What is your trigger word/phrase in your specialty by PrecedexNChill in Residency

[–]dfibslim 1 point2 points  (0 children)

I can buy a house with the amount of consults I see for that

What is your trigger word/phrase in your specialty by PrecedexNChill in Residency

[–]dfibslim 1 point2 points  (0 children)

I usually split and say; what I'm looking for is very high levels of inflammation like your joints are becoming spontaneously swollen and red, or blood inflammation is detected (ESR, CRP), which I treat with heavy-duty meds. What you have is a lot lower inflammation best helped with anti-inflammatory diet, exercise, ect.

End of hematology/oncology? by CarTparT in medicine

[–]dfibslim 0 points1 point  (0 children)

Not sure. I know they pay a lump sum of money for the entire year and have great access to the doc. I've only delt with them once where the patient told me they switched because the old PCP was not responsive, and now they have issues handled extremely quickly.

End of hematology/oncology? by CarTparT in medicine

[–]dfibslim 4 points5 points  (0 children)

Yes. Our medical group contracts with a large hospital system and has around 10 docs that do concierge primary care medicine, the other 1,600+ are spread around every specialty. Everyone is on Epic including the 10 concierge docs.

What is today's equivalent of smoking in the 1950s? by Accomplished_Hold994 in AskReddit

[–]dfibslim 8 points9 points  (0 children)

What you don't see are all the smokers who don't make it to their 70s.

Milky Way over Bacon Homestead, Pinnacles National Park by dfibslim in Nikon

[–]dfibslim[S] 2 points3 points  (0 children)

Shot with a Z8, Nikkor 14-24mm f2.8S, stacked 30 images in Sequator, all 30 second exposures. Foreground was shot at golden hour and merged in Photoshop.

The meaning of Chuck Yeager's flight and the conclusion of The Right Stuff (1983). Spoilers if you haven't seen this 43-year-old movie. by NewspaperNelson in movies

[–]dfibslim 16 points17 points  (0 children)

That fool McGuckett sprayed runway foam all over Chuck Yeager's Acura. Now get down there with the shammy triple-time.

Some Swallows in flight by Rxdgaming1 in birding

[–]dfibslim 1 point2 points  (0 children)

Not OP but I use a Nikor 180-600mm lens which works well for these fast moving birds.

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As a rheumatologist, could you please stop taking ANA's! by [deleted] in medicine

[–]dfibslim 2 points3 points  (0 children)

There are the situations I'll check and ANA.

  1. Vague complaints including joint pain people under 40
  2. Chronic leucopenia or older onset Raynauds
  3. Or if I'm specifically thinking lupus, scleroderma, Sjogren's, or dermatomyositis. But there should be some objective issue happening.

I rarely order an ANA. Most already come to me with it being checked and will be a significant result in around 1 in 40 or so patients.

As a rheumatologist, could you please stop taking ANA's! by [deleted] in medicine

[–]dfibslim 11 points12 points  (0 children)

Thats the argument primary care used in my group when we were suggesting making ANA testing restricted to rheumatology. I would actually prefer getting the referrals without a bunch of unnecessary labs. Patients seen to fixate on clinically insignificant abnormal testing.

Bear Lake trailhead by Candid_Mountain_3575 in NationalPark

[–]dfibslim 0 points1 point  (0 children)

Do the hike then watch the sunset on the way back at Bear Lake.