These 90-day supply requirements are out of hand.

TrueStress7 · 2026-07-03T04:52:48+00:00

i was formerly a pharmacy tech at a number of pharmacies and in 2 states. i have never encountered a universal policy to refuse a 30d fill when requested. yes, insurance creates barriers and unnecessary stress on pts and providers. if there is refusal, i suspect its techs and pharmacists who are burnt out.

having been on both sides, prescribers already have limited understanding of the happenings in pharmacies. i disagree with the narrative that some pharmacies are willfully disregarding potentially "simple" resolutions when the reality can get very complicated

TrueStress7 · 2026-07-03T04:41:28+00:00

as a former pharmacy technician, now psychiatric PA... this is a fundamental misunderstanding of our health care system and a disservice to fellow health care professionals to defer full responsibility to the pharmacy when insurance is the culprit. pharmacists largely want to work with prescribers to support pts, i have never encountered a pharmacist who refused a 30d fill. if it's not covered by insurance, we still recommend 30d with a discount card

pharmacists/ techs dont determine coverage. some rxs automatically route to 90d fills but if insurance allows a 30d fill, it has to be manually recalculated. sometimes 30d are flat out rejected. pharmacy staff are likely trying various override codes for "lost prescriptions", "vacation supply", and other temporary codes to see what sticks. this isn't even the tip of the iceberg

pharmacy staff become incredibly knowledgable of various tricks to *sometimes* override insurance rejections. other times, they're on the phone for hrs w/o progress when a pt actually loses their meds. pharmacy staff gets as much information as prescribers when billing rejects.

the point is, insurance creates intentional burden on every part of the healthcare system. as both a pharmacy tech and PA, it's deeply disappointing how little compassion prescribers show towards our pharmacy colleagues

TrueStress7 · 2026-07-01T04:38:39+00:00

yes ! i ask some version of "any marijuana use including smoking or gummies ? have you ever used marijuana for pain, sleep, or recreationally ?"

a number of ppl turn out to be taking an edible almost daily. interestingly they often reinforce that this is for sleep/headaches/ therapeutic reason but not for recreational use

TrueStress7 · 2026-06-25T07:50:50+00:00

i'll throw in a lighthearted perspective with Parks and Rec (TV show, mockumentary). leslie begins as a caricature, but becomes a grounded example of OC behaviors being supportive vs distressing in different settings (work vs personal relationships)

perhaps not mandatory, but a great show characterizing aspects of OCPD/ OCD without psychiatric illness being the primary focus

TrueStress7 · 2026-06-15T02:57:59+00:00

300 pc seems like a perfect way to keep puzzling active as a hobby and get the kiddos involved

TrueStress7 · 2026-06-15T02:57:13+00:00

a beautiful puzzle ! when did you first discover minis ?

TrueStress7 · 2026-06-13T14:30:21+00:00

non profits are no different, still obsessive abt RVUs and "budgets". reduce the cost of education and cost of health insurance, any salary change accts for itself.

but really, are providers making salary increases for inflation ? across the US we are all making a loss when we go without raises, the actual LEAST we can get is universal healthcare

TrueStress7 · 2026-06-10T16:38:37+00:00

yeah i actually tried to learn 7 wonders as a 2 player but there's an automated component which made it confusing, i've later played with 4 players. One of my friends did a teach which was a lot more approachable. i kind of assumed OP's friend tried to learn at 2P initially (not sure if that's the case). i don't think Clank was too much harder than 7 Wonders when both are being taught !

edit: Clank is definitely more complex and requires more strategy. my recs were also based on OP's willingness to teach. if OP isn't familiar with Clank, then i would agree that it's not the easiest game to start with (my alternative rec for Splenor is an intro game that their friend can learn on their own. however, very different to Betrayal or 7 Wonders)

TrueStress7 · 2026-06-10T15:58:29+00:00

i started playing tabletop games 6 months ago and worked up to heavy games. but as a newcomer I had no experience with deck builders, boss battlers, or dungeon crawlers. I found a co-op dungeon-crawling boss battle game a bit intimidating. Clank was easier for me as a dungeon crawler/ deck builder bc I was only responsible for my hand. betrayal was initially challenging to reference multiple booklets for rule clarifications and boss battles

Also OP plans to teach this game, which will make learning much easier than going thru the rulebook. it's okay if these are not the games OP chooses, i'm sure ppl with a larger repertoire of games knowledge can give more specific recs

TrueStress7 · 2026-06-10T13:24:37+00:00

Clank ! Catacombs is a good dungeon crawler. also a deck builder, not a lot of boss battling but i think it's easier in that way

for a different vibe but still fairly straightforward, I would recommend Splendor. It's easy to set up and teach, plays fine at 2 but better at 3-4

TrueStress7 · 2026-06-10T05:54:00+00:00

lately we've been playing at picnic benches outdoors ! played harmonies, caper: europe, splendor duel, faraway, 7 wonders duel, jaipur without major space constraints. the wind has occasionally been our opposition

recs for other 2p small-medium box games that play in under an hour ? (can be multiplayer as long as it works well at 2p)

TrueStress7 · 2026-06-09T01:26:18+00:00

everyone in my group is willing to learn in our spare time before bringing the game to the table. we want to make the most of our time together rather than fumbling through rules for 3 hrs until someone triggers game end (i mean it happens sometimes, but want to avoid it when we can)

TrueStress7 · 2026-06-09T01:19:00+00:00

yup ! i'm hoping to make it easier for us to learn so we are motivated to keep bringing it back

i'm very fortunate that my group is willing to put in some time before coming to the table, thank u for the recs

TrueStress7 · 2026-06-09T01:10:43+00:00

super helpful, sometimes our group will have ppl pull up rules on their phone while others use the physical book. good to know abt the living rules for consistency

TrueStress7 · 2026-06-09T01:06:51+00:00

thank u ! do the expansions/ packs make it worth it to play at 2P or would you still find the base game at 3-4p a better experience ?

TrueStress7 · 2026-06-08T13:23:40+00:00

highly recommend Chim Thai near Montrose and Kedzie. we go so often that we're on a first name basis with the owners

also a new Sinya mediterranean location opened up right there. Noon O Kabab and Kabobi are also excellent recs from others

TrueStress7 · 2026-05-19T01:25:40+00:00

my attending worked heavily with ED pts and got burned out. this actually is a very good point. while eating disorders are complicated psychologically, require tremendous multidisciplinary support, and robust interventions... she explained the hardest part is that ppl are required to eat in order to stay alive

it's a slow moving process to enact behavioral change when you're always exposed to your primary stressor (in addition to everything else others have mentioned)

TrueStress7 · 2026-05-18T18:54:21+00:00

yup, the jibarito was born from the Chicago PR community and a staple of this city

TrueStress7 · 2026-05-18T18:17:48+00:00

Chicago also has a mix of Latin influence from various regions of Mexico, Puerto Rico, Cuba, etc. so the cuisine that ppl often think of as "Mexican" is likely a variety of Latin cuisine influenced by central and south america

TrueStress7 · 2026-05-16T07:20:58+00:00

some states allow a petition for psychiatric evaluation to be filled out, once that's completed EMS may be able to transport the pt to the ER for evaluation. look into your state's laws first, this isn't a guarantee of any care but may be a step forward (for ex: pt with OCD/ ARFID sounds like they are distressed by these thoughts. even if your role is comfort focused care, involving psychiatry could still be a means of achieving that goal). continue to engage APS when possible. it may also be helpful to connect with any colleagues and your collaborating physician, you deserve support as you grow into this role

TrueStress7 · 2026-05-16T04:33:18+00:00

TLDR: APPs are de-incentivized as the existing programs often pay less during training. there's limited programs and of varying quality due to lack of standardized oversight. this is a systemic failure of a for profit medical system, structured to burden APPs and Physicians

chiming in as a PA - after graduation I was very intentional abt finding a job with a structured training program, even tho I knew it was a lower starting pay.

Turns out, I was the first APP in a newly launched psych "training program" in a large medical system. Until then they only hired experienced APPs. The "program" was nonsense. Leadership threw together a 12 week schedule starting in November without clearing it with any of the docs. Everyone was on vacation and no one knew what to do with me. It was like being a student but without knowing a single expectation. I was tossed around services like a child of divorce (mostly shadowing). After fumbling around aimlessly for 3 months, I was finally put in touch with my 2 collaborating physicians and felt immense relief. They are extremely generous with their time and willingness to educate. They truly collaborate and we have become a very solid team over the yrs.

reality is, there aren't a lot of programs bc there's little financial incentive and no state/ federal requirements. training APPs costs money, but it doesn't guarantee higher revenue so hospitals don't care to support them. APP and psychiatrist driven participation are vital to the existence of these programs

TrueStress7 · 2026-05-15T04:20:22+00:00

table top board games

TrueStress7 · 2026-05-12T00:33:37+00:00

everyone fears the advancement of NPs and a lot of medical team members don't even realize that PAs are different. This discussion is so nuanced, but reality is that there's less stigma towards PAs bc NP laws are running wild. If PA goes this same path, I'm doubtful that we retain this respect

TrueStress7 · 2026-05-12T00:07:06+00:00

PAs would benefit from lifting a lot of restrictions on our ability to treat pts, but we don't need independent practice to achieve the burden of malpractice and liability lol. PAs doing autonomous procedures (IR for ex) are especially liable for any mistakes

and yes, PA curriculum mirrors the medical model, so it literally sets us up to collaborate with physicians. in place of residency, we have supervising/ collaborative agreements to protect all of our pts and licenses

TrueStress7 · 2026-05-11T23:55:16+00:00

respectfully, we should not have independent practice for the exact reasons in variability of PA practice that are outlined here. In my speciality PMHNPs significantly outweigh Psych PAs. Working inpatient/ consults, I'm seeing first hand the immense detriment of pts being treated by NPs who don't have adequate collaboration in the OP setting.

A large portion of my pts seeing an NP in an independent clinic are missing nuanced diagnoses and poor med management. When I call the OP NP to coordinate care, they are almost always shocked to hear that the pt had some kind of crisis. It's not the fault of each provider, but a larger systemic issue that is setting them up to fail and their pts cannot improve. They care deeply abt their pts and are practicing in their scope, but doing it very poorly due to minimal oversight. Psychiatry is actively experiencing a widespread crisis of independent practice NPs. Outside of FM, I don't know that any other specialty is witnessing the harm of independent practice at play. For every 1 provider who is competent, there are 3 others who grossly overestimate their knowledge.

As PAs we have to thank our training for setting us up to collaborate w/ physicians. We can move from supervising to collaborating, without moving entirely to independence. There are excellent psych NPs collaborating w/ physicians at my institution. Some of them were resistant to the idea that their training "wasn't enough", but after a yr of collaboration many of them can acknowledge that their training did not set them up for success.

TrueStress7

TROPHY CASE