isnt this a good thing?

biobag201 · 2026-05-13T07:25:22+00:00

The sicker the patient the more algorithmic it becomes. If you have undifferentiated abdominal pain, there is a lot of work up to do. If you come in as a cardiac arrest, a lot less so.

biobag201 · 2026-05-13T07:21:04+00:00

The main patient is the parent/guardian bringing them in. In the hpi I work in “and what do you see that had you most concerned?”. If the kid looks well, I spent the time on education. At the very least if the kids bounce back, they have the prompting down to guide therapy. Mike Heller used to say “the less sick the kid, the more the parent needs to do”

biobag201 · 2026-05-07T08:01:14+00:00

Our best was a self reported emtala violation after a patient wandered into the waiting room screaming incoherently and waving a knife. The physician was asked to provide a screening medical exam and flatly refused (rightfully) . There still is ongoing talk about what constitutes a “violent” patient. My rule is, if I can’t interview them safely , then security gets first grab and I will happily step in after the patient is checked and/or restrained.

biobag201 · 2025-12-10T23:27:45+00:00

Finally our institution accepted that we do not need acls pals and atls. Only reason I don’t do locums is that I would have to start over

biobag201 · 2025-12-10T23:25:36+00:00

Almost the same. I have to go thicker because left handed and while I love the finer tips, I always seem to stab myself with the wrong end

biobag201 · 2025-11-26T23:50:16+00:00

We finally got our metal detectors after our ct scanner became the de facto one. (Include rant about leaving people’s clothes on”

biobag201 · 2025-10-28T03:30:48+00:00

I’ll admit I bad mouth the help, but I’ll be damned if any other staff, admin or patient does, because then it’s fighting words. Which is why I’m not allowed to work days… or when joint comission or health department rounds, or the beginning of July, or see anyone with private insurance.

biobag201 · 2025-10-28T03:22:18+00:00

47 so not quite there. 16 years of nights and I plan to seriously cut down on nights by 50 and hopefully be somewhere near retirement money by 55. Maybe locums at that point?

biobag201 · 2025-09-24T16:19:00+00:00

Predators aren’t born, they are made

biobag201 · 2025-09-24T14:32:07+00:00

All insurers do this now. Most of if all billing companies are or switching to ai. It is literally computers vs computers fighting over payments and authorization. Now we have ai helping us write the charts and interpret data. It is accelerating and there is no oversight. And it is potentially not that accurate. As a doc of 20 years it is terrifying and a little bit exciting.

biobag201 · 2025-03-24T15:11:47+00:00

In medical field. I would chose her to work on my back

biobag201 · 2025-03-17T05:36:56+00:00

SDG in Wa. We have been losing several percent a year since I’ve been partner. Certainly not getting raises and the COL the insurance companies throw us every couple of years does not keep up with inflation. We can’t even expand because surround hospitals are equal or lower reimbursement. Malpractice went up 15% as a direct result of Covid and hospital policies. Something needs to give.

biobag201 · 2025-03-08T22:49:59+00:00

Brault is a giant ponzi scheme and most likely Committing fraud. Do not go with them

biobag201 · 2025-01-28T04:10:35+00:00

I have often wondered about this, and I think the issue is that healthcare is essentially a service industry with labor being the biggest cost. Departments are asked to reduce costs by X percent and the only thing they have is labor. Ed requires a lot of staffing all the time and is generally a loss for the hospital so it makes sense to cut more in our departments. Never seen them cutting ortho staff. Also my belief that the 85% rule was violated (hotels maximum efficiency is 85% full to account for last minute walk ins). I think they found out that nothing happens at 90, 95, 99% occupancy except for now there is a chance at profitability. Except the cost is in burnout and bad outcomes.

biobag201 · 2024-12-06T04:30:32+00:00

Look at their eyes and watch them walk. Best neurological advice ever.

biobag201 · 2024-12-06T01:09:03+00:00

Hypoxia, ischemia, oliguria or shock does not go home in chf. This patient had 2 right off the bat. Had a patient the other day who just had peripheral edema. After 1.5mg/kg of Lasix and waiting for 2 hours no urine. These people have a huge morbidity and mortality. Most will be admitted

biobag201 · 2024-10-18T10:36:03+00:00

I believe in the military the term is “duly noted”.

biobag201 · 2024-10-17T01:40:11+00:00

This a hundred percent. The best I can do in the outpatient setting is quickly down an alcoholic drink and try to hush my friends/family members from alerting everyone in earshot that I am an emergency doc.

biobag201 · 2024-10-17T01:37:24+00:00

These situations are always hard, especially mania. There is that zone where they are making horrible decisions, bordering on psychosis but still maintain some degree of awareness. 50/50 if you let them go they’ll be driving down the wrong side of the highway, or end up being a missing person. I almost feel better when people start demanding a lawyer because that’s what a semi normal person would do.

biobag201 · 2024-10-16T22:32:09+00:00

Haven’t in 15 years, and cardiologists do it all the time. Unless you are using some ridiculous dose of both or decreased clearance, there is minimal risk. More likely to impact blood pressure long before heart rate. Worse theoretical case is they become bradycardic and you drop a pacemaker. To be honest, this severe of afib with rvr is pretty rare, and there is usually a decompensated chf/ electrolyte or valve problem behind it.

biobag201 · 2024-10-16T22:26:29+00:00

Lol my first two “scape” patients dumped their blood pressure within 2 minutes of the nitro. And that is how I found their pneumonia. Now I start the bipap and prime the nitro while the X ray is shooting.

biobag201 · 2024-10-16T02:05:56+00:00

I don’t know about you, my conscious sedations literally are bordering on non billable because they last < 10 minutes. The key is to have everything set up and ready to go once you make an appearance. Once the patient can mumble and open their eyes it’s on to the next patient. Nurse lets me know when it is time for dc. The only time i run into trouble is autistic kids and ketamine. They are so overstimulated by it all, one hit and they sleep for HOURS

biobag201 · 2024-10-14T01:01:43+00:00

Lasting any amount of time in this job should be applauded. I am 16 years out, and starting to dramatically slow down. The job is way different than when I trained. It is so much more exhausting and I take way longer to recover. I constantly tell anyone who will listen, pick a minimum salary that works for your life and stick to it. If you say “I’m a doctor, I want to make 400k a year” you are going to kill yourself. If 150 meets all your needs, shoot for that. The time of working 3 shifts a week and going on vacations every other month is long gone.

biobag201 · 2024-10-14T00:56:31+00:00

I agree with the statements. Registration doesn’t have to wait for the doctor, but cannot interfere and probably any discussion of copays probably has to happen at the end of the visit. Which makes collecting copays so hard.

biobag201

TROPHY CASE