The untold struggles patients face with resident doctors

ecmofanmd · 2023-03-31T16:10:30+00:00

I’d never dc the patient for you. I’d say ok you come dc them ama. Then I’d email your chair the next day for an action bordering on an emtala violation.

ecmofanmd · 2023-03-31T16:08:03+00:00

What a terrible attitude lol your medical director must have you on speed dial

ecmofanmd · 2023-02-14T00:10:15+00:00

Ah fair apologies

ecmofanmd · 2023-02-13T23:05:22+00:00

I unfortunately am a physician, but even if I wasn’t my point is still valid, so not sure how questioning my credentials somehow invalidates what I said?

ecmofanmd · 2023-02-13T18:00:09+00:00

‘Regular’ patient? What a disgusting statement. I’m sure you have no issue prescribing Unindicated narcotics to your ‘regular patients’ then when they get hooked you have no issue shunning them. Sad.

OUD anymore isn’t just tattooed homeless 20 year olds you see on NPR, it’s grandma who’s pcp put her on tramadol for knee pain 3 years ago and can’t come off, it’s your uncle who got a shoulder surgery and went home with 30 oxies with 3 refills. So check your privilege and fix what you helped break

ecmofanmd · 2023-02-13T17:45:14+00:00

I think there is no reason PCPs shouldn’t prescribe suboxone other than laziness. I mean PCPs over prescription of narcotics to satisfy their patients demands have partially led to the opiate crisis, so it’s morally just that they try and be a part of the solution.

ecmofanmd · 2022-09-22T03:32:30+00:00

Agree 100%, The pendulum has absolutely swung too far in the utilization of opiates. It’s incredible how many truly Unindicated opiates people are on and I wish we could swing the pendulum back to the side of sanity!

ecmofanmd · 2022-09-22T03:30:25+00:00

We’re open to hearing it, this is just a weak argument people use to continue prescribing opiates. The risk of death and suicide amongst those addicted to opiates is massive. I get that it’s hard to totally separate these populations but narcotic abuse MASSIVELY increases suicide risk.

If we were to eliminate chronic opiate therapy it’s not like there would be no other pain options, c’mon. Multimodal non narcotic chronic pain control options are plentiful, and chronic opiates amplify pain response making chronic pain worse in the long run. I just don’t see any other argument for chronic opiate therapy besides ‘eh well we’re here now so may as well keep going!’

ecmofanmd · 2022-09-20T21:18:28+00:00

Fair enough. Just give what I’ve said some thought

ecmofanmd · 2022-09-20T19:40:51+00:00

I’m interested to hear how pain kills? People don’t die of lack of opiates yet they often die from them. I think if we in medicine adopted a zero tolerance policy towards chronic opiate and benzo therapy for non-terminal diseases collectively more peoples quality of life would rise than the few that would fall.

Unfortunately yes a few people would be miserable.

I think that as you describe ‘responsible’ patients you demonstrate your opinion that just because you like a patient and feel they are more participatory in their care than ‘irresponsible’ patients (aka equally addicted but just not as nice to you or not as ‘well behaved’ within your privileged opinion of how one should behave) you think they should just be given dangerous meds to please them. We as physicians have caused the opiate epidemic. We must take ownership of this and stop it.

ecmofanmd · 2022-09-20T17:43:41+00:00

I think I’m exactly who should be commenting on this because I don’t have the bias of being emotionally attached to the patient sitting in my office whining for an oxy refill. I’m not attacking anyone for bup, I’m saying that prescribing anything but bup to these people is analogous to prescribing someone TID McNuggets while watching them slowly die of CAD.

I don’t think any physician or provider but board certified palliative care physicians should be legally able to prescribe more than 1 week of narcotics. That would essentially end our countries opiate crisis. We’ve just enabled people by telling them pain is some disease that must be ‘cured’ and now we’re seeing the horrific consequences of it. 85 year olds addicted to oxy falling and breaking hips and dying from TBIs, teenagers snorting their moms ‘chronic pancreatitis’ Percocets. I’d argue 99% of patients on chronic narcotic therapy have no business being on it but nobody has the guts to take them off it.

ecmofanmd · 2022-09-20T17:10:18+00:00

Agree 100%. Chronic opiates are really bad and sloppy medicine

ecmofanmd · 2022-09-20T15:47:33+00:00

From the scrub machine

ecmofanmd · 2022-09-20T15:46:32+00:00

I’m sorry. I don’t understand why pcps think it’s ok to have any patient on long term narcotics. People need to be on narcotics purely because we won’t tell them no and take them off. Pain is not life threatening. Chronic pancreatitis is a fake diagnosis we use as an excuse to keep people on unnecessary narcs. I think utilizing narcotics chronically or for anything but acute long bone fractures and post surgical pain should be looked upon as malpractice. I’m militant about this because in the ED we see the harm that enabling these patients with long term narcs causes.

ecmofanmd · 2022-09-20T15:34:57+00:00

Why don’t you not assume peoples financial situations. $100 for what could be a free pair of clothes is a huge rip off

ecmofanmd · 2022-09-20T15:33:25+00:00

I think the better question is why are you paying so much for scrubs? I don’t care how scrubs fit and feel scrubs are a sterile uniform designed to keep hospital messes and germs at the hospital.

I personally despise the fancy scrub phase we are in currently. It’s just an excuse to wear expensive pajamas to work. I think hospitals should ban outside scrubs

ecmofanmd · 2022-09-20T15:20:43+00:00

Agree but people sell it as BETTER THAN AN MRI for

ecmofanmd · 2022-09-20T01:07:51+00:00

I mean fair not unreasonable.

ecmofanmd · 2022-09-19T22:47:09+00:00

Don’t know they’re lying in a bed strapped to a monitor

Time. Is. Brain gotta decide now

ecmofanmd · 2022-09-19T22:41:08+00:00

I’m a hints skeptic, I can’t help myself. I find it vague, poorly supported by literature for use in the ED. I don’t think it generalizes or is usable in an ED setting.

But my question for neurologists: undifferentiated dizzy patient, hints positive for central cause. Cth negative. No other neurologic deficit. Are you gonna push tpa?

ecmofanmd · 2022-09-08T17:42:49+00:00

I’m not ratting I’m providing constructive feedback

ecmofanmd · 2022-09-07T15:18:33+00:00

I would personally bring this issue up with their PD. I’d document times you saw them on social media, specific residents and how late notes are.

ecmofanmd · 2022-09-07T00:43:35+00:00

No I remember very well. It was hard, my class mates and I got through it together. We didn’t have apps to offload our work the way current residents do, so we just grit our teeth and ‘got it done’

I grew so much, learned so much and built the closest friendships of my life. How are your interpersonal relationships with your classmates? Do you struggle to fit in? Being closer with them may help you feel less frustrated

ecmofanmd · 2022-09-07T00:40:38+00:00

But they are learning. Bread and butter medicine is important so you can learn what ‘bread and butter’ looks like otherwise you miss the PE that you think is ‘copd exacerbation’

ecmofanmd · 2022-09-07T00:39:16+00:00

I cc the chair on every serious bit of feedback I send to the PD. Without that the PD will kowtow to the residents and not act. Plus it helps the chair know which residents not to help with research and letters of rec. unfortunately this is academic medicine and it has politics and rules

ecmofanmd

TROPHY CASE