irismadison

[irismadison]

What are some of the best and worst value-based care metrics payers want your practice to hit?

Value-based care is a double edged sword, and sometimes one of those edges is like a dull and jagged blade trying to slice brisket.. just doesn't work even in the hands of a trained professional. But other value-based metrics are not only reasonable, but proven to improve individual and population health.

As much as you can safely divulge, what are some of the metrics your payers want you to hit, the good, the bad, and the ugly ones. If you can share any additional helpful context, that would also be great (e.g. metric is to lower A1c levels by X and we have a large population of diabetics, or to reduce reduce length of stay, and now patients are getting discharged prematurely, etc. etc).

Subjectiveness accepted, opinionated folks welcomed, non-clinical people who just know what the contracts say, please also chime in!

submitted by /u/AESDEEEFJAYKAYELSEM [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/ANlU86S

[irismadison]

I am no longer qualified to be a Pediatrician

…because I just got peed on. I was examining a baby and I opened the diaper and ::BOOM!:: it was like Old Faithful had gone off. All over me.

This is the first time since I was a resident in the NICU. Of course it happened in front of all of the nurses and I never heard the end of it. “Hi, Dr. MikeGinnyMD, did you bring your raincoat today?” “We gonna have a dry day today, Doc?”

I swore it was the last time. Not even my son has managed to get me.

I shall carry this deep shame for the rest of my life.

-PGY-soggy

submitted by /u/MikeGinnyMD [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/2WvnkxQ

[irismadison]

PCPs or Endos, what's the fast rate of a1c drop you've seen?

Had a patient who went from >12% to 7.5% in 8 weeks. Metformin, ozempic, glipizide, and jardiance with diet control.

submitted by /u/outsideroutsider [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/7qKM5zV

[irismadison]

What does “routine annual labwork” and ER diagnostics looks like outside of the US?

Just had a patient bring their records from Korea where she states it is common to pay $100 for a very comprehensive blood panel, XRays, EKG, etc. We also see ERs doing a slew of routine things including CTs even when the likelihood of dangerous stuff is quite low (young people with chest pain, headaches, etc). Can anyone outside of the US share insight into what the standard of practice is?

submitted by /u/HereForTheFreeShasta [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/WVzxCkl

[irismadison]

Negative Urine Nitrites and Pathogen Identification

I've come across a question regarding the interpretation of urinalysis in the setting of clinical UTI symptoms. Nitrites are produced by common urinary pathogens, namely enterobacteriaceae, and not by others, most notably Enterococcus, Psuedomonas, Acinetobacter, and Staph spps. After looking for data, I have seen clearly that a negative urine nitrite is not enough to disregard a diagnosis of UTI given the above pathogens.

My question is centered on empiric antibiotic selection: in a patient without risk factors for resistant organisms, should a negative nitrite in a clinically apparent UTI be an indication for broadening Abx selection to cover the above pathogens? What percentage of negative nitrite tests in clinically apparent UTIs result from nitrite producing organisms such as E. coli?

submitted by /u/godzillabacter [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/oK4xOSg

[irismadison]

Who does financially support the medical textbooks industry?

I am talking to you, medical students, residents and doctors. Hundreds and hundreds of new medical textbooks are published every year by Elsevier, WK, McGraw Hill et company. I ask you, do you buy them? And if so, do you actually read them? In the Internet era? Are those books a safer source of information? A lot of them are in the $200-$400 price range, not cheap, maybe for US attendings. And more on this, I guess this question is more addressed to attendings, seeing that students love videos series preparing for the Boards, and residents, I don't know, but I do not see them sleeping with Harrison under their pillow.

Plot twist: I am a medical student and I love reading textbooks and seeing them in my collection, I am very old school.

submitted by /u/HopefulTip6499 [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/UEAnZkW

[irismadison]

Is the Heidelberg stomach acid test reputable and still used in GI medicine?

I was interested in learning more about measuring stomach acidity, and I came across this Heidelberg stomach acid test. A lot of the papers that come up in Google Scholar for it are from like 1969, and most of the providers I see online that administer it have more of an "integrative wellness" vibe rather than a conventional clinic vibe.

Curious to hear any thoughts.

Thanks.

submitted by /u/TissueReligion [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/4VaMbIg

[irismadison]

These labs seem useless or at best wasteful.

Have you actually used RBC (separate from Hb and Hct on CBC), MCHC (CBC), MCH (CBC), MPV (on CBC) in your clinical reasoning? I rarely go beyond Hb/Hct, MCV, and RDW when looking at RBCs. Has a low creatinine ever been relevant? Why not only have an upper limit of normal? I feel like these just freak patients out for no reason and aren't clinically helpful, but please teach me something new if I'm wrong. Are there other labs you see as wasteful?

Total protein is another one. It could be helpful in rare situations like nephrotic syndrome or multiple myeloma, but you would be ordering other things anyway. It seems wasteful to include in a CMP, why not make it a separate order and add something more useful like mag or phos to the CMP?

Lab rant over.

submitted by /u/This_is_fine0_0 [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/BZfVRo6

[irismadison]

Medical Phobias

Random, but have any of you guys ever struggled with medical based phobias that have affected your practice? A colleague of mine is really struggling with cartilogenophobia and she’s in her first year of residency. She’s really struggling and I want to give her some support and remind her she isn’t alone :)

submitted by /u/Embarrassed_Clue_929 [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/gq7OAYS

[irismadison]

Current Causes of Death in Children and Adolescents in the United States | NEJM

submitted by /u/michael_harari [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/MxeZ14G

[irismadison]

'Beyond outrageous': L.A. company faked COVID test results, authorities allege

submitted by /u/kumquat_of_destiny [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/B7UE8Ok

[irismadison]

Guess the Diagnosis

70 year old male presents to the emergency room by wife and brother-in-law for confusion, slurred speech and altered mental status that began approximately 2 hours before en-route to the hospital. The patient's mental status had been normal earlier in the day. Upon arrival to the ED, the patient was confused and was having difficulty following basic questions.

Vital signs were: Temp. 36.3°C. 128/78 mm Hg. Heart rate 68 bpm. Resp rate 14 breaths/min. O2 sat 97% (room air).

Neurological exam revealed no focal findings.

The patient was not talkative and provided very little information.

Bicarbonate value was below normal range. Anion gap was above normal. Osmolality and osmolal gap above normal. Ethanol found in blood test (<10). Ethylene glycol found in blood (550).

submitted by /u/AliceGoneMad [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/rZEp4mC

[irismadison]

Calorie Restriction with or without Time-Restricted Eating in Weight Loss

submitted by /u/SerPounce218 [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/t4Hi6PE

[irismadison]

Can a physician practice under his preferred name with a fictitious name permit?

If a doctor's preferred name is different from one's official name on his diploma can one still use his preferred name with a FNP or a "doing business as" permit

Legal name change is not an option for the moment.

submitted by /u/TheArmchairWanderer [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/KTRqZrt

[irismadison]

Biweekly Careers Thread: April 21, 2022

This is the weekly careers thread.

Questions about medicine as a career, about which specialty to go into, or from practicing physicians wondering about changing specialty or location of practice are welcome here.

Posts of this sort that are posted outside of the weekly careers thread will continue to be removed.

submitted by /u/AutoModerator [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/kByHINt

[irismadison]

Dysphagia / Aspiration Diet Recommendations

Hello, Meddit. Someone close to me has recently developed dysphasia and is aspirating if he eats anything that is not a liquid or smoothly puréed. Have you found any specific foods or formulations that patients tolerate well/enjoy? We have him on Ensure and give him frappes/ice cream as he can tolerate, but I’m looking to see if there is anything he can actually enjoy, as he’s in pretty poor health and want him to like what he is eating while he can. I appreciate any information you all can provide!

submitted by /u/occams_claymore [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/8g95AQ2

[irismadison]

Documenting a disorganized visit

Ya’ll ever sit down at the computer after a visit, starting at your empty encounter note, and think to yourself, “Now how am I going to document that in a way that is coherent and doesn’t make me look incompetent to my colleagues.” When documenting an encounter in a organized way takes more time than the visit did. Had one of those today. For certain patients on my panel, when I review notes from other docs, and they read legibly I wonder how often they are salvaging things after the fact. Not making anything up, just shaping the visit a bit. I don’t use a scribe but sometimes I wonder if a scribe ever asks a doc, “Uhhh what do you want to write for that…”

submitted by /u/DrBleepBloop [link] [comments] from /r/medicine: a subreddit for medical professionals https://ift.tt/PaioSml