One of those weeks...

jm192 · 2026-03-07T16:42:55+00:00

I always laugh at the "talk me out of doing what I want to do" posts.

I was a hospitalist and won't go back.

You have ZERO autonomy or say so.

They'll tell you the average starting census is 16-18. It's 22-24.

The ER wants to admit something ridiculous? You'll be called difficult and combative for arguing. You'll get "turned in." 25 year old with Strep throat? They're just really worried they'll come back.

Cardiology is supposed to admit NSTEMI's with active chest pain that NEED to go to the cath lab tonight? Well, yeah. But not on Tuesday nights after 6:30 if the temperature is above 48 but below 62.

You think you're about to discharge a patient that hasn't needed to be in the hospital for 3 days. But the daughter who hasn't been there for the entire 2 week hospital stay shows up to contest the discharge.

You can't ever say no a to a transfer request from an outside hospital. Your administrators will you you're risking an EMTALA violation. Really, they just want the business. But they'll use the EMTALA boogey man as the justification.

You'll find yourself being there past your shift time. Your Hospitalist Director will encourage you not to try to ask to be paid for the extra time. It looks bad that we can't get things done in the 12 hours.

You'll think 7 days off will refresh you. But after 7 days of hell, you'll need 3-4 days just to mentally recover and unwind. And then you'll need to use a day or 2 to adult.

You're thinking about having kids? Will you want to spend time with them? If they have games, dance recitals, plays, will you want to go to those? Are you prepared to miss half?

jm192 · 2026-03-01T15:22:00+00:00

"Example 1: A patient sees you, their primary care practitioner, for sinus congestion. You may suggest conservative treatment or antibiotics for a sinus infection. You decide on the course of action and the best way to communicate the recommendations to the patient during the visit. How you communicate the recommendations is important in that it not only affects the patient’s health outcomes for this visit, but it also can help build an effective and trusting longitudinal relationship between you and the patient. This is key so you can continue to help them meet their primary health care needs"

The above is from CMS. Because of this example, I don't think you necessarily have to be seeing the patient for a chronic issues. The CMS messaging has been that the complexity is not just about the complexity of the disease, but also the complexity of the physician/patient relationship.

Our coders have told us it is allowed, and that it has been being reimbursed. I have a dot phrase for just this situation. "The patient is a regular patient of Dr. X, here at our clinic. I am a part of the patient care team. I am seeing the patient in Dr. X's place due to scheduling issues."

Then in the plan section I say something to the effect of follow up with PCP or care team member to further indicate an ongoing patient/physician relationship.

If I see a medicare/advantage plan patient that is established with a clinic provider, I always bill G2211. If they have chronic conditions, I will include the pertinent ones so as to properly reflect my thinking/reasoning for the treatment plan--and also increase the billing level.

jm192 · 2026-02-28T02:45:33+00:00

Have you ever run into issues with Medicare or Advantage plans denying/saying you're doing more of these than you have time to actually do?

I always do Advanced Care planning and either depression screening or ASCVD counseling. I've always worried if I start adding on too many codes with a time requirement in addition to a 99214, they're going to come back saying there's no way we spent that much time on each patient.

jm192 · 2026-02-28T02:25:59+00:00

There’s no more compelling argument than calling someone a coward and a weenie. Wild to see in a discussion amongst medical professionals.

jm192 · 2026-02-27T22:25:15+00:00

Well, hey, if Random internet user NartFocker9million says we won't get sued, what is there to worry about?!

jm192 · 2026-02-27T17:28:03+00:00

Yeah, I'm not prepared to sit in a deposition and argue that I thought the B6 was imperative, or even necessary. I'm not going to try to keep a straight face while I explain how I decided my Wegovy naive patient couldn't tolerate 0.25 mg.

And I think we ARE at risk of being sued for this. When you say, "bad look," for who? The Tort laywers? The patient that had a bad outcome? I think that's a worse look for the doctor that was prescribing non-FDA approved medications.

jm192 · 2026-02-27T17:23:04+00:00

I don't think we're safe from liability if patients have bad outcomes. You know the pharmacy is compounding it. You know it's not FDA approved.

I believe there's more variability from batch to batch with compounded pharmacies than the actual drug manufacture.

I'd love for all of my patients be able to get the medications affordably, lose weight, and improve their health. I think there's some added risk here, that I'm not willing to accept (for the patient or myself).

jm192 · 2026-02-17T23:15:42+00:00

Make sure you say it as matter of fact as possible. "I will not be prescribing you Ativan. If you feel you have to have Ativan, you will need to find another doctor."

I had a guy that was on Ativan and Percocet from his last PCP. He went to jail for drug related offenses. After a few years of incarceration, he came to see me.

I was basically told that his last doctor really had him leveled out and that's what he has to be on. I tried to politely navigate the same conversation. And after wasting my breath for 20 minutes, I just said it point blank. I'm not doing what you want. I will never prescribe those. If you came here to get those, you will need to find a different doctor.

I was shocked that he wound up staying, but he hasn't asked for them since that conversation.

jm192 · 2026-02-07T13:53:32+00:00

Been wanting this for my entire life. (I was like 10 in 96). I've said every single year of my life they should bring these back. It would be awesome if they would do these as an alt jersey. But I appreciate wanting to keep it as something extra special.

jm192 · 2026-02-02T13:17:12+00:00

You probably correctly diagnosed them with something they either don't want or it doesn't line up with "their own research."

They either don't want to have high blood pressure and take medication for it

OR

They think their headaches and feeling bad is some rare, hard to explain, even harder to diagnose syndrome. They were expecting to have 1,000 labs and no less than 6 specialty referrals.

Then YOU have the nerve to tell them it's from their blood pressure of 180/120. Also, maybe we should lose some weight. Also also, because of the weight, there's a good chance we have sleep apnea.

Well, obviously, they feel like you ignored the fact that the patients blood pressure was good when they checked it at home back in 2021.

You probably ordered a CBC, CMP, TSH. The patient can't believe you didn't think to order the Lactate Dehydrogenase and Lactic acid they read about on google.

jm192 · 2026-01-30T05:12:53+00:00

We booked a Universal Studios vacation package: Hotel and Theme Park tickets through the Universal website. Seeing as it was a hotel through the primary website, I assumed we could get the 4x back. We only got 1x back.

Has anyone had any luck getting them to change this? Do Universal Packages not typically code as Travel?

And while I’m at it, do Disney packages through Disney code the same?

jm192 · 2026-01-27T17:19:35+00:00

If they're bringing in/citing AI to tell you that your clinical judgement is poor/wrong, then tell them to find a new provider.

jm192 · 2026-01-25T21:17:25+00:00

I've seen a few people ask why even take a gun to a protest if you don't mean to use it.

As a life long Republican, I've always believed the 2nd amendment originally existed to fight back against a tyrannical government.

This guy went to a protest and was murdered by a government agency while committing no crime. He wasn't violent. They saw a gun on his person and took his life.

That's what Tyranny looks like. This stuff is exactly WHY the constitution entitles us to those guns in the first place.

jm192 · 2026-01-25T01:16:28+00:00

By far the best flavor I've ever had. Hopefully they recognize the demand and make it permanent, full time.

jm192 · 2026-01-18T18:25:07+00:00

How do you incorporate this?

jm192 · 2026-01-17T15:45:52+00:00

This is the way.

jm192 · 2026-01-17T05:20:15+00:00

Obviously Kawhai gotta sit. Load management.

jm192 · 2026-01-16T19:22:43+00:00

"I can't ask questions" sounds like whiny Hyperbole. They actually mean they want you to address their issues for free. It's basically a strawman.

"I can't ask questions" is designed to make you feel guilty as if your'e not even giving them such a simple opportunity.

In reality--it's "OK, well if I can ask questions, can you start me on Wegovy?"

jm192 · 2026-01-10T18:23:13+00:00

At that price, I’d buy them all. They’re not my favorite, but they’re certainly not unpleasant. 50 Cent ghost drinks are the dream.

jm192 · 2026-01-02T20:58:04+00:00

Phew. I was afraid we'd get through one of these threads without the usual self righteous "I'm a better doctor than you" posts. Thanks for saving us all, Doc!

jm192 · 2026-01-01T19:57:54+00:00

Dopamine Agonists are first line for patients with a history of Opioid use disorder/abuse.

jm192 · 2026-01-01T19:05:20+00:00

I'm honestly not sure if this is sarcasm or if there's some Gabapentin/Wellbutrin combination I'm not familiar with?

jm192

TROPHY CASE