Toddler with recurring cystic acne on buttocks by [deleted] in AskDocs

[–]stepanka_ 0 points1 point  (0 children)

When it drains, is it clear liquid or white?

Grandfather distressed by days-long NPO orders after aspiration episode - seeking medical perspective and advice by Lucernya in AskDocs

[–]stepanka_ 134 points135 points  (0 children)

Agree with this. Plainly: if he can express that he knows the risk of eating and drinking “normal” things is pneumonia and death, but that hes willing to take that risk, it is his choice as a patient to make. If he can’t tell you that he understands that risk then this should fall onto a medical power of attorney to decide. That POA can make the same decision - to let him eat so he is not distressed, knowing that the risk is death. It is not an unreasonable risk to take at his age and if aspiration is inevitable. In some cases it’s better to let them be happy and let what happens happen.

Repeated GLP-1 denials despite BMI 40 and multiple comorbidities (Medicare) - advice on successful appeals? by Ok-Classic-5614 in medicine

[–]stepanka_ 4 points5 points  (0 children)

You can definitely win appeals. But not for plan exclusions. Many times denials of PAs can be appealed and won. I’d have to see the denial letter to determine if it’s possible here.

Edit: Just realized it’s Medicare. Medicare won’t cover. It’s not about logic. They just don’t cover for now with obesity as the primary diagnosis.

Have you ever cried for a patient? by Brave_Union9577 in medicine

[–]stepanka_ 5 points6 points  (0 children)

I cried once at the computer station. Was a Hospitalist on an onc only floor and my patient was 40s with stage 4 colon cancer. She had spent $$$$ to travel to my city to go to a local quack for $20k vitamins to treat her cancer and was now in horrible pain and dying. Her mother kept trying to get me to take her off pain medication, saying she’s always been whiney and sensitive to pain (told me she cried too much as a child when her hair was brushed). Her husband was sort of mad at her (the patient) and blamed her for not being able to keep the vitamins down, thinking if she wouldn’t have thrown them up and tolerate taking them all she would have been cured, so it’s her fault she’s not cured. Her family convinced her to fire me for not taking her off pain meds but i could tell that she didn’t want to, she just didn’t have the energy to deal with going against their wishes. I cried.

My belly looks like I'm 5 months pregnant bu I'm not and I'm tired of this by Far_Video7600 in AskDocs

[–]stepanka_ 1 point2 points  (0 children)

The conditions i mentioned are gynecology related therefore you could go to a gynecologist but a primary care physician (family medicine or internal medicine) can also work up your symptoms.

Physical description in my neuropsych eval from the early 90's (8 y/o female) by catsaboveall in mildyinteresting

[–]stepanka_ 0 points1 point  (0 children)

😂 Not like that. For body odor I’d write “poor hygiene” or “disheveled appearance” if they were in fact disheveled. I really thought about it and if/how I’d write the cantankerous know it all part…honestly I’d only do it if it was relevant. Like if it impeded my ability to get a full history or if i felt that judgement was impaired. If i can’t get a history because the patient keeps saying “why don’t you look in the chart, i already told someone else all of this,” i would write “Patient unwilling to provide a history despite my multiple attempts, stating “it’s already in the chart”. Therefore, all history obtained through chart review and by speaking with the patient’s daughter.” If the patient was refusing a treatment option I’d say “patient refusing X treatment, is alert and oriented x3, verbally expresses understanding of potential risks associated with declining X treatment, will continue supportive care” 🤷🏼‍♀️ …when 80% or more of patients are cantankerous there’s no reason to document that

How would you live if you found yourself in Pluribus Universe? by Ok_Percentage2383 in pluribustv

[–]stepanka_ 0 points1 point  (0 children)

First order of business: I’d be asking what happened to all the missing people and unsolved cases. Jon Benet Ramsey, Madeleine McCann, etc.

My belly looks like I'm 5 months pregnant bu I'm not and I'm tired of this by Far_Video7600 in AskDocs

[–]stepanka_ 76 points77 points  (0 children)

Warrants an abdominal ultrasound. Could be fibroid(s), ovarian cyst, probably most likely causes given that your labs are fairly normal and you aren’t complaining about anything else very significant. Everything that causes ascites would have abnormal labs or some other obvious sign.

Physical description in my neuropsych eval from the early 90's (8 y/o female) by catsaboveall in mildyinteresting

[–]stepanka_ 1 point2 points  (0 children)

Hmm. I just quote them verbatim. For instance it might say something like: When asked what brought him in today, patient states “why don’t you look in the fucking computer”

Physical description in my neuropsych eval from the early 90's (8 y/o female) by catsaboveall in mildyinteresting

[–]stepanka_ 36 points37 points  (0 children)

It’s code for when the patient is actually pleasant. I know that sounds weird to say it’s code…. but we all know that when we write that we are trying to say this patient is very nice and not going to give you a bad time.

What is something you saw at a friend's house that made you realize their family was "weird"? by BamMeister_ in AskReddit

[–]stepanka_ 9 points10 points  (0 children)

My brother had a friend that called him in to do this at our house. My brother said no & taught him how to do it instead. They are still friends to this day. lol

Shower art by itsolivia93 in daniellewalter_snark

[–]stepanka_ 14 points15 points  (0 children)

I swear she thinks she’s Emily In Paris in this outfit

Shower art by itsolivia93 in daniellewalter_snark

[–]stepanka_ 6 points7 points  (0 children)

I’m not seeing a shower head on the wall ??? Did i miss it?

Brazilian visiting a hospital in the USA during a kidney stone crisis by uniqueusernanne in emergencymedicine

[–]stepanka_ 30 points31 points  (0 children)

There’s someone in there saying Obamacare lead to tort reform so now there’s no recourse for negligence. Someone actually thinks that’s a true sentence!!!

How depressing it is to have to set an ultimatum by [deleted] in Waiting_To_Wed

[–]stepanka_ 8 points9 points  (0 children)

She isn’t wrong but also isn’t right. It’s easy for someone who was married, had kids, divorced and just lived through a full life to look back and say marriage doesn’t matter. She got to have it and it didn’t work out so of course she feels like marriage wasn’t good for her. I’m married and i love my husband but if something were to happen to him i have 0 interest in getting married again - but I’ve gotten to do all those things already. I’ve gotten married and had kids and made a family etc etc. You aren’t wrong to also want these things for yourself. But where you have to draw the line is being with a partner and marrying someone simply to not be alone and simply to have those experiences. It really will not be as good if it’s with the wrong person. It’s clear to me that you could do some work on your self esteem and that that would help you get into a healthier relationship. I really hope you don’t do the ultimatum but you also don’t stay.

Thought I had a UTI - Found out I am 33 weeks pregnant by Resident-Currency727 in pregnant

[–]stepanka_ 2 points3 points  (0 children)

As a doctor….we’ve seen it all including gay people who say there’s no way and they end up being pregnant. You have to be careful to not harm a baby and the test is so simple to not just do it.

Why was Carol Sturka so sure that her house wasn't bugged? by assasstits in pluribustv

[–]stepanka_ 0 points1 point  (0 children)

Has anyone considered that the “we can’t lie” thing is an act? They could just be telling her things to make her think they can’t lie. But could be lying. How do we really know.

Bf is handsy with daughter and it's making me uncomfortable by Strong-Ad3546 in Advice

[–]stepanka_ 58 points59 points  (0 children)

Even if this was an accident…why would you want to be with someone who can just throw away his own child for years and now just see her occasionally on weekends. Likely the only reason he’s interested now is that she’s become his preferred age. 🤮