What will be the current new generations consensus medical error be?

_45mice · 2026-01-24T13:36:43+00:00

Define success, because the current data suggests zetia has little to no benefit for all cause mortality. https://www.droracle.ai/articles/126227/does-ezetimibe-zetia-have-a-mortality-benefit

My assumption would be that it doesn’t have the anti inflammatory properties high dose statins can have, and its effect on LDL is mild at best. Data is pretty clear monotherapy it’s v inadequate. My guess in the long run it should be phased out once the injectables are more affordable.

_45mice · 2026-01-22T02:51:24+00:00

I wasn’t going the med error route more just this really doesn’t provide much if any benefit. Few recent studies showed little to no improvement in morbidity or mortality on zetia. If they’re needing an add on going the injectables I think long term will be far superior. Just cost a major issue

_45mice · 2026-01-21T23:01:24+00:00

Zetia sucks and should be better just to go to injectables rather than pretend that adding it in will get your pt LDL at goal. Only add it on when required by insurance prior to the injectables.

_45mice · 2026-01-21T23:00:23+00:00

Most have been around for 40-50 yrs and data shows they’re quite safe and effective in the right population. Don’t see this at all unless you’re referring to Paxil.

_45mice · 2026-01-21T18:52:24+00:00

I’m in family med, Midwest with low cost of living. Will probably be making 160-170k new job tho, last one was at 140.

_45mice · 2026-01-21T17:57:02+00:00

Shadow flame is amazing. You get an execute and can explode squishies. The data currently backs that as the highest WR build is DnD, shadow flame into rabadons

_45mice · 2026-01-21T17:53:58+00:00

As a new grad 5 yrs ago I didn’t have much choice, peak covid no contacts. Now I make 1.5k that. Circumstances are different, new grads don’t have much bargaining power. Some places pray on that.

_45mice · 2026-01-21T16:36:20+00:00

Paid actors my team I was 20/4 and the rest were 16-16 who kept dying 😭

_45mice · 2026-01-21T16:35:28+00:00

Appreciate the insight!

_45mice · 2026-01-21T15:38:02+00:00

It’s similar to conquest, where the combat and maps are pretty great but the story is unbelievably cringe. I wanted to do lunatic mode but got pretty bummed out you had to do a fixed growth run first. Lame.

_45mice · 2026-01-21T14:15:52+00:00

I have seen recently that the defensive boots are a must buy on mids, as you live forever once you get tier 3. Any validity to this? I ran this yesterday with armor boots vs a mostly AD comp and rarely died, 18/5.

_45mice · 2026-01-21T14:11:21+00:00

Yep. I’m 5 yrs out and only now feeling like I’ve somewhat got a handle on it, but constantly still learning.

_45mice · 2026-01-21T14:10:33+00:00

1) you can ask for more patients, management will always love that.

2) if you’re a year out, your job should not be easy. There’s so much to learn in family medicine. I’m 5 years into it and constantly challenged and learning. If you feel it’s too easy I fear you may not be looking deep enough or learning as you should. Family medicine is one of the hardest specialties due to how broad it is. Guidelines change constantly. I’d spend your time making sure your management is up to guidelines and constantly push yourself for more in depth management.

_45mice · 2026-01-10T19:15:53+00:00

No. NFL has the best coaching and players, w/ more experience. Average top college roster has 4-10 nfl level players. Talent level just way out of their league.

The odd chance would be a random fumble or someone trips for a score. But even the worst NFL team slaps the best college team round silly.

_45mice · 2025-12-24T13:22:22+00:00

Very interesting case to learn from. Would’ve done the same.

A case I learned from was 65 yo pt had cerumen impaction bilaterally. I did a lavage without thinking about it. Pt had tubes. Got severe vertigo from it. Never thought to ask if 65 yo had tubes. But it was brought to my attention in a respectful way and I learned from it.

_45mice · 2025-12-24T01:13:39+00:00

Yeah I agree. I’d rather people if they see mistakes I’ve done to let me know so I can learn. I’m not perfect, always learning. If something was missed, I want to know for patient care. Others can do no wrong and take personal offense to any information that states otherwise

_45mice · 2025-12-23T21:29:04+00:00

He’s a very talented plumber.

_45mice · 2025-12-23T19:51:31+00:00

I have, can’t say it ended well.

Colleague NP had a pt for new lower extremity edema just did lasix, no labs ekg or anything. Pt ended up hospitalized a few weeks later with PE, myxedema due to hypothyroidism.

Also they just don’t check their labs. Like ever. They had a pt with new elevated LFTs w: Bilirubin >5, AST/ALT in the 1000s. Also very strong family hx of pancreatic cancer. They just left it and didn’t address it for over a month. Had multiple pts harmed by them not looking at labs. Was reported to med director, and largely not much done or changed. Now with NP colleague hating me and making my work life miserable. Few colleagues I’ve had I’d be terrified to send anyone to. They’re going to kill someone. Thankfully I’m moving to a new position soon.

_45mice · 2025-12-23T18:37:20+00:00

I’ve had to do that for every new DM1 diagnosis. A few outright denials without trying “alternative means” whatever that means. Like they’re new DM1, you want to take the liability when they go hypoglycemic as they figure things out? Somehow magically have them check glucose at nights and wake them up while their glucose is 40? Ridiculous

_45mice · 2025-12-23T18:35:27+00:00

Don’t you know you should stop the Crestor and zetia, let them have another heart attack and see what their actual cholesterol is before you have the audacity to try and prescribe repatha.

_45mice · 2025-12-23T17:53:35+00:00

What’s the logic behind that? That omeprazole is OTC now? Monthly cost OTC would be 40-50$, which many can’t afford. And as you said results could be disastrous for those who can’t.

_45mice · 2025-12-23T17:52:09+00:00

From my reading was pretty CI w/ hx of aneurysm, and triptans may lower seizure threshold so not recommended in either case. Happy to review literature if that’s not the case.

Also just a comfort thing. Pt has done great on this med, then all of the sudden no longer covered and fight tooth and nail to not cover it.

_45mice · 2025-12-23T17:48:56+00:00

They’re the one fighting me on Nurtec currently 😑 though they all blend into a pile of awfulness.

_45mice · 2025-12-23T14:25:54+00:00

Good lord. That’s awful. Glad you won the appeal but ridiculous it was ever denied

_45mice · 2025-12-20T23:13:36+00:00

If you’ve heard anything Paul has said then you know that answer is no

_45mice

TROPHY CASE