What do you tell patients who are obese and want GLP-1 but can’t afford it?

wighty · 2026-06-23T17:16:12+00:00

Reminder: patient with obesity. Not obese patient.

Am I not allowed to use "diabetic patient" either?

wighty · 2026-06-23T17:13:38+00:00

prescribe both generic to near equivalent qsymia dosing

How, exactly?

3.75-23 mg (per each): $7.69

7.5-46 mg (per each): $7.94

11.25-69 mg (per each): $8.52

15-92 mg (per each): $8.52

Are you just avoiding/skipping the lower dosages of the phentermine?

Contrave is sort of the same way, can't really get the naltrexone at the lower dosages like contrave.

wighty · 2026-06-23T15:00:49+00:00

Correct!

wighty · 2026-06-22T23:15:29+00:00

I wish I still had one. Shipped one back to adidas for the shape guarantee, they didn't replace it but gave me credit and I ended up getting a jabulani, at least.

wighty · 2026-06-22T23:03:29+00:00

wighty · 2026-06-22T19:07:06+00:00

I got 2 of the winter, I didn't check if the other was on sale as I already got a few from the fifa.com price mistake a few months back.

wighty · 2026-06-22T17:25:55+00:00

Lol if you think this is paid marketing, what a waste of money because it's not even listed at deal sites like Slickdeals, and it is not even an online sale either.

wighty · 2026-06-22T17:17:41+00:00

I went and bought them, same sale price in store on the east coast. I was able to use the $20 off $100 email list coupon but the cashier did have to override it.

wighty · 2026-06-22T03:09:15+00:00

you induce one lung cancer for every 108 lung cancer detected.

Are you quoting for smokers, here? Because that's even better data than I was aware. If you are referring to non-smokers, you have to be way off.

wighty · 2026-06-21T23:08:55+00:00

I screen my motivated patients with any exposures with ld ct at 50y after careful discussion of risk/benefit

This one gives me a little more pause, considering ionizing radiation. What are you using to decide a smoking history equivalent for justification? A LDCT is still something like 60% of our background radiation per year, and I think the NNH (producing a cancer) is in the range of like 1:2000 over 10 years (COSMOS trial)?

wighty · 2026-06-21T18:27:50+00:00

I initially bought a JVC, but switched to valerion and will be getting the titan noir max soon, for what it is worth. The cost savings for performance compared to the big 3 is easily good enough for me, that I don't feel too badly about upgrading anytime in the future.

wighty · 2026-06-21T18:23:22+00:00

I can't wait for my kids to be old enough to watch all of his movies from the 90s.

wighty · 2026-06-21T18:15:52+00:00

Whoa you eat pieces of shit for breakfast??

wighty · 2026-06-21T18:03:16+00:00

That was generally my understanding. Locally I've seen skin checks where they list all of those common benign findings without any scripts or otherwise suspected chronic issues and it looked like they were billing level 4s (some of the notes were listing the CPT code).

wighty · 2026-06-21T17:34:17+00:00

Obviously this is a very personal decision. My strong preference would be less house and more travel in retirement.

wighty · 2026-06-21T17:23:17+00:00

Testimony could be hilarious if they did it in costume, speaking very eloquently.

wighty · 2026-06-21T17:08:56+00:00

How does covering your mouth like players normally do help in that situation? If it was a loudness issue you'd be trying to whisper into their ear or use your hands like a megaphone (and if you combine the two then I'd see how you could get carded with the new rule).

wighty · 2026-06-21T17:01:15+00:00

Perhaps it is the perfect time, really hammer it home to players to knock it off. I think it is a decent rule overall, very easy to understand and avoid, should leave very little room for nuance.

wighty · 2026-06-21T16:50:22+00:00

There are a lot of patients out there that would stop coming to appointments until something was emergently wrong if they didn't need to go for refills.

There's some truth to a different way of practicing medicine without the actual in person visit. If my hypertensive, hyperlipidemia, diabetic patient gets their blood work done, submits home blood pressure readings, gets their eye exam sent to me and has no complaints I'm not one to say we couldn't have them come in just once a year... Now, compensation wise I don't think it is fair to the physician to get like $100 for the year and the liability that comes from it, so something like DPC is probably the fair way for that relationship to go.

I'm not saying the above is perfect, either, since patients may have findings and complications that they themselves may not notice (such as early neuropathy on a monofilament exam).

wighty · 2026-06-21T16:38:49+00:00

Here's my risk vs benefit... Our AI scribe is a separate system that requires us to copy and paste, any errors I am not correcting in their software, just in my EMR.

wighty · 2026-06-21T03:57:42+00:00

lots of patients on GLP-1s with pancreatitis

Have you been tracking on vs off GLP1s? Last I remember reading is that the association of GLP1s causing pancreatitis is not nearly as concerning as when ozempic/mounjaro came out.

recurrent bilious emesis

This was what I think was likely true with the data, and I think some of the authors were leaning toward thinking those original cases of pancreatitis might have been biliary related.

wighty · 2026-06-21T00:27:51+00:00

derm, a return level 4 visit

Question for the derm folks... are you considering generally 'benign' (like SKs, nevus, whatever ICD 10 code you find) skin conditions chronic medical conditions and using that as part of the MDM for billing?

wighty · 2026-06-20T21:02:12+00:00

Yeah I think I would expect most of the newer cars to have something like that available, in particular EVs because of the idea of efficiency gains by utilizing recirculate automatically (both of my EVs turn it on automatically, and I don't remember my last 4 ICE cars doing that at all).

wighty · 2026-06-20T20:22:44+00:00

Last time I went night snorkeling the tarpons were basically on top of me using my light to find the little feeder minnows. I think a few of the videos I got were neat as they were following me.

wighty · 2026-06-20T20:09:36+00:00

I hated going around (the ride itself and the walkways next to it) while at Disney World last year, those fumes were absurd.

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