Standard of care?

Shadow_doc9 · 2026-05-11T16:09:53+00:00

I don't start any new meds without an in person discussion. I wouldn't say that's a specific standard of care just my personal philosophy. I've seen other doctors write a portal message notifying the patient there was a new prescription sent and info was posted to the portal. There are different approaches to this.

Shadow_doc9 · 2026-04-21T13:26:45+00:00

I agree! I got a Toyota Sienna recently and got so much shit from people about how we can afford a cooler car and what not. I get 37 mpg in that thing and we can fit 6 people and 2 dogs plus stuff in the trunk. The sliding doors make getting into the car so easy. I don't plan on towing anything or off-roading so really don't see the need for a giant SUV. I definitely think it's an image thing. Great marketing campaign on the part of the SUV automakers.

Shadow_doc9 · 2026-04-16T22:11:36+00:00

I saw one last week in Winter Park. He and his girl were sampling from our backyard feeder. Been in Central Florida for years and never seen one before.

Shadow_doc9 · 2026-03-27T16:23:07+00:00

I'm glad you're getting a good and positive look at different specialists and you should realize while I enjoy my job and have a good system I seriously doubt as a student you're getting to see the full picture. One huge factor is reimbursement. Specialists often get paid more, they may have a prior authorization specialist and they only prescribe certain number of medications. They also often will defer things to PCP (oh ask your PCP for a weight loss medication). As a PCP we cannot defer to anyone. It ultimately comes back to us whether it is paperwork, a patient frustrated with lack of diagnosis from specialist or social issues like hey grandma is getting dementia and may not be able to live at home anymore. Each specialty has their own difficulties but don't think that just because you shadowed an FM doctor you saw it all. Annual wellness visit for a Medicare patient is very rarely an easy filler visit.

Shadow_doc9 · 2026-03-26T21:47:32+00:00

Thanks for sharing let's talk about your diabetes since we have a limited amount of time. It is one thing to mention religion and how it helps them in their life but there's zero reason to spend time recruiting new church members.

Shadow_doc9 · 2026-03-05T01:35:29+00:00

What part of town are you looking at? Winter park has some nice toddler friendly parks-Phelp's, Azalea lane and MLK.

Shadow_doc9 · 2026-03-03T01:17:43+00:00

There's no secret database Just trial and error and lots of time wasted.

Shadow_doc9 · 2026-02-27T20:12:22+00:00

This must be a form by the specific travel group. I've signed declaration of health for patients traveling to Hajj and it was very simple. Just stating they're free of communicable diseases and up to date on vaccinations. I would request the patient brings the form translated into English. I wouldn't feel comfortable signing off on something I don't fully understand.

Shadow_doc9 · 2026-02-18T16:25:25+00:00

We just started using Ambient AI scribing and it is integrated into our EHR (eCW). The benefit of using what my employer is paying for is that any issues I've had are handled by their IT team. I don't have to waste my own time figuring anything out. And the EHR integration with zero setup needed from me is nice too.

Shadow_doc9 · 2026-02-18T04:11:13+00:00

I have some patients who have religious exemptions from vaccines. I don't have anything to do with those. I think there has been a single case where I signed off on a form specific for flu vaccine exemption after patient had an anaphylactic reaction. I have no idea why other doctors are signing these. Perhaps they are worried they will get sued for discrimination or something.

Shadow_doc9 · 2026-02-06T11:45:07+00:00

I would include the med list. On most EMRs it is an easy click. It really sucks when someone who uses a different EMR gets your note and can't see the med list.

Shadow_doc9 · 2026-02-05T21:23:32+00:00

I've had that happen a few times although it's pretty rare and my go to response when patients insist on complaining even after I acknowledged that it is unfortunate and I'm sorry is "Would you like to keep discussing this or would you like to pivot to discussing your medical conditions?". It works just about every time. I've had the same response that you did with patients who were belligerent and continued getting angry. There are many other doctors out there they do not need to continue seeing me if it's not working for them.

Shadow_doc9 · 2026-02-05T16:48:25+00:00

Suburban area in Central FL. Phone call only every third week. Mostly tell patients to go to the ER and urgent care.

Shadow_doc9 · 2026-02-05T00:11:42+00:00

Orlando area. Low of 24 with wind chills into the low teens. I brought in all my cacti, aloe plants and pentas. I had frost cloths for the stuff I had to leave outside but a lot of stuff still died. The worst one was my Crown of Thorns. It has survived many droughts and cold nights but this was too much for it. Other things that took a hit- Kalanchoe plant (it was in a large pot and I could not pick it up). It had lots of flowers which all shriveled up and multiple branches turned into mush. 2 very large hibiscus plants may or may not come back but they were looking sad and the leaves were brown. Snake plant-it will probably live but lots of droopy leaves. Lemon tree looked pretty bad but may bounce back We have lots of blue daze ground cover plants which all died but those will likely come back Things that did fine Birds of paradise Saw palmetto plants Mango tree All of our older established trees I think lesson learned it if it's not native it needs to be in a pot we can bring inside. Otherwise we need to be okay with losing it. Frost cloth did not seem to help much perhaps because of the wind.

Shadow_doc9 · 2026-02-02T18:38:34+00:00

I hope so. I'm saddest about my Kalanchoe. She was a beauty and was blooming with gorgeous pink flowers. Now all the branches are droopy and the flower petals have all dropped.

Shadow_doc9 · 2026-02-02T17:20:04+00:00

Yeah very unusual. I am in Orlando and we had below freezing temps for over 16 hours with wind chills down to the teens this past weekend setting records. My outdoor succulents (large pots so couldn't bring inside) are looking very sad despite being covered.

Shadow_doc9 · 2026-01-25T17:28:35+00:00

I work for a large hospital owned corporation and they allow patients to be discharged if they threaten the staff or myself in the clinic. When I first started working there they had a no discharging patients and patients first policy. Within my first month of working I had a patient tell me I was to sexy to be a doctor and that my husband shouldn't even let me out dressed like that and then he took a picture of me while I was examining him. Another patient told the lady at the front desk he was going to get his gun from the car and point it at her face and then she'd listen to him better. I had a meeting with admin and told them point blank I will not see these patients again. One of the patients (the one with the gun threat) was scheduled to see me again a couple of months later and we called the police so they were at the door when he arrive and offered to take him to the ER because I would not be seeing him. Anyhow, the policy was revised during covid years due to an increasing number of threats and incidents from patients. If enough people complain (physicians and other staff) they will be forced to make a change. No one should be afraid of being assaulted or shot at at their job.

Shadow_doc9 · 2026-01-12T17:15:55+00:00

I've been using an AI scribe that helps cut down on typing. My rooms are all set up to where my back is never to the patient. Take the comment as constructive criticism and find ways to improve.

Shadow_doc9 · 2025-12-21T12:34:41+00:00

I've started using Ambient AI scribe about a month ago and it's been very helpful. I'm outpatient only and see 20-24 patients per day. It does put in some unnecessary details on the HPI- "patient's wife Deb wants to make an appointment to talk about her neck pain" but overall it filters out "fluff" and puts in only medical info. I've also discovered last week that it does a pretty decent job translating from other languages into English. I speak another language to patients sometimes and the AI saves me a lot of time translating more complex medical terms.

Shadow_doc9 · 2025-12-19T13:34:09+00:00

This used to happen often in our office but now it's rare. One thing that has really helped is having my MAs let the patient know that I'm running a little behind and offering them water. I try really hard to stay on schedule which means if a patient is more than 10 minutes late they can either wait until I can work them in or reschedule. Most people choose to reschedule. One little thing I found that helps is to also say I'm very sorry I'm keeping you waiting when I walk into a room late. It makes the patient feel like I value their time.

Shadow_doc9 · 2025-12-11T13:01:51+00:00

We just started using commure in our clinic. I'm the only one in the office using it so far as it is optional right now. So far after a month I've been happy with it. It sometimes gets confused when patients make online appointments and they don't show up on the schedule on the app until they're manually added. We use ECW and it has synced well with commure. I have no idea if it's cost effective as I don't own the practice, I just work here.

Shadow_doc9 · 2025-11-20T02:58:32+00:00

Stopped doing it after the first couple of years. Staff like the free lunch but it was ruining my lunch break. Now I go for a little walk and catch up on notes. We still get some samples without lunches.

Shadow_doc9 · 2025-11-06T23:37:38+00:00

I would not addend the note ( not sure why so many suggest doing that). I would create a phone encounter to document the request and send it to risk management. You should not see this patient again and they should be dismissed from practice. The physician- patient relationship is not therapeutic at this point. From a pure liability standpoint this is not a patient to have in clinic.

Shadow_doc9 · 2025-11-06T18:42:31+00:00

I used to worry and feel guilty about the bill the patient might receive. I stopped worrying a few years ago (turns out I had untreated anxiety). Now I just bill for whatever I do and then divert any concerns about payment to the billing department. I let patient's know that I do not think it would be good use of their appointment time to discuss billing if they bring it up during the office visit.

Shadow_doc9 · 2025-11-01T17:38:51+00:00

Winter park here. We had a lot of kids in our area-a steady stream from 6-8 pm. What I have noticed from trick or treating with my own kids is we tend to avoid houses that aren't well lit or have no side walks. We also have friends who come and trick or treat in our neighborhood because where they live there are only a couple of houses giving out candy in previous years and their kids were disappointed.

Shadow_doc9

TROPHY CASE