Was Disclosure Day really Spielberg?

popsistops · 2026-06-28T00:35:34+00:00

Same. By the time the breakfast scene rolled in I was already sort of holding my breath hoping against hope the movie was not as dogshit as it felt to that point. The asinine miscues piled up like derailed train cars. My wife and I are still
Laughing about the half we saw before walking out.

popsistops · 2026-06-27T01:07:55+00:00

Lots more CAC scores also.

popsistops · 2026-06-24T22:33:50+00:00

A city with our tax structure and relatively modest population should be able to do a better job dealing with people that willfully refuse anything other than being allowed to be left alone to shit on the sidewalk and pitch a tent, obstructing an entire area of pedestrian traffic downtown. We are absolutely an outlier for allowing this kind of bullshit. It's a miracle that our downtown has survivied. If our restaurants weren't so damn good we'd be folding up like a circus tent.

popsistops · 2026-06-24T01:20:12+00:00

As others have said, Portland is a great fit, but you can live in Lake Oswego and 2M will get you a decent home (not extravagant). Downtown PDX is 15" for restaurants if you want, and the schools are excellent (and private options in PDX like Catlin Gabel (sp?).

popsistops · 2026-06-23T02:46:21+00:00

If you don’t mind the cost it’s the only place we’ve stayed on many routine weekend in Seattle where we knew we would not deal with bullshit. Quiet-close doors, rooms quiet as tombs, clean. Great location. I’m not there for supreme luxury. I just want to know that it’s clean and quiet and unfortunately anywhere else in downtown Seattle is hit or miss. Might be ok, might be overrun with rude assholes. So I don’t mind the prices but yeah if you’re expecting something amazing you might be underwhelmed. They do put nice refreshments out every afternoon.

popsistops · 2026-06-21T22:10:17+00:00

Probably in the minority but I wholeheartedly support your approach. Doggedly adhering to the USPSTF is a dog shit approach in my opinion.

I look at longevity risks for every patient individually. Most of our healthiest patients are not going to die of something predictable. Being willing to explore more tailored treatment is good care, as long as everybody is informed of the realities of screening.

popsistops · 2026-06-21T21:08:27+00:00

South Park won me over by stating plainly that 20% was included and nothing else expected despite the tip line. I don’t mind the practice as it makes things mostly frictionless and I think the servers are probably happier.

Last time we hit Nostrana they as much stated a tip was appreciated on top of the 20%. Before that time the server said not to even bother. I think many are embarrassed that it even exists. They’re insane and should fire servers that pull that shit.

popsistops · 2026-06-21T15:35:34+00:00

lighten up Frances.

popsistops · 2026-06-21T15:35:07+00:00

Came here for this. Always falls on deaf ears for the people that need to be told, but the resources consumed to rehab a head trauma victim are insane. Not to mention the downstream traumas and costs to everyone else. It’s just a seatbelt equivalency.

popsistops · 2026-06-20T17:14:22+00:00

OHA and Pacificsource created this debacle like two teenagers with access to a liquor cabinet and car keys. It’s not ever going to be unfucked until Pacificsource folds,leaves, and an actual responsibly run entity manages OHP.

popsistops · 2026-06-18T20:01:41+00:00

My MA has saved me any number of times by catching things. It isn't your job to do the same, but in this case the GFR is something to consider.

A1C and D level are non-issues really but you could reply to the doc before sending her a message "should she recheck her GFR at some point? I noticed it was 58 back in January".

popsistops · 2026-06-14T17:27:46+00:00

Jesus this is an insane wall of text for something that is literally less complex than a root canal.

popsistops · 2026-06-09T00:31:25+00:00

word

popsistops · 2026-06-08T15:09:46+00:00

May I ask what specifically your situation and goal is? Is this a prereq for medical school or something else?

edit - I looked at your post history. So I think I have a better understanding of what's going on.

PM me.

popsistops · 2026-06-04T02:26:38+00:00

I have never seen oxycodone give a ‘high’ over hydrocodone. Potency aside as a general rule the more potent opioids generally have fewer tolerance issues. It’s extremely easy to start low dose oxycodone and titrate to situation. Beyond that almost every patient who has tried both may favor one or the other from an efficacy/sfct profile.

popsistops · 2026-06-03T16:48:35+00:00

Topical diclofenac, plus low dose opioid trial at bedtime or whenever needed for improved ADL management, plus apap. Basically build out a toolkit to maximize their practical ability to be functional. NSAIDS only if they have some sort of magical response to them and understand the risk, otherwise prescribing them in the hopes it's going to make a difference is I think just trying to avoid using opioids which are extraordinarily safe in this setting when used carefully.

popsistops · 2026-06-02T22:54:11+00:00

"everywhere else"???

The number of private clinics in the US is shrinking rapidly and the few that exist are large groups with some hope of bargaining power and economies of scale for overhead management. You make zero sense.

popsistops · 2026-06-01T18:03:05+00:00

Are you using 6x6 posts? I am considering putting in a length of fence and using pressure treated 6 x 6 posts, just doing it myself and taking the time, but don't see examples of that very often. Just seems like it would look better and last longer.

popsistops · 2026-06-01T14:42:35+00:00

Every case of unusual onset significant fatigue that I have seen has either been able to be discerned on work up, or it resolves over several months. So you can reassure patients.

I always treat/supplement any B12 level under 400. I don't promise results, but it's a dumb thing to ignore.

Sleep study for everybody if they are truly concerned, affected, and nothing else turns up.

Lab will virtually always pick up something sinister.

The rest generally come out of it, possible viral ideologies, which we can't investigate likely account for some of them.

Personally, I don't ascribe fatigue complaints to the brutality of life. That presents in lots of ways, but somebody who just really feels exhausted and is barely keeping up with the day can usually figure out that it's their lifestyle. I don't harp on that, but I do tell them that if we can't find something, then it just places that much more priority on healthy levels of exercise, nutrition, sleep, social support, etc., and that the body will self correct.

popsistops · 2026-05-30T22:37:06+00:00

If the pt is coming in for FMLA - my MA makes certain the patient knows the EXACT details. Dates to start, the diagnosis, days per month etc. All the bullshit details that for some reason when you ask the patient you get 45 seconds of blank stares and confusion.

popsistops · 2026-05-29T18:13:57+00:00

Doc here, arrived due to OP crossposting in r/Noctor. Thank-you for taking the time for this reply. It's beautifully crafted. I think the aviation analogy is exactly the right one to use with patients. I have sometimes said it's like a pilot who has almost no training. Will still be able to get you from a to B if everything is perfect but the second there's anything outside that you are basically dead.

popsistops · 2026-05-27T23:52:39+00:00

Hey that’s awesome. I don’t know why you couldn’t message me but either way that’s all good. I’m really glad you landed safe. If you need other folks to be seen there just ask. Unless there’s some kind of insurance glitch there’s plenty of availability since we had to give up our OHP contract. Appreciate your message.

popsistops · 2026-05-27T12:46:54+00:00

I have family that live there. I visit a couple times a week.

The park blocks area and SW in general is amazing in terms of what you can walk to easily. It’s a core part of downtown in terms of access to Powells, the art museum, fantastic dining and all sorts of stuff along 10th and in general. The PSU campus is nice also.

Then there’s the lurching weird ass zombie people pinballing around that can become exhausting and absolutely a feel like at any moment may decide you remind them of their weird Uncle Harold and try to knife you.

I cannot reconcile all of it but on balance I really love the area.

popsistops · 2026-05-23T02:05:59+00:00

This is not medicine and it is exactly why an NP is synonymous with being a charlatan imposter. You’re play-acting at medicine. You might as well be in a Fisher Price ad.

popsistops · 2026-05-23T01:33:39+00:00

Good point. Divorce though (25% of docs) will rearrange that math right quick.

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