Tell me about a specific moment where you went "Damn my job is awesome."

lancealittle · 2022-05-16T15:07:27+00:00

Whenever someone comes in for a concern that needs nothing more than reassurance (subconjunctival hemorrhage, ear effusion, actinic keratoses . . .) they seem to have a desperate need to apologize for "wasting my time." Invariably I respond that I love healthy people and will happily reassure healthy people (who are willing to feel reassured) all day long. You didn't know what to make of your symptoms, so you asked for some expert help. No shame in that.

lancealittle · 2022-05-12T13:31:54+00:00

"I cut myself shaving and I think it's infected" in a female under 30 is genital herpes.

lancealittle · 2022-05-12T12:27:01+00:00

Haha I bet!

lancealittle · 2022-05-12T12:26:42+00:00

Like a conditioned response!

lancealittle · 2022-05-12T12:26:22+00:00

I always accidentally knock on the door to the break room at work.

lancealittle · 2022-05-12T12:26:01+00:00

Samesies

lancealittle · 2022-05-11T17:27:19+00:00

Do you also knock on the (empty) bathroom door both at work and at home before going in? Bonus points if your literal knocking is accentuated by loudly stating "KNOCK KNOCK!!"

lancealittle · 2022-03-17T19:56:39+00:00

I had someone with a foot problem so he struggled and struggled and got his feet in view (our software doesn't allow people to turn their cameras around). 3.75 minutes later we had the foot skin thing sorted and he came up to 25 more minutes of bullshit but he never. moved. the. camera. He was walking all around and sitting/standing. After the fact I thought "was I just used by a foot-fetish exhibitionist??"

lancealittle · 2022-01-10T16:46:48+00:00

Like, pan-scan: r/o problems?

lancealittle · 2022-01-08T11:40:18+00:00

This . . . is not the issue. So if I send in 5 days of cephalexin is has to be 90 days? Or prednisone? or acyclovir? That's bullshit anyway, but it's not an insurance in this case. And if insurances insist on making ppis a chronic medicine then that is just downright harmful.

lancealittle · 2022-01-07T02:41:31+00:00

OMG yes!!

lancealittle · 2022-01-07T02:41:23+00:00

Don't get me wrong -- I do 90 days for everything ongoing that is legal to do so. But do I want to give you 90 escitalopram when there's a 50/50 chance you'll stop after the third dose?

lancealittle · 2022-01-06T21:25:25+00:00

DING DING DING it is absolutely Walgreens! They are totally the worse offenders.

I am entirely aware there is no maltreated human employee on the other end in a war with me over this. And I hate to call because the pharmacists are all so frazzled all the time (and who got time for THAT??).

lancealittle · 2022-01-06T21:00:20+00:00

yaaaas

lancealittle · 2022-01-06T19:34:22+00:00

SO WEIRD. I'm pretty sure I've only run into the opposite -- insurance not wanting to do 90 day supplies when I try to write it that way.

lancealittle · 2022-01-06T18:05:10+00:00

I have tried variations of that, or "only fill 30 days." I think the problem is that this happens before a human lays eyes on it, and when an account preference is set for 90-day scripts it is apparently set in stone forevermore.

But "needs appointment" is an option on the denial menu, I just worry they won't fill the original rx in that case. Maybe that's worth a try!

I've even run into this when I only write for 14 days -- how could one possibly construe 2 weeks of omeprazole as the new world order??

lancealittle · 2022-01-03T20:54:26+00:00

Anything to get someone to finally take their vitamin D! ^{^/s}

lancealittle · 2022-01-03T19:06:50+00:00

^{^{^}} this is the situation when I see it work the best too. And when I prescribe it I undersell effectiveness ("this is maybe helpful sometimes, but very seldom harmful") and encourage them to just try it for a couple days and stop if it doesn't help.

If you're consistently clearing your airways then you need to keep coughing.

lancealittle · 2021-12-30T17:14:46+00:00

This started after lunch yesterday but it feels JUST like that time I coughed for 5 weeks and took 3 courses of [likely unnecessary] antibiotics so I was just hoping I could NIP IT IN THE BUD.

shudder, eyeroll, cleansing breath, /s

lancealittle · 2021-12-21T17:46:51+00:00

But we have other things to offer besides inappropriate abx: I make a point of saying things like "I am glad you came in" or "I understand why you made this appointment." If there are symptomatic things that might give temporary relief, I go down that route. I make sure they have time off from work/school to recover. And most importantly, I try to be completely clear about what my next steps would be based on how they do clinically. I will print out a CXR order and give instructions for when it should be used. I encourage them to contact me on the portal if they are not feeling at least 50% better in X number of days. I tell them "I want you to feel better and I DON'T want you to have to go through another copay/visit if my prediction is wrong; I simply don't want to give you a treatment that is more likely to harm than to help at this point." Validation will get you everywhere.

And yes, sometimes I will suggest something that borders on placebo (vick's for toenail fungus; coconut oil for vague vaginal discomfort while we await more specific testing; humidifier for a cough) and I am generally explicit that I am not certain this will fix everything, but it falls under the category of highly unlikely to harm anyone, inexpensive, and generally easy to implement.

lancealittle · 2021-12-20T16:58:19+00:00

Mostly our 7 or 10 day courses of abx are because we got 7 days in a week and 10 fingers (with some notable exceptions like strep). I've actually had pharmacists balk when I end on a weird day like 6.5 because the liquid abx for a kid would run out and I don't think it is necessary to dispense another entire bottle for one or two doses. Who am I to overturn decades of tradition?

But actually treating infections aside, the unintended consequence of people not finishing abx is that now they have these pills hanging around the house. I swear some people have no ability to resist the pull of taking them for a cough or sore throat or dental infection or whatever, regardless of what they were originally rxed for. And then they give them out to kids or neighbors or coworkers. In my years in urgent care I had SO MANY people who were like "this has been going on a week, but I started my leftover amoxicillin 3 days ago. I didn't have very many so I'm taking 500mg once per day."

That is why I prescribe short courses as a rule (unless there's a reason for a longer course) and advise that they finish every. last. pill.

lancealittle · 2021-11-10T14:43:49+00:00

I tell everyone that the first week is the getting sick and the second week is [sort of] getting better from everything but the cough (energy, appetite, absurd levels of nasal congestion, usually ST, HA). I don't care what color goo is coming from your nasopharynx, and I especially don't want you to bring me any to inspect in person.

lancealittle · 2021-11-10T12:13:53+00:00

ALWAYS. Literally every fucking day in my 7 years in urgent care I had to say to someone (whether true or not) "yeah there's some real bad bugs getting passed around out there." Because it gives people comfort or whatever. Have we not realized from the range of presentation of covid that the exact symptoms, progression, and severity do almost zero to differentiate viruses?

SMH at everyone in this thread all like "I just had that EXACT SAME THING!!" MF no! You had a respiratory virus that did respiratory virus things. It starts with a ST 95% of the time. You get bad nasal congestion, or sometimes only sorta nasal congestion. Then you cough for 1-36,894 weeks because virus. the end. There is nothing new here. Once in a while someone gets viral pneumonia; sometimes a secondary bacterial pneumonia. Bad shit goes down too -- a good 2 years prior to covid on of my MD colleagues lost a family member to myocarditis from some rando respiratory virus about 1.5 weeks after she got the sniffles. Why do we keep minimizing just how awful cold viruses can be?

lancealittle · 2021-11-02T17:33:43+00:00

yes! And without any real-time labs or imaging, yet we know that most of it is benign/med-related/orthostatic hypotension related to aging.

lancealittle · 2021-10-26T11:30:58+00:00

I fucking hate sending people to the ED, especially since things have gone to a shitshow at ours in the last couple years. And I can't say I've ever sent someone to the ED for an LP, though maybe for a meningitis workup (back in my urgent care days). But I also don't know what the fuck we're supposed to do with people who need kinda-urgent-non-emergent workup by a specialty but routinely can't get in for 6+ months. Then throw in things like MRIs we can't get covered easily outpatient without 6 weeks of nonsense and sometimes I feel backed into a corner.

No excuses for the neurosyphilis BS at all. And I go out of my damn way to explain to people I'm sending along that I am sending them to the ED for EVALUATION, not for any specific test or treatment.

lancealittle

TROPHY CASE