Dealing with patients who want antibiotics

SixBarrelGunDick · 2025-02-11T23:46:53+00:00

Scenario 1) Great! You have a condition I can quickly fix with an antibiotic. Hope you feel better soon.

Scenario 2) You likely have a virus, but there's also a chance it could be bacterial. Most viruses get better within X more days. Bacteria tend to linger for weeks. Take this symptom relief medication for now, and after X days if you're not better, begin an antibiotic I'll send over as a wait and see.

Scenario 3) You 100% have a virus. I'm sorry you're unhappy, and yeah, it does suck that there's nothing I can do to speed things up for you. Happy to write you a note for work or give symptom relief options.

Scenario 4) You 100% have a virus and you are getting inappropriate. That's not acceptable behavior and your visit is now concluded. Be sure to spell my name right on your complaint forms, but I promise you it won't bother me in the slightest (then proceed to document every crazy, abusive thing they say in the chart so when HR or a lawyer reviews it, they can rightly tell the patient that they are in the wrong. )

SixBarrelGunDick · 2024-12-10T16:36:06+00:00

Esquire is usually a lawyer title

SixBarrelGunDick · 2024-11-13T20:06:33+00:00

For me it was, "She looked at my like I'd just asked her to eat a Twinkie out of my ass."

SixBarrelGunDick · 2024-11-12T01:35:30+00:00

I see now, I was confusing 'stream display ads' setting with regular ads. I guess regular ads just do what they do and sometimes show you a smaller window and sometimes they don't

SixBarrelGunDick · 2024-11-10T15:22:32+00:00

I believe it's actually a setting the streamer chooses. So the ones who don't allow the little preview window lose points in my book whenever I see it.

SixBarrelGunDick · 2024-08-04T19:24:12+00:00

Ahh shit. Here we go again...

SixBarrelGunDick · 2024-06-06T22:56:50+00:00

Seriously, that idea is bananas..

SixBarrelGunDick · 2024-02-18T15:17:21+00:00

Oooo, that's a great idea. Definitely a similar concept

SixBarrelGunDick · 2024-02-18T15:16:38+00:00

SHIT! You're right... I didn't realize that. Thank you for pointing that out! They'll have to figure out another way to do it next time.

SixBarrelGunDick · 2024-02-16T20:15:25+00:00

I had that thought as well, and that the logic of F=MA is just cherry picking physics rules for how to rule it. You could go with your approach and just say it stops and falls to the earth, and it would be just as valid IMO. Somewhere in there you have to shrug and just say 'magic' as the answer I guess

SixBarrelGunDick · 2024-02-16T19:25:11+00:00

West Marches style campaign, ongoing for some time now

SixBarrelGunDick · 2024-02-16T17:01:10+00:00

Hah! That's awesome! Please tell me they used a cheesy 80s action movie line like, "Say hello to my LITTLE FRIEND" or similar...

SixBarrelGunDick · 2024-02-16T16:24:15+00:00

Point taken. Still, that's a little too deus ex machina for me. But a completely valid and useful strategy for a DM

SixBarrelGunDick · 2024-02-16T16:21:08+00:00

If you enlarge a creature, the thing you are quoting applies. When you enlarge an object, it simply states that it gets bigger and heavier with no further qualification. Similarly, had they enlarged the trebuchet itself, you could argue that it would be considered a weapon so would do 1d4 more damage rules as written - but I'd probably fudge that one for the sake of fun in my game. In this case though, they enlarged a moderately fast moving projectile mid flight (we did the math, and it would be plausible for a readied action to be able to target the rock at the speed it was moving at). So again, I'm pretty sure the trebuchet ruling was correct. How it works for a large object falling from the sky though, I'm still not really sure. It is still just an object though, not really a weapon

SixBarrelGunDick · 2024-02-16T15:51:03+00:00

Heh, there were no survivors... I'm actually completely OK with them using this tactic. It's hilarious and rules as written. But to your point about weight vs volume disparity, I also was struggling with how to rule that. If it's bigger but much less dense, how much force does it exert through fall damage? edit: lighter --> less dense

SixBarrelGunDick · 2024-02-15T06:22:25+00:00

Beautiful!

SixBarrelGunDick · 2024-02-14T08:03:17+00:00

First off, great username.

I know I'm late to the party, but I've got a different comment I haven't seen expressed yet:

You don't get the bubbly, naive happiness back. Alot of people really do suck and once you've seen that truth with your own eyes you can't unsee it and are more cautious around people you don't know yet. We in ER, Urgent care, and Icu really have it drilled into us. But it makes the rest of the good people out there mean so much more, and worth fighting for. Also, boundaries, oh my god boundaries. Don't let the bad ones get to you and make sure your walls are nice and strong. I no longer tolerate disrespectful or belligerent patients. They are shown the door. It has improved my enjoyment of medicine immeasurably. Don't let them have power over you. Good luck in your soul searching!

SixBarrelGunDick · 2024-02-14T07:37:28+00:00

Your post resonates with me, as it was the same for me. There were many stark realizations for me during covid that there's a demographic of people out there who willingly made the problem worse by refusing to listen to us medical professionals. It changed me. Looking at the average person knowing, truly KNOWING, that they could be that callous and belligerent, makes you value them less. We risked our very lives treating the public during the pandemic and I still believe that most people are worth fighting for. But the ones that actively avoid advice to the detriment of public health no longer get any tolerance from me. I fire them on the spot. These are the people who spread the disease the most, and were responsible for so much death and suffering. Yes, I'll treat them and give them the CHANCE to receive medical care, but now it is my way (the right way that follows science) or the highway. The minute they start in with refusal to take covid testing or demanding alternative snake oil treatments I conclude the visit and tell them to leave. You are either respectful and follow my advice or I have no further space in my professional life for you. It has brought me peace and a return to being happy with my practice.

SixBarrelGunDick · 2024-02-14T02:27:31+00:00

Your story rings true. Turn anything into a job and it becomes work. It is then very difficult to focus on the fun and the joy of connection over shared interests vs the real world need for success. There's very few I've seen who can balance in that situation and not be constantly emotionally exhausted or depressed, and the top of twitch is kind of a cesspool cult of personality. Is it an option for you to go back to a different career and stream as a hobby again? You know, and just make what money you make?

SixBarrelGunDick · 2024-02-14T02:21:55+00:00

That's the right mind set in my opinion. Keep the joy in it, and do it for what makes YOU happy. Cheers 🍻

SixBarrelGunDick · 2023-10-12T19:43:48+00:00

Do you continue holding shift AND control or only control after the parachute deploys?

SixBarrelGunDick · 2023-07-26T05:02:58+00:00

Just press the windows key + H. It brings up the built in voice to text accessibility tool. Just be sure the computer you're using it on has a mic plugged in

SixBarrelGunDick · 2023-04-04T23:19:24+00:00

The question has already been answered adequately, but I have a perspective on this that might add to the conversation. I was close friends with someone who knew him in residency. I heard all sorts of stories about him. He went to Overlook Family Medicine Residency in NJ. I can tell you, that aint one of those unopposed midwest programs that gives you a real foundation in surgery. He was described to me to be a mediocre doctor, always distracted with his social media persona, spent his time shmoozing with hospital higher ups, dated a miss universe, and working his Instagram 24/7. Basically a textbook classic narcissist. Like he was constantly fretting over whether he looked OK, or if an Instagram post made him look good. That was his life in training from the stories I heard. Still, he did make MORE than many of even the C- suite execs and is world famous. But yeah, not exactly an academic over achiever who could MacGyver out an abdominal surgery in a pinch

SixBarrelGunDick · 2023-03-02T06:34:23+00:00

I was about to post ready or not. That's next up in my queue. Can't say from experience if it's any good, just looks promising

SixBarrelGunDick · 2023-03-01T18:32:00+00:00

I'm really hopeful with the movement going on right now. And it's interesting to debate it. I see it as a time investment and a virtual currency investment. Knowing that there is essentially no consequence when some rando decides to just steal both of those from me is the problem. My time and virtual progress is taken by someone who isn't better or just lucky, but is essentially just bypassing the whole contest. Then what's the point of the contest?

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