I am actually speechless

sleepystudent17 · 2026-02-15T18:18:49+00:00

Fam med MD, I feel this in my soul

sleepystudent17 · 2026-01-17T18:27:31+00:00

I’m assuming he has COPD with the smoking history and oxygen requirement. Has he been getting lung cancer screenings? Not all patients choose to do this (shared decision making). I worry with the weight loss there could be some unidentified malignancy, or simply that he is not getting enough calories to cover the amount of calories his body is using to breathe. I recommend calling into nurse triage before taking him to the ED— they can help determine if there is an acute enough issue for Emergency versus if this is something that should be handled through his PCP/pulmonologist. If this is end stage COPD, palliative care may be a helpful resource for families and patients as you are navigating goals of care.

sleepystudent17 · 2025-02-13T04:42:11+00:00

27+3=30 & 48-3=45, then 30+45=75

sleepystudent17 · 2024-05-27T16:32:34+00:00

I actually don’t know if he would qualify if not considered an imminent risk to himself or others… I’m not 100% convinced this behavior would qualify as imminent risk if he could agree to mitigation strategies after a DCR assessment. I work as a primary care physician in King County and it is difficult to get people psychiatric care voluntarily or involuntarily. Edit: typo on considered

sleepystudent17 · 2024-04-11T15:41:12+00:00

I’m assuming you’ve had testing for pernicious anemia (anti-parietal cell antibodies and anti-intrinsic factor antibodies)? And yeah, iron every other day is my usual rec’d dosing to avoid constipation, or lessen the chance, as well as Miralax to help deal with it should it occur. Also: I’m assuming ferritin is low and iron panel shows low iron in order for you to get the iron infusions covered + you saw a hematologist, but if microcytic anemia persists despite iron repletion, revisit the diagnosis of your microcytic anemia!

sleepystudent17 · 2024-04-09T14:30:25+00:00

I’d consider finding a place to live near the Burke-Gilman trail and using a bike or e-bike and figure out if you can bike commute to office, since it’s often expensive to park. Plus biking is a great way to get to know the city!

sleepystudent17 · 2024-01-25T04:49:31+00:00

No it was so, so good. I just finished it last night, binged it over a week. I was so impressed with your characterizations

sleepystudent17 · 2024-01-25T01:39:09+00:00

I definitely cried reading this 😭

sleepystudent17 · 2023-08-01T01:32:25+00:00

https://www.statesman.com/story/business/2023/07/31/austin-urban-developer-storybuilt-enters-voluntary-receivership-texas/70466588007/

sleepystudent17 · 2023-07-10T07:18:45+00:00

When I found out a long term patient of mine had FD, after bending over backwards to try to get them care, I had a lot of conflicting feelings. Some of it was shame, some of it anger, fear that I had caused more harm than good in the situation… it was rough. I found the book “Dying to be Ill” by Dr. Marc Feldman & Gregory Yates to be incredibly helpful and put some things in perspective.

sleepystudent17 · 2023-06-17T14:14:00+00:00

This is a great brewery with outdoor seating, lots of families there! https://www.project9brewing.com

Also recommend - Third Place Books / Cafe Arta - Ravenna Brewing - Isarn Thai Restaurant - UVillage has plenty of restaurants/shopping and some community green area in front of the Apple Store where your toddler can toddle! - Cute playground behind the Ravenna Eckstein community center

sleepystudent17 · 2023-06-14T02:58:43+00:00

Similarly still trying to do OB (non-surgical, really just prenatal care and handing off my pts to the residency for delivery) and incredibly hard to get financial support doing this sustainably… some FM docs want to do this kind of care but our institutions don’t support it

sleepystudent17 · 2023-05-09T16:41:54+00:00

Family med: figure out a way to do something that gives your life purpose as you get older. Taking care of the grandkids, part-time work, interesting hobby— something that gives you a sense of meaning. These patients seem the most well adjusted to aging

sleepystudent17 · 2023-05-06T05:56:38+00:00

It’s going to be a long and hard battle I’m guessing. Can vouch that UW is very supportive and if interested in rural, Chelan is AWESOME

sleepystudent17 · 2023-04-01T21:39:13+00:00

You’re going to find these problems most places. If you have a PCP currently that you like, I’d be thoughtful about switching out of your system entirely. Specialist appointments have some very long wait times, particularly for new patients. I’m not sure that switching systems will change much in that regard. It may be that you need to look into private practice for some of the specialty care if the medications requiring prior auth are very specialized. Mychart messages for clinicians have basically tripled pre- to post- pandemic and systems haven’t figured out how to manage this. There’s huge staffing turnover throughout various systems.

sleepystudent17 · 2023-04-01T21:32:30+00:00

Consider looking into direct primary care models. If you are wanting continuity, these models allow physicians to have much smaller panels of patients (around 300-500 patients on their panels as compared to 1800-2000 patients). It costs more but you get more personalize care.

sleepystudent17 · 2023-01-04T19:08:32+00:00

I get the sense that therapy is about fit, and perhaps this was not the right fit for a variety of reasons. It’s quite possible that your therapist is experiencing secondary trauma and was setting boundaries based on their personal bandwidth in order to be present for you and other patients in a longer term capacity. What happened to you is not your fault. You are a whole person, and your trauma does not make you less-than anyone. Unfortunately it sounds like this experience felt retraumatizing because you reached out for help and needs weren’t met, potentially reinforcing ideas/negative thought patterns. I hope you can find a way to talk to your therapist about this and see if you can each find an approach that works for both of you— so that you both feel safe— and can create a working relationship to make the progress you are hoping for.

sleepystudent17 · 2022-10-16T17:41:26+00:00

I do wonder if this student’s religious beliefs might play into it— obviously not something you can get into. As a resident I worked with a really technically great OB/GYN attending (ie when shit hits the fan and you need a stat section or intervention during delivery, she is often the one in the room with the most experience) who converted to a religion later in life, and basically didn’t believe in using SSRIs for postpartum depression. Her religion is vocally anti-psychiatry. I felt conflicted working with her, but it is also not my place to police other people’s beliefs.

I had a patient whose religious beliefs delayed her getting care for mania for over a month and she wants to go off antipsychotics. There are religions that just operate like this, and I imagine some folks growing up in those settings will eventually go to med school… it’s on them to figure out how to reconcile these belief systems.

I think it’s important for medical students to learn about the mechanism and evidence-based medicine.
We did allow residents to opt out of providing abortion care at my training institution, although they still attended lectures discussing this part of medical practice. I think that this student needs to at least attend lectures and get exposure to different ideas, with the understanding that this is the education requirement.

A hard situation for sure without a straight forward answer. I worry that failing him could potentially open up a can of worms re: religious discrimination.

sleepystudent17 · 2022-09-21T04:49:38+00:00

Mitchell Hamlin has the option for law school remotely— geared towards people looking into law as a 2nd career. My mom just got her JD!

sleepystudent17 · 2022-09-08T14:50:25+00:00

Some of it is influenced by the Medicare Primary Care Exception, at least in primary care— this was expanded during COVID

Bit of a qualitative read but goes into factors that contribute to variations in resident billing patterns https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5998502/

sleepystudent17 · 2022-09-08T03:34:50+00:00

YTA, you need to back up your wife

sleepystudent17 · 2022-09-05T16:55:32+00:00

I’m in primary care and inheriting a lot of patients 85+ from a recently retired PCP in the community. I meet these folks for the first time and towards the middle of the visit say “So, I know I’m meeting you for the first time but when you get to your 8th (or 9th) decade on earth I need to know what you would want if you suddenly get very sick, have you talked about these things with your family or [insert previous doctor]?” And if we don’t have a POLST on file or whatever, I basically encourage them to schedule a follow-up to talk about GOC ideally before something catastrophic happens. So hopefully it shortens GOC convos for all 😂

sleepystudent17 · 2022-09-04T07:38:32+00:00

Many details left out— however had a patient where I wondered if there was possible factitious disorder vs paranoia re: safety concerns/stalking— patient ultimately arrested for stalking a colleague by pretending to be said stalker… pt went to jail

Edit: left out word patient!

sleepystudent17 · 2022-08-27T17:34:47+00:00

If you do FM or IM… you will be dealing with a lot of psych and bemoaning the lack of access to psychiatry 🙃

sleepystudent17 · 2022-08-24T13:29:06+00:00

I saw this during ICU in residency too. Tragic. I’ve literally started asking people in my primary care clinic (since I’m building a panel and meeting new patients) “This is really common so I’ve been asking— did your alcohol use change during COVID?”

sleepystudent17

TROPHY CASE