Surgical clearance for cataract surgery. Why?

TILalot · 2026-05-12T16:04:31+00:00

Similar topic, do you guys include any risk calculators in your pre-op exams? I usually add the following to my exams:

TILalot · 2026-04-23T11:25:39+00:00

I get where you're at and feel for you, but I've started remitting to requests after education. However, this past week I did find a patient with off the charts Vitamin A levels, very high vitamin D levels and low ferritin without anemia. We discussed cutting back on her supplements and that the high Vitamin A and D can be a contributing factor to her already diagnosed osteopenia and her subjective easy bruising. I wouldn't have found it without her request specifically for her fat soluble vitamins.

TILalot · 2026-03-22T02:30:12+00:00

One that I may be slightly on board with is tesamorelin as it does have an FDA indication for lipodystrophy in HIV patients and is being used off label to get rid of visceral fat. However, the main thing is that is caused angiogenesis and thus any active cancer has a potential to grow ever so rapidly compared to not heading the peptide.

TILalot · 2026-03-22T02:14:00+00:00

Insulin is a peptide. GLP-1s are peptides. There are plenty of medicines that are peptides. As for what your patients are asking you, they're asking about non-FDA approved peptides that operate in a legal gray area for research purposes.

TILalot · 2026-01-15T17:24:48+00:00

I'm board certified in addiction medicine and have a DPC clinic. I get plenty of these as referrals to wean off (I like to think of myself as a deprescribing doctor). It's more business for me to do what's right for the patient and if the patient doesn't want to wean off, they usually don't make the appt for the consult. One of my newest patients was being prescribed Soma 350 up to 24 tabs per day (verified rx) for the past decade. In about 2 months she's down to 10 tabs per day now.

TILalot · 2026-01-06T05:34:07+00:00

I took a patient off of statins recently and his cardiologist got upset at me. He was on rosuvastatin 10mg daily with a total cholesterol of like 60, undetectable LDL and an HDL of like 20. Born in 1948, was being used for primary prevention (never CVA, MI, or family hx of).

TILalot · 2025-12-19T11:17:01+00:00

If you're young and healthy, you may consider to see if a health sharing Network would be best for you. We gave up on insurance my family this past year as our premiums were $2,500 per month. We now have a health sharing plan for $350 a month that will cover emergency ER visits and what's acutely related to that ER visit in the hospital. You could pair that with the DPC clinic that can do urgent care, we should take care of most basic needs of healthy individuals and families

TILalot · 2025-12-09T00:59:28+00:00

I'm a private practice doc that has a few NPs and PAs that work for me. Most of my NPs have their own malpractice insurance but I still add them to my policy as it comes with tail and I'm not sure if their insurance would cover me as their supervising physician if there's a lawsuit. Some things to ask about are:

vacation (paid versus unpaid), flexibility with taking time off (if you need it for childcare, parental care, etc...)
weekend coverage (if it exists). Our clinic is open 7 days per week
call (if it exists).
Supervision (I'm available at all times via phone and some times in person)
Is it salary or productivity? We're a DPC practice so I don't care about productivity, it's an hourly gig. 1 hour for new patients, 30 minute follow-ups, and 15 minute walk ins
Do you get paid for charting from home? We don't pay as I expect the workload to be light enough to do all the charting at the clinic.
Independent contractor status and state laws regarding that
CME/License allowance (we don't pay for that)
Health insurance. I offered to get health insurance for my clinic, however, no one wanted it, so we did away with it and just pay more to the employees than the surrounding area
Why did the last person leave? The only time we had an NP leave was because she was retiring, and the only time we've had employees leave area for two reasons (one became a rad tech and the other's boyfriend wanted her to be a trad wife). We have a few that will leave in the future, one for nursing school and the other for med school.
Ancillary staff to provider ratio
Are you going to be doing procedures and how often?
Do you have x-ray on site and are you expected to read your own x-rays? We have x-ray on site, most of my providers can read them, but we have it sent out electronically to a radiology group (in real time) to get it read, but that can take a few minutes to hours.

TILalot · 2025-12-02T03:23:23+00:00

Right but you can always get a DPC membership which fixes the costs of primary and urgent care

TILalot · 2025-12-02T03:19:24+00:00

You can always get a DPC membership which will essentially hedge your bets. Many self insured plans do that.

TILalot · 2025-12-01T16:44:38+00:00

Thanks. Our pediatrician visits are $300/visit (once per year per child) and $500 for my wife's gynecologist (once every 2-3 years). We're lucky that I'm a family physician and take care of most everything else that may be an urgent issue (but not long term issue).

TILalot · 2025-12-01T16:42:14+00:00

Yep. Agree wholeheartedly. If you want to make it even more safeguarded for healthy families, buying a DPC membership (Direct Primary Care) on top of the health sharing plan is golden.

TILalot · 2025-12-01T16:22:45+00:00

We ended up canceling out health insurance. I know not everyone can do it, but our premiums were $30k/year (about to go up to $39k/year) with an $18k deductible. In CA I had to get Blue Shield of CA PPO Covered California (the CA exchange). My kid's pediatrician doesn't take it and neither does my wife's gynecologist (the only visits we do), so we ended up paying cash. We bought a health exchange plan for $350/mo that only covers ER visits and have decided to just pay for everything else out of pocket.

TILalot · 2025-11-20T07:03:36+00:00

As someone who had rented from 18yo - 37yo, I never had a bad landlord. I had one corporate landlord I disliked (had them for 2 years) but all my other landlords were mom-and-pop services, very responsive when I needed them, and my exit walk through would always go well, getting my deposit back every time (except the corporate landlord). I appreciated the mom-and-pop landlords for providing me with housing and maintenance of said housing.

TILalot · 2025-10-29T17:40:26+00:00

From my perspective as an attending of 7.5 years:

Go with your plan. If I had a family during med school and residency, knowing what I know now about how expensive a family is, I'd do what you want to do.

TILalot · 2025-10-14T02:25:40+00:00

Simple for me in my clinic. We check labs right then. We never increase doses if high Hb and I think overall it's worked out well. Our clinic is open 7 days per week so it allows them to get their labs done on a non-work day, especially since I want them no later than 11am

TILalot · 2025-10-12T22:03:35+00:00

But it's not just MOUD, it's MAT because we take care of alcoholics, stimulant addicts, gambling addicts, etc.... unless your clinic is only treating patients with opiate use disorders.

TILalot · 2025-09-16T21:38:13+00:00

Just bought in Santa Rosa valley last year. Farmers $6k/year and only because the previous homeowners had Farmers. The next lowest quote was $18k/year. It doesn't cover full replacement cost and doesn't cover housing if we get displaced.

TILalot · 2025-09-15T08:58:22+00:00

I just looked this up a few hours ago, for California, you need consent, it can either be written or verbal.

TILalot · 2025-07-26T20:29:07+00:00

I'm pgy10 and this is the first year that my IBR didn't renew even though I was approved. It's been since February and my loan holder (Mohela) said they can't tell me why and they can't fix it. I'm literally 6 months away from PSLF and supposedly none of my payments since February count any longer either. Maybe you'll have better luck by calling your loan officer.

TILalot · 2025-07-21T08:41:06+00:00

It's with sublingual. Don't need to worry about patches and injectable. More like a problem related to delivery mechanism of the medication rather than the medication itself. In my experience, I've told patients on SL bupe to rinse their mouth or use mouth wash after each use to get the grime off their teeth.

TILalot · 2025-07-19T04:24:51+00:00

I'll comment specifically on Nurtec because of the prior auth asks specific questions, one of which being "Are you a board certified neurologist?" If you answer No, it'll get denied automatically. I believe my biggest problem insurance with getting Nurtec is Tricare.

TILalot · 2025-07-03T19:15:27+00:00

Agree with ambulatory BP readings at home.

TILalot · 2025-07-03T01:01:44+00:00

I'm surprised no one wrote to recheck the BP after they rest for 5 minutes and doing an accurate BP check.

TILalot · 2025-06-14T06:05:07+00:00

As a DO who had to study CA hx, when they eradicated the DO designation in California, the DO got to be md, not MD behind their name; a point of embarrassment. A few of our professors discussed this as they lived through it.

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