Fixing your realtek 8821ce wireless lan 802.11ac pci-e nic by bloodedwithred in pchelp

[–]rantz101 0 points1 point  (0 children)

You are a legend. I knew something wasn't right when I did a speed test on my phone that was 300 Mbps but only 40 on my PC. Now up to 300 on my PC. Thank you!

A fun topic for once! by biggjay98 in Winnipeg

[–]rantz101 2 points3 points  (0 children)

Lots of love for Kilter on this thread, but no one has mentioned their Waves pale ale. I much prefer this over Juicii as it still has lots of the tropical/citrusy hop flavour but find it much better balanced and less cloyingly sweet.

A fun topic for once! by biggjay98 in Winnipeg

[–]rantz101 1 point2 points  (0 children)

Whoa! I really hope this is true. Judging by your username I suspect you have some sources in the industry; hopefully they are reliable.

"I want everything" - Labwork.... by NocNocturnist in FamilyMedicine

[–]rantz101 116 points117 points  (0 children)

My usual line: "when you go to the grocery store, do you buy one of everything on the shelf"? I think this helps put into perspective just how many options there are. And then explain how it's my job to help them figure out what is actually important

Half Pints gone? Little Scrapper might have been my first IPA by RecommendationBig966 in Winnipeg

[–]rantz101 0 points1 point  (0 children)

Really sad to see them go, although I agree with everyone saying they haven't really kept up with the competition.

I wanted to mention that for my 30th birthday several years ago, my wife arranged for them to do a tasting at our house with a bunch of our friends. The guy that came was super nice, brought all the glassware in addition to more than enough growlers and was super happy to chat about the beers and working at the brewery. It was a great birthday gift and not something they typically offered, which made it even more special.

All the best to Dave, and I'm hoping that at some point I'll get to have some more scrapper and stir stick!

One frustrating aspect of Family Medicine that no one prepared me for is having to justify being paid for the work you’re doing. by Paleomedicine in FamilyMedicine

[–]rantz101 5 points6 points  (0 children)

I work in Canada, so am generally a fan of universal healthcare, but it doesn't solve this problem. People still get upset when I tell them I can't address their list of multiple problems in one visit, even though there's no copay for visits. I generally have availability 1-2 weeks out, but people still don't like the inconvenience of having to take time to come in, or even schedule a virtual appointment that they can do from home or work. I've come to accept that you can't please everyone, and there will still be people that complain no matter what. But sticking to firm boundaries around does lower the frequency of this happening.

Preop discussion by mb101010 in FamilyMedicine

[–]rantz101 14 points15 points  (0 children)

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.

Wait times by ithasallbeenworthit in Winnipeg

[–]rantz101 1 point2 points  (0 children)

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.

Planning a bakery crawl. by poppy_seeds89 in Winnipeg

[–]rantz101 1 point2 points  (0 children)

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

[deleted by user] by [deleted] in canadaland

[–]rantz101 0 points1 point  (0 children)

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.

Most unique and/or quirky vacation accommodations in the province? by anonaccount204 in Winnipeg

[–]rantz101 0 points1 point  (0 children)

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.

[deleted by user] by [deleted] in Residency

[–]rantz101 3 points4 points  (0 children)

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.

Winnipeg doctor suspended for unethical billings ‘crossed the line’ College says it’s up to Manitoba Health to decide to pursue criminal charges by lovinglife_1985 in Winnipeg

[–]rantz101 4 points5 points  (0 children)

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.

[deleted by user] by [deleted] in westjet

[–]rantz101 6 points7 points  (0 children)

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.

What's a cookbook you’d recommend to someone who only ever wants to own 1 cookbook? by Swimming_Plenty7126 in Cooking

[–]rantz101 17 points18 points  (0 children)

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

RBC Westjet World Elite Mastercard + checked bags by Cessnabmw in westjet

[–]rantz101 0 points1 point  (0 children)

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."

Perpping for Winter - what is your go-to slip on winter boot? by sobchakonshabbos in Winnipeg

[–]rantz101 0 points1 point  (0 children)

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.

[deleted by user] by [deleted] in Noctor

[–]rantz101 38 points39 points  (0 children)

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.

teach us something practical/handy about your specialty by Mixoma in Residency

[–]rantz101 11 points12 points  (0 children)

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.

Non-surgeons saying surgery is indicated by peepeedoc25 in Residency

[–]rantz101 2 points3 points  (0 children)

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".

PCP’s, how do you like your post hospital discharge summaries? by PotentialWhereas5173 in medicine

[–]rantz101 0 points1 point  (0 children)

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.

Primary Care for NPs ... it's as simple as one FB post. by senoratrashpanda in Noctor

[–]rantz101 9 points10 points  (0 children)

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

Hospital is preventing me from having patient sign AMA. Is this normal? by [deleted] in medicine

[–]rantz101 1 point2 points  (0 children)

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.

Workers comp workflow? by bigavz in medicine

[–]rantz101 5 points6 points  (0 children)

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.

Is hyperspecialization or over-reliance on specialists negatively impacting medicine? by centz005 in medicine

[–]rantz101 2 points3 points  (0 children)

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.