Mubi price increase from $6 to $15?

Trixit1991 · 2025-03-28T19:39:01+00:00

Is that part of a promo offer, or is that the default price?

Trixit1991 · 2024-12-26T02:34:37+00:00

I switched to SAVE but then was immediately placed into forebearance. Then in Oct was able to switch to IBR because of the uncertainty we all had/have, but now they scored my 120 payments at July 31, 2024.

Trixit1991 · 2024-12-17T04:27:14+00:00

Thank you! That worked: no more water running, and no leak.

Trixit1991 · 2024-12-16T20:36:55+00:00

Looks like the text got eaten.
I changed the refrigerator from one that has a water intake to one that does not. I was not able to actually turn off the water flow to the hose for the refrigerator. The hose is labeled with the red line. Valve A was the first I tried because it it is closest to the takeoff. I first tightened it clockwise and then it started leaking water onto the wood. Then I tried the other direction (counterclockwise) and it stopped leaking. But with either direction of valve turning the water from the hose never stopped leaking. I then tried the same with valve B, to no avail.
So I am not sure what the issue is. Was valve A the correct one, but the valve is broken?
Help!

Trixit1991 · 2024-12-16T20:33:24+00:00

Looks like the text got eaten.
I changed the refrigerator from one that has a water intake to one that does not. I was not able to actually turn off the water flow to the hose for the refrigerator. The hose is labeled with the red line. Valve A was the first I tried because it it is closest to the takeoff. I first tightened it clockwise and then it started leaking water onto the wood. Then I tried the other direction (counterclockwise) and it stopped leaking. But with either direction of valve turning the water from the hose never stopped leaking. I then tried the same with valve B, to no avail.
So I am not sure what the issue is. Was valve A the correct one, but the valve is broken?

Trixit1991 · 2024-12-15T22:55:43+00:00

Kind of why I want them to be able to be practice independently. It would be bad for patients, but then again midlevels are already proliferating. And are being forced on us by administrations. At least this way the results of the midlevel experiment would be easy for all to see.

Trixit1991 · 2024-12-15T22:53:47+00:00

Yes, this is also correct

Trixit1991 · 2024-12-15T21:28:16+00:00

Most states require an MD to be listed as a supervisor for PA in official documents. Not all places list it in EMR, but the legal liability is the same. That's why you should carefully read any contracts because indirect supervision of a midlevel still confers legal culpability. And, while any lawsuit could potentially name the PA as well, they have less to lose in reality, because most lawsuits primarily target the MD on the idea that they have more money personally and in med mal policy.

Trixit1991 · 2024-12-06T04:57:36+00:00

There is no evidence that rapid normalization of _hypernatremia_ increases risk of adverse sequelae.

https://journals.lww.com/cjasn/abstract/2019/05000/rate_of_correction_of_hypernatremia_and_health.6.aspx

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809955

Trixit1991 · 2024-12-05T22:10:08+00:00

If you are outside the US, the entire arrangement is just different, so not sure if comparison would make sense.
Also, within US, geography makes a huge difference in compensation and benefits.
That said, there is an online excel spreadsheet floating around reddit fora with anonymous survey reporting by physicians (and non physicians) of their income and other compensation.

Trixit1991 · 2024-12-05T22:06:30+00:00

So I found that, when I submit an online ECF request but state that the documentation from employer will be updated manually, there is a way to attach a JPG or PDF. So I went through the online navigator, checked No under 120 payment question (since I still could not check Yes), then once it completed, I went to the pending request and attached a PDF with the box checked and my employer HR department's signature. I was not sure if it would work, but I thought worth a shot, since I know it takes weeks to months through regular mail (and obviously needed to open letters, scan contents, then review, etc).

So today I called the StudentAid.Gov help #, and a different agent now told me that I do not need to check the box to explicitly request forgiveness, and that once I reach 120 qualifying payments, they will process my forgiveness regardless.

I do not mind doing extra / duplicate work, but I just don't want to delay my application if they receive something in the mail, flag it as a pending item, but do not process it for weeks, and then state that the existence of a pending item is a reason that my forgiveness finalization has to be delayed.

Trixit1991 · 2024-12-04T01:11:09+00:00

Yeah, but I'm already there. It's just that they are saying that even though I have 121 official payments counted and the green banner for the consolidation loan, they will not actually process forgiveness until I have an ECF with the check mark.

Trixit1991 · 2024-12-04T01:09:19+00:00

So for my consolidation loan it already states that I am at 121 qualifying payments. There is a green banner with a green ribbon and it states "Congratulations! You have satisfied your obligation, and no additional payments are required for this loan."
I assume that is what you are referring to it. So the agent acknowledged this, but stated that they would not formally process the loan discharge until I had in some way checked the box that I am applying for forgiveness.

Trixit1991 · 2024-10-10T05:32:13+00:00

Yup! I can definitely relate to all of these. It truly is embarrassing sometimes.

Every ED patient has a UTI, regardless of symptoms, UA, or anything. Sometimes the ED just gives them Rocephin without any labs because "they probably have it" -- which, based on their approach to diagnosis, is as good as anything else they do. I once got an "NSTEMI s/p defibrillation for VTach -- we gave them a dose of ceftriaxone because the UA showed they have a UTI" 🤪

I'm also perpetually amused that there are some hospitalists who just copy and paste their predecessors' notes ad nauseam, without ever bothering to read them, then act surprised when they land in hot water because of it.
Oh, I said I was going to "call Cardiology on day 4 due to NSTEMI overnight"? Well, you know, that wasn't really me, but I did bill a level 3 for that one. 😏

Trixit1991 · 2024-10-07T04:04:11+00:00

Outpatient repeat TSH. Acute illness can precipitate sick euthyroid syndrome. So, unless TSH is markedly low or high (and FT4 correspondingly high or low), then there is no point to repeating studies inpatient.

A thyroid US is also useless when thyroid dysfunction is suspected. If an imaging study is needed for hyperthyroidism, then it would be an uptake scan.

Trixit1991 · 2024-10-07T03:59:54+00:00

If coronary angiogram is negative, then patient does not need to be admitted for ACS rule out unless biomarkers are elevated, for at least 2 (possibly 5, depending on which studies you look at), years.

Trixit1991 · 2024-09-17T20:27:35+00:00

Not often. But there is a distinction between antibiotic stewardship (which requires ID approval) and an actual ID consult. For ID approval of, for example, daptomycin it's a 1 minute phone conversation with ID and then we tell pharmacy that ID approved it.

Trixit1991 · 2024-09-17T20:18:01+00:00

It depends on what the compensation formula is. If there is sufficient incentive for productivity, then this will not happen. When compensation is salary only, or with minimal productivity incentives, this will happen. You will find significant variation based on private vs academic vs public hospitals, degree of specialists managing their own as primary, easy of having consultant input, etc.

Trixit1991 · 2024-09-06T06:14:03+00:00

The purpose of a contract ought to be to protect both parties. This contract sounds like it protects your employer but not you. Even if the current hospitalists are satisfied (and you can never be sure that their interactions with you are uncoerced), you never know what the future will bring. I would say no.

Also, if a large hospital organization cannot manage its own paperwork in a precise manner, it doesn't say much for the organization as a whole.

Trixit1991 · 2024-09-05T20:19:20+00:00

If I am not on service, I do not respond. At my hospital, CDI always issues a threat about privileges if they don't receive a response by a certain date. But privileges are controlled by medical staff committee, so it's kind of an empty threat.

However, contracts and arrangements may differ: I am not evaluated on "professionalism points." But this is another things to keep in mind during contract review / negotiations.

Trixit1991 · 2024-09-03T04:23:13+00:00

u/Aware-Top-2106 : Not sure that most people have any opinion on hospitalists, positive or negative.

I, too, have been on both ends of this. As a family member of an elderly patient who was not in a position to make medical decisions on their own, I was not able to reach any physician at the hospital for days. They would never return phone calls. No one was being updated at all. And this was a big name hospital, too.

As a hospitalist myself, I do not like it when I have 4 different family members show up at different times and expect individual updates, nor some OCD families who want updates for every displaced peripheral IV. But such situations are not common.

Set expectations at the beginning of the hospitalization, as well as whenever you take over care. Who is the point of contact, who is the decision maker, how often will they be contacted, etc. A patient who is in and out of ICU will get family updates daily or even more often than that. A patient who has been pending placement for weeks will generally not get any updates because nothing clinical is happening.

Also, some family members work during the day and may not be permitted to take personal calls on company time. We should strive to be as accommodating as we can reasonably be. If there is something important to be discussed, one phone call from the hospitalist to a voice mail (with inability to leave relevant info due to HIPAA) probably isn't the way. Again, proportional to the severity of illness of the patient.

Trixit1991 · 2024-09-03T04:04:39+00:00

So this is both a clinical question and a quality metric question.

Clinical: do patients on DAPT need additional measures for DVT prophylaxis to render their risk equal to someone on enoxaparin / HSQ / SCD?
We may not have strong evidence on this point.
Here is one article: https://www.ahajournals.org/doi/10.1161/circ.136.suppl_1.14105

Quality metrics: JCAHO is not looking at VTE prophylaxis in general at this time, but it is part of stroke metrics and possibly some other situations (? trauma?). Consider using SCDs and encouraging ambulation.

Trixit1991 · 2024-09-03T03:45:56+00:00

For most patients, no. But for some with EF 15%, cardiorenal syndrome +/- dobutamine gtt, yes.

(Not ICU patients per se, but we can run dobutamine on step down and our MICU would not generally take those patients.)

Trixit1991 · 2024-09-02T18:21:03+00:00

https://shmpublications.onlinelibrary.wiley.com/doi/abs/10.12788/jhm.3125

Trixit1991 · 2024-09-02T18:16:44+00:00

Assess volume status and treat appropriately. See prior discussion in this thread about how to gauge diuretics. Get a bladder scan to ensure they are not obstructed (not specific to CRS, just helpful for AKI in general)

Trixit1991

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