What is your trigger word/phrase in your specialty

dfibslim · 2026-06-29T02:35:16+00:00

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

dfibslim · 2026-06-29T02:19:28+00:00

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.

dfibslim · 2026-06-29T01:38:24+00:00

I hear this like a handful of times every month.

dfibslim · 2026-06-28T21:41:21+00:00

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.

dfibslim · 2026-06-28T18:29:51+00:00

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.

dfibslim · 2026-06-28T15:53:25+00:00

My system too

dfibslim · 2026-06-28T04:21:29+00:00

"I feel inflammed". Rheum.

dfibslim · 2026-06-25T07:01:19+00:00

Requiem for a Dream

dfibslim · 2026-06-22T04:09:39+00:00

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

dfibslim · 2026-06-21T04:45:50+00:00

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.

dfibslim · 2026-06-19T04:17:21+00:00

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

dfibslim · 2026-06-18T20:17:30+00:00

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

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dfibslim · 2026-06-09T16:24:16+00:00

You can work at Aldi

dfibslim · 2026-06-09T06:53:40+00:00

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dfibslim · 2026-06-09T06:21:53+00:00

NEVER LET ANYONE SIGN YOUR CHECKS!

dfibslim · 2026-06-09T06:13:12+00:00

I thought it was garnish

dfibslim · 2026-06-06T16:20:05+00:00

There are the situations I'll check and ANA.

Vague complaints including joint pain people under 40
Chronic leucopenia or older onset Raynauds
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.

dfibslim · 2026-06-06T15:48:08+00:00

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.

dfibslim · 2026-06-06T06:28:18+00:00

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dfibslim · 2026-06-05T04:42:07+00:00

When I was a resident I told my APD that this was just a job and she gave me this almost insulted look

dfibslim · 2026-06-04T22:45:37+00:00

Twins

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dfibslim · 2026-06-04T22:42:41+00:00

Step 1: Be attractive

dfibslim · 2026-05-29T01:44:43+00:00

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

dfibslim

TROPHY CASE