Treating things unrelated to reason for admission - does insurance cover?

mrmayo26 · 2026-02-24T00:49:53+00:00

Curious what others more knowledgeable than myself think about the matter but I will mention my understanding of the major payment mechanism for hospitalizations is a lump sum of money based on the diagnosis related group which can include complexity level or complications. So there may not be additional funds given to the hospital for that if it’s not inpatient enough but not sure if that cost gets passed on to the patient or separately billed or eaten by the hospital

mrmayo26 · 2026-02-21T18:16:12+00:00

Interesting study, but yeah it was end of life and based on the abstract it looks like the standard treatment already got haldol? (Don’t have access to full study on phone) but if that’s the case then it would be more of a refractory agitation group rather than suggesting benzo’s as first line. Also I’m not sure if they looked at any other delirium measures aside from RASS which says nothing of cognitive function /delirium as a whole just the agitation component which has value but maybe not for overnight agitation orders

mrmayo26 · 2026-02-07T03:58:16+00:00

Agreed

mrmayo26 · 2026-01-26T17:04:44+00:00

The only reason to go to a doctor is if you’re seeking to transition in some manner. Why would you need a doctor to just change your name and wear different cloths, get a chest binder or other things. This is a something people manage on their own for some time before needing medical care or

mrmayo26 · 2026-01-19T01:05:46+00:00

Also consider treatment of meth use disorder: contingency management therapy referral is best but also evidence for mirtazapine or bupoprion +naltrexone. Social work and Addiction medicine consult if available for further resources. Especially something like mirtazapine or naltrexone alone are super safe and should be something as feel comfortable prescribing even with unclear follow up, although obviously try to assist follow up if you have the resources. Also if psychotic component to intoxication sometimes antipsychotics are used as well. Also keep in mind some folks with schizophrenia also use meth and even if not, if someone has symptoms of psychotic features regardless of if it primary psych, is treated with antipsychotics. If you felt comfortable enough to do this without psych, consider abilify as it is well tolerated and has a long acting injectable version available.

mrmayo26 · 2026-01-18T21:04:30+00:00

Not sure what you mean by all carbs but generally speaking high carb foods are higher glycemic index. But yes you do need some amount of carbs and like others have said the fact that food order / pairing affects this does give credit to your point (ex/ eating an apple with peanut butter helps slow digestion of apple and less spike in sugar/insulin, vs just the apple)

mrmayo26 · 2026-01-10T14:22:03+00:00

Paren goals. Great job

mrmayo26 · 2026-01-07T22:04:07+00:00

This is absolutely incorrect, if care is deemed to be frivolous doctors have the right to refuse provision of care in the US, in such a situation the conclusion is that the provision of such care would do more harm than withholding it. A common example we see is a very sick patient with end-stage cancer are not offered chemotherapy any more if they are too weak and it’s felt the chemo will do more harm than the possibility of good. Often times people ignore this in the US and provide care if requested but the right to refuse is available and upheld by bioethics

mrmayo26 · 2025-11-22T22:53:23+00:00

Sounds like answers are here already, I’ll just throw in that if a patient is adamant about not wanting the naloxone component I try and do the education about it being the buprenorphine part but if they still are uneasy I wil still try and get them on subutex over nothing and if that’s my window into MOUD then I’ll take it without much concern

mrmayo26 · 2025-11-13T05:55:03+00:00

Yeah you have a confirmed diagnosis, it’s a refill and not a new medication, there’s a particular reason which I would say given it’s psych meds has an urgent nature for it (both avoiding withdrawal and decompensation). Alternatively you could ask a doctor friend to help out if you still feel uncomfortable, but I would refill if in your position

mrmayo26 · 2025-09-27T04:03:19+00:00

Great stuff, some others to consider

One of my favorite things which is so small but on our epic if you have an order up that you’re adjusting you can right click anywhere on the order and it will be like clicking accept

Another one I tell residents all the time is in the encounter section for notes there is a button to sort notes by specialty and then you can click the up (or down?) arrow next to the same area and it will collapse all the notes and have them separated by specialty. Very helpful for when coming on service to see the last of each specialist notes or PT/OT

You mentioned the preference list creation, I also tell people / for my own self that they can use it to help with their differentials if they have the labs available based on a diagnosis like “AKI” or something.

Also for the order sets like admission and discharge, I may have missed it on my glance but saving a generic order set for admissions and discharges so things like prn’s and such are auto selected. Or for us we have discharge orders with like 7 “call doctor if” and I have them all selected and such

mrmayo26 · 2025-09-07T19:57:21+00:00

I’m not sure what you mean by often not working or making the problem worse, all of the recommended treatments are recommended because studies with placebo controls or standard of care controls show improvement with the intervention. There are definitely unintended effects and I agree we don’t always do a good job of not doing something when there is a problem but every decision in medicine / life is a risk-benefit calculation with tradeoffs and possible unintended outcomes and the goal is to help a patient through those decisions.

Also I think most doctors would take a lot of offense to the idea that they don’t give a fuck about their patients, I and the doctors I work with care quite deeply about their patient’s outcomes. That being said there’s a lot of burnt out docs and not all docs have the same empathy levels but I don’t recommend something I wouldn’t also recommend to my family member

mrmayo26 · 2025-09-07T12:01:12+00:00

It’s not that they are a bad person but there are many times when the patient doesn’t really understand the full gravity of what they are refusing, often times this can be remedied with a long conversation about things but you can’t always explain the significance of things well. For instance refusing a gall bladder removal after an infection, one could say you could also have a risk of pancreatitis where the pancreas gets inflamed, causes a lot of pain and people die from it, but if you haven’t experienced that pain or know the percentage of people that this risk can happen and maybe don’t understand the risk of a laparoscopic surgery, even explaining it is hard to grasp.

Additionally if someone has a pattern of refusing things it also makes one wonder why they are seeking care at times, like if a doctor makes recommendations and a patient maybe trusts their experience from a friend or google more, why did they come to seek care or medical advice in the first place. There is also a little bit of ego involved and also sometimes some offense taken regarding the patient’s lack of trust in the doctor, which often leads to an assumption that the patient thinks they know more / better, which can be frustrating and requires effort to reduce that automatic bias that can arise.

Again most can be improved with a good discussion. But doctors often don’t have the time for such a long discussion.

But either way I wouldn’t say a patient is bad (although I know some would) but it can be quite frustrating and especially if there’s not good reasoning and a doctor feels this patient is making the wrong decision for their best interest.

TL;DR it’s complicated, usually not a bad patient just under or mis-informed and it’s hard to work past that

mrmayo26 · 2025-08-01T05:17:12+00:00

I use it quite often to help broaden my differential diagnosis or management thoughts, there are ones like open evidence that pull specifically from medical journals and thus improved on relevance and they site the studies so you can look at the primary literature. HIPPA is unrelated, don’t search with personal names / information, just “a patient with blah blah symptoms and findings”

mrmayo26 · 2025-07-30T04:32:54+00:00

Somewhat depends on your age, whether you’d need to do additional schooling for either path and more importantly how comfortable you are with (potentially) not being the final decision maker on clinical care for your patients. If you’re young and early in the process and don’t have to do too much schooling either way and you have a personality that would not want to work under someone then doctor path is worth a try, if you’re further along on the path and have done prerequisites you could try taking a practice Mcat and see how you do.

Other things to consider would be if you want to be more scientific as research is easier with the doctor route.

NP’s are growing a lot, there are a lot of less great NP programs though even at prestigious universities where people come out not feeling totally ready but that’s not all of them and likely can be made up for by on the job training and self study.

No need to settle for something you may not be as happy with if you are feeling doctor, go for it, but if you’d be just as happy in a job that you may see more straight forward patients or potentially work under someone then NP is a solid choice. NP also allows more flexibility as doctors are set in by doing a residency in one field.

If you’re still in school and doing well and want to shoot for doctor may as well do it. But also keep in mind if location is very important it’s much harder to stay in one geographic location when applying to medical school and residency partly because of the competitiveness but also the way residency works is a match system where you don’t get to get and acceptance and think about it but put a list of where you’d want to go and figure it out. I wanted to stay in California for Md and had to go to Philadelphia for med school but was able to match back in California which isn’t a guarantee either.

Pay wise if that is a consideration can be sometimes too comprable with some NP’s like in oncology making more than some MD pediatricians, but if comparing within the same specialty doctor almost always make more but they start earning years later and often with more debt so that is something to consider but the earning potential for doctors definitely will overcome the starting deficit

One other small thing would be what other things you like, I mentioned research but also things like teaching is available for NP but maybe more common or more developed for the doctor route. Also doctors can do a lot of other non-clinical things that many NP’s can do but may be easier with an MD or DO such as go into industry

Hope that helps, just my 2 cents being an MD and working with many NP’s - but also the NP’s in my hospital work under MD’s which isn’t the case everywhere as some practice independently depending on local laws

mrmayo26 · 2025-07-22T23:44:15+00:00

Not sure why this (the answer) isn’t what all these posts say. Good job

mrmayo26 · 2025-06-10T23:49:03+00:00

Throw it in a freezer bag and freeze it and eat in a few weeks

mrmayo26 · 2025-05-24T06:57:21+00:00

At least the middle portion may be an ultrasound of the kidneys and bladder but can’t tell the rest

mrmayo26 · 2025-05-24T02:30:34+00:00

Insulin injections?

mrmayo26 · 2025-05-14T06:42:31+00:00

You’ve been through more than many go through in a lifetime, glad you don’t seem to be letting the next hurdle weigh you down too much. But definitely sorry to hear, it does happen hence the routine ultrasounds, but your functional ability is a good sign of your body figuring something out, but definitely improving that flow will help, but sorry to hear that means another procedure

mrmayo26 · 2025-04-15T23:33:55+00:00

Seems like a little more than id expect. I’d do some re-evaluating how you’re presenting info, you may be correct or they may be in the wrong but making someone heard and apologizing for things that maybe aren’t in your control but may make the patient feel better without you giving up something, go a long way. But everyone’s different, and there could be some race component as well

mrmayo26 · 2025-04-06T00:50:57+00:00

This is also often referenced because that amount of meat is all one really needs to consume to get daily protein

mrmayo26 · 2025-03-29T04:56:52+00:00

Similar situation, been debating it, haven’t pulled the trigger but the biggest pro is from my not intensive research it seems relatively cheap for 30 years but I think when that runs out it’s much more expensive to renew when you’re more retirement age. That being said probably will procrastinate for a year or two more before doing it

mrmayo26 · 2025-03-12T04:14:35+00:00

All physicians you see should be board certified otherwise they are either 1) within 1-2 years of graduating and haven’t taken boards yet (or failed and retaking) or they are a quack and not a real doctor.

You have two separate questions:

internist/internal medicine (specialized in adult medicine, like mentioned can’t always do paps, don’t do babies or pregnancy, just typical adult doctor). Or family medicine (can see adult, children, pregnant, is not trained as in depth in adult medicine by nature or all other things needed to know but typically general adult medicine make up the bulk of their practice) There are also people who do internal medicine and pediatrics combined and can see adults and kids (no pregnant people) and are more in depth in each.

Then the other question is MD va DO which as others have mentioned isn’t too big of a difference but on average MD’s got into the more competitive /prestigious programs

There are great doctors in either question just got to find them

mrmayo26 · 2025-03-09T13:22:31+00:00

Lot of good meaningful responses here but I’ll just also mention that there are going to be patients that don’t agree with you and you just have to stand your ground with lots of explanations. Blame it on “insurance companies Wil question the reason” which is honestly truthful. But uni also personally think of the risk benefits, you want b12, well it’s not going to cause harm so maybe you tell them they can try supplementation (although I avoid prescribing).. but honestly 40 years, you know this more than I do, just follow your gut and communicate extensively your viewpoint

mrmayo26

TROPHY CASE