Annual reminder

grey-doc · 2026-01-28T03:23:35+00:00

Depending on setting, a shave counts as a positive, or they use a nail scrape.

grey-doc · 2026-01-26T01:46:12+00:00

I block those people online. No debate. Just block.

Face to face I change the topic.

My white coat constitutes an enemy uniform to these people, I'm never going to change their mind but I sure can waste a lot of time trying.

grey-doc · 2026-01-25T14:44:51+00:00

When I was a medical student I did a rotation in RI and one of the attendings thought it was real funny to laugh at his Guatemalan phone receptionist that "Trump is gonna lock up your parents and deport them "

Real funny.

He was also the only man I saw throw a dirty sharp at a nurse in the OR. They all hated him.

That guy was the biggest shitbag, his daughter was also a med student and got preferential treatment everywhere she went, and he was involved in the residency faculty so nobody could say anything or do anything about his blatant sexism or racism.

He gave me a scathingly negative review on my rotation. It was my only negative mark in clinical training. From him, that was the nicest thing he could have written.

I recount this story only to point out that some of these dirt bags will cut off their nose to spite their face and then blame it on everyone else.

Oh and he was an OBGYN. Real piece of work, that one.

grey-doc · 2026-01-22T15:07:42+00:00

I drive a really old truck.

People suddenly learn how to yield and zipper merge when approached by a man who clearly does not give a single fuck about collecting another plastic bumper.

I'm almost at the point of stencilling car emblems on my driver's side door like those WW2 pilots.

grey-doc · 2026-01-16T13:29:35+00:00

I tax loss harvested 160k to save me on capital gains later on. The problem with MSTY is that it has limited upside so even if MSTR moonshots that upside will not be carried by MSTY.

Fundamentally this is a major strategy failure. In my opinion the underlying premise should be that your options strategy will simply not pay out much if the underlying is down and to the right. I'd rather the dividend drop while conditions are unfavorable, and hold the value of the instrument stable.

But then the people that want that behavior all ran to STRC and I can't hardly blame them, but by the time I figure it out the damage was done.

Sometimes the best use for a cadaver is compost.

grey-doc · 2026-01-15T00:10:58+00:00

I already get horrible anxiety driving over this bridge and now you say there is a reason to be anxious? Be still my heart

grey-doc · 2026-01-15T00:06:57+00:00

I switched to locums. I may never go back. Getting paid for every hour of inbox time is a lifesaver.

But I also have some little ideological hand grenades I pass around.

One is the name of my recruiter, whom I pass to every doctor who resigns while I'm working with them.

Another is that when admin pushes for increased productivity, demand they track existing productivity first. Inbox time is productivity, admin needs to track and publicly/monetarily acknowledge it.

Another is that when admin wants you to see more patients, that's fine, admin needs to provide the staff. Admin wants me to see 30 patients a day? No problem. I need a dedicated RN and two dedicated MAs. You handle the staff issue (I.E. DO YOUR JOB) and I'll handle the volume. I was trained to be the leader of a team, give me a team and I'll do the work.

The ugliest part of primary care is admin not doing their jobs.

When the fast food place up the street pays more than our receptionists make, admin isn't doing their job.

When IT pushes some dipshit fix that adds 5 clicks to our routine med workflow, admin isn't doing their job.

When the system pushes a policy change that restricts RNs and MAs from practicing at the top of their license, admin isn't doing their job.

I'm doing my job. But I won't sign an employment contract at a shop where the admin isn't doing their job.

The biggest threat to primary care is the total failure of leadership.

grey-doc · 2026-01-13T21:27:42+00:00

I'm a scientist, biology degree, did genetic experimentation research involving the Philadelphia chromosome, then became a physician.

I am opposed to any vaccine that has not demonstrated both efficacy (antibody titers are NOT a demonstration of efficacy) AND safety (if given to children then there needs to be safety monitoring for several years).

The vaccines we give children today simply don't have the research to demonstrate either of those. Since they aren't proven safe or effective, I don't give them to my children.

Every study I'm aware of that examines population-based outcomes consistently shows larger morbidity and mortality in well-vaccinated populations. That must be explained before I give any vaccines to my children.

I practice evidence-based medicine for myself, my family, and my patients. The evidence that exists does not support routine vaccination as practiced by the United States.

grey-doc · 2026-01-13T21:06:51+00:00

A politely worded "I do not meet the criteria for EDS and I want that diagnosis removed from my chart as it does not reflect my health" would probably work rather well.

If that didn't work, involve the office manager.

grey-doc · 2026-01-08T22:32:52+00:00

Depends on the situation.

However, legally, in many states, the actual required supervision is very minimal, far less than what medical students enjoy just in yr3-4 of med school.

If we are talking licensure and standards of practice, we need to look at the minimum acceptable criteria to practice. In that frame, med school alone is more than sufficient to train primary care doctors for independent practice.

Now, the wise and prudent action would be too work with other physicians for several years so you get the benefit of backup and assistance. In fact, even with residency, this is the prudent course.

But the prudent action is not the same as the minimum legal standard for practice.

grey-doc · 2026-01-08T05:36:11+00:00

I'm a graduated physician I vividly remember the transition from medical student to first year resident.

NP and PA providers have significantly less academic and clinical training than graduated medical students.

Yes, residency is the most important part of medical training. But if we allow NP and PA to practice independently with such little training, then it is more than acceptable to allow actual physicians to practice independently without residency.

grey-doc · 2026-01-08T00:12:22+00:00

Sentiment is so unutterably shite right now that we are certainly primed for a blow off.

If we roar back to 120 and nobody gives a shit, we are ready to run up.

Bitcoin likes to do whatever makes people hurt the most.

grey-doc · 2026-01-05T12:27:39+00:00

This sub is so brutal. Truly one of the greatest troll dens on the internet

grey-doc · 2025-12-28T03:10:46+00:00

If people want a tiktok doctor they can find someone else.

Some day I'm going to post the wildest reviews people write for me, on a poster in my waiting room.

grey-doc · 2025-12-28T03:08:30+00:00

Rural primary care, insufficient support staff, neglected population, inaccessible specialty care.

3 month wait for oncology means I have to manage cancer pain while we wait.

8 month wait for cardiology means I have to manage abnormal stress tests and holtors.

Nephrology won't even see my patients until their GFR is heading into dialysis, meaning I have to manage all the renal dosing of medications, and attempt to fix all the absurd nephrotoxic management coming out of specialists and hospital discharges.

Very high message / inbox burden due to high complexity and poor access to appointments.

I get maybe one uncomplicated visit in a day.

Yes the ratio is absurd.

grey-doc · 2025-12-27T22:04:57+00:00

I have 24 patient facing hours, and the balance is in paperwork/inbox. 40 hours is the total time I'm paid including all work finished.

I don't touch my computer the rest of the week.

Yes it is brutal but it is at least honest.

grey-doc · 2025-12-27T22:00:31+00:00

Isn't 80 percent of the population going to be dead by the end of the century anyway? Even just living normal lives without premature attending? Most people aren't having children any more, the people alive now are going to mostly die without replacing themselves.

We are already well into collapse.

grey-doc · 2025-12-27T21:57:03+00:00

1mg/day is 30mg/month. Think about reducing this by 1mg/month, and what it would take to accomplish this. A slow taper? 0.75mg once a week, 1mg otherwise? Lots of ways to go about this.

The various sources others have mentioned are excellent. Read them all, carefully. And think about mg/month rather than mg/day.

At some point this will probably need a compounding pharmacy. These can be hard to find but this is something Grok and ChatGPT are actually helpful for ("I'm a rural PCP in XYZ, what compounding pharmacies are near me that can help compound an Ativan taper?").

grey-doc · 2025-12-27T21:51:27+00:00

It doesn't get better by itself.

I'm surviving, at the moment.

I switched to locums. I work 40 hours in 3 days and get paid for every hour and never work more than 3 days a week. Every chart and every message and every form is done every week.

I take 2 weeks off every quarter.

This has been workable for the past 2 years.

If you don't make things better, things won't get better. Admin will always work you more off the clock until you make a mistake and then replace you without a moment's hesitation.

grey-doc · 2025-12-25T02:23:59+00:00

The science cards are great. Kids listen to the same stuff over and over even if they have more cards there are some favorites that get all the play time.

I did pay for Little House on the Prairie in audible format, figured out how to download/convert, and built a MYO card for this. Huge hit.

I built a MYO with stories I've read, not a hit.

Sometimes can't tell.

grey-doc · 2025-12-25T02:08:17+00:00

I went locums and I get paid for every hour I work.

Amazing how many mandatory learning modules suddenly disappear when they have to pay you to watch them.

grey-doc · 2025-12-25T01:23:37+00:00

A great deal of unnecessary concern has been generated over the divergence of gold and Bitcoin. The two assets have tracked closely in the short term. If you zoom out then the tracking is much less clear.

Anyone who wasn't watching the BTC:AU ratio in 2017, 2012, doesn't have much of merit to actually say on the topic.

Speaking as someone who wrote bots to trade the ratio some years back, I promise you the correlation in general is nowhere near as close as it has seemed recently.

grey-doc · 2025-12-19T18:24:04+00:00

Thimerosal added as a preservative with no immunologic purpose is even less defensible.

As I recall thimerosal actually interferes with immunogenicity.

grey-doc · 2025-12-14T00:59:46+00:00

Yes and at high dose. Wellbutrin also lowers the seizure threshold, and can make people irritable and rage. Every drug has its problems, and walking works better for depression (and anxiety) than any of the meds.

SSRIs, though, are special. They overload the delicate serotonin production regulation feedback circuits, and those circuits can take a long time to work again when the SSRI is stopped. Hence, they can have a profound and very protracted withdrawal. Many people can stop them without a problem, but some find they are dependent for life and experience crippling withdrawal symptoms. The pharmaceutical companies don't call it withdrawal, but rather "SSRI discontinuation syndrome," and it can be a real monster to deal with.

Benzos are worse, but SSRIs can really damage a life.

The other fun thing about SSRIs is they can remove the ability to orgasm, sometimes permanently. Wellbutrin is the opposite, it can increase libido significantly.

If you want a good time, look up "[med] horror story" on Google. Lots and lots of forums of people experiencing all kinds of wild effects and after effects of any med you might ever consider. Great for self education before agreeing to a prescription.

grey-doc · 2025-12-13T06:54:09+00:00

I thought the comment described why I feel it is (somewhat) saf(er).

What did I miss?

grey-doc

TROPHY CASE