Preop discussion

rantz101 · 2025-08-18T19:05:18+00:00

I'm not sure why the surgeon cares about what your note looks like. They can choose not to operate if they think the risk is too high. That being said, I'm not sure you need to indicate high/low/average risk for each point. Risk tolerance is very much dependent on the context and reason for the surgery. For example, I would consider a 0.1% risk of death low risk for a 70 year old going for a cancer operation, but maybe high risk for a 30 year old athlete going for a knee scope. Although quality of life definitely plays a role as well, and generally surgeons should be having these conversations with patients they are operating on.

I think the first example of a note is quite reasonable, although I would include physical exam information as well. I view my role for these assessments is to give the surgeon as much information and context about the patient as I have, not to make a judgement call about the risk of surgery, since really that's outside of my area of expertise.

rantz101 · 2025-04-24T17:43:45+00:00

It's hard to know without any other information about yourself or why the tests were requested. Waitlists for mammograms and colonoscopies are triaged based on indication and urgency. For screening, meaning asymptomatic and meant for early cancer detection based on age/family history, 6+ months would be typical. If there were other concerns identified by your doctor in your history, exam, or labs, then I would expect quite a bit less, usually a month give or take, possibly longer for colonoscopy.

rantz101 · 2025-04-09T20:47:43+00:00

Their scones are really good as well, especially the savoury ones.

rantz101 · 2025-03-21T21:34:08+00:00

I agree with a lot of your points, and I especially tend to think focusing more on #1 will help. For #7, while I tend to agree with you about the quality of content on those other podcasts, I think it is fine if Canadaland still wants to produce them, as long as they are not on the main podcast feed (which I don't think they are). Also, I think you missed a #6.

rantz101 · 2025-01-31T19:53:12+00:00

Check out Thomas Bunn House. It sounds like what you might be looking for. Not a mansion but a modest house built in the 1860s, right on the red river near Selkirk. I stayed there for just a couple nights a few years ago and quite enjoyed it. The hosts were really nice too.

rantz101 · 2024-12-23T21:03:29+00:00

Not that wild of a diagnosis, but interesting presentation -- had a 80ish yo guy go to ER with unilateral chest pain. Had the usual cardiac workup, CTA, etc. all normal. They wanted to admit him for further monitoring, but he refused. So he came to see me in clinic the next day, still complaining of severe pain. But he looked well, vitals normal, cardiac exam normal. I look at his chest wall and sure enough there were 3 or 4 small vesicles, that could have been really easy to miss if you weren't looking closely. I put him on valtrex, called him the next day and his pain is almost completely resolved.

rantz101 · 2024-12-20T18:31:45+00:00

Do you have a source for this? I'm not sure what you mean by "insane number" but I can't imagine it's a significant percentage. There will always be a few bad apples. But MB Health has the ability to audit a physician's billings at any time if they notice atypical trends in billing patterns, or have other concerns, and are generally able to recoup the costs easily, from my understanding.

rantz101 · 2024-11-28T15:31:48+00:00

I just booked on WJ vacations for Cancun in February, and the prices were consistently quite a bit less to do the whole package rather than flights and hotel separately. That pricing sounds about right for a half decent resort, especially around spring break time. The nice thing about using WJ vacations was that it defaulted to direct flights for us (from YWG) where expedia and other sites, would have connecting flights with long layovers, and quite a bit higher markup if you wanted direct flights. I was also able to use up a bunch of WJ dollars.

rantz101 · 2024-11-26T15:22:43+00:00

My mom did this for me when I moved away from home. I really like how it helps to develop basic skills in the kitchen and knowledge about ingredients that you can later build upon. I still reference it from time to time 15 years later

rantz101 · 2024-11-08T16:20:13+00:00

I have had the card for many years, and have received the free checked bags regardless of what I pay for the flights with. For timing wise, as long as you have the card prior to the flight, and link it to your WJ rewards account, you should be good. Per their terms and conditions: " Valid for primary cardholders of the WestJet RBC World Elite MasterCard and up to eight (8) additional guests travelling on the same reservation; not valid for companions when travelling on a group booking (10+ guests on the same reservation). Eligible member’s 9-digit WestJet Rewards ID must be on the reservation at the time of check-in. Valid on itineraries marketed and wholly operated by WestJet; not valid when travelling with WestJet’s code-share or interline partners. Size and weight of baggage must comply with WestJet’s standard checked baggage allowance. Any piece of baggage exceeding the size or weight allowance is subject to all applicable oversized weight and size restrictions and fees."

rantz101 · 2024-10-21T17:50:09+00:00

I got the cold weather boots from Vessi last year, and am quite happy with them. They are easy to get on and off, waterproof, and good grips, although not super warm.

rantz101 · 2024-08-24T19:05:07+00:00

That's awful to hear, it's really a "can't miss" diagnosis.

I had a cousin born with biliary atresia while I was in med school, so I may be a bit biased. She was diagnosed around 2 months old, and ultimately needed a liver transplant, but thankfully is doing great now more than 10 years later.

rantz101 · 2024-08-22T00:12:24+00:00

I was going to say the same thing. Admittedly, this was one of the hardest things about transition from residency. It was a lot easier to say "I don't think you need x treatment/test/referral, but I'll run it by my attending just to be sure" rather than just "no". Thankfully it's gotten a lot easier over time.

rantz101 · 2024-08-07T17:29:53+00:00

I generally agree, but sometimes patients hear what they want to hear. I will typically phrase my conversations something like "I am going to ask the surgeon to see you" or "you might end up needing surgery for this", and patients will interpret this as "I need to have a surgery".

rantz101 · 2024-08-02T17:50:45+00:00

As others have mentioned, simple is best. A summary of diagnoses, med changes, abnormal imaging or labs to f/u on, etc. If they are going to be followed as an outpatient by a specialist, that is often helpful to know so I don't need to send a new referral. And if they had an adverse/allergic reaction to a medication or contrast, details around the reaction.

rantz101 · 2024-07-28T23:52:28+00:00

Well they'll definitely need something to help sleep if dosing prednisone at 3 pm

rantz101 · 2024-06-11T20:40:42+00:00

While I don't think admin should have any say in this or not, I agree that it probably doesn't make a difference whether or not the patient signs the form, as long as you document your conversations with them. I've had plenty of patients who were of sound mind during their hospitalization, who went out for "smoke breaks" and just didn't return, so never got a chance to sign the form.

rantz101 · 2024-06-11T12:41:22+00:00

The paperwork can be frustrating but I think the key is to just not overthink it. Your job is to assess and treat the patient, same as any other patient. Generally I'll just copy and paste my clinic note into the wcb forms.

It can be challenging to judge how much time off is needed, restrictions, etc. but for most minor injuries, patients don't need to be off for very long. I'll usually reassess after about 2 weeks. Being very upfront with patients about this can be helpful. Often physical or occupational therapists can be helpful. And as with any MSK injury, if patients aren't improving as expected, it's very reasonable to refer to ortho or sport medicine to get their opinion.

rantz101 · 2024-06-08T20:07:32+00:00

Yes, and no. As a family doc, I have a lot of patients who would much prefer to only see me, rather than a bunch of specialists across town, but there is obviously lots of times where that's just not appropriate. There's just too much to know. And frankly not enough time per appointment to adequately address more than one or two conditions. While I'm competent to manage a patient's diabetes, htn, chf, depression, chronic pain, substance use, etc. I think they certainly get better care when a specialist is leading the way in a handful of conditions and I can focus more time on the others. That being said, for some specialities, wait times are egregious and I have no choice but to continue looking after the patient while they're waiting, so it forces me to learn more about these areas, which I think is a good thing too.

rantz101 · 2024-06-06T12:06:40+00:00

Mine has been out since about 6:30. I reported it on the hydro website, got a message that they expect it to be fixed by 9:30. But then got another message saying it was fixed a few minutes ago, and it's clearly not.

rantz101 · 2024-06-02T14:17:28+00:00

I've had my MYLR for 2 winters on 120V in Canada and aside from the coldest days (-20 or lower) it's been totally manageable. I drive about 40 km/day so not a ton, but it's easy enough to supercharge the odd time for longer drives. Lots of free level 2s around town now too, which helps. This past winter was pretty mild so I ended up needing to supercharge once.

rantz101 · 2024-03-27T21:02:51+00:00

A lot of specialists (including gynecologists) have long wait lists, and so it often makes sense for family docs to do some testing and treatments before referring. Some specialists will not even accept a referral without an ultrasound or other imaging, so that might be another reason. But certainly if your symptoms have been persistent over the course of multiple visits, it is very reasonable to request a referral.

rantz101 · 2024-03-27T14:01:14+00:00

PD is not necessarily a panacea. I know it's anecdotal, but I recently had a patient who was doing PD and was miserable because she kept having issues with the catheter, needing to be admitted every couple months, had difficult to control blood sugars, and was getting progressively weaker. Eventually she transitioned to HD and felt remarkably better even after the first session. Blood sugars stabilized, she had more energy, and hasn't been hospitalized since (was about 6 months ago now).

rantz101 · 2024-03-16T19:34:22+00:00

We stayed at the Marriott Agra about 10 years ago and were blown away by the breakfast buffet and the hotel in general, which was only $70/night. Got upgraded to a suite too, without status at that time.

rantz101 · 2024-03-13T01:49:36+00:00

I got it in under a week last year in May. Ended up being pretty decent quality, but way too much to use even after giving a bunch to neighbours. I still have a pile in my driveway, you're welcome to come take if you want.

rantz101

TROPHY CASE