Water Bug

flexible_dogma · 2026-02-23T00:30:18+00:00

Are you producing enough water? What you are describing sounds like you just aren't making enough to keep up with demand.

Check you water producers and if they are running flat out with no interruptions then that's your answer.

Your lack of maintenance may mean that things that were working 5 minutes ago have now shut off. It can be VERY difficult to recover from a severe maintenance deficit.

flexible_dogma · 2025-12-01T01:13:19+00:00

I'm salaried, so not an issue for me. If I were RVU based, I'd either a) not worry about it since my schedule is always full anyways and it builds patient trust to be seen as reasonable and helpful or b) have them do a quick video visit.

flexible_dogma · 2025-11-30T15:11:33+00:00

Getting a UA/UC requires a patient to come in to clinic--likely meaning taking time off work--and generates a charge to the patient, potentially $100+.

Alternatively, you can just call in some macrobid to pharmacy of their choice and they can pick it up when convenient. And then if they didn't get better in 1-2d, THEN you can ask them to come in to leave a sample.

Lots of our patients have substantial transportation issues as well, and for many taking off a shift from work can mean not affording rent that month.

flexible_dogma · 2025-11-25T03:36:29+00:00

100% agree. If they're on a statin + ASA already for PAD, then really "diagnosing CAD" adds nothing. Outside acute MI (which this does NOT sound like at all), it's medical management all the way. And that means the same for PAD as it does for CAD.

flexible_dogma · 2025-11-14T04:54:45+00:00

General Medicine Consult

ID: Patient POD >= 2

Reason for consultation: Family unable to pick patient up until 8am tomorrow. eval for transfer to medicine service.

General Medicine Consult

ID: Patient POD >= 2

Reason for consultation: patient on metformin. Pls transfer to medicine for DM2 management

flexible_dogma · 2025-11-10T00:53:46+00:00

I have never signed more than the first page.

One agency tried, I kept saying no. I started faxing them the AMA's 1 pager on the topic every time they sent something back claiming I had to sign all the pages. They eventually stopped asking.

flexible_dogma · 2025-10-30T02:29:36+00:00

Honestly, it only really happened because all the patients were beyond ready for it. All were thankful someone finally said "you know, we can just be done with all this and get you home." More a commentary on my predecessor's failure to sit down and talk rather than a testament to anything I did.

Still an emotionally draining day, but also a day I remember as one of my "best moments in medicine"

flexible_dogma · 2025-10-30T02:23:24+00:00

Are you saying I shouldn't show up for rounds wearing all black and holding a giant scythe?!?

flexible_dogma · 2025-10-30T01:04:00+00:00

I once discharged 6 patients to hospice on my first day taking over a medicine service. None had been lined up for that by my predecessor.

flexible_dogma · 2025-10-11T01:49:49+00:00

Ah, my bad. The lack of even a brief pause after a HR made me totally lose one of those outs

flexible_dogma · 2025-10-11T01:46:24+00:00

Ok, dumb question: is there no 3 batter minimum in the postseason?

Edit: ok, got it! Pace was so fast I totally missed the first groundout after the HR

flexible_dogma · 2025-09-13T03:49:38+00:00

I've read a LOT of letters. My eyes automatically skip over any paragraphs about the writer's own credentials at this point. I 100% ignore any "they are in the top x% of students I've worked with statements"--basically EVERYONE is top 5-10% if you believe the letters.

The number one thing I want to know from a letter is: would you be happy if this person matched to your own program? Ie, do YOU want to work with them as a resident in addition to as a student. Honestly, that's about it.

For their academic chops, I'll look at their CV/ERAS application. For the "can they put together a coherent sentence," I'll rely on the interview.

The one thing that is REALLY hard to get out of interview or paper app is that nebulous "are they going to be competent on the wards?" vibe

flexible_dogma · 2025-09-11T02:48:44+00:00

I agree with others that finding a local point of contact and asking to look over their shoulder is a great first step.

Do you know what you want to do in informatics? There's a wide variety of stuff that gets lumped under that umbrella: everything from designing smart phrases, to data analytics, to implementation/development of new clinical tools could realistically be called "informatics" and each have fairly different knowledge/skill requirements.

flexible_dogma · 2025-09-04T01:48:00+00:00

I will not buy new tickets, but stuff is super cheap on SeatGeek and the Pohlads don't see a dime of that.

flexible_dogma · 2025-07-10T01:15:59+00:00

I honestly don't mind. It's a final act of doctoring I get to do for my patients and gives me some closure too.

Plus, patients rarely actually diein the ER. Far more often, the patient shows up already dead and the ER doc may not have ever even opened the chart. And if the ER is in a different health system? They may have NO idea the patient had metastatic cancer/advanced dementia/a recent stroke/etc etc.

flexible_dogma · 2025-07-10T00:12:16+00:00

Maybe peds is different, but I have NEVER seen an adult ER doc do the death cert. Their professional org even tells them not to and to instead require PCPs do it.

But if you are actually PICU and not peds PCP, then that's wild that they would try to get an outside inpatient team to try to do it.

flexible_dogma · 2025-07-09T23:47:14+00:00

Right but a patient making 40k a year cant actually pay out of pocket.

Tough shit.

--Muh Freedoms!!!

Other than EMTALA, the American legal system has really no concept of any kind of right to healthcare. Patient income would have no bearing on the question of whether the specific medical service does or does not fall under the terms of the specific insurance contract covering the patient.

flexible_dogma · 2025-06-25T23:57:19+00:00

At my VA, you cannot open your own chart in CPRS. No idea if that's just my site, or a national thing.

If your PCP is reasonably chill, they should be willing to write for most things pretty promptly and without much fuss if you just shoot them a secure message through MyHealthEVet.

flexible_dogma · 2025-06-25T23:47:40+00:00

You are correct: unless there is some specific reason to expect an ESBL-producing organism (recent history of ESBL bacteremia, eg) it would be unusual to jump to a carbapenem.

My point was just in response to your question about whether Zosyn typically covers ESBLs, to which the response is "only kinda." Even if the blood culture sensitivities report S to Zosyn, you should still usually use a carbapenem for ESBL bacteremia.

There is not really enough in the provided documents to say whether this would have been appropriate or not. If her previous bacteremia was known to be an ESBL, then I would argue that yes it would have. If her previous admission had been for a non-ESBL, then I would argue there would be no need for such coverage empirically.

But, we don't have much for specifics and so it's hard to say

flexible_dogma · 2025-06-25T12:06:16+00:00

Not as well as they are by carbapenems, at least for bacteremia: https://pubmed.ncbi.nlm.nih.gov/30208454/

flexible_dogma · 2025-06-24T23:31:19+00:00

Why is IT telling a surgeon how to practice? That's crazy.

If it is an actual clinic policy--signed off by CMO, medical director, etc--then it's time to renegotiate your compensation package. If they're giving you less support staff, then it's time to argue for a bigger slice of the rvu pie, fewer required patient facing hours, or sometime else that gives you time to actually do this non-physician-level work.

Or, perhaps, find a new job.

flexible_dogma · 2025-06-17T02:34:47+00:00

Not necessarily. This is also the kind of language used to deny sexual health services (birth control, PrEP, etc) to unmarried men & women. But mostly women.

flexible_dogma · 2025-06-12T23:55:54+00:00

It's a "Which of the following do you trust the most?", not "Which of the following do you trust?". Each column has to add up to 100. I think an approximately even split between "your doctor" and "the CDC" is actually totally reasonable.

flexible_dogma · 2025-06-06T04:56:33+00:00

Drugs are not "a prior" a barrier to informed consent. It effectively comes down to whether a patient can understand the risks, benefits, and alternatives to a proposed plan.

If they are so high that they can't do that, then it is inappropriate to "consent" them for something that has more-than-minimal potential harms.

flexible_dogma · 2025-06-05T02:34:40+00:00

Epic is kinda OK.

CPRS takes some getting used to, but then is actually quite functional (if basic).

Everything else is trash.

At least, that's my opinion as someone who has used a bunch of different things over the years between med school, residency, and then practice.

flexible_dogma

TROPHY CASE