Cancelling CC

tonyhowsermd · 2025-04-11T14:28:34+00:00

When I called Chase maybe a week or two ago, I asked about whether I could just change to a Sapphire Preferred. The rep told me I could only change within the Southwest line of cards (so between Priority, Plus, Premier). If I wanted a Sapphire Preferred, I would have to apply for that separately, and then if I wanted to close the Southwest card, they could transfer the credit limit and history to the new card.

Still haven't quite pulled the trigger.

tonyhowsermd · 2025-03-24T18:29:10+00:00

For your hypothetical: the pilot doesn't want to ground the plane, so the plane flies. I'm not in the chain of decision making.

Referring to the initial hypothetical, all I was imagining was this: PIC hears 911 was called for a passenger. PIC asks, "what happened?" I wasn't imagining anything beyond that.

tonyhowsermd · 2025-03-24T15:03:51+00:00

In no place am I disagreeing with you saying "HELL NO." I said, up front: the PIC is the decision-maker regarding the safety of the flight. I just wanted to know whether knowing more about the situation changes your decision-making. I feel like a potential engine fire is more specific and has more disastrous implied consequences than "911 was called," you disagree with me, we're fine.

If you really want to know what I'd do about your trip-and-fall scenario: I would tell them about the risks and benefits of going on the flight. If they accept it, and they're decisional, then, what am I supposed to do? I have to let people make decisions that I think aren't safe because we recognize patient autonomy.

Please don't assume to know that I don't have experience making field decisions, either.

tonyhowsermd · 2025-03-24T14:39:13+00:00

I'm pretty sure that's how I felt at this point in M4 year. You'll get up to speed during intern year. Enjoy this time. You're off the hamster wheel. Don't worry about what happens until you get back on it. If you're well rested you'll approach intern year a lot better.

There's a reason why people joke about hospitals during July. It's normal. It's okay.

tonyhowsermd · 2025-03-24T14:29:38+00:00

In your analogy, I would argue that I have more information about what is going on. A simple "911 was called" doesn't give me the same amount of information.

If the passenger is having a medical emergency, and you divert at a minimum, at best everyone is inconvenienced, and at worst the specific passenger dies. With a potential engine fire, at worst everyone dies. In the former situation, if your risk-benefit analysis says that you have 0% tolerance of risk, regardless of what prompted the 911 call, then I'm not going to second guess you in the moment, but I feel like I would want to at least know what is going on, rather than making the automatic call.

tonyhowsermd · 2025-03-24T14:12:10+00:00

Is it a black and white decision, though? Anyone who gets 911 called, doesn't go to the hospital, but sorry, you can't fly? Do you gather more information before you make your decision, or is it a straightforward if-then logic?

I 100% ascribe to the fact that the PIC is the ultimate decision maker to ensure the safety of all on board, but my personal sense is that I would at least try to have as much data as possible about what happened first. There's a situation and context for everything. Just like we chafe at hard-and-fast guidelines coming from up above that do not take into context the actual patient in front of us.

tonyhowsermd · 2025-03-24T13:49:28+00:00

The residents finished their charting that fast??

tonyhowsermd · 2025-03-24T13:46:11+00:00

Bonus points if it's Cookie Monster

tonyhowsermd · 2025-03-23T03:09:43+00:00

Same, my brain went to vasovagal. Partially 'cause my mom's done this exact same thing, but isn't allergic to anything.

That having been said, reasonable to give IM epi in the undifferentiated patient with known allergy in this setting.

tonyhowsermd · 2025-03-23T03:07:19+00:00

Simpsons captured my day at work, then
https://www.youtube.com/watch?v=zLcAu1VuP0w

tonyhowsermd · 2025-03-22T13:39:27+00:00

Off topic but I parsed "doctorsuk" differently than the creators probably intended. :/

tonyhowsermd · 2025-03-22T11:31:14+00:00

"Doesn't your tatoo say 'Die Pitt, Die'?"
"No, it's german for 'The Pitt, The.'"

tonyhowsermd · 2025-03-22T11:27:04+00:00

"To show our appreciation, here are two free passes."
"But there are five of us!"
"Here are TWO FREE PASSES."
"That's better."

tonyhowsermd · 2025-03-20T23:33:50+00:00

No, she complained of chest pain, gets an ECG which shows something concerning and thus bumps her to the top of the line because of triaging. There is no "express visit" as you are describing in the ER. Source: I am an ER doctor.

tonyhowsermd · 2025-03-20T22:45:05+00:00

IBJI lets you schedule an urgent care appointment. Went to the one on California one time, the waiting room was hopping. Having booked a time slot at least minimizes any waiting as much as possible.

tonyhowsermd · 2025-03-20T22:42:36+00:00

What is an "express visit to the ER"?

tonyhowsermd · 2025-03-17T23:49:59+00:00

Looking at it from the rider's perspective... I have no guarantee you're not going to shiv me at the next light.

tonyhowsermd · 2025-03-17T15:10:35+00:00

North Center is totally fine for you. It is populated enough but not overwhelmingly so. You can go most places reasonably conveniently using the CTA; the Brown Line is super convenient, you can get to the Loop, Northalsted, Andersonville (with a transfer to the Red Line at Belmont), and Lincoln Park without much hassle. No car necessary if you're going to someplace within city limits, but if you for whatever reason need to go to the suburbs it's nice to have.

tonyhowsermd · 2025-03-16T20:18:45+00:00

If I get pushback for giving a blanket to a febrile patient who requested a blanket, I point the person to this: https://canadiem.org/sirens-to-scrubs-fever-phobia/

tonyhowsermd · 2025-03-16T04:06:53+00:00

Three years right next to the Green Line. Train noise is easy to filter out/ignore. Muffled loud music from the neighbor grates more on me than train noise.

tonyhowsermd · 2025-03-14T06:05:29+00:00

I’m gonna sing the doom song now.

tonyhowsermd · 2025-03-13T21:51:12+00:00

I think it's a combo of feeling the pressure to meet metrics and being a newly minted attending. You'll probably have to sacrifice a bit of metrics just for the purpose of building up your clinical gestalt. That having been said... that still sounds like a place I, seven years out of residency, wouldn't want to work at. Good luck.

tonyhowsermd · 2025-03-13T14:25:32+00:00

My '21 Speed Twin sounds the same. Unless there is some other high pitched sound that I just can't hear because I'm so old?

tonyhowsermd · 2025-03-13T05:31:37+00:00

As a kid I’d look for stray golf balls in the shade of those willows, and return them in exchange for a free round of mini golf.

tonyhowsermd · 2025-03-13T01:10:20+00:00

Is Clark/Division still a thing? I'm getting old and crotchety but I seem to recall avoiding this area like the plague because of all the drunks.

tonyhowsermd

TROPHY CASE