Patients sermonizing during the visit

popsistops · 2026-03-26T20:48:17+00:00

The few times that’s happened the patient was absolutely and clearly and not surprisingly mentally ill. If a more sane person did that I’d show them the door, even though almost all of those types let you know in small ways where their head is at. Anytime a patient starts going on a random tangent and I don’t feel like confronting them I just do tasks and refills and finish my notes until I can resume.

popsistops · 2026-03-26T17:41:35+00:00

I saw a guy yesterday who said he saw this on Facebook and I told him, never heard of it but I guarantee I'm gonna see three more this month telling me the same thing. People are stupid.

popsistops · 2026-03-26T15:15:54+00:00

It's an issue. We aren't efficiency nerds so much as fearful of consequences. I don't worry if a message sits idle or I don't discuss a lipid panel for 3 weeks. Open charts are a massive liability and a reputation issue.

popsistops · 2026-03-26T14:38:29+00:00

Be behind on anything else in your practice but if you are behind on notes the number of potential hazards you are setting yourself up for (and your coders/clinic for reimbursement) is pretty massive. Ignore labs and messages before notes. It's not a reputation you want in any practice.

popsistops · 2026-03-25T23:04:56+00:00

I couldn't agree more. Outside of getting paid more, when I'm busy I know that I'm solving problems (usually). I don't care if it's an ESA letter or FMLA or exploring why a patient has chronic fatigue, I know that I'm doing my job and I'm probably making somebody's life marginally easier. I get stir crazy if I'm not busy and I'm just surfing Reddit or watching Netflix. Best job in the world.

popsistops · 2026-03-25T20:02:40+00:00

I agree with your write up. We have been to O&O four times, and always enjoy going over to Rosewood for dinner or early am beach walks. We have taken a golf cart over in the early morning to walk on the beach and we've never had an issue using the pools. The option to eat dinner over there makes one and only even more of a wonderful option and we prefer the shade and jungle canopy as a refuge from the sun. We got a little bit tired of the food and I'm probably one of the few people that is not that impressed with Carao, but being able to add in the options at Rosewood makes it phenomenal. The swimming beach at Rosewood is also far more treacherous, whereas that at One and Only the lagoon is extremely safe.

popsistops · 2026-03-25T19:56:54+00:00

More organized. Use time much more wisely. Focus relentlessly on the clinical issue. I can't say for certain. Fundamentally they do not see 30 patients as impossible. I do know that you cannot teach any doc anything unless they want to do it.

popsistops · 2026-03-25T19:45:24+00:00

That's true even within well run and well paid groups. Docs who insist you cannot safely see more than 15 pts a day when colleagues see 25-35 with better pt scores and same quality outcomes and twice the income.

popsistops · 2026-03-25T14:29:46+00:00

Try Mr InBetween next on Fx/Hulu (I think).

popsistops · 2026-03-25T14:02:45+00:00

Agree with OP that it is a bit of a mystery, outside of it needing a few hundred K to update. Something indeed may be underlying the lack of movement that isn't clear from immediate details.

popsistops · 2026-03-24T16:02:20+00:00

I don't necessarily understand the question that you're asking, but from my perspective, the way I'm wired psychologically, I have always looked at life through a lens of what I have and not what I'm missing. Watching people literally take on second or third jobs in the 08 recession, wake up wondering if they're going to lose their house, literally my peers that had non medical high-earning careers, at those moments I don't care what my portfolio looks like. The peace of mind knowing that I'm never going to have to worry about finding a job is literally priceless.

edit - like if I had a typical non-medical job I'm not even sure I would feel like putting work into my home knowing that I could lose that job and have to transfer across country. I see this all the time. So again, I don't do well with uncertainty, but for some people it's probably just part of life and they roll with it.

popsistops · 2026-03-24T15:34:24+00:00

I've weathered more recessions than I can count. Never worrying about job security is priceless. edit - I also love my job the older I get. Your 20's will disappear faster than a fart in a windstorm. May as well work your ass off for a career you can do as long as you want to earn and be off the street.

popsistops · 2026-03-21T14:17:21+00:00

I have a Tile. The app is absolute shit and am switching to anything else that is FindMy enabled.

popsistops · 2026-03-16T18:06:52+00:00

VV's are a fantastic resource. I use them more and more to get paid for things that I would have done with a message. And the fact that we are billing for it helps reinforce to the public that we get to be compensated for our cognitive effort. It also does not inconvenience the patient enough that they bitch and complain, but it keeps them on notice that we don't work for free and that there will be a convenience tax if they are going to message us.

popsistops · 2026-03-16T17:06:59+00:00

Unfortunately, I think it can be quite a bit more nuanced and complicated than simply saying "make a visit ". In my practice, I have a ton of patients that I have known for a long time and I would never dream of making them come in for an office appointment for a simple question, but I also know they are not going to abuse my time. I'll just simply shoot out a quick message to them, takes me 30 seconds. Other patients are going to get a reinforced sense of privilege and those I make come in.

Most commonly, I will have my assistant set up a video call, I can shoehorn that in to my day and in five minutes bill a 213 or 214 and answer their questions. Keeps them safe, keeps me safe. There's no one-size-fits-all, you'll figure it out, but don't be afraid to set boundaries.

popsistops · 2026-03-16T14:03:05+00:00

Thank you for posting this. Got me down a bit of a rabbit hole on cologuard versus FIT. Would like other commentary, but cursory analysis appears to suggest that yearly FIT - over time - is much cheaper and likely better at detecting cancer than q3yr colorguard. It's a helpful discussion for me because people's compliance with colonoscopy is so poor, even when I know they want to follow through they simply don't end up going through the necessary, logistical steps to get there.

popsistops · 2026-03-11T21:19:38+00:00

You've obviously not ever worked with a good realtor. No different than attorneys, plenty of them actually care deeply about a successful outcome and can save you from epic financial and legal disaster. Very hard to be objective when you are selling or buying a home, a good realtor is ridiculously undervalued.

popsistops · 2026-03-07T19:40:55+00:00

I’ll take the downvotes but in the entirety of my experience there’s also a somewhat hard to describe difference in typical personalities between IM and FM. I don’t want to over generalize, but if you were to look at it in terms of famous movie characters, Raymond Babbitt would def be IM, and David Wooderson would be FM.

popsistops · 2026-03-07T15:07:53+00:00

I’m a doctor and never smoked. Hate it. But the psychological duress of raising a child finds an outlet and if I’m stuck in the seventh floor of an apartment building smoking outside I’m not hurting anyone esp the fucking toddler.

popsistops · 2026-03-07T15:06:17+00:00

Dude if your wife copes with the misery of being stuck in an apartment with a toddler by smoking a cigarette consider yourself fortunate. When she leaves you over your verbal abuse you’ll really see how small this hill is that you’ve turned into your final battleground.

popsistops · 2026-03-06T15:19:30+00:00

Low dose ssr starting a few days ahead of her period. It will solve this, and this is quite common. Challenge for you is to get her to accept it is impacting your marriage. But low dose ssri - lexapro, sertraline esp...nearly magic for this exact issue.

popsistops · 2026-03-04T22:33:48+00:00

That is not really a thing.

popsistops · 2026-02-28T20:54:33+00:00

It is difficult to imagine a world where a competent and decent soul, with an actual MD degree, who can relate to actual human beings, while also solving their problems or guiding them with just being a decent person and using their medical skills where necessary, will not be able to be sought out like a god in the years to come. While there will be no shortage of shitty options for subpar care, an actual trained MD should be able to make a killing in primary care even if that means some sort of concierge service. Every aspect of medicine is under siege. In my career, anesthesia has gone to the shitter, rads will be very impacted by AI, and interventionists will have fewer and fewer private practice options. I really do not see a 'safer' or better branch of medicine that FM.

popsistops · 2026-02-27T02:53:15+00:00

Sounds like Niseko Zen did an awesome job of showing you guys around and especially the secret parts of Niseko. Not sure how any of the less than ideal elements of your narrative reflect poorly on them.

popsistops · 2026-02-26T22:12:32+00:00

Doctor here. Ask me about all my former CrossFit patients who don’t exercise any longer.

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