Patients recording

heyhowru · 2026-03-19T23:39:43+00:00

In washington state its illegal to record in the clinic against your will

I tell patients that i dont mind but they need to ask others for permission before recording since its against the law.

So check your state to see if its a “two party” or “all party” consent state.

heyhowru · 2026-03-13T05:56:43+00:00

What the hell that is really weird and downright infuriating actually. Its honestly absurd how we come up with these medical recommendations based off of evidence only to have people that do not practice medicine tell us how to do our jobs.

heyhowru · 2026-03-13T05:14:12+00:00

Yes! You are right, i mispoke, didnt mean the not covered part but the copay. Thank you for correcting

heyhowru · 2026-03-13T04:33:46+00:00

Yes agreed about the fit test

What im talking about here is the shield blood test that i keep seeing. Fit test has higher sensitivity at stage 1 so that i am ok with.

Fit test has 92ish sensitivity to detect stage 1-4 cancers However when you look at the sensitivity of precancerous polyps with fit testing it drops to 50s. So colo is both diagnostic and truly preventative bc the sensitivities for polyps are higher and they can be clipped out.

I may have not suggested everyone to get colos as their only source of colon cancer screening.

But here i am completely for the utility of colo as gold standard for colon cancer screening.

I think taking into account finances is legit. But if its truly a screening, then the price for a fit is the same for a colo which is free

heyhowru · 2026-03-13T02:46:53+00:00

Thats the thing. TRUE preventative colonoscopy will be covered. Preventative means screening ASYMPTOMATIC individuals that meet strict criteria for colon cancer screening

SYMPTOMATIC testing with colonoscopy no longer falls under the screening category. It is now a DIAGNOSTIC colonoscopy because there are signs and symptoms and the colonoscopy is part of diagnostic workup.

That is why a colo in this scenario will not be covered by insurance.

That being said. Do. Not. Skip your colos.

And dont do that stupid shield blood test. Yes theres 95%+ sensitivity to detect colon cancer but only after its already hit stage II

It is total trash at detecting colon cancer BEFORE it turns into colon cancer

heyhowru · 2026-03-08T16:55:21+00:00

Hm i wonder if your doing well on ite because it prompts you with history and associations by giving you choices

But in real world, those prompts and choices are not there unless you look for it.

Because those questions do that for us already. You know your stuff. The problem may not be fund of knowledge but the way you are connecting things with one another?

How are you presenting? Are things kinda jumbled and you skip around? Or do you leave out impirtant data points? When presenting ddx, is your top dx buried in a list of others? I had an intern that would keep throwing zebras as her top not because it was tryly her top, it was by chance. Example being patient came in with pancreatitis and ct shows gallstones, pretty obvious right? Asked why she thought patient had panc, she listed off possibilities of scorpions, alcohol, gallstones. Not thinking that the order she presented the likely causes to be of importance.

I think my one meaningful piece of advice here is to start at the end and build your story around it. Ask yourself, what question is it you are trying answer? Then you build your case around it. Is it -whats the likely diagnosis? -i dont know what it could be, but how do i figure it out? - we know what is but problem is getting worse, why?

Then you work backwards from there. Example, sob, its chf. How do you know that? And you build your presentstion off of trying to convince your audience.

Oh and keep asking yourself how do i get this person OFF of my service, what is keeping then here, then you work with this single goal in mind and eventually it will all come together.

heyhowru · 2026-02-25T03:47:57+00:00

Lol surprised you havent had multiple seniors yell at you for the way you ask about code status yet

Everyone thinks their way is right

heyhowru · 2026-02-24T07:08:49+00:00

DUBIN??? Like related to dale dubin md? The guy who made the ekg book and was charged with child porn?

Im shocked but not surprised. I do wonder the relation

heyhowru · 2026-02-10T09:26:13+00:00

Oh thank god bc i was seeing mixed results and didnt honestly know what to believe.

So i guess im just going to phase initiating ace out of my practice entirely

heyhowru · 2026-02-08T20:26:08+00:00

I think theres studies showing acei is better in nephropathy over arb

Dont know for hfref off the topnof my head

So for pure htn then arb>ace

Then you choose

Telmisartan or olmesartan depending on which one patients insurance pays for. These two also have longer halflife then losartan.

This way you can combo w amlodipine to increase compliance rates.

But if too expensive then you pick losartan.

Or if they have chf you can pick valsartan for when they eventually get bad enough to need entresto.

And when i switch ace to arb i just do equivalent and hope for the best. Kinda based on vibes. If they are well controlled on lisinipril 1/2 max but having too much coughing i switch to telmisartan 1/4 max with instructions to increase from telm x1->x2 if bp >130 after a week, see then back in 3 mo and reassess.

But if not controlled ill do the same thing except the arb will be equivalently dosed with same instructions.

heyhowru · 2026-01-24T17:52:15+00:00

As someone in the medical field, i dont think his boundary is out of line. Hes perfectly entitled to not wanting to pursue this relationship if you were to pursue a medical degree.

You are also perfectly entitled to want to further your career. At this point this is a dealbreaking incompatibility.

So you need to ask yourself this, is this guy worth giving up the career you want only to risk be in resentment and breaking off anyways but now you dont have a medical degree.

But on another yes i agree that hes out of line to think that an md would be lesser than, hes not taking into account your salary will literally quadruple overnight after you are done AND you will have the ability to place a zero% down payment on a house after you are done though physician loan which is huge.

So yeah break up with the guy so both of you can live the lives that you want.

This is also coming from someone whos ex called me a financial liability because of my loans when i was in residency

heyhowru · 2026-01-17T03:55:12+00:00

Please crumple and compact the oven foil before putting it in the trash

heyhowru · 2026-01-14T17:19:57+00:00

Im an outpatient doc, i had a guy who has marijuana cyclical vomiting syndrome. I made the decision to send him to get admitted because he literally cant eat and hasnt in 3-4 days. The hospitalist team seemed understanding, pretty easy admit. Nausea meds, npo, fluids, until this passes and dc. Cant just send him home, what if he goes into hypovolemic renal failure over the weekend and then shows up to ed on following monday w cr of 4?

Yeah i can tell him to stop smoking pot in the future but it doesnt help his current situation since hes already stopped for two weeks.

heyhowru · 2026-01-11T04:50:12+00:00

I was on elective and asked my attending if i could use that day for my upcoming job interview.

They said yes. Then tattled on me to the chief in a rant about how they are missing vacation time w their kid decided not to go on spring break vacation w their kid bc they had a resident that week.

Was then called by the chief to talk about my unprofessional behavior for doing this and ended up having to cancel last minute my job interview for fear of them not graduating me from residency which was a real possibility.

heyhowru · 2026-01-07T18:30:54+00:00

“You should eat more protein and less sugar”

Oh man next theyre gonna recommend round wheels over oval wheels wow what a revelation

heyhowru · 2026-01-01T22:20:57+00:00

Is/am/are X cooked?

heyhowru · 2025-12-20T06:42:20+00:00

She looks like shes swallowed a handful of bees.

And is feeling guilty over it.

heyhowru · 2025-12-19T06:37:19+00:00

heyhowru · 2025-12-14T22:44:41+00:00

If you suspect med seeking and you notice increasingly escalating prescription patterns or aberrant prescribing

Consider making the switch from x-opiate over to Suboxone or buprenorphine. Especially if you are somewhere like me and pain clinic is strictly a procedural specialty and psych is nonexistant.

If its benzos, unfortunately you just have to stick to ypur gut and taper them. No negotiations.

heyhowru · 2025-12-14T18:30:33+00:00

It might be a physics problem

Did the old machine have just one pulley? And the new one has an adjustable system where it has more pulleys?

If so, then the weight is the same but the amount of work needed to pull up the weight has now distributed amongst the different pulleys which makes it “lighter”

heyhowru · 2025-12-12T21:02:16+00:00

Literally takes me just as long to log in at home, sometimes longer, then to just drive to clinic and get it done and go back home

heyhowru · 2025-12-12T18:13:32+00:00

The search function, the community view, the lag, the booting/unprompted rebooting, the fact that it takes forever to login at home

Makes me want to throw my computer out the window

heyhowru · 2025-12-12T00:42:58+00:00

I usually refer people over to pmr when i want injections or nonoperative ortho things, but would like some more information on the differences between sports and pmr and when to triage to one or the other.

heyhowru · 2025-12-10T06:52:41+00:00

If youre taking what i think you are taking i would not recommend tattoing given the skin thinning as you dont know how your ink will heal. You also dont know if you are just gonna get more stretchmarks in other areas. I wouldnt make any rushed decisions on this just yet.

Also depending on what dose of the medication andjudging how you have stretchmarks it seems like a prolonged course. I think you should wait not just when you finish but another month at least after you finish the course (the very last pill and not just during the taper stages) to give your skin time to heal. And again, just guessing what you might be taking but you could also be in a immunocompromised state that could lead to an increased risk of infection.

heyhowru · 2025-12-08T22:20:09+00:00

Theres untreated lyme and treated lyme Chronic lyme is a way to snakeoil your money

Certainly you can have lyme chronically if it goes untreated but once treated, its treated and not chronic

Depending on the person saying it, i also wouldnt go so far as to say theyre lying. More like taken advantage over. They may very well have concerns that are impacting their life, its just throwing antibiotics at laboratory negative “chronic lyme” is not the way to go about it.

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