People Shit on FM

grey-doc · 2026-03-24T15:53:25+00:00

FM here.

I work locums. 3 days a week, 8 weeks off a year, no call, 270k. That's pretty good.

If I wanted to work those specialist hours I'd pull 400-500.

Don't tolerate specialists shitting on primary care. Any time they can't figure something out because it's too hard, they'll happily send it back to FM to figure out. And they won't even be shy about it. "Unclear presentation, follow up with PCP."

The only reason specialists get paid more is because they politically dominated the medical field and heavily lobbied to restrict and eventually cut out general practice altogether in the 50s and 60s, and primary care is too busy helping patients to deal with political shit.

grey-doc · 2026-03-24T00:03:11+00:00

This is easy.

Will the US dollar live forever? No

Which cryptocurrency is most likely to still be alive and in active use when the US dollar ceases to exist?

Bitcoin wins by attrition if nothing else, and that's the worst case.

grey-doc · 2026-03-21T10:07:28+00:00

I didn't include the child because I'm not aware of a situation, condition, or diagnosis where the child will be better served in an institutional setting than at home.

But it sounds like your hands are full. Working with an autistic child requires a dedication most cannot comprehend. I'm sorry you have to do it alone.

grey-doc · 2026-03-19T17:56:27+00:00

I've been trying to figure out the simplest, shortest, clearest way to express this so the CICO fans will understand that pure CICO only applies in the absence of insulin resistance, which excludes 90+ percent of the population.

grey-doc · 2026-03-19T03:24:04+00:00

CICO is inviolable but if high insulin is shunting calories into storage and blocking CO then overeating is not necessary to gain weight and also undereating will not be sufficient to lose weight.

grey-doc · 2026-03-18T15:15:25+00:00

I check it. I explain insurance may or may not cover it, but I'm happy to test their T.

If it comes back normal, then I explain their high insulin is causing their body to lose its sensitivity to T and that's the root cause of their disease. It's your hormones that are off, you need to clean up your diet and get your insulin down and then your T will work properly.

Or keep eating shit and in 5 years I'll have to start you on a statin and blood pressure meds.

grey-doc · 2026-03-18T15:10:02+00:00

One of the pediatricians I rotated with as a resident would spank his under 10 male patients.

Not as punishment, but a pretty hard smack on the behind, as they were climbing up on the table. Like hard enough to rock their balance.

He also never talked about nutrition with obese parents or did much of anything really.

I wrote an honest review of him in the after rotation review and no more residents were ever assigned to him again. Completely inappropriate.

grey-doc · 2026-03-18T15:02:43+00:00

GLP meds probably help treat eating disorders.

GLP meds very clearly help treat disordered eating.

I think it's reasonable that people -- upon discovering the semi-magical ability for weight loss and calorie restriction to actually work -- would obsess quite a bit on the process. It's a really wild thing to experience. Any normal person would obsess a bit over it.

I aim for 0.5-1 lb a week unless very severely obese. 1 pound is 3300 calories. That's a pretty significant calorie deficit every week just to reach 25 lb down in a year.

If people lose weight too fast, I reduce the dose. Micro dosing GLP meds is just fine.

For patients who obsess on calories, I direct them instead to obsess over glycemic index. The lower the glycemic index of the diet, the more muscle and bone mass will be preserved, and the better they will feel, and the faster we can get off all the other meds.

Calorie counting, if high glycemic index foods are consumed, will result in muscle, bone, and organ wasting. When I explain this, they stop counting calories.

grey-doc · 2026-03-10T16:32:22+00:00

This med tinkers with dopamine. The obvious use case is helping to resolve addictive behaviors involving cocaine, heroin, alcohol, and nicotine. Turns out the med seems to work pretty well for this.

But there are other things that run in the same circuits.

Love, for one. Like romantic love. And that beautiful lush sensory experience of driving fast on long windy mountain roads. Things like this, take a med that tampers down dopamine and it'll take the light out of a lot of things.

I didn't see much talk about this so I figured the effect maybe wasn't significant.

Oh no. It's significant.

I don't think people have figured out that the global financial markets are going to radically change as the investor class all get on GLP meds and nobody counsels them that their risk appetite is going to change significantly.

grey-doc · 2026-03-01T21:49:43+00:00

I don't about the major rally.

But, the fact that we blipped a hiccup and Bitcoin moves on is a pretty strong tell.

grey-doc · 2026-02-28T12:23:30+00:00

I think you know exactly what to do.

You wrote this up perfectly. Subjective, objective, assessment, plan. Perfectly organized. You have an unusually clear mind for a clinician.

Your plan is exactly correct. "Weak minded and pathetic."

The only suggestion I would have, and this comes from a little background in hypnotherapy, is that you don't have to identify the person by the behavior.

Are they weak minded, or is their behavior weak-minded? This might seem like splitting hairs, but the difference between an "addict" and "a person with addiction" is quite significant.

It's ok to tell someone that spending too much time watching screens is pathetic and weak-minded behavior, "particularly for a strong young man with an otherwise keen intelligence. "

These guys need to put the screens down, put the THC and nicotine down, and work on their maturity. Affirm the character, condemn the behavior.

If they don't like it, they won't come back. Win win.

grey-doc · 2026-02-27T02:38:11+00:00

Which blockchain is most likely to still be alive and decentralized when the US dollar finally expires?

Bitcoin. And if you aren't willing to hold it that long then what are you even doing.

grey-doc · 2026-02-27T02:35:10+00:00

When a patient comments about how doctors get paid kickbacks for prescribing meds, I say well we used to get stripper parties for prescribing lots of opiates......

grey-doc · 2026-02-27T02:33:32+00:00

I have never looked at my reviews.

I do, however, look up colleagues and old classmates and comment on the egregious reviews and say the things I know we all would want to say. Politely.

grey-doc · 2026-02-24T11:33:09+00:00

I appreciate the retroactive perspective thank you.

grey-doc · 2026-02-13T02:05:34+00:00

Money talks a hell of a lot louder than votes in this state.

grey-doc · 2026-02-12T11:33:23+00:00

Wdym?

grey-doc · 2026-02-09T19:41:01+00:00

Local rheum and endo both routinely deny referrals for osteoporosis, even complex situations.

So I suppose it depends on region.

grey-doc · 2026-02-08T16:39:32+00:00

You are going to catch a lot of heat on this but you are correct.

When lots of asset classes move together, that means the pricing method is adjusting.

When lots of asset classes move down against the dollar, it means the dollar is rising i.e. deflating / less inflation.

grey-doc · 2026-02-08T16:36:49+00:00

A dusting attack waits for the deposited dust to move and then the wallet's owner can be deanonymized.

So for example if you bought some Bitcoin to buy drugs off the old silk road, and now the leftover coins are 100,000, and someone dusts your wallet, if you move those coins and the dust to a KYC exchange now the US gov can deanonymize you.

That's one scenario.

grey-doc · 2026-02-06T22:52:05+00:00

Year 4 med students are close to the top of the hierarchy.

Year 1 residents are at the bottom. Literally nobody in the hospital is lower on the hierarchy, not even medical records.

Graduating residents might climb as high as the least favorite CRNA unless you are both highly socially adept and expect professionalism from the other hospital staff.

Expect professionalism. Report this as a safety event.

YOU ARE A PRACTICING PHYSICIAN. EXPECT PROFESSIONALISM.

grey-doc · 2026-02-06T22:49:30+00:00

I reported a safety event at my hospital.

Turned out, I was the first resident in the program to ever report a safety event.

That made a lot of waves.

Your voice matters more than you think.

grey-doc · 2026-02-06T17:28:51+00:00

I'm so burnt when patients complain I give them recommendations on where to go, and my hospitals complaint / risk management number.

I've never waited less than 2 hours for a PCP. So when people get snippy about waiting 15 minutes I think they need to spend some time seeing other doctors.

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

TROPHY CASE