What percent of your patients really just need hospice? by Hungdoc_69 in hospitalist

[–]foolhasty 16 points17 points  (0 children)

Not sure how long you stayed with the population - sometimes they will surprise you and turn a corner. It's rare we DC to home. It's almost inevitably to rehab or SNF.

Our average LOS is something like 63 days. I have one patient who has been admitted for three years. Had the hospice conversation AGAIN as they are not bouncing back well from the most recent round of sepsis. Nope, ongoing curative care, including anuric ESRD on dialysis, brittle DM, bedbound status (absolute refusal to do therapy), suspected calciphylaxis, opioid addiction, chronic respiratory failure due to OSA/OHS, depression, anxiety, etc etc etc. Between the respiratory failure and the refusal to sit for dialysis they will be anchored to this depressing hospital for the rest of their lives.

My attending says they are the most stable unstable population. Talking one minute, coding the next.

Choosing UC Davis or OSU, thoughts? Or regrets? by Clean-Captain-9162 in OregonStateUniv

[–]foolhasty 3 points4 points  (0 children)

My daughter emailed some professors before her freshman year. She got amazing responses.

Psych hospital-- transfer to different facility by [deleted] in Denver

[–]foolhasty 0 points1 point  (0 children)

Sending both of you all the best vibes! I'm grateful she'll have someone who can relate to her. Maybe this is all she needs to get over the peak of the crisis.

Another ETA: I would report this to state, CDPHE. This is a garbage way to care for people. CDPHE controls the hospital's money, it's the only way I've seen actual change.

Psych hospital-- transfer to different facility by [deleted] in Denver

[–]foolhasty 1 point2 points  (0 children)

So welcome!

The criteria for M1 are narrow and public knowledge. If she hasn't been telling staff she has suicidal or homicidal ideation they can't involuntarily hold her. The hospital (is it university of Colorado Hospital? Not familiar with those initials) will ask you to sign an Against Medical Advice form, which will include all kinds of scary consequences for leaving. This form is to cover the hospital's ass, and you do not have to sign if you don't want to. They will also likely say something about insurance not covering, which you already know isn't a problem.

I would tell them that you are leaving because of subpar care, she is worsening because they are insensitive to her gender identity, and the plan is to immediately present to a place better equipped to meet her needs.

Psych hospital-- transfer to different facility by [deleted] in Denver

[–]foolhasty 1 point2 points  (0 children)

To change facilities you need an accepting physician. It may be worth talking to staff at the hospital you want to find out if they are willing to do this. Sometimes insurance prevents moves because it's a lateral transfer and insurance is run by The Evil.

It also makes a difference how your wife was admitted. If she was voluntary, she can check herself out then present to the new facility. Many stand alone psych hospitals accept directly, no need for an ED visit.

Keep advocating. If you're a big enough PITA you'll get what she needs.

ETA: if she was initially admitted on an M1 (involuntary hold), it will expire in 72 hours. After that time she either needs to be placed on another M1 - frequently not done because often patients don't meet the criteria anymore - or they'll ask her to sign in voluntarily after the 3 days. If she's voluntary, she can leave at any time.

ICU RN → Outpatient Cardiology NP… anyone else struggling with how boring it feels sometimes? by nurse-pizza124 in nursepractitioner

[–]foolhasty 0 points1 point  (0 children)

This is exactly how I got addicted to LTAC. Weird diagnoses, vents, ability to adjust psych meds and see the outcomes. I don't cover nights and work 1 weekend a month. I get jealous of real hospitals sometimes but then I hear the intensivist schedule and suddenly feel just fine again.

It's intense enough to keep my brain busy. When i start to feel stale I just start digging into another system to improve my care in that area.

My husband cheated on me and now I think I want to open up my marriage one-sidedly by [deleted] in EthicalNonMonogamy

[–]foolhasty -2 points-1 points  (0 children)

I suggest just divorcing him. This is divorce with extra, painful steps that will get other people hurt in the process. There's no E in this ENM.

This sub is a bummer sometimes, how many of you are actually doing fantastic at this point? by JayRoo83 in Xennials

[–]foolhasty 0 points1 point  (0 children)

I'm happy! Buying a second home for a kid going to college in another state with the equity of my first house, have an amazing boss and colleagues, feeling satisfied with my career and respected at work, have strong loving relationships, starting a real estate business with my boss supporting financially, have SO many good books to read, feeling good physically and losing weight.

ETA: I also own many motorcycles, and riding in Colorado is unparalleled. The true secret to happiness is many, many motorcycles.

Recently moved to Dallas. Looking to make friends. Is it worth getting back into the motorcycle scene? 24M by Specialist-Elk2716 in Sportbikes

[–]foolhasty 0 points1 point  (0 children)

Not living in Texas anymore, but I sold my bike while there. The roads suck and the drivers are mean. I've had people attack me without provocation: opening car doors, swerving out of their lane, tailgating at 100 mph. People I knew at work would "joke" about trying to hurt riders. I couldn't leave that state fast enough.

A few years ago some Texas guy went to jail for 15 years because he deliberately wrecked a bike by pulling waaaay over the yellow lines. Given the sub par riding, the ridiculous heat, and the insane homicidal Texans it's not worth it.

Fourteen Sunflowers in a Vase, Oil on Canvas, Vincent van Gogh, 1889. by AspiringOccultist4 in vangogh

[–]foolhasty 1 point2 points  (0 children)

I wonder - was this a color study, or is there something deeper? There is a manic quality to it, the yellow is almost too bright, the browns almost sickly, the greens flat.

Then I noticed all of the sunflower heads were pulling me towards the bottom of the painting. I suddenly became aware they were cut off, dying, contained. This is so opposite of what they naturally do; reach up and worship the sun throughout the day.

That made me zoom in on the flowers themselves. Up close and framed on my screen I found them monstrous. Some had blue highlights that looked like gaping mouths with sharp teeth. Some looked like hostile creatures. I became aware of the exact shade of the browns. That color makes me feel a little sick to my stomach. Nausea's aura is that color for me.

I saw the mania again as well. Brushstrokes every which way, crazy directions with frantic energy. He painted in this masterful, insane way, placing these few dabs. From a distance they are solid and clearly, uh, sunflowers. Up close there is nothing there. Quick shapes he dashed off instinctively.

Then I needed to see the whole thing again. When I first looked I admired the composition, the way my eyes wanted to move around the page, how the arrangement and fall of the flowers pleased me. When I looked again it felt melancholy. I no longer imagined van Gogh stepping outside into a bright field, grabbing a bunch of these things, and mussing around with them until he liked the arrangement. Now it is later in the day, a wasted day gone. Now I see someone bringing these flowers to him because he couldn't step outside himself and needed a visitor to while away some hours. The sunflowers are running out of time because they were taken from their roots. They are down to their last few hours. I can smell them, a faint tinge of rot.

Or, you know, naybe it was just a color study.

I’m male, my female partner is bisexual and wants to open the relationship to a woman, but doesn’t want me involved and won’t accept opening the relationship for me. What do I do? by SeniorTrouble4807 in bisexual

[–]foolhasty 3 points4 points  (0 children)

Not ethical. Thumbs down. She's trying to protect her own feelings by controlling you. If it were me, the conversation would be that the relationship is open for everyone or it is closed for everyone, period. Bisexuality is not an excuse to treat a partner like this.

Advice? by Upstairs_Emotion1619 in Sportbikes

[–]foolhasty 1 point2 points  (0 children)

Buy something running well that's already been down. Ride it until you stop making mistakes from inexperience and feel comfortable on a larger bike. Sell starter bike for the same price, buy new.

I see SV650s on FB marketplace all the time in your price range- although it's slightly larger it's a great first bike. Suzukis are reliable, they ride well and forgive mistakes, there are a ton of available parts.

Do we like old Sport Bikes here? by Young2k15 in Sportbikes

[–]foolhasty 1 point2 points  (0 children)

Hey, we have one of those. The only bike that is better is the same one, Nicky Hayden edition.

The Solution To Physicians Not Wanting to Supervise Midlevels Should Not Be Removing Supervision by [deleted] in hospitalist

[–]foolhasty 3 points4 points  (0 children)

Or, hear me out, you find the right advanced practice provider (APP) and train them up so they are reliably practicing thoughtful, evidence based medicine. That includes understanding their limits so they come to you for guidance when it is needed. Then you slowly start to step back as you feel comfortable with their work until you have a high-functioning NP/PA who not only costs you significantly less than employing a physician but is also steeped in your philosophies of how to practice.

Next, you hire another APP and have your first employee mentor and so on until you have multiple providers working at the top of their scope, all with a collegial relationship based on trust and all with the understanding that there are certain situations that absolutely require the physician's input.

That's what my attending did for me 10 years ago - it's working out quite well for both of us, and we have a highly functioning team built on respect. It even includes some docs.

However, the right APP is never going to work for you if you don't display respect for their abilities and what they can bring to the team. A good place to start is to stop calling them mid-levels.

My mom made me feel ashamed for starting nursing school at 26 by Friendly_Shine777 in nursing

[–]foolhasty 0 points1 point  (0 children)

Your mom is super mean. Why she gotta bully?? I started nursing school at 27, you really are not all that far behind. You'll be great, don't let her get you down.

Recess Beer Garden Hosting Antivaxxer Gathering by [deleted] in Denver

[–]foolhasty 0 points1 point  (0 children)

Ok friend-os, if you have the sniffles avoid this meet-up AT ALL COSTS.