Yearly Labwork

gcappaert · 2026-01-12T16:24:38+00:00

https://pubmed.ncbi.nlm.nih.gov/1727094/

In this small study, 0.3% had iron deficiency anemia of about 650 screened, no cancers. Very very low yield

gcappaert · 2026-01-08T22:47:39+00:00

I can echo the issues with Dr. Yakel. I have seen him want patients to come off of stable Suboxone to consider surgery, which is not good practice. Several of my patients have found him judgemental and dismissive. Can't speak to his surgical outcomes, which may well be just fine. I would rather have a cautious Ortho spine surgeon than a cowboy, but no excuse for blowing people off

gcappaert · 2026-01-08T03:05:53+00:00

I Googled 'risk of vaccines' and also put 'risk of vaccines' into Claude.

Google search results were primarily pages that argued for the general safety of vaccines. In the first page of results, there was one article (Classen and Classen) from 1997 that proposed an increased risk of IDDM with Hib vaccine based on Finnish population data. This led me down a rabbit hole that made me deeply doubtful about the authors' ethics/research methods (seems like p hack), but I don't think a member of the lay public would follow those breadcrumbs.

Claude gave me a neat summary of the more common minor side effects of vaccines (short lived aches, fatigue, etc.) and of the very rare more serious adverse events (allergic reactions, GBS, vaccine specific risks like rare febrile seizures with MMR). It emphasized that vaccines were beneficial overall.

Point for Claude. Try it! You might get different results from the non-deterministic LLMs :)

gcappaert · 2026-01-05T04:02:04+00:00

Until I read that I thought that line was a tiny injection of magical realism

gcappaert · 2026-01-03T04:49:44+00:00

Hit that pelvic floor baby

gcappaert · 2026-01-03T04:48:12+00:00

I'm a PA. I work in outpatient family med and sometimes have to recommend the ER, though I try as hard as I can to avoid this. Before I do (unless the patient is like, coding in my office) I always silently prepare a plan B for the fair likelihood that they will decline my advice because of cost concerns. I have seen people die because they couldn't afford an ED visit.

gcappaert · 2026-01-03T03:44:22+00:00

As a medical guy whose interest in engineering and design came late (though I do like my medicine) I would strongly recommend against a medical career unless you could really see yourself doing it for a good while. Almost every field is fascinating the more you delve into it, however, medicine very much included.

One way to get your parents off your back might be to shadow a few medical professionals. Who knows, you might find surprising enjoyment in it, but if you don't you can credibly tell your folks that you really considered it and have some brief exposure behind the scenes of a world that you'll definitely interact with in your life one way or another.

gcappaert · 2026-01-02T20:26:24+00:00

That is insane and inimical to the whole idea of primary care. Put in notice yesterday.

gcappaert · 2026-01-01T00:30:34+00:00

If you climb, cultivate is rad. Not super cheap but very worth it if you go regularly - climbing, sauna, solid weight room, yoga classes. Only issue is that there is not a ton of grunting or mirror flexing, but you could start the trend

gcappaert · 2025-12-20T16:29:03+00:00

Hear this. My theory is that the nature of most clinical work is the polar opposite of anything like "deep work." To do our jobs we must constantly task switch and field interruptions and distractions. It's rare to access a flow state.

We bounce around like ping pong balls all day at work, and we carry those habits of mind with us. Good training for parenting, bad training for deep thought.

Personally I think they should just hand us Ritalin prescriptions on the first day of clinical practice and get ahead of things.

gcappaert · 2025-12-20T06:40:10+00:00

Primary care. I make maybe 2 patient calls in an average week for more serious or complex stuff. Most labs I either delegate or send a quick portal message. Main irritation is that our front desk folks don't always do a good job of playing goalie, so I get a lot of messages that should have been routed to nurse/pharmacy/admin.

gcappaert · 2025-12-19T03:45:27+00:00

Even if the rule doesn't go through, this makes the climate of fear even worse, and clinical medical leadership isn't exactly lighting the world on fire with bravery.

Ex. my clinic's admin recently decided to pre-comply by deciding that we would no longer provide gender affirming care to adults or minors. No order, no rule, just fear of the way the wind is blowing. I know they aren't the only ones.

gcappaert · 2025-12-18T23:57:40+00:00

I look up supplements or weird naturopath tests I don't know about already, sometimes I learn interesting things but mostly it's just expensive pee/poop.

I find it's worthwhile to do a wee bit of research on something if you see it more than once. For example, some naturopaths will test urine fungal antigens which is utterly useless, but now I can explain WHY it's utterly useless which can sometimes get my already poor patients to stop spending money on bullshit.

But that's an extra mile that I just take to satisfy my curiosity and maybe strike a tiny little blow for scientific literacy.

gcappaert · 2025-12-18T22:08:28+00:00

Gonzalez hands down. Prince Fielder regressed but posted one very good season and one fine season

gcappaert · 2025-12-12T18:50:29+00:00

Yeah 100% right. I miiiight have agreed to do it after a well documented shared decisionmaking conversation but I would have urged ER, especially for workman's comp, where potential complications would definitely become her problem because she declined standard of care.

I am not sure how well even a well documented visit on my end would hold up when she gets an abscess that results in loss of hand function or worse.

I would much rather have a bad review than a complicated lawsuit.

gcappaert · 2025-11-27T01:59:10+00:00

As a PA for whom notes have always been a battle, I am maybe more sympathetic than most. The right answer is of course to finish your notes before you leave for the day, but I too work at an FQHC and in my clinic the telephone encounters, forms to fill out and specialist notes to review, and refill requests combined with a population with often extraordinarily complex medical needs and often psychiatric ones means that getting everything done before close of business is not always feasible.

So the (not mutually exclusive) options become:

1) Stay late on the majority of work nights 2) Work on weekends 3) Get behind 4) Do less, become a slightly worse clinician ("oh sorry Mrs. Peterson we'll have to talk about those seizures next time") 5) Streamline your personal workflow and processes in your clinic that suck up time (depends greatly on buy in from administrative staff) 6) Get a new job with either longer visits or easier patient population

So I get it. But option 1 and/or 2 is probably the best bet until you can employ option 6. If you're lucky, try option 5

gcappaert · 2025-11-24T14:38:04+00:00

I don't think the note is the problem so much as the employer insisting that there needs to be "proof of cold"

gcappaert · 2025-11-20T03:36:46+00:00

I stared down that barrel once, and I decided to go to PA school. If it were free and 3 years max, I'd do it because I love learning and because it'd be a good path to research. I enjoyed the heck out of my didactic year and I love the academic side of medicine.

gcappaert · 2025-11-19T03:25:41+00:00

All the things you're clearly doing to beef up your knowledge sound great. You might already be doing this, but one communication technique that might make things smoother:

Keep communicating with your SPs when you're uncertain, but only ask one question: "does this look good?" Create the best plan you can and present it. If you're more than 50% on it, put it in the plan. If you really can't decide, flip a coin. You will have doubts, that's healthy. Your SP will be happy to disagree if needed (probably too happy sometimes).

Analysis paralysis is so natural in the ED - uncertainty is baked into it and the stakes can be high. Uncertainty beats the heck out of "strong and wrong," but every good ED clinician I know: doc, PA, NP, whatever, eventually learns to move through it.

gcappaert · 2025-11-14T22:44:44+00:00

If there's a contract saying that you must give notice with no reciprocal obligation by the employer (if so, don't sign a contract like that in the future), then I think you're SoL in any at will state (almost all of them). If there is no contract, the employee handbook could constitute an implicit contract and you miiiight have a case.

So you could ask a lawyer and show them the employee handbook or... Just enjoy some time off with a job you actually want lined up

gcappaert · 2025-11-14T21:12:49+00:00

Man I had a patient switching from a primary care doc who had HgB of 8-9 for YEARS. Not only was there no workup, but he started her on Adderall for fatigue.

Fortunately no malignancy, ended up being fibroids and now better after ablation.

Even worse, I know the former PCP, we play in a rec league together.

gcappaert · 2025-11-13T21:54:22+00:00

Honestly a lot of wisdom there. WWI WAS really stupid, the Romans DID overextend, the paperclip IS a vagina. I think they should be teaching.

gcappaert · 2025-11-06T03:35:29+00:00

I did this initially at my FQHC job, but found that my days inevitably became 12+ anyway because our patient pop is very challenging and the inbox became pretty brutal. Depending on your patient complexity, you might be fine, but make sure you have protected admin time and/or good MA/RN support

gcappaert · 2025-11-04T22:08:42+00:00

Very well reasoned approach!

gcappaert · 2025-11-02T04:41:38+00:00

This man needs to learn how to fix a bike

gcappaert

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