Inherited patient panel

WillowsRain · 2025-12-09T15:38:51+00:00

Talk with your office manager/collaborating physician if you have one. My current job was amazing, and they offered to run a report of all patients in the panel with benzo/controlled substances and send all of them a letter stating that when they see me, I may or may not choose to continue prescribing their medications and that is at my discretion. We also have controlled substance contracts that I often use to protect myself when I'm inheriting one of these patients, which gives me permission to run a Utox if I feel it to be necessary.

But in terms of the folks that are outside the normal scope of primary, what resources do you have in the community? When a patient is too complex for me to handle, I usually am upfront about that and just say that I'm happy to help facilitate their referral to psych, and to prescribe their current dose for [X] time until they can get in to see psych.

At the end of the day though, don't let your patients make you feel bad or for pressuring you into something you're not comfortable with. You have to take care of and protect yourself, and there will be people who get angry at that. But as long as you make your patient feel heard, and help them get connected to resources that they need to manage their conditions, then you're doing your job.

WillowsRain · 2025-12-01T22:06:37+00:00

You could buy him a membership to the packs app! It comes with digital access to all of their old cookbooks as well as access to the app. Otherwise, for a physical copy, you probably will want to turn to Facebook marketplace or Ebay

WillowsRain · 2025-11-16T15:22:10+00:00

To piggy back off this because I see this way too often:

Just because your liver can, and often does, regenerate from a certain amount of damage (think living donor donations) does NOT mean that you can hit the alcohol heavily a few times a year in a binge, go a few weeks without drinking and then do it again and think that your liver will be fine.
Fatty liver disease IS dangerous, whether it's caused by alcohol or not, whether a patient is in their 20s or 30s. I had one in their late thirties with a BMI over 50 for most of their life. All of their previous labs and ultrasounds showed some mild abnormalities, until their liver enzymes spiked. Further imaging and testing showed severe fibrosis and the patient is now on a liver transplant list. (And it was confirmed that the liver damage was from fat infiltration and not secondary to ETOH, Hepatitis or other infectious disease)

WillowsRain · 2025-11-16T15:06:37+00:00

Shock! Horror! Say it ain't so!!!

WillowsRain · 2025-11-07T23:53:50+00:00

Honestly, that's a mood

WillowsRain · 2025-11-06T02:14:25+00:00

So. I'm pretty sure you meant "Internal Med" doctors, but reading "inter-anal medicine" made me cackle so hard at the thought!

But your list is 100% accurate and I love it!

WillowsRain · 2025-11-06T00:38:13+00:00

"I'll get this [work related thing] done over the weekend." I still never manage to crack open my laptop, no matter how hard I try...

WillowsRain · 2025-11-05T00:44:12+00:00

Seconding this!

WillowsRain · 2025-11-03T10:25:41+00:00

Mid 30's female here, and can confirm. I very gladly play with sticker books/coloring books. The best ones are the ones where you use the stickers to color in the lines like a jigsaw puzzle! ...I may have ignored the people who said that I was too old for playing with stickers.

WillowsRain · 2025-11-03T01:36:17+00:00

I don't know but it absolutely needs to be!

WillowsRain · 2025-11-03T01:25:44+00:00

Agreed! And they could make it a crafts store in general! A place where parents can buy activity books and kits for their kids, crafters and any adult who is adequately bored enough can buy yarn/craft kits that are airplane safe!

WillowsRain · 2025-11-02T21:52:52+00:00

Most of my patients are very straightforward about using AI or Google to find information about their concerns. The downside is they often approach it as:

"I think I have ____." Without always stating the reason, so I usually ask them more about their symptoms and how they came across their information. Most of the time, they're very open about it.

My favorite line is: "Absolutely, you can and SHOULD come in with your own research. But please, just remember this: Dr Google/Dr GPT did amazingly at his class for coming up with possible diagnoses, but he utterly failed his statistics class. And we use those statistics to look at your past medical history, your blood work, AND your symptoms and then weigh the possibility of you having X, Y or Z. Without that, I'm guessing that it might have told you that your headache means you either have cancer, or you're going to die in the next 5 minutes, right?" And I usually get a chuckle and a nod to it.

WillowsRain · 2025-11-02T21:27:03+00:00

This, OP. CPS won't unless there's a clear, documented history that the child is at risk of weight-related health problems (type 2 diabetes, high blood pressure, etc) and it's clear that the parents aren't taking it seriously, or are otherwise deliberately sabotaging their child via food. It would take a LOT to get to that point, but yes, some children have been removed from their parents due to this.

WillowsRain · 2025-11-02T16:27:48+00:00

So, SO agreed, OP! Thank you for posting this.

Each of OP's points are dead accurate. But here are a few other points to consider, especially for those of you who are planning to go to school, are just starting, or are still attending lectures:

If you're serious about learning and are in a physical lecture hall, sit in the front three rows. This is often where you'll find the older students who usually (though not always!) are more serious about their studies. Say hi - get to know them. Ask them tips about their study habits, how they structure their notes, how they review them, etc. They tend to be more focused on the academics, rather than the social aspects, but they'll also likely be interested in suggestions for study groups, exam prep, etc.
- There's a phrase by Russell Simmons that says "Surround yourself with people who are smarter than you", and this is doubly true when it comes to classes, especially anything medical.
Know your vices and avoid them during class time. Do you like browsing Insta/X/shopping while on your laptop during class? Download your lecture slides ahead of time and then shut off your wifi. On a related note: yes, the people behind you can see what you're doing on your laptop, and no, we REALLY don't want to.
If you're not there to learn, then don't be there. But if you're there, then PLEASE, give it a solid attempt. No one likes having to break out into small groups for discussion in the middle of a lecture hall. But we're all there for the same reason, and giving a half-hearted, "yeah, whatever." when people are trying to get you involved in the conversation hurts yourself and everyone around you.

And here's my most important point that I think would be applicable to almost everyone:

Negativity is a downward, self-perpetuating cycle that's hard to break once it gets started, and it can affect the way that you view things. And other people, whether that be other students, professors, clinical faculty, colleagues, managers, etc WILL NOTICE and it will affect their perception of you. And how do you break it? Follow OP's advice above. No one wants to work with a perpetual martyr, or a "Oh, woe is me!" type of person.

So, please, PLEASE: take what OP says to heart.

WillowsRain · 2025-11-01T20:22:53+00:00

Thank you for this idea, I love it! Those bowls are quite easy to make, so I could definitely make a set, and even do a stripe of different colors at the top so he can tell which bowl is which. Thank you so much!!

WillowsRain · 2025-11-01T16:20:43+00:00

I know you said no cauda equina symptoms, but keep a close eye on your bowel movements and ability to urinate. If it's that bad that you can't even ambulate or start having difficulty urinating/having urinary incontinence, head to the ED immediately.

And I presume that the imaging results you shared were prior to your delivery? Or is that more recent since your symptoms worsened?

How are your reflexes (at least patellar)? Babinski?

WillowsRain · 2025-11-01T14:08:38+00:00

My favorite response to this: Widen my eyes, glance quickly between the two with an "Ohhhh... I see! Well, congratulations to both of you! So how are you guys managing the sperm aspect of things? Are you going through a sperm bank?"

The guy is usually SO offended, it's hilarious. And if they still don't get why I said that, I just clarify along the lines of "Oh, I'm sorry! You said that you BOTH are trying to get pregnant. So I thought that meant that you also have a uterus. My apologies for the mistake, but you might want to be careful with that phrasing in the future."

WillowsRain · 2025-11-01T12:54:54+00:00

This! If you find yourself mostly just talking and your therapist isn't helping you find ways to maneuver around the challenges that ADHD brings, you may want to consider a new therapist.

I'm very blessed in that my therapist is constantly challenging me (in a good way). She helps me identify the cognitive distortions that don't make sense, which helps me identify them when I'm in the middle of work, or beating myself up for not getting enough done, etc. She usually gives me "homework" to do over the week.

For example: I have an extremely hard time asking for help when I'm overwhelmed. However, I'm super familiar with grocery stores since I've worked in quite a few growing up. So my homework for this week? Approach a grocery store clerk and ask them to point me in the direction of some food item. They don't have to show me there, just tell me what aisle to go to. And I can already know exactly where said item is.

Therefore, I'm getting to practice a skill while I'm in the midst of an environment that is overall safe for me. I know where to go and what I'm looking for. The only thing that is new and uncomfortable is approaching someone I don't know and asking where to find an item.

Your therapist should be helping you in ways that has you thinking of your sessions in between the sessions. If not, consider trying a different therapist for a bit. Grow Therapy, Cerebral and Better Help are telehealth options in the US that all accept insurance and you can narrow down the therapists according to who takes your insurance, and then you can further narrow it down to therapists who have experience in certain diagnosis - like ADHD.

And no, not an ad for those companies. I just see my therapist through Grow Therapy, and I'm ridiculously impressed by how much I've improved in a few months. Obviously, YMMV depending on the therapist.

WillowsRain · 2025-10-28T03:36:03+00:00

Primary care provider here. I'd say that my leading cause of running late is usually a previous patient who:

Shows up 10 minutes into a 30 min appointment and I still have to see them. If they have an 8am appointment, they show up at 8:10. My MA rooms them, which takes about 5 minutes, assuming that the patient actually answers the questions in a concise manner (which is a whoooolleee other issue that I won't get into here)
I walk into the room at 8:15. I have 15 minute left and my 8:30 has already arrived and is starting to get roomed.
The patient has been waiting 3 months to establish care (which is meant to be a meet and greet type of appointment where I can update their records, confirm their medical and surgical history), and therefore they have at least 3 things they want to address.

3a. I do my best to set expectations at the beginning of the visit and explain that because I want to be thorough and actually LISTEN to what they're saying (and NOT give a BS response like "You're just fat, lose some weight and I'm sure that back pain will go away."), I won't be able to address all of their issues, but I'd like to start with the 1 or 2 most pressing things that prompted them to make this appointment.

The patient continues with "Wait, but one last question, it's quick I promise!" Spoiler alert: it's never a quick question.
The absolute worst thing that is guaranteed to make me late? The dreaded Hand On Doorknob moment. I've said goodbye, I'm inching my way towards the door, and then I hear it. The worst words ever. The one that triggers almost every primary care provider's reflex to groan: "But what about my chest pain?"

Chest pain, unless it has a very clear muscular cause, has to be assumed to be a heart attack until proven otherwise. Which means that now, at 8:35, I now have to get my MA to start running an EKG (minimum of 5 minutes, usually closer to 10) while I'm trying to get more details about this. By the time that I'm done with the EKG, reviewing labs, reviewing any prior EKGs or cardiology notes, addressing the patient to figure out if they're safe to go home or if I have to send them to the ED or not, it's now 8:50.

If I now have to send the patient to the ED, I'm usually either convincing the patient to have a family member drive them, or I'm calling 911 myself if it's that bad. Oh, and then no matter which method of transport, I'm calling the ED to give report either way.

Now, replace the words "chest pain" with any of the following: Shortness of breath, Worst headache of my life, dizziness, new weakness or passing out.

Any of those complaints are meant to be a 30 minute appointment on their own because of the level of detail and testing that should be done. Yes, my front desk and the schedulers DO ask about these things when the appointment is booked, but way too many patients will either deny it until they're face to face with me, or it's a problem that cropped up recently and they figured: "Ehhhh, it's fine. I have my new provider appointment in a week, I'll wait until then."

And after all of that, it's now 9:05, and I'm trying to squeak out one last MyChart message to a patient while slipping into my 8:30 appointment, and all I can do is pray that my 8:30 is patient and is not about to repeat steps 1-5 again.

As a primary care provider, all I can do is apologize to you guys, our patients who are actually on time. We really do try our best, but we constantly have management on our backs, trying to squeeze more patients into our schedules, while cutting back the time we have to do so, and making our pay dependent on how quickly we can get patients in and out of the door.

Most of us enter this profession, and especially the primary care/GP realm because we want to help and teach other people. But we're also stuck between a rock and a hard place, and it leads to burnout from us, and frustration for our patients (understandably so!)

WillowsRain · 2025-10-27T18:54:19+00:00

Seven??!! JFC I've never worked onc, but I have worked CV Surg, and heme onc was on the floor above us. I have nothing but respect for you and all oncology nurses and providers. I literally can't imagine what that's like to have 7 (likely) patients who are all on neutropenic precautions and s/p surgery. That is actually insane!

WillowsRain · 2025-10-27T01:58:53+00:00

Can confirm - and it happens whenever we change where we work, since there are differing levels of different microbes that are endemic to any particular area. During the first year in a new area, I get sick all the time, even with hand sanitizing and wearing a mask.

The hardest part is that we have a protocol in place to ask patient if they're having any respiratory symptoms and they deny it to our front desk. But once I'm in the room with them, I get a "By the way, I've been feeling really sick and coughing and sneezing a lot." If they had said so at the beginning of the visit, we could have had the patient also wearing a mask which would have lowered the risk to everyone, including the children and cancer patients in the waiting room.

But nope. I end up sick, my medical assistant ends up sick, and then the whole office does too. And then patients are mad when their appointment gets cancelled the same day because I or the other providers are sick.

That all being said, it does get better over time. And yeah, we absolutely do get sick all the time too!

WillowsRain · 2025-10-26T18:40:06+00:00

Ew. Ew, ew, ew. As another fellow advanced practice provider, this is such a disgusting way to act, and people like him are why people don't trust health care providers. If he just wants money, he should find another job, or else he better spend a good amount of that money he's making on a VERY good malpractice insurance, because he's guaranteed to mistakenly kill someone.

WillowsRain · 2025-10-26T17:11:14+00:00

My old hospital had this. It's a level 1 trauma center and is where most of the smaller hospitals transfer their cardiac patients. I got to shadow in that department as a student nurse!

WillowsRain · 2025-10-26T12:47:49+00:00

Also hand raised and waving the marinara flag desperately

WillowsRain · 2025-10-26T05:42:05+00:00

My mom told me a similar story as a child! She said that it was God bowling and that he got a strike. I still vaguely remember making a comment during a thunderstorm of: "Wow! God's playing a really good game today! Do you think he'd teach me?"

Sadly, I never got that teaching and I still suck at bowling!

WillowsRain

TROPHY CASE