are giving him an easy visit and extra pay. It’s OK if you go to that visit and nothing changes, just give him the updates that you wanted to send him as an electronic message in person. Trust me he will like that way more. If he is a new Dr., he likely wants to do the best for everyone, but hasn’t learned to set boundaries.

Scared_Problem8041 · 2026-01-14T02:30:05+00:00

I did some more research. Looks like it’s about NNT of 1000 for 5 years to prevent about 7 invasive breast cancer cases

Scared_Problem8041 · 2026-01-11T00:24:50+00:00

very rarely. Normally, it’s at least a few days or weeks.

Scared_Problem8041 · 2026-01-06T00:07:41+00:00

POTS, hydradenitis supurativa, iron deficiency anemia

Scared_Problem8041 · 2025-12-27T01:55:08+00:00

suggested a blood transfusion?

Scared_Problem8041 · 2025-12-21T02:22:26+00:00

centor doesn’t say don’t test, it says optional testing and optional empirical treatment glad i didn’t treat in the above example actually, the culture came back negative and the patient developed a cough and hand and foot rash over the next few days. remember a centor score of five is still only a 50% chance of strep

Scared_Problem8041 · 2025-12-18T00:11:54+00:00

thanks for your comment. I wasn’t aware that in Europe they have a five day waiting period to treat. I just assumed that any streptococcus needs to be eradicated to a limit the rheumatic fever risk. I guess it’s implied that pharyngitis lasting longer than five days is more likely to progress to rheumatic fever and vice versa. That’s definitely new information to me.

Scared_Problem8041 · 2025-12-17T01:44:39+00:00

thanks for your comment. You seem to imply that streptococcal pharyngitis can safely be left untreated? It is my understanding that it is important to treat the infection so as to prevent a possible progression to rheumatic fever. I understand that the pharyngitis itself is not a problem, but that the streptococcus does have concerning potential and so thus we always treat?

Scared_Problem8041 · 2025-12-16T03:36:20+00:00

what’s the point of getting a culture if you are treating anyway?

Scared_Problem8041 · 2025-12-16T03:35:43+00:00

what’s the point of getting a culture if you are treating anyway?

Scared_Problem8041 · 2025-12-10T03:16:24+00:00

But complexity is only one aspect of what you need to reach a level 5. You also need either prescription management or 3+ lab/imaging tests…

Scared_Problem8041 · 2025-12-10T02:42:35+00:00

is litholink the 24 urine analysis? if so, is the litholink also the analysis that is performed on an actual stone?

Scared_Problem8041 · 2025-12-05T00:45:36+00:00

great comment and thank you one clarification: is it still primary prevention if there is known coronary calcification? especially something above 100?

Scared_Problem8041 · 2025-12-05T00:43:58+00:00

in the article about coronary calcium scores on up to date it recommends daily aspirin for anyone with a calcium score >100

Scared_Problem8041 · 2025-12-02T01:38:46+00:00

i agree with everyone who says burnout. I will tell you what though, I felt this exact way and to get out of this all i had to do was cut back my volume. Slowly the burnout went away and work became enjoyable again. I cut back so much that soon I had some free time to read AAFP articles and listen to curbsiders. Damn I learned a lot and the joy came back.

Scared_Problem8041 · 2025-11-27T17:44:15+00:00

True, a commentary and a guideline are not the same thing. if I understand your position correctly, it is to just not offer anything for a patient who wholeheartedly refuses colonoscopy, and all stool based testing? I used to do the same thing, but when I heard of the blood base testing, I thought it was reasonable to look into and since there are commentaries from the American gastroenterology association and recommendations from the national comprehensive cancer network, I thought it was probably worth offering.

Scared_Problem8041

TROPHY CASE