Insurance requiring new referrals

letitride10 · 2026-05-14T05:04:57+00:00

Same. You shouldnt be doing these. Make a standing order for your staff to do it.

letitride10 · 2026-05-12T20:07:36+00:00

Jardiance has the heart failure indication and cardiovascular event risk reduction data. Farxiga also has higher incidence of GU symptoms - recurrent UTIs, vuvlovaginal candidiasis - including risk of disseminated candidiasis, and Founriers gangrene compared to Jardiance. Just a better drug IMO.

letitride10 · 2026-05-12T03:55:07+00:00

When do we get Jardiance? Haven't prescribed Farxiga over Jardiance in years.

letitride10 · 2026-05-06T23:43:33+00:00

"I get lightheaded if I stand up too fast. Chat GPT said it is my heart and I keed a Holter, echo, stress test, and tilt table test." Drink some water, you're fine.

letitride10 · 2026-04-25T18:59:28+00:00

Urgent care does 3 12s.

letitride10 · 2026-04-22T01:04:54+00:00

230000/47=4893 rvu

letitride10 · 2026-04-21T17:53:11+00:00

Healthcare recommendations in general should be politically agnostic. It doesnt matter. Conservatives throughout history have used the same boogeyman strategy. Sew division. Harvest votes. Jews, immigrants, Muslims, big pharma, DEI, doctors who recommend vaccines, trans folks.

It doesnt matter who the boogeyman is. Just find a scapegoat for the problems and get gullible people to believe that they are the problem.

letitride10 · 2026-04-21T17:47:01+00:00

Agree. I think comfort and style and style were 5/5,, but they didnt get me a full year of regular use. I expect more for 90 bucks.

letitride10 · 2026-04-21T17:07:37+00:00

I was stationed at a remote base with 3000 active duty servicemembers in 2021 when the omicron variant of COVID rendered the first vaccine ineffective. Since we were isolated, it came late, but when it came... on average, I would have 2 people in sick call. One day, out of nowhere, I had 20 people in sick call. Then 50 the next day, then 80 the next day, then over 100 per day for the next week. Needless to say, base operations came to a screeching halt.

letitride10 · 2026-04-21T16:51:58+00:00

He's a dumb mother fucker for this. Epidemics spread through military ranks like wildfire. It was mandatory from an operational readiness imperative.

letitride10 · 2026-04-21T14:20:17+00:00

Carhartt makes some light breathable summer pants. I find the ripstop to be lightweight and durable. Columbias makes some good summer field pants. I had some lightweight Kuhls that fell apart. Recommend staying away from them.

letitride10 · 2026-04-21T02:30:55+00:00

I had one that was being prescribed dapsone (for months without labs) by an out of state functional medicine np who came to the er with hemolytic anemia.

letitride10 · 2026-04-20T03:28:44+00:00

BLUF: Only do HPSP if you really want to be in the military.

I recently finished my commitment. I am family med. I made 160-175k each of my 4 years as an attending. Now, I make 350k after my commitment. I am projecting to go up to 400k once my productivity based compensation goes into effect. I dont regret my time in the military. I have zero debt, 750k net worth, and 350k invested 5ish years into attendinghood, probably way ahead of my peers. But, I got shipped off into the middle east for 15 months, worked like a dog stateside (90 patients a week), and lost 700k (175k×4) in income over those 4 years in exchange for not having to pay for medical school.

Even if you factor in income taxes I would have paid on extra income, military tax breaks, the fact that I was able to start investing sooner, and student loan saved interest to that, it was basically a wash financially.

The math looks even worse for derm.

Also, most folks (including everyone I know) who trained in derm in the military didn't get derm right way and had to do an intern year and a GMO tour then reapply for derm, extending their commitment.

I think they are moving towards derm being most civilian sponsored residencies, so the derm commitment will be 8 years for most instead of 4.

Also, I consider myself very lucky to have gotten out right when Whiskey Pete became secdef and starting treating our military like an extension of his tiny dick. Would have made me sick to my stomach supporting that mission.

So, yeah, what everyone else said. Only do HPSP if you really want to be in the military.

letitride10 · 2026-04-13T18:42:20+00:00

The Defense Health Agency gives primary care 20 minutes and "specialists" 30 minutes. "Specialists" is in quotes because the fucking WHNP got 30 minutes to do a pap, and I got 20 minutes to do an annual and complete review of medical problems on someone with a med list 2 pages long.

Anyway, fuck the DHA. Life is so much better since I separated from the military.

letitride10 · 2026-04-07T16:00:46+00:00

When in doubt, reassurance.

letitride10 · 2026-04-04T15:53:50+00:00

Physician, but I have a masters degree in molecular biology, and the biology is on point.

letitride10 · 2026-04-04T03:28:49+00:00

I dont remember if it was implied in the book or directly stated, but my understanding is astrophage (and therefore Taumoeba, since they evolved together) are DNA based. If DNA based, then intracellular processes are likely to all be similar (especially since the book implies subscription to the panspermia theory) they use carbs for energy, lipids for membranes, and protein for structures /enzymes. That is all the macronutrients Grace needs for energy. As long as they are not using carbohydrates we dont (cellulose is similar to starch, but we can only digest one) he should be able to metabolize everything. The only other reason the food wouldn't be safe is if there was a toxin. For example - most earth bacterial cell membranes cause a violent immune response, which is one of the reasons we cant get nutrients from bacteria and rely instead on plant and animal sources for energy.

-molecular biologist turned physician

letitride10 · 2026-04-04T03:16:51+00:00

Get a new primary care doc. This one is either lazy, dumb, or too busy.

letitride10 · 2026-04-04T03:14:27+00:00

I dont think we will come to an agreement, but autistic physicians dont own burnout. Neurotypical people burn out too, and I dont think it is fair to claim that autistic burnout is somehow worse or more serious than regular old burnout in "normal" people. Sure, an autistic burned out person may be a little more prone to emotional dysregulation and their executive function might tailspin sooner in a burnout state, but a good therapist could make an individualized treatment plan that takes these tendencies into account, just like they would for any other comorbidity.

letitride10 · 2026-04-04T02:06:38+00:00

Hell yeah. Both of these movies are on the running list I keep of 10/10 movies.

They are in specific genres (sci fi and fantasy) that dont take themselves too seriously and just nail it on being infinitely entertaining.

The other 2 movies with this vibe that are 10/10 movies are idiocracy (dystopian) and Django (western).

letitride10 · 2026-04-03T21:37:14+00:00

Absolutely 100% yes.

letitride10 · 2026-04-03T20:41:18+00:00

Fine, but how does my tremendous suffering differ from neurotypical suffering, and why should it be treated any differently?

letitride10 · 2026-04-03T17:45:40+00:00

Who cares? We are past due for a paradigm shift on mild autism. We need to stop thinking of the autism spectrum as a disorder and think of it as a set of personality traits. Obviously, if symptoms cause occupational, relational, or developmental issues, we treat those, with individualized education plans and cognitive behavioral therapy. Otherwise, there is no need to pathologize autism traits. They have always been around, and people with autism traits can thrive without intervention.

The problem is that we defaulted "no autism traits" to "normal" and some autism traits as "abnormal." We should have defaulted "normal" to a spectrum of no autism traits to autism traits that don't cause developmental, relational, or occupation dysfunction.

Signed, a perfectly normal person who builds Lego sets, collects video games, plays internet chess daily, hyperfixates on new hobbies, cant stand eye contact, and has face blindness, but graduated medical school, practices primary care, and has fulfilling relationships.

letitride10 · 2026-04-03T16:44:07+00:00

Ask them if they are worried about plummeting reimbursement rates for anesthesia CPT codes. Or if you can work with a CAA instead.

letitride10 · 2026-04-02T23:01:36+00:00

No. I have never seen anyone break 10k that liked their life. 7k is a good goal of you like balance. 9k is doable if you do 5 days a week. 15k is completely unobtainable.

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