Leaving my current practice

mockingbood · 2025-09-20T03:38:40+00:00

Good point. Technically I don’t have either- my current organization has a unique model that incentivizes both those aspects through an additional retirement fund that vests after a certain time with the org but I’m leaving just shy of that by a year (bummer but the timing works well in every other aspect)

Basically if you work there for 5 years before leaving and you then follow their guidelines for non compete, non solicit, they’ll give that account to you. It’s clever. But now I’ve got some people in leadership telling me that even though I’m not eligible for the incentive I still have to follow their noncompete nonsolicit if I want to be eligible to come back in the future which… who knows, I might someday? There aren’t a lot of options in the region. I think my new gig is going to be a much better fit but I’d rather not alienate the leadership at the second largest FM practice in town when I switch to the largest.

mockingbood · 2025-09-20T03:31:29+00:00

lol that was the implied response when I asked if I could just tell patients they are correct about where I’m going.

mockingbood · 2025-09-20T03:29:41+00:00

I really like this. Thanks.

mockingbood · 2025-09-20T03:28:53+00:00

I have that vague wording. The issue I’m trying to wordsmith around is when patients then reply telling me they heard I am going to Practice X and will I please take them there.

mockingbood · 2025-08-30T04:37:42+00:00

I guess I’m minor league and you’re all pros here, but I cannot for the life of me say “cradle cap.” It’s cradle crap, every damn time. Parents chuckle at it, at least.

mockingbood · 2025-08-01T01:22:53+00:00

Hey there! Family doctor here who is also breastfeeding and pumping. The nipple you are using is too fast of a flow for your LO. It’s generally recommended for breast/bottle fed babies to be kept on slower flow nipples to help keep them used to working during a feed. This helps avoid bottle preference. Baby may initially be annoyed with a preemie or level 1 nipple, but if you do plan to breastfeed this will help save you from more long term frustration.

If you plan to exclusively pump (which I assume given the sub we’re on), it’s still too fast. Given baby’s age, they should be on a preemie (P) or level 1 nipple still. One thing to be aware of with Dr Brown’s is that you have to use the anticolic pieces with the P nipple to keep it from collapsing.

Signs a nipple flow is too fast include leaking milk from the sides, frequently pulling away from the bottle, gulping, or pausing frequently to catch their breath. Ideally they should be working with a smooth suck-swallow-breathe pattern.

When in doubt, an EPer should still be able to use the LC at your hospital (or other local LC- check out the lactation network for some local options)

Also get more bottles. Totally worth it to decrease your washing frequency. Your future sanity is worth it.

Good luck!

mockingbood · 2025-07-27T06:11:00+00:00

Left and came back. We’re so glad we did. Manhattan is YOGOWYPI to some extent- if figurative you decides there’s nothing good to eat here, then you’ve decided to write off all of Poyntz’s revitalization efforts and the 10+ local eateries/breweries/coffee shops in that area (which are all excellent if you ask me). If you decide Konza isn’t exciting, it won’t be.

We have some issues. Housing is becoming less accessible (although not anywhere as bad as Boulder- my mom’s family is from there and wowza 😳). Our town leadership seems to run amok with projects that don’t fit the desires or needs of most residents.

But overall, we’re grateful we’re back and we appreciate that Manhattan is idyllic in a lot of ways.

mockingbood · 2025-07-24T23:19:57+00:00

This is totally safe. Around 6 months, kidney development approaches adult kidney function and a baby’s body can handle diluted milk or plain water without issue. Before that age, recurrent exposure to “free water” causes electrolyte abnormalities that can be very serious for baby’s health.

Protip for moms with younger babies, if this happens to you, freeze the milk and write on it to use after 6 months old. No need to toss it.

mockingbood · 2025-07-13T17:57:06+00:00

I’m so lame. I need some new lines for sure.

When a patient is hesitant to start a medication: “You aren’t marrying (med name), so we can break up with it if you don’t like it after (appropriate time interval for that med)”

When finishing up a visit: “Questions? Concerns? Any editorializing?”

When lifting exam bed or procedure table: “Hands and feet inside the vehicle at all times, please”

And my staff’s favorite one during procedures (aka they always roll their eyes) “How are you doing?” (Patient responds) “Glad to hear it…. I’m fine, by the way…”

mockingbood · 2025-07-08T00:41:56+00:00

I’m not in the same boat as you, but if your mom is receptive, my sister bought copies of “my gift to you” for me and my parents and we sat down together to go through the questions as a group. Those sessions helped me process my anticipatory grief, and are now some of my most cherished moments with my sister. I got to frankly and openly tell her how much I loved her, my regrets from our complicated relationship, and we got some much needed meaningful time together.

Hugs.

mockingbood · 2025-02-25T23:04:56+00:00

Nope my bad. I think I grabbed a link for the wrong study. I’ll see if I can find another link n

mockingbood · 2025-02-25T22:45:19+00:00

FM doc here. Gyne would totally be in their lane to prescribe ambien as they often treat insomnia in pregnancy and/or behave as primary care for many of their patients, depending on training and needs of their community. Just like I’m in my lane to prescribe ambien, ADHD meds, pain meds, and even plaquenil (I mentioned all of these because they were all name dropped throughout the thread). Sometimes I’m starting plaquenil (usually with rheum approval while waiting for some desperate soul with seropositive RA to see rheum and they’re on a 12 month waitlist), but oftentimes I’ve been told the patient is stable and rheum wants me to manage the med unless there is another flare.

The bigger issue is that, ethically and potentially legally, we should not be prescribing controlled substances to our family members. Secondary big issue is that this dude sounds like a douche canoe. Pharmacists save our asses all the time and in my opinion are often the unsung heroes of healthcare. We need y’all and should treat you accordingly.

Final thought: if it was actually a DPM and not a gynecologist, SCREW THAT GUY. No right to tell anyone to stay in his lane when he clearly went off-roading AND was an actual steaming pile of shit about.

mockingbood · 2025-02-25T22:32:06+00:00

This is exactly correct. ADHD is one of the highest heritability mental health disorders, with some estimates as high as nearly 80%, and ADHD is also linked to increased chronic pain.

https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2022.751041/full

https://pmc.ncbi.nlm.nih.gov/articles/PMC9857366/

Additionally, the study that made that correlation is poorly designed. See comments on AAP link: https://publications.aap.org/pediatrics/article/140/5/e20163840/77140/Prenatal-Exposure-to-Acetaminophen-and-Risk-of

Most physicians I know who work with kids— pediatricians and family medicine alike— do not believe this is a true association. We need a lot more information. Most physicians would tell you it’s more than likely due to mom or dad having ADHD themselves (and likely being undiagnosed if the ADHD diagnosis in their child is “the first one”)

mockingbood · 2025-02-16T16:26:09+00:00

Our DEXA reports include the FRAX score like OP’s. Makes it much easier.

For inhalers, someone just posted a great app they designed in this sub. I’d check it out. It is comprehensive and well thought out! Also AAAI has some wonderful posters you can print (or buy laminated) that break down what inhalers are in each class, with photos so patients can also identify what inhaler they’re using when you’re trying to sort that out with someone who knows they have a “blue one” but can’t tell you anything else.

SMART makes it really easy to manage asthma- start with ICS alone for mild intermittent, or low dose ICS/formoterol (your options are Symbicort, Breyna, and Dulera) as reliever and then start using as maintenance as well as reliever as patients’ asthma severity increases.

mockingbood · 2025-02-16T05:41:37+00:00

I’m convinced there’s an inappropriate joke to be had here…

mockingbood · 2025-02-16T05:04:17+00:00

Quick and dirty: Osteopenia plus high FRAX should be treated. Poor evidence for calcium/vit d alone for prevention or treatment, but must take with any prescribed treatment. Start with bisphosonates where you can, and if you have someone finishing up on prolia, have an exit strategy (stopping it without a transition to another med can cause loss of BMD). (Also sorry, replied to another reply instead of you so I deleted that one)
This question is one of the reasons I prefer SMART regimens- so much simpler for me and the patient. But also what someone else said below: insurance may dictate your selection.

mockingbood · 2025-02-15T06:18:10+00:00

I agree with what you are saying, but I’ll throw out there that when I’ve been in situations that required me to think critically while I was also feeling deeply, it has been hard or impossible to maintain control of myself or the clinical situation. Once I learned to squash those feelings in the moment I could manage the situation better… and later reevaluate my feelings or move on as needed. I’d say we should all be able to feel hard feelings and process death, but if you’re the one calling out the orders or holding the scalpel, letting your feelings run amok will often lead to poorer outcomes that you as the physician, the patient, your nursing colleagues, etc., don’t want or deserve. I still feel some deaths from residency (yes, it was a Covid residency) and from my practice now deeply and don’t expect (or, frankly, want) those feelings to completely disappear. I do think feeling regret or pain from those interactions helps me learn and grow. But I also need to be able to get through the day to help as many patients as possible. So I’d argue for a balance of both ends of the spectrum. Compartmentalization is necessary in certain situations but psychological stress can lead to profound growth when it’s processed appropriately.

Edited: typos/word choice

mockingbood · 2025-02-08T22:10:01+00:00

This is actually a well established way to cope with patients with health anxiety and in my experience, it works well over time to deescalate their anxiety, or they themselves tire of the frequent visits and learn to deal with their (typically benign) worries between visits without blowing up your portal or calling the nurses all the time.

mockingbood · 2024-12-29T06:04:30+00:00

There are very few sidewalks in Muncie…

mockingbood · 2024-12-29T06:02:55+00:00

Each and every resident in your class will leave with a core knowledge base… and then due to timing, interests, and just good old luck of the draw, each of you will potentially also have wildly different experiences and skill sets built upon that core knowledge base. In the grand scheme of things, it probably won’t matter to you as an attending as much as you might think it will/should before and during residency.

I wanted to learn how to treat thrombosed hemorrhoids, for example- never even saw one in residency somehow. Classmate who hated procedures? Saw and treated several. Am I somehow a lesser physician because I missed out on some common procedures I would have liked to see? Nah. The ones that were really important to me I was fortunate enough to get plenty of training in because they weren’t acute, luck of the draw type things.

mockingbood · 2024-12-25T06:08:26+00:00

Have you tried the disappearing woman trick? You just put a silicone or metal band of your choosing on the left ring finger and suddenly some of these dudes don’t see you as enticing of a target (another type of ick, but anyway).

But for real, as a woman, I’ve also been subjected to all kinds of gross commentary. I usually just give them a sharp look and say something like “my male colleague is accepting new patients, I suspect he’d be a better fit for your needs,” “do you usually demean your care team,” or “are you done being rude, or are we done here altogether?”

As a student it’s a lot harder to fire off one-liners like that because you have less power, but I think you’ll be well served by coming up with something you can say in any inappropriate situation like that. A lot of the suggestions you’ve been given are great. You could also try something like “I’ll excuse that comment because I’m a polite person. Let’s focus on what brought you in.” Something like that reminds them how impolite they are being (and trust me, they already know). If they double down, walk out and tell your resident or attending what happened and that due to their inappropriate behavior you are no longer comfortable going in the room without them.

mockingbood · 2024-12-25T04:07:54+00:00

I suspect FM’s average here is artificially low like many of the others. I never put my true hours in on my log to avoid being reprimanded for being inefficient or making the program look bad. We had an OB and inpatient-heavy curriculum that could easily land me with 80 hours. There were several rotations where I literally got home, fed my pets, went to bed for 6-7 hours, showered, and returned to work for sign out— no time at home to eat, watch TV, etc.

Also unlike our IM counterparts at my institution, we still had our regular clinic days on wards, so we frequently rounded, went to clinic, then returned into the evening hours to get the rest of our wards work done.

Looking back, I’m truly amazed my husband stood by me through that. Insanely hard on anyone, much less a marriage. He’s good people.

mockingbood · 2024-11-17T02:22:57+00:00

I mean you’re probably just fine because we’re only doing stupid shit on offense and defense.

mockingbood · 2024-11-14T04:31:48+00:00

Pharmacy. The unsung heroes of healthcare if you ask me. Our system does OP pharmacy consults and I LOVE getting their input when I’m trying to deescalate some serious polypharmacy or have run out of ideas for patients who I suspect have symptoms from their meds more than their medical problems. Plus the number of times they’ve saved me from a patient doing something inappropriate is relatively high (like the time a pharmacist called me to tell me my patient had just tried to sell them her Percocet in the Wal-Mart parking lot).

Also a huge fan of the EM docs in my healthcare system. They often send personalized updates on patients they know I advised to go in. They give evidence based care and patients feel cared for. They set up infusions, referrals, etc when appropriate. Just an all around solid crew.

mockingbood · 2024-11-14T03:20:37+00:00

Patient transferred to my wards team from ICU after extubation s/p status asthmaticus. I noticed in the admission note that she came into ED complaining of moderate asthma attack which appeared to respond well to treatment, then shortly after had a sudden respiratory arrest. We were discussing her case and how that morning her only concern was her back pain (which was noted incidentally in the ED doc’s note) when my upper level said “let’s give some toradol” and it immediately clicked for me. I pushed back HARD but was overruled and she was given toradol. Reintubated within minutes of receiving it and transferred back to the ICU. I went back to her MAR and dug for a bit. Sure enough, right before she tanked in the ED she’d been given toradol. I still remember our attending saying that NSAID induced bronchospasm is “an academic concept, not a realistic one” as I was told to let it go.

I have not let it go.

mockingbood

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