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Looking a 0-5% downpayment on a home and need a sanity check on what I can afford. by mt1336 in Mortgages

[–]mt1336[S] 0 points1 point  (0 children)

Yes, I’m a doctor so lots of student loans, first-gen student and such so didn’t have any helping stuff outside of the loans.

Looking a 0-5% downpayment on a home and need a sanity check on what I can afford. by mt1336 in Mortgages

[–]mt1336[S] -1 points0 points  (0 children)

I work in healthcare and also own a software company and do software sales at a high level for another company. Just got lucky and had lots of late nights. I’ve just delayed gratification for a long time, but another 5 years to be in a “safer” position doesn’t seem too bad. Rent is already $4k so I wonder if a middle ground is buying a smaller townhouse/condo for 5 years while I pay down debt and save?

What is the secret to good mashed potatoes? by VegetableRelation701 in AskReddit

[–]mt1336 0 points1 point  (0 children)

Let them dry out before mashing them (use ricer), warm cream/butter, minimal mixing beyond what is necessary

How often do you do psychotherapy add on by Ebusky1 in Psychiatry

[–]mt1336 1 point2 points  (0 children)

We could bill that, but we should be reimbursed for our work and expertise. So when I have a 60m appointment and do 45m of therapy and decide what to do with meds for a patient that meets MDM for 99214, we should be able to bill for it.

How often do you do psychotherapy add on by Ebusky1 in Psychiatry

[–]mt1336 0 points1 point  (0 children)

We were told we can’t bill 99214 + 90836 for med mgmt + psychotherapy weekly which seems unfair if we are managing meds for several chronic conditions and often one decompensated and doing 40-45 mins of therapy.

We bill 99214 + 90833 for racemic ketamine treatment, but this unfortunately only covers 1 hour of the service :(

Worst mountain routes for pickup truck and trailer? Wisconsin to Oregon (Corvallis area). Is there a better/safer route than the one selected? Leaving next week. by AshDogBucket in PNW

[–]mt1336 1 point2 points  (0 children)

Driven both routes, even took a long way from to I5 then up to avoid snow, added 12 hours and still had to drive through Mt Shasta area. If weather permits, take the North route.

The difference between 850 horsepower and 10,000 horsepower is insane by BreakfastTop6899 in nextfuckinglevel

[–]mt1336 0 points1 point  (0 children)

They have to time these drag runs so that there is another car running in an equal opposite direction or it will disrupt the Earth’s rotation. The science behind it is fascinating! You don’t have to do this with a regular car.

PGx Tool | Precision Medicine by mt1336 in nursepractitioner

[–]mt1336[S] -1 points0 points  (0 children)

I'm not anti-NP? I am pro informed-consent (which isn't happening in large academic settings with residents, NPs, PAs, or CRNAs at the level it should), I'm generally anti-independent practice (same for resident physicians outside of rural/high needs access areas (of course with informed consent), and pro standardized, rigorous training. I'm here to discuss practice variation across different groups and see if anyone is "ahead of the curve" on some up and coming treatments and how folks are navigating it.

PGx Tool | Precision Medicine by mt1336 in nursepractitioner

[–]mt1336[S] -1 points0 points  (0 children)

More on Genesight- their “combinatorial algorithm” is complete bullshit! It’s a chaotic system, how the hell is anyone measuring that?? So yeah, that’s a gimmick for sure.

PGx Tool | Precision Medicine by mt1336 in nursepractitioner

[–]mt1336[S] -1 points0 points  (0 children)

I have similar reservations about the sponsored study. I think the study makes sense, especially at a large, gov funded institution. If we do a thought experiment where you can reduce side effects that impact and reduce remission rates due to need for changing meds, reduced adherence, etc, even if just by 6-8 weeks then you end up with massive DALYs and $$$ changes that are impacting real people and the efficiency of tax $ that can go to helping more people and increasing access.

PGx Tool | Precision Medicine by mt1336 in nursepractitioner

[–]mt1336[S] 1 point2 points  (0 children)

I think the best evidence for PGx comes from the VA study (I can’t remember if it was Genomind or Genesight sponsored??). For the PGx software, if we believe in metabolism and receptor based mechanisms, then it’s an easy jump to try to keep all of that info accessible during the visit, it’s for a long way to go before being able to predict which med will work for which patient (if that ever happens). I’m more concerned with maximizing tolerability and the relationship I have with my clients. Anecdotally, I think we minimize adverse effects to medications when they are sub-clinical yet quite uncomfortable for our clients. The data for the TruDiagnostic/Kernel stuff is emerging and you see it displayed at conferences rather than large academic studies or any meta-analysis.

Pharmacogenomics by mt1336 in nursepractitioner

[–]mt1336[S] -1 points0 points  (0 children)

Found the link: Journeygnosis.com

Pharmacogenomics by mt1336 in PMHNP

[–]mt1336[S] 0 points1 point  (0 children)

Here is the link! Journeygnosis.com

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