#Family Medicine

[appalachiananarchist]

Actual letter I received after a patient's migraine rescue med got denied:

We have denied the request for Sumatriptan for the following reasons: patient has failed to try the preferred alternatives: 1. Sumatriptan 2. Rizatriptan

One of these days I am going to make headlines as a clearly documented case of spontaneous combustion when the anger boiling inside me explodes, exploding me with it. At least on that day I won't have to deal with insurance companies anymore.

Another gem from this week: I sent a lady with suspected acute ischemia of the limb to the hospital where she had a CTA done. Insurance wanted to deny it all because I "did not do an ABI" before sending her. Because, you know, when someone's leg is purple and cold with no palpable pulse, you should definitely delay hospitalization to do some ABI testing to confirm there's a problem.

[emgoesmed]

1/25/2023

Today’s my day off of clinic and I’m at a local cafe feeling cozy and ready to study. One of my favorite winter moments is a lovely snowy winter morning when I don’t have anywhere to be.

[wayfaringmd]

“Shouldn’t my insurance pay for it if you ordered it?”- patient exasperated about the cost of a necessary but uncovered test. Welcome to America, where insurers without medical training determine what service is medically necessary.

[eirianerisdar]

The department’s chief doctor wants to call you, the secretary says. How about 12:45 pm, she says.

…12:45 pm is 15 minutes before the end of morning clinic session, which means in order to answer his phone call I either have to see each patient in 5 minutes instead of 6 or ask my last three patients to wait past clinic time

I call them at 12:30 telling them I have six patients left and could the boss please call me at 1pm instead

They have now rescheduled to 4:45 pm so I have the privilege of seeing my 29 afternoon session patients not in 3 hours but in 2hrs 45 mins instead which comes out to an even 5.5 mins per person

Because God forbid the boss not leave for his lunch hour on time

[heardatmedschool]

“This is Gynecology, not Family Medicine. We are not happy here.”

[justinesattendingadventures]

I survived residency!

Yes I still have 7 days left...

But I have now officially graduated!

[dxmedstudent]

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[trishmishtree]

The funniest part of doing my KSA modules (to keep my board certification) is getting to see a bunch of other random doctors complaining in the comments of each question about how dumb or unfair a question is

There was one question asking us to calculate a positive likelihood ratio and the comments were full of people complaining about how clinically irrelevant the question is

Every time I see a question with like 10+ comments under it, I know it's going to be a doozy that everybody got wrong and is salty about

One dude is so sick of this question set that he's just started leaving sad face emojis in the comments

Pretty much every question has comments under it that are either "the test writers are in the pocket of big pharma, always pushing to start drugs!!!" or "your question is bad and you should feel bad," with the occasional "your question is out of date, they updated the guidelines in 2022"

Every time I get one wrong after multiple tries, I can always count on the slew of angry doctors in the comments airing their grievances and know that the problem is the question, not me 😂

Oh boy, you know they're gonna tear this question a new one

[amarcare]

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[appalachiananarchist]

Funny clinic story: I had a lady come in to establish care. She moved here from somewhere out west. She had COPD from smoking. She was distraught that "some doctors don't treat a lot of COPD and don't know how to do it well." She asked me over and over again if I was familiar with COPD management.

Sweet child. You are in central Appalachia now. Welcome. We have one functional communal lung between all of us, and it is damaged, too. I learned how to manage COPD before I learned how to take a medical history.

[emgoesmed]

1/10/2023

First day of family medicine rotation, enjoying it but still feeling tired from the holidays and struggling to get back into a routine. At least my friends’ cat is adorable 🥰

[wayfaringmd]

She’s fine, she’s just psychotic. Sometimes people are just psychotic and you have to deal with it.

- local psychiatrist

[eirianerisdar]

Nothing like breaking down sobbing in front of the associate consultant today telling her why I had to take two seperate sick days last month because the patient load is wearing me out

I told her I can't see patients the way I want to if we have to see a new patient for 2-3 complaints every five minutes, eight hours a day with a short lunch in the middle. Working 5.5 days a week

Her response was to tell me "Hey don't go into too much detail with some patients who don't want to listen to you."

Which, I mean, fair enough, but it doesn't change how the doctor-patient consultation model was modeled after a minimum 20-minute consultation and I get five

I mean she did say that I managed to address a lot of patients' concerns within those five minutes so patients are usually very grateful to me but it's a cold comfort when she essentially is saying if you don't want to burn out you have to care less about certain patients

If doctors seem in a hurry sometimes this is one of the reasons

[heardatmedschool]

*while practicing otoscopy on Student 2*

Student 1: Ewww...

Student 2: Gee, thanks.

Student 1: Sorry, it’s not that your ear in particular is gross, it’s just that ears gross me out.

[justinesattendingadventures]

I Have a Job!

I'm now realizing that this little medblr has been severely neglected during residency, but I'd rather neglect a blog than my mental health I guess. But hey I have a job! I'll be working at a private practice starting in September, doing family medicine (including pediatrics and gynecology), procedures, osteopathic medicine, and gender affirming care. I think it's a good fit for me and I like the idea of a salary rather than RVU based payment. I don't ever want to slip into thinking of my patients as money.