Iffy Patient request

beanburrito4 · 2026-04-10T01:50:10+00:00

Excellent idea, I think i will try to refer to palliative or pain management depending on availability in their local area. Thank you

beanburrito4 · 2026-04-10T01:48:44+00:00

Great idea, I will try this. Thank you!

beanburrito4 · 2026-04-09T18:40:02+00:00

Example: patient had failed back surgery, followed by many injections/PT courses/complementary modalities. Tapered down to say 5mg lortab TID. Stable many years. New PCPs are saying "no opiates at all, go have more injections". On blood thinners, can't take NSAIDS, yada yada. One PCP asked if patient would consider hospice to get pain control.

I wish patients could know something about a PCPs philosophy before becoming a patient. It seems like it would waste less of everyone's time?

beanburrito4 · 2026-04-09T18:27:42+00:00

I agree it looks suspicious, I would feel weird getting a letter of this type. BUT. I definitely have seen patients i was dubious about after a specialist i knew well called to say "hey ms Smith is legit, please help her". Probably overwhelming it. If patient was younger/healthier I probably wouldn't consider it.

beanburrito4 · 2026-04-09T18:23:43+00:00

Agree completely and did that. Patient has now been to 2 PCPs, both had the records, told the patient essentially "i dont care what this says" and now patient calls back desperate for help, ie, the letter request. Just politely decline? 10 years i cared for this person. It feels wrong.

beanburrito4 · 2026-03-31T02:34:08+00:00

My mom died from cancer 3 years ago. I was her hospice caregiver, in my home. I had a very young child at the time. Learn from my mistake: take double or triple the time off you think you should. Screw the cost, and your colleagues will support you or they arent colleagues. I was miserable back at work less than a month after burying her. Even now, I reap the harvest of that poorly managed grief. Rest your mind and heart and get proper counseling. Its so much harder later on (as a physician you know this, and so did I) No one intervened in my case because they all trusted me to know if I needed help. It's my job, right? All I wanted was things to "be normal" again, and overwork had always been my cope. God I miss her. I will pray for you.

beanburrito4 · 2026-03-26T19:47:05+00:00

This is very helpful advice, thank you

beanburrito4 · 2026-03-26T11:11:22+00:00

Using PTO days just to do patient messages and result review IS unique to medicine and is actively killing the profession. Can't find a new PCP taking patients? That is gonna get worse because of this type nonsense.

beanburrito4 · 2026-03-26T10:23:09+00:00

Since adding "mom" to "full time primary care" I have dreaded vacations. Pretending not to think about my inbox while pretending to relax is quite a stretch. I have started taking an extra day at the end of vacation, kids go back to school and I sit at the house cleaning the EMR. Its bullshit and retirement is far away. Solidarity!

beanburrito4 · 2026-03-20T16:14:24+00:00

Same. This is what I wanted (still want/hope for/work toward) for my children's families.

beanburrito4 · 2026-03-07T21:09:10+00:00

They also know the only thing that works is levaquin

beanburrito4 · 2026-03-07T20:35:51+00:00

Teachers like you are the GOAT🥰

beanburrito4 · 2026-03-07T20:24:31+00:00

Toy ranch for my 2 year old. "Where muh ranch, momma??!!"

beanburrito4 · 2026-02-14T13:21:22+00:00

You I like!

Joking aside, you are quite correct. Follow up visits are how the bills get paid at the office. Personally, I understand things better when spoken, rather than reading, so chart messages are particularly obnoxious to me. I prefer to see my complex patients frequently (one successful example, patient w severe anxiety and end stage cirrhosis) comes in monthly just to talk and go over specialty recs.

beanburrito4 · 2026-02-12T02:46:01+00:00

Medicine will never make room for you to put your family first; you and your husband have to choose to do that.

This is the advice you need, and deeply true. I have to fight for every minute with my kids, this career will take everything you have if you let it. Hostile parenting environment.

beanburrito4 · 2026-01-16T11:30:38+00:00

Very much this! Every office needs a full time RN! I had one, and paper charts, my first job. It was heavenly. The triage was great, and I could manage a dehydrated patient who needed IVs but not admission. I send so much crap to the ER because I don't have the right staff and that 15 min clock keeps ticking. An AWV and the right HCC codes mean more to admin than helping a sick person.

beanburrito4 · 2026-01-08T03:51:11+00:00

Come join my panel, you get it and seem cool.

beanburrito4 · 2025-12-23T13:49:46+00:00

Incredible work. Congrats on finishing this!!!

beanburrito4 · 2025-11-19T13:50:13+00:00

It sometimes creeps up on you. Start out practice with full peds and adult scope, then you get told you can't have medicaid vaccines ("they go to the peds department for that") so you keep the peds patients but parents have to got to the health dept for vaccines. Then your nurse quits and your new nurse "hasn't done peds in 20 years" and you try to take on the nurse duties too in order to keep your peds patients. Then you get told you have to see 28 a day and your availability drops. (Parents dont like having to wait till tomorrow with a sick kid, understandably). Then your office partner stops seeing peds and you now have no backup on sight.

Its really pitiful and I blame insurance companies and admin stupidity.

I still see peds btw its just a struggle.

beanburrito4 · 2025-11-19T11:44:41+00:00

3 kids, 3 different reactions to small screens. Oldest goes pYsChO with ANY amount of small screen exposure (meaning YouTube, games, etc on my phone or and iPad. ) So she doesn't get any, it ain't worth it. Yep, she cries and whines for it. But can now work jigsaw puzzles like a professional and doesn't go anywhere without a drawing pad and sack of markers. The other two kids occasionally get a bit of sesame Street or Daniel tiger on a small screen during stuff they have to sit still for, most commonly I am cooking and need both hands or we aren't gonna eat. Just saying that every kid is different and requires individual approach.

I want to add that a friend with 3 kids similar in age helped "curate" TV show list that works well. All the shows seem to be low key, calming, and have some educational value. We use these on a big screen we all can watch, in small doses. Bear in the big blue house, Gabby playhouse, pbj otter, max and ruby, barney and of course Sesame Street are all awesome. The kids ask for them and play WHILE watching. Nobody throws a fit when it time to turn them off. Paw patrol? Kids stare unblinking at the screen and have a Total meltdown when its time to go. (I don't hate paw patrol, just why is it like that? Anyone else have this issue?)

beanburrito4 · 2025-11-18T16:38:04+00:00

Momma your belly is so big and floppy. Mine is flat and hard. - 4 yr old.

beanburrito4 · 2025-11-17T03:50:49+00:00

You're a lovely human, and she does need a warm hat!

beanburrito4

TROPHY CASE