cranquis

[cranquis]

I just can't.

We are practicing medicine in a country of cromagnons.

Today an elderly patient's daughter asked if I could guarantee that the blood I might need to give to the patient (in case the patient is actively bleeding out during the surgery, which had a pretty high chance of happening) is from a donor who hadn't been vaccinated against COVID.

Not gonna lie, I needed a moment to recover from that

[cranquis]

So good, as always. LOL!

I get so pissed off when I ask what parents' thoughts are on vaccines and if they have any questions, and the parents just smugly ask me if I get my kid vaccinated, like it's going to lead to some big "Gotcha!" moment

Yes, I vaccinate my kid

Yes, even flu and COVID

Hell, if I had it my way, she'd get an early MMR right now even though she'd have to get the shot again when she is 12 months old - that's an extra shot and I'd be first in line for her to get it

Don't try to 'gotcha' me, we have the same vet and animals don't have HIPAA - I know you vaccinate your livestock because our vet was doing a farm call vaccinating your herd when my dog was stung in the muzzle by a bee and acted like the world was ending and we had to wait until he was done to bring her in (she was fine, she'd just never felt pain in her life before being stung by the bee, the psychic damage she incurred was severe but luckily no lasting physical harm occurred)

I cannot begin to fathom why you'd protect your cows' health but not your kids' health

But I don't throw that in your face because my mama raised me right

If you want to risk your kids' health by not vaccinating, own it and own the consequences

Don't be a coward and try to pull my fully vaccinated kid into it

[cranquis]

(X)

[cranquis]

i am without words.

Great.

[cranquis]

Co-signed, E. Cranquis, MD

[cranquis]

This information needs to be part of the US med school curriculum.

Blogging this tweet because this explains SO MUCH about the mindset of pretty much all the folks I’ve known who’re against single-payer, it’s not even funny…

[cranquis]

Insights!

Thanks, @populationpensive :)

This is probably a weird question, but I don't really know anyone who works in the medical field to ask directly. I've been considering a career change to respiratory therapy, but I knew there were several different areas in the healthcare field so I took a class at my local CC that involved "discovering different healthcare careers" and had us talk to and shadow many different occupations. I had 2 different professionals through this class tell me studying Respiratory Therapy wouldn't be worth it because they were being phased out because others within healthcare already know how to do the job they do. Do you know if this is true or not? I was really excited about pursuing this, but I don't want to spend time and money pursuing a degree if it is being "phased out." I haven't been able to find anything about this through just looking it up online, if anything my research indicates Respiratory Therapists are needed and in demand right now, so I'm a little confused.

Hi! Well I think that's a great question, but I am as "in the dark" as you are about this, since I don't work in a hospital setting with respiratory therapists.

I'm going to assume you're in the United States? You can send me another anon ask if not, so I can clarify the country in question for anyone who might have info on the topic.

Ok, let's punt this question out to the readers -- anybody have insights on the current and future demand for respiratory therapists in US healthcare?

[cranquis]

This is probably a weird question, but I don't really know anyone who works in the medical field to ask directly. I've been considering a career change to respiratory therapy, but I knew there were several different areas in the healthcare field so I took a class at my local CC that involved "discovering different healthcare careers" and had us talk to and shadow many different occupations. I had 2 different professionals through this class tell me studying Respiratory Therapy wouldn't be worth it because they were being phased out because others within healthcare already know how to do the job they do. Do you know if this is true or not? I was really excited about pursuing this, but I don't want to spend time and money pursuing a degree if it is being "phased out." I haven't been able to find anything about this through just looking it up online, if anything my research indicates Respiratory Therapists are needed and in demand right now, so I'm a little confused.

Hi! Well I think that's a great question, but I am as "in the dark" as you are about this, since I don't work in a hospital setting with respiratory therapists.

I'm going to assume you're in the United States? You can send me another anon ask if not, so I can clarify the country in question for anyone who might have info on the topic.

Ok, let's punt this question out to the readers -- anybody have insights on the current and future demand for respiratory therapists in US healthcare?

[cranquis]

Behind the Medic: Well that sucks.

Office printer repair guy: The paper gets jammed if you don't fluff the pages first by fanning them a bit.

Cranquis: Yeah, I always do that when reloading the paper.

Nurse Naive: OH YES, DR CRANQUIS IS A PROFESSIONAL FLUFFER!

Cranquis:

Nurse: WHY? WHAT DID I SAY?

[cranquis]

This may seem like a meme, but it is real. It's formatted like this to get people's attention and be memorable, in the hopes that maybe it saves some lives.

Edit 1: If any of you are unsure that this is real, check out the notes of folks talking about it.

Transcript:

[transcript of sign] 

Are you currently struggling with … MEDICAL BILLS? 

… Perhaps you should try … FAPping! 

Financial Aid Policy 

Did you know that most hospitals and some doctor’s offices are what is known as a 501r, or “medical non-profit”? 

This means they are legally required to have a “financial aid policy” or “charity care policy” 

What is means, is that they are LEGALLY REQUIRED under United States Law to provide FREE OR DISCOUNTED healthcare, and also to FORGIVE EXISTING MEDICAL DEBT to individuals with financial difficulty. 

Basically, every household making und $100K a year is eligible for a reduction in their medical costs. 

Billing departments often try to push people to get on a “payment plan” if someone asks, but don’t accept it! 

Ask if they have a Charity Care or Financial Aid policy “Based On Income.” 

If it looks like you might not qualify? 

Apply anyway. They try to scare people away with scary processes. 

YOU QUALIFY. EVEN IF YOU ARE ALREADY IN COLLECTIONS. 

[/end sign] (Credit to Moonlit-wings for the transcription.)

[cranquis]

https://www.dea.gov/everyday-takeback-day

A list of free drop-box locations across the United States where you can dispose of unwanted/expired medications.

[cranquis]

Your recent reblog made me sad, but also makes a lot of sense. I've been following you since I was in medical school, and I'm now in my fifth year of specialty training (I am not American). I did occasionally wonder why I've been seeing less of the kind of content you used to put out.

All I can say is - thank you for the work you do. I've seen enough online to get an idea of what you must face on a daily basis. I think I'm lucky that somehow, the doctor-patient relationship overall hasn't deteriorated to such an extent where I live (yet at least), but I definitely understand the frustration and despair of trying to communicate with people who aren't coming into the conversation in good faith.

You've always been a kind of role model for me in terms of your passion for your work and your open sharing about your faith. I guess I just wanted to say that I hope you find hope and joy in your work, even if those you serve aren't wise enough to appreciate what you do for them.

Hi, my colleague! Hey first of all, thank you for your kind words of encouragement and affirmation. Negative med-related interactions (online or in person) anymore just roll off me, but the positive ones still give my heart a thrill! :) And congrats on your continued journey down the medical pathway.

Second, I'm glad your message gives me the chance to clarify for all my long-time Cranquis Pants* that I still do enjoy my work. I have been doing the exact same Urgent Care job in the exact same location (with quite a few staff turnovers) ever since I finished residency 17 years ago! I still enjoy the bulk of my patient interactions, I continue to hone my diagnostic skills, I feel very confident in my procedural skills, I have a reputation in our local medical community as a reliable and thorough physician, and I have a loyal group of patients who routinely nag me to "quit urgent care and become a regular doctor so we can be your primary care patients". My staff likes and respects me (despite my best efforts to ruin that on the daily, with my puns etc); I like my staff and appreciate the hard work they do in the face of the same administrative and societal opposition that I encounter; I am not distressed when little kids freak out during physical exams (and my success rate of turning those frowns upside down with playful interactions and silly sound effects is pretty darn good).

I am blessed with amazing work-life balance, more than the majority of Family Medicine-trained physicians I suspect. I carry no pager, I take no call, I leave my work at home when I go home. I know my schedule months in advance, I have a shift template that gives me plenty of week-long stretches off, and I have my Sabbaths 100% free to attend church and spend time with my family. My pay is decent and my benefits are solid, my debts get paid and I have a roof over my head. My kids and wife are happy to see me come home. Personally, I really have nothing to complain about.

But the bloom is off the rose for my profession as a whole. The politics and trends of the US health care system continues to disenfranchise physicians, devaluing the years and $$ invested in becoming physicians, over-valuing patient satisfaction scores and inexpensive labor and glitzy administrative initiatives and staff rumor mills more than evidence-based, experience-driven clinical medicine. The power structure is upside down, as if doctors ought to be automatically doubted and disdained by pharmacists, insurance companies, administrators, patients, and APCs because of their systematic educational journeys and reliance upon scientific evidence.

And one of the saddest results is watching medical professionals turn on each other. The fragmentation and super-specialization of every aspect of medical care creates artificial "us v. them" scenarios; specialists and primary-care battling over who does the paperwork for pre-op visits and FMLA, ER and Urgent Care arguing about how much workup should be undertaken by the UC when the patient is obviously going to need ER management, primary-care so overwhelmed with insurance-required goals that their patients can never get same-day/soon-day appointments, pharmacies so understaffed that it's easier for them to tell the patients that "the doctor never sent the prescription" when in reality ...

I could go on.

I miss the old days (said the geezer on the internet), when I could enthusiastically support a pre-med student's dreams of getting into medical school and "helping people as a doctor someday." Now I wince at the idealism in a high-schooler's eyes, and try to find a nice way to say "there's more options for helping people than just becoming a doctor... be sure you have your motivations straight, because medicine is not what it was even 10 years ago..."

So hope and joy in my career? Hope for the profession of physicians, I have little. But I make the joy in my practice when I can make it, and I only expect to find joy in my non-medical time with family and hobbies and travel and friends and the lifestyle which my medical career still does make more feasible than otherwise.

*Probably not the term historically assigned to "fans of this blog", back when I posted frequently -- it's been a minute -- but if not, SHOOT that was a missed opportunity.

[cranquis]

As an urgent care doc for 17 years, I watched the Covid pandemic (and the accompanying explosion in conspiracy pandering) dramatically damage the foundation of a good doctor-patient relationship: the mutual expectation that both people in the exam room are allied against the patient's disease.

Now the battle lines are so often "doctor vs. patient's disease, patient's self-diagnosis, patient's social media and news consumption admonishing the patient that doctors can't be trusted, patient's hostile attitude, patient's assumption that its ok to verbally or even physically intimidate a medical professional..."

And against those odds, why should I bother to object even slightly when the patient insists on pursuing whatever subjective tangent they desire? Go ahead, start mocking me for "still thinking covid exists," or grumbling when I ask if you've ever been vaccinated for XYZ, or ranting about how the zpak antibiotic knocks out your 24 hours of viral congestion. I will just sit there, tapping my fingers absently on the keyboard as if I'm jotting this all down in your chart, while hoping for an opening to still nudge your health in a saner direction and get this visit over with.

If that opening never comes? As of 2021, I no longer attempt to kindly address and rephrase your misconceptions, distilling my hard-earned education into layman's terms for you, partnering with you to redraw the battle lines into a mutual battle against your disease.

So congrats. You win. You and your disease.

It’s been really interesting to see the turn medicine has made with the public over the past several years. I would never advocate that you should trust any physician blindly, but it’s quite amazing that those with GED level education are trying to convince others glucola is evil, the vitamin K shot is unnecessary, and that doctors order certain medicines and tests because “big pharma” pays them to do so.

I want to be very clear- as an EM physician I am paid hourly, much like all other EM physicians. I do have an RVU component meaning I make more money if I am more efficient but that is only a minimal component of my pay. I want to have conversations with my patients and help address your emergencies, but it’s incredibly difficult when I’m met with antagonistic attitudes from the start that stem from misinformation and fear mongering of online crunchy mom influencers.

[cranquis]

This might not be the right place to ask but I always appreciate your insight on this hellsite. I recently finished undergrad and have started doing research to hopefully gain some industry knowledge and eventually go to med school. I have worked in emergency medicine for many years and it has really inspired me to pursue medical school with being an EM physician as a tangible end goal. My problem is that now that I am doing research it feels like the ball is going to drop at any moment. Like in clinic I get anxious that my subject will code while we are talking or seeing the paramedics transporting patients raises my heart rate. I feel fine and calm most of the time but I just have this nagging fear that something terrible is going to happen to my subjects or the people around me. And I know that I have clinic RNs and my MD nearby and I know where the crash cart is but it is still stressing me out. I don’t know how to rationalize it as I have never had any real anxiety or fear surrounding my time in the ED.

I guess the root of this question is that you probably saw a lot of intense things during rotations/clerkships/residency that were in high stress environments like the ED, how do you manage that working in an urgent care where things are less life and death most of the time - obviously there are still critically sick/injured people who show up there instead of the ED and the ED is getting the 2a medication refill requests, but I think you know what I mean.

Sorry if this is rambly, I just haven’t been able to see my ED people in a while and I can’t really talk about this sort of thing with many people outside of them. Once again I appreciate the insight that you bring to these sort of unique to healthcare situations, it has made dealing with patients and a failing system more bearable over the years.

Hello my aspiring colleague! I think I understand and empathize with where you're coming from.

The more you learn about what can go WRONG with a human body, the more you expect it to go WRONG. Like, any moment now. And when you're surrounded by the sickest of the sick, that starts to seem the norm. You expect This Guy, being transported for subacute cough, to crump... because you've seen other Guys with subacute cough crump.

[Crump: verb; to suddenly decompensate clinically, usually right after you told the attending that the patient looks stable.]

In a similar fashion, when I did my pediatrics rotations in med school and residency, I felt like Mrs Cranquis and I should never ever have children, because "look at all these tragically sick unfortunate children! Look at how suddenly these healthy kids can have an accident or develop symptoms from a hidden congenital condition!" It took a few years to put it into statistical perspective and realize that the odds of having a healthy child are actually better than 50:50.

But regarding your increasing worries that someone will crump in your presence - thankfully, the more you learn about what can GO wrong, and the more times you SEE things go wrong, the more you are also learning about what YOU can do to FIGHT wrong. This helps you fine-tune your anxiety into a Spider-sense -- an ability to be aware that your patient might crump even before they crump, which gives you the time to mentally (and clinically) prep for the worst and take steps to prevent it, to marshal your resources and colleagues and even make a "crump preparedness plan".

In fact, with a few years of experience, you learn to be grateful for that sudden ball of stress in your gut, as your subconscious points out the subtle clues that This Guy needs your full attention.

So I hope this helps give you the oomph to keep on going, friend!

[cranquis]

My most common piece of medical artwork.

Drawing for patients, especially if you preface it with "I'm no artist, but..." is always met with appreciation for your effort to make things simpler to understand.

“When in doubt, you can always explain to a patient with a drawing. They always appreciate it, no matter the education level.”

Solid advice.

[cranquis]

Dr Cranquis thank you for all you do. Urgent cares and the ppl who work there do so much for the health of the public, but get so little appreciation. So here is some appreciation.

Anyway cheers from an EMS worker who also worked through covid and watched/watches with horror and despair ...

Thank you, my colleague! Stay strong, and stay safe.

[cranquis]

I appreciate you trying to help people with medicine

I received this the same day I reblogged that awesome/depressing post about zombies and pandemics -- and I really appreciate your appreciation.

As the perceived value of professionally-trained healthcare workers has dropped in the US, the subjective value of even the smallest of genuine expressions of gratitude has skyrocketed!