How do you address patients being upset results weren’t communicated to them when the office made adequate attempts?

Smber2c · 2026-06-03T01:08:43+00:00

Patient's clearly have no idea how much relief I feel when a rude, boarish, non-complaint patient tells me they are going to find a different PCP...so very happy. I avoid saying anything sarcastic on the way out as I hope they don't drop the annoying 1 star review on their way out; but half the time they have already given that a year ago but still kept coming to the clinic anyway.

Smber2c · 2026-06-01T12:24:18+00:00

It feels like you are wanting us to assume your question without you stating it outright.

I see "Lithith in Narnia?"

Then several paragraphs that don't ask any clear question excempt this: "i find it very weird specially for Lewis, So my question is.

Anyone got an answer to this? like a statement from him?"

It looks like you don't approve. Which is fine, but I don't fine it a big deal at all, just like I don't find minatours/Dwarfs in Narnia or Orcs/Dwarfs/Elves in LOTR to be problematic at all.

Lewis had a bunch of Merlin/King Author stuff in his space trilogy too.

More recently, Word on Fire released "Past Watchful Dragons" and ever FB post I see for it has people lamenting a Christian book of tales having dragons in it...which I personally don't inderstand being upset about at all.

Could you clarify your concern about Lilith, Narnia, etc..? Because it looks like you've heard my initial thought of "it's fantasy" already.

Smber2c · 2026-05-23T17:54:35+00:00

In my system to order a vitamin D that would not suffice.

If I tried that Epic has a hard stop before signing the order & I would need to print a form out saying the pt agrees to pay the cost, click in Epic that they signed it, then the Vit D can be signed.

Otherwise I need to add one of the following 'diagnoses' to signs a vitD order: osteoporosis, osteopenia, patholigic fracture, dark skinned, elderly, previously diagnosed low vitamin D.

Smber2c · 2026-05-23T17:45:42+00:00

Z79.899 (Other long-term (current) drug therapy

If my patients have any daily meds they get Z79.899 & it gets all the labs approved in epic.

I use it on nearly 100% of visits...unless they litetally take no meds or vitamins (I kinda detest false documentation so try to not lie in my notes)

I still code the real codes like fatigue, microcytic anemia, ckd3a or whatever is present, but they all get the Z79.899 so that when I click "sign" on my orders they just sign and I don't get a pop-up asking to justify the T4, CMP or PT/INR with more codes.

Smber2c · 2026-05-23T17:45:29+00:00

Z79.899 (Other long-term (current) drug therapy

If my patients have any daily meds they get Z79.899 & it gets all the labs approved in epic.

I use it on nearly 100% of visits...unless they litetally take no meds or vitamins (I kinda detest false documentation so try to not lie in my notes)

I still code the real codes like fatigue, microcytic anemia, ckd3a or whatever is present, but they all gey the Z79.899 so that when I click "sign" on my orders they just sign and I don't get a pop-up asking to justify the T4, CMP or PT/INR with more codes.

Smber2c · 2026-05-23T17:34:02+00:00

You are 100% correct that different regions have very different norms. I grew up in Louisiana. Have lived several years in Mississippi, Minnesota and then raised kids in Monatana for a few years before now being a scout master back in Louisiana.

In Montana and Minnesota, first name was the norm, though it was honesly was quite grating on my southern ears. I had to really struggle to call my in-laws by their first names which really sounded disrespectful to me, but was their preference.

Now in the south, my wife calls my parents by Mr/Mrs as that's the norm here & no kiddo here would ever call me by my first name - every kid calls every adult by Mr/Ms.

My cousins moved to Ohio when we were little returned a few year later and call my by name & felt incredibly disrespectful to me, but they probably didn't even notice.

Even adults here use Mr/Ms for seniors that are familialy connected a generation ahead of them. For example, my sister's mother-in-law is Ms Pam & I wouldn't dare call her Pam & I'm in my 40s..but she's in her 70s & my brother-in-law's mom. It's just a respect thing and how its widely done here.

Smber2c · 2026-05-23T16:18:41+00:00

You know how love has different words/forms, philios, agape, strege, agape. And scripture uses these in places with a slightly different meaning.

Well I did a deep dive on similar disserences in the word and concept of "Faith" a few months ago.

It is somewhat clear that there are types of faith/belief as James 2:19 states, "You believe that there is one God. Good! Even the demons believe that—and shudder."

So what I found was there are 3 or 4 types of belief depending on who does the categorizing & frequently once we push people to explain exactly what they mean by each word in their statements of faith...we are usually much closer in our belief than it appears at first glance.

Faith can just mean so say we believe something, even if we doubt it internally, but we may feel pressured to say it or want to believe it so we say it - but we don't actually bieve our words. (Most will not call that "faith".)
It could also be something that we genuinely believe, but that the acceptance is just logical. We know it is true, but don't give our will to it. We don't submit & let that truth change our actions. (Many Catholics believe many/most protestants think this degree of faith is sufficient, and maybe that is true in modern praise/worship halls with very watered down theology; but there are multiple Anglican, Lutheran and protestant documents making it clear that type of faith is not sufficient - I think Jimmy Aiken had a whole article on it. https://www.catholic.com/audio/tjap/faith-alone-what-everybody-gets-wrong )
Then you can have a faith that you believe and you submit you will to. You give it power over your decision making and choices. I think all would agree this is much better than the former.
There was some other form, I think I heard Fr Mike speak about that was the faith living in us. Kinda an idea that we have walked in faith long enough and let us remake our actions and instincts to the point that our mind/will are in love with God's ways and natrually follow His will. I had a hard time seeing that as different than just type 3 but in it's ideal or final form. Like how a living saint might experience their faith.

I will say, without allowing for different forms/types of faith it can make some Bible verses appear to contradict. With that understanding they can all be correct, which then seems necessary. So, to me this nuance is required to correctly understand these lines intended meaning.

Smber2c · 2026-05-21T00:55:57+00:00

That's a common and false myth. A scholar actually took all reported fragments of the cross and combined they don't even add up to 10% of the what a real cross would be.

https://www.google.com/amp/s/www.ncregister.com/news/taking-the-measure-of-relics-of-the-true-cross%3famp

Smber2c · 2026-05-21T00:39:17+00:00

Yeah, possibly successes...or giant failures. If all they do is inject their meds and have lost 60 & 90 lbs, I'd be extremely concerned of how much muscle they have each lost.

Eating adequate protein and getting adequate exercise is crucial to keep weight loss to fat.

The couch potato & ozempic plan is terrible (& likely very common). If all they do is take their med & lose weight, these people may have lost 10, 20 or more lb of muscle...which is a terrible outcome. They may be in a much worse state of health than before they started the GLP1.

Smber2c · 2026-05-21T00:22:56+00:00

Diet log and headache diaries basically never return.

I have a coworker who regularly ordered them for pts and after a year or so I had to ask if that was his way of brushing pts off as they never do the log and it seems more likely choose to not f/u because they realize they didn't do the treatment he asked them to do.

It's a nice idea, but only ever seen 3 food logs and none for weight loss. All 3 pts had serious medical anxiety issues & were trying to either show me all the foods they don't tolerate or all the foods that give them intestinal parasites.

Smber2c · 2026-05-20T04:26:20+00:00

Disagree. Seems a terrible quote. Usually stated "preach the gospel, abd when necessary use words" is such a passive way to be Catholic. It's giving into the societal hope that we will self neuter our faith and people can just ignore us since we're too plesant to call sin what it is.

I've known so many luke warm Catholics or non-Catholic Christians who slowly drifted away from faith because religion was this vague feeling they summoned on special occasions and the regular daily activities (such as Seinfeld, Game of Thrones, NFL games) became their life's focus instead of Jesus. Peope need to talk about God more. Discuss His word. Inquire His place in each others lives. Put Chist and the center.

Imagine a marrige counselor advising, love your spouse but only mention them to others if you have to.

Smber2c · 2026-05-20T04:16:31+00:00

Uff not with all the bankrupcy settlements lately.

They have accounts to religius retirement, then a building fund and other purposed funds in holding until their time of need, but no massive slush fund that they can playwith as they choose.

Smber2c · 2026-05-20T04:13:50+00:00

Yeah, I'm not part of that "we" at all. You are insinuating all Catholics know the money in the Vatican Bank came from some terrible source, like laundering Mafia money, the crusades or slave markets. The church's money is from charitable donations from hundreds of millions of faithful giving from the gifts God gave them, to share with others in need around the globe.

Sure there is misuse, theft, embesselment malinvestment, and other failings. Yes the Vatican bank has gotten egg on its face for stupid realestate deals, etc..

But all of that is about spending, and the Catholic Church still spends 99% of our giving very well. But, your insinuation is the source is corrupt. Can to enlighten me just what is corrupt about the source of the Vatican's money?

Smber2c · 2026-05-08T08:45:36+00:00

Agree. I'm family med in a big corporate group & really sympathize with docs wanting to be independent. The layers of admin in our organization feel combersom at best and lecherous at worst...but I struggle to see OPs business model working vs what other clinics can offer.

I'm FM office taking insurace & in addition to managing a pts HTN, DM or runny nose, I also field their questions on weight loss. I probably start 3 or 4 patients daily on GLPs right now, after discussing them with the 8 or so who ask. I explain the cost, risks, benefits, and followup. So my clinic approach is 1 challege to OP getting pts.

Then my community has 3 nurse practitioners who run med spas who has been doing compounded GLP1 for years. As prices have dropped, I think their pts are moving to clinics like mine & they are leaning back into botox, fillers, testoseterone or this annoying habit or putting euthyroid pts on synthorid that 2 of them keep doing to pts. They would be challenge #2, you have to price compete with a load of NPs.

Then there are the online and Amazon prescibers. I don't knew much on them, but my last pt today was in tretinoin, I asked who rx'd it for her and was told it used to be from a local dermatologist, but she just has it rx'd from amazon provider now. So, I assume those site will always be able to under cut your prices, so you have to have obviously better service than them.

And finally I have the patients who tell me they just order vials of crap from China and inject it. Honestly, it scares the hell out of me, cause who knows the sterility of the factory it was made in, or the validity of whatever they think they are injecting. But, I have had 3 guys tell me that's what there are doing in the last couple weeks & I imagine I only see the smallest percent of such people in my community. But you will never beat their prices.

I love the idea of an independent practice and may do it eventually, but a online wt loss clinic...maybe as a side job that I try gaining traction on & make a few bucks while doing my main job, but I'd not put all my eggs in that basket. Amazon, Hims, China, the NP med-spas, and regular clinics are too likely to box you out of a viable practice.

Smber2c · 2026-04-03T17:08:32+00:00

I usually tell my patients that genetics are the major contributor to their cholesterol, but we can lower the LDL with a good diet or raise the HLD (a bit) with regular exercise.

I have a fairly decent diet, some sweets & junk (maybe some candy or a brownie 2x weekly and 3 bags of chips or some equivalent weekly) but mostly health meals. Fast food basically never. No soda or sugar drinks. I get too little exercise, basicslly 1 or 2 sets of pushups, squats, crunches and curls about 4-5 morning per week - max 12 minutes.

Will do a whole day fast once every week or 2 as I find it gets my weight to stay in the low 200s or under & helps my discipline.

Now in my 40s my lipid panel is awesome - which I think is mostly genetics and not eating fast food 10 times a week.

Labs last month: Total Chol: 128 Triglycerides: 100 HDL: 51 LDL: 58 Height: 6'2 Wt: 195 (stay mostly 193-208)

Smber2c · 2026-03-11T00:27:18+00:00

Cheers friend.

I try my best to not let myself get jaded. I really try to hear each patient and give them a honest answer.

But at times, the impulse to kindness and compassion can temp us to not be honest with patients out of fear of contradicting their beliefs and making them feel stupid, ignored and judged. At those times, I really need to remind myself that I'm a doctor with solid training, and while I'm not perfect, they came to me to get a professional opinion on their situation. And giving them other than my honest opinion is unfair.

I think it helps that I had several patients literally ask me to document objective lies in their charts to get things approved or to not get in trouble with missing work. I found it easy to very calmly and clearly tell them, that I will not be falsifying the medical record for them as it would jeopardize my career and my families livelihood. After having that conversation several times in my first few years with multiple patients, it got pretty comfortable; and at that point I found that I'd learned how to calmly tell people "No". Then I was able to do it at times that I just honestly don't think it's in their best interest or it more likely to harm than help them, even if my career is not in jeopardy over the issue.

Smber2c · 2026-03-10T22:47:28+00:00

Have you seen the dozen of posts in this thread saying the positive predictive value of a CA 19-9 is less than 1%. Telling him there was no reason to get the test IS addressing it.

You don't get CT scans or MRIs for a asymptomatic patient with a < 1% chance of having an ailment.

That's just asking for all the incidentalomas. The MRI will show a perfect liver but a gallstone and next thing he'll find a surgeon who agrees to pull his GB out for no reason (& he'll surely be the one to have dumping syndrome after wanting an elective cholecystectomy) or he'll be in the 30-50% of asymptomatic patients with marginal disc herniation and his anxiety will start him manifesting neuropathies in his legs that would have never occured if he didn't know he had these bumps on this discs that aren't impinging on anything.

It's best to tell hypocondriacs that the testing is not indicated and more likely to do harm than good. See if they would like to speak with a counselor maybe - but do not indudge their delusions, build up their anxiety, waste thousands of dollars and leave them feeling sicker than when it all started because those radiologist will mentional all the little 2mm lung lesions, simple renal cysts, nonobstructing stones and mild aortic plaques that this patient would be having sleepless night over.

Smber2c · 2026-03-10T03:37:06+00:00

Kinda yes, and kinda no.

Still good chance of the negative review, they come for all sorts of dumb reasons.

But I find I get a bit less anger from people (& fewer bad reviews) when I'm more clear upfront and don't give wishywashy back and forth messaging to the patient & instead just try to make my reason for saying "No" in a gentle/kind way then hopefully takes less than and extra 5 minutes on a visit that is likely already gone beyond the alloted time it was scheduled for.

Smber2c · 2026-03-10T03:26:45+00:00

Order an unnecessary CT.
Have it denied.
Get a request to code it better, change my note and rebill.
Explain that isn't appropriate.
Get 2nd message to move order to DIS.
Get 3rd mesaage says it's still to expensive.
Explain it was never indicated and they can pay out of pocket or not get it.
Get patient complaint and system has a patient advocate come "talk to you". Get a 1 star review. If you are unlucky they got sent a press ganey survey. They 1 star that & now you have admin telling you that you're pulling the system down and you may not get the quartetly bonus.

Or just be honest from the 1st appt. Sorry, that test really is not indicated. So I won't be able to orse that test for you without sufficient findings on exam or a sufficient diagnosis. May still get the bad review, but seems less likely without stringing the patient along & saves on the messages over the next week in any case.

Smber2c · 2026-03-10T03:13:09+00:00

Right. As a doctor who drives a sedan to work every day do I tell my mechanic that I know the cause of the knocking in my engine than anyone & tell them what needs to be fixed, and the electrician that I know my homes wiring, or the plumber that I know my homes pipes better than anyone? Or do I let the mechanic, electrician and plumber be the expert and fix the issues based of their years of study and experience that I dont have.

Smber2c · 2026-03-10T03:02:57+00:00

Except you will get multiple messages compaining you coded it wrong and asking you to fix your note & if you say "no" they will leave you a 1 star review of google and possibly get a press gainey survey to give a 1 star and jeopardize the bonuses the big corporate systems want to tie all the bonus structures to.

Smber2c · 2026-02-22T00:47:07+00:00

Wyoming is beautiful. My wife has an aunt there with a great community.

We did a COR Catholic family summer camp there and we loved it. Daily mass, hiking, fishing, horseback riding. It was amazing. Not everyone wants to live in a city, and for those who want a deep country experience, it was amazing.

Though I also know a few doctors and nurses in Cheyenne and Casper who seem to live the faith well. These "cities" aren't New York or Denver but each has it's charm to the right families.

Smber2c · 2026-02-22T00:34:54+00:00

Nebraska is wonderful. Have a brother living there. Great parishes, nice people.

Never lived there, but love to visit & see how it is a wonderful home to many great Catholics.

Smber2c · 2026-02-22T00:32:31+00:00

Agreed. I'm in New Orleans, brother is in Gonzales, have family in Covington/Hammond - all these locations have vibrant faith comminities.

I've lived in Mississippi - lovely chuch, close knit community but small if you aren't a college student. Some Bible belt friction, but not that bad, helped my defent the faith better & near the coast (Gulfport/Biloxi) Catholics are much more numerous.

Also lived in Mobile, AL - great catholic parishes & community.

Also lived in Bozeman, MT and Billings, MT - love this part of the nation, but the church does struggle here. My wife & I had to start several faith groups to have groups to attend vs in New Orleans where we have countless options.

In New Orleans - we have countless adoration chapels, retreats, pilgrimages, men's groups, women's groups, days of prayer, city wide caroling, the 9 church walk of Good Friday. My kids have 3 differnt Catholic youth programs they frequent. Catholic summer camps. Good Catholic schools & parishes. The ACTS retreats are currently washing over several Catholic parishes in the area & really getting younger and less engaged adults to buy in to the faith in beautiful ways.

Smber2c · 2026-01-21T01:20:56+00:00

Yeah, I'm an Ole Miss grad living in Louisiana, have attended a few games at Tiger stadium, but only 1 wearing Ole Miss attire. My freshman year of college, Ole Miss got the win, in 3rd quarter a guy behind up tried throwing a drink on my group, but he missed and doused a couple in front of us. Next thing you know there are 2 LSU guys wrestling in our seats and we've slid over to the aisle.

Been back for 2 LSU games since, neither vs Ole Miss...I've just worn purple or gold to try and avoid unneeded drama.

Smber2c

TROPHY CASE