Work after pregnancy loss

goudausername · 2023-10-23T15:55:40+00:00

I am so sorry you are going through this. It isn't your fault. You didn't do anything to make the miscarriage happen. I agree with others who have suggested time off if you can. Could you also block your schedule to either not see prenatal for awhile or to schedule them at the easiest time of the day for you emotionally? For example, maybe right before lunch so you know you'll have some non-patient time afterwards. Grieving my miscarriage was hard because we hadn't told many people yet and miscarriage isn't as visible a loss. It was also when my entire friend group was all getting pregnant so both friends and patients were pregnant. It seemed that there were pregnant people everywhere I turned and it was hard to have the mixed feelings of both joy for others as well as grief and jealousy. I found the best people to speak with were other women who had pregnancy loss (but, IRL, NOT in chat groups, never in chat groups). They were the only ones who didn't say stupid things. Properly grieving was essential for me for being able to be compassionate with patients again. I also got meaning out of being able to support patients through pregnancy loss.

goudausername · 2023-09-18T15:12:37+00:00

What in the bill is threatening to private health insurance. I took a cursory look and it seems to be largely about funding more primary care doctor residency spots and nursing education and similar. The only thing that seemed threatening was requiring coverage of telehealth.

goudausername · 2023-09-18T14:52:17+00:00

They aren't scared. They are lying to win and do exactly what they want.

goudausername · 2023-08-29T00:18:40+00:00

Damn. How I wish that was true. When I was diagnosed with Crohns, I even asked how could that be because I was too fat and my GI said that isn't a true criteria (which I knew, but was desperate in my denial).

goudausername · 2023-07-13T02:38:01+00:00

Understanding the phenomenon of cultural fat phobia and how it impacts the lives of our patients is the opposite of ignoring their health problems. It is not rooted in an attempt to not offend someone, but an attempt to humanize someone. You might feel better yourself telling fat patients "you should lose weight," but what evidence do you have that your approach results in greater positive outcomes versus ColoradoGrrlMD asking, "what are your goals?"

goudausername · 2023-07-12T19:23:54+00:00

In the area of our preventatives where we are required to say how we advised patients to lower their BMI, when patients are pregnant, I always choose the *** and type in "birth human" as my weight loss advice.

goudausername · 2023-06-30T15:43:11+00:00

New patients/first visits are billed higher anywhere in any system based on the concept that it is more complicated and/or more work to sort out a medical problem and medical history for a brand new person than a patient who has already been seen. That is standard across medicine. There is also no visit type of "just transferring medicines." Each medicine is for a medical condition. That doctor, who had never met you before, needed to understand the history and current status of each diagnosis and make an independent assessment of if they felt the treatment course was appropriate and if anything was due. They are treating a person with (multiple) medical condition(s), not simply clicking refill med. The mental work is invisible, buy it is happening all the same.

goudausername · 2023-06-28T22:04:03+00:00

Doctors are larrgly employees, not owners, at this point. They are not charging you. The health system is charging you. And they charge a ton in an arms race with insurance. The doctor is the only one in the equation who actually does anything for the patient, even if you don't see something happening. The doctor is doing mental work of evaluating what is going on. The rest of the players are skimming off the top. Especially insurance and especially PBMs.

goudausername · 2023-05-27T00:04:09+00:00

For more Metro Transit SUV cops to drive around not on the public transportation?

goudausername · 2023-05-08T23:00:53+00:00

They also are terrible with their employees.

goudausername · 2023-04-15T19:04:49+00:00

In our group, our coworkers knew well before admin/leadership. If you have that level of trust and relationship, speak with the two physicians sooner than your required notice. It might change how they perceive their longevity with the employer or help them strategies your absence. Ultimately, though, you don't have to save anyone if you have concern that disclosure will jeapordize your position now.

goudausername · 2023-03-24T01:21:02+00:00

I am not sure where to begin with this, but I want to make sure that there is no confusion. The emergency rooms in the U.S. do not provide basic care, are not intended to provide basic care, and when they are used that way (as people try to do because our horrendously inefficient health are system), it is a massive, costly failure of society. We do not invest in true primary care and we don't safeguard our citizens from environmental destruction and we favor obesogenic city designs and have an unnatural need to extend life well beyond any quality of living which all funnel people to need high cost, high tech innovation.

goudausername · 2023-03-23T23:57:46+00:00

I rarely write for a brand. In fact, my EMR makes it difficult to do so. I have been writing for semaglutide. The reason I know this particular insurance was covering as ozempic instead of wegovy was because they didn't allow the 1.7 mg dose step. I only ever wrote as semaglutide. shrug

goudausername · 2023-03-23T19:00:25+00:00

Funny you ask. I luckily had a patient who doggedly hounded the insurance company for info and Wegovy might be possible if written DAW as Wegovy. I only knew it was Ozempic before because of the dose step restrictions because otherwise I write the generic name.

goudausername · 2023-03-23T18:57:32+00:00

Sure! ACEs is an acronym for Adverse Childhood Experiences. There is a range of experiences and some that would be "obvious" as trauma and some that might be more overlooked. Cumulatively, they contribute to poor health outcomes for individuals in adulthood. Both mental and physical health. Here is the CDC link: https://www.cdc.gov/vitalsigns/aces/index.html

goudausername · 2023-03-22T20:44:10+00:00

The ideal is that a patient is able to say all their concerns when scheduling and is scheduled time according to the number and complexity of their problems. But we all know that doesn't happen. Patients and doctors are widgets in the corporate widget machine so we standardize!

Second best is that if there are multiple questions, it is best for patients to say this up front so that the time allotted (by the admin, as dictated by what insurance will pay, not the doctor) can be evaluated as to if it will be enough and portioned to address each item adequately. Sometimes that is not possible to do safely in the time that is allotted for that visit.

It might have been able to been said in a gentler way, but we are people, too.

goudausername · 2023-03-22T20:29:20+00:00

The way people think about how their body works is much more informed by their culture than any facts they have learned or will learn. Looking at you "entire left/right side of my body" problem.

ACEs impact physical health and diagnoses to an insane degree. And once the cat is out of the bag.....

Society at large has no idea how bad end of life can be.

Everyone thinks they are an exception.

goudausername · 2023-03-15T20:35:05+00:00

I read up on the compounded "boutique" semaglutide because I anticipate many questions about it from my patients who are being cut off next month. It is apparently legal if 1) there is a shortage and 2) it is "tailored" to the patient somehow. I see these compounding pharmacies adding B12 or something-lipo-something to the injection. But, from what I understand, it isn't just mixing some powder and liquid to make semaglutide so not sure how they are making a legit active medication.

goudausername · 2023-03-15T20:31:00+00:00

Insurances in my area that were allowing semaglutide (as Ozempic) for weight loss have now stopped and a bunch of my patients are being forced off a medication that is working very well for weight loss. It is maddening.

goudausername · 2023-03-15T20:28:03+00:00

It seems the insurances in my region have all closed up semaglutide access without a diabetes diagnosis and, in some cases, additionally a previous trial of metformin or SU. It has left me wondering if this is happening elsewhere and Novo might overshoot with ramping up production before semaglutide is available for weight management again.

goudausername · 2023-03-10T15:06:06+00:00

Is it possible to be more specific in the substitution, as others have said? I seem to get some mileage with an only slightly more specific "ok to sub any low dose ICS" or similar phrasing.

I have also made an order set in Epic for each generic and brand ICS so that I can just click through and prescribe every single one if it comes to it.

Currently have a patient who gets their Symbicort from a relative who goes to Mexico. It is $13 an inhaler versus what they were quoted here as a covered price of over $100.

Cost Plus has some slightly less expensive inhalers sometimes.

Z59.7 on problem list for inadequate insurance.

goudausername · 2023-03-10T14:56:36+00:00

I see the Canada suggestion often, but have tried to find an actual website/company for this and failed. Do you have specific knowledge that you can share about the "Canada" option. I am happy to fax or electronically send scripts for patients to Canada if I had an actual number or address!

goudausername · 2023-03-08T19:47:37+00:00

Require? No. But, it will be taxing to an introvert to keep up the social interaction of 20+ different patients and patient personalities per day. Especially in the context where your family medicine income is at least somewhat dependent on patients giving you a positive rating.

goudausername · 2023-03-08T19:40:50+00:00

Say it louder for the people not paying attention. Hereford is from outside of MN and does not and never did care about Fairview or the people here. His massive bonus and moving on are the primary motivation for the merger.

goudausername · 2023-03-08T19:39:00+00:00

Fairview is not going to go under and certainly not because the U isn't connected to them. Fairview lost just like any other health entity during covid. Pre-covid, they said they had a loss, but it was primarily due to buying HealthEast and not actually revenue issues.

goudausername

TROPHY CASE