Febrifuge

Here’s a counter-point, not necessarily because I have strong opinions but because it’s a worthwhile discussion: what value does the physical exam actually bring? One of my MD practice partners has been working on the concept of the “evidence-based physical exam,” and I’ve found it fascinating. It’s actually something of a return to the core Osler kind of point of view. History-taking should get you most of the way to any diagnosis, or so goes the theory, and any physical exam (or blood work, or imaging) should ideally be something you do to confirm the things you’re pretty sure you know,

Got my second Pfizer dose around 2pm Thursday. Had not pre-dosed with ibuprofen the way I had with dose 1, but I did take 600mg later that evening. Slightly sore arm Friday morning, otherwise fine. Started feeling achy and tired mid-day Friday, then by 2pm it was clearly on. Took 400mg ibuprofen then, and I managed to power through the brain fog and close out my clinic day on time. Went home, ate some comfort food, went to bed, and had chills and body aches all night. Still feeling tired and useless in the morning, but the effects had worn off by 2pm Saturday, pretty much. Today was a nor

Got my first dose of Pfizer 7 hours ago. Feel absolutely fine. The injection didn’t hurt, and the deltoid is no more sore than with a flu shot. We’ll see how the rowing machine likes me tomorrow morning I guess.

They put it in writing? Impressive... most impressive.

Got my email today. Could have signed up for 6:30am tomorrow, but I went for Thursday afternoon next week, right before I have some days off anyway.

I am constantly looking stuff up, right there in front of the patient. Have been doing so for 11 years of practice. We even have a big flatscreen LCD on the wall that shows my screen to the patient. It doesn’t make you look dumb. Excusing yourself every few minutes like Clark Kent on a college football Saturday looks weird, though. I just click the UpToDate link right there in Epic and say, “hey, so what you have is ____, and the last time I dealt with a case of this, it all turned out great. I just want to check real quick and make sure nobody changed a guideline, or did a study that

Our org is back in the mostly-okay range too, in terms of revenue and margin, so as of the paycheck coming end of the month, we will be back to 100% of salary, up from 70% during June-August. And apparently in January the plan is to pay us a lump to get back almost all of the rest. It’s nice to be in MN, where HMO’s legally need to put profit into patient care.

Mostly Allen Edmonds lately. The key is to never wear the same pair two days in a row. Primary care work means I rotate between about 4-6 pairs, if you count the dress boots. Being at home two days a week makes those slipper days unless I have to run errands later.

We rotate, and lately the 8-12 Saturday in clinic has morphed into 8-noon both days of the weekend, but from home doing phone and video. It’s similar to being on call, in a way. And yes, we get the time back. For me, that’s an 8-hour Monday I don’t have to do, those times when I’ve just done the weekend.

I’ve been mostly ordering Td, except I’ve also been finding that families with babies on the way often need pertussis boosters anyway so for the past year or so I’ve done TDaP when the patient is about to be, or is likely to be soon, a grandparent/ parent/ aunt or uncle.

Sounds like Professor Doctor needs to speak with someone in the legal department of his university. This is an employment law question, really.

You should have a patient message/ email template ready to go, with your own summaries of a few key points, and links to your state Dept of Health page and the CDC page. That helps when people have email, or when your EMR system has a patient portal. It can also be a little like a talking points summary for when you call people — get used to figuring out the best, clearest, most succinct way to deliver the key points. Wouldn’t hurt to have a letter version you can mail to the patient’s home, after the conversation. Specifically what kinds of concerns have you run across, that you ne

Yeah, personally I consider the RVU system to be way too easy to abuse and manipulate, plus I feel like being salaried allows me to make better and more appropriate clinical decisions. But that’s a different discussion, for another time. Right now, my organization has had everyone salaried see a 30% pay cut. Meanwhile, the RVU-based clinicians are being paid 70% of whatever their average monthly collections were during 2019. And we’re pretty lucky, compared to some other health systems in our area .

Yeah, 70% of previous for us too, starting May 1 and due to be re-assessed at the end of August. To be fair, even with all the telehealth going on, volumes are down a bit and I am actually leaving on time more often lately.

Spam aside, it’s interesting to see this old thread come up. How is everyone feeling NOW about telemedicine? Me, I’ve had a few recently where it’s clearly not the best option, but for example this morning my patient either has biceps tendinitis or maybe some shoulder arthropathy. In the clinic, I could do some passive ROM maneuvers and feel for the crepitus or any clunking, sure. But video is good enough for checking some key active ROM and ruling out quite a few possibilities. And the plan is the plan regardless, at least for now. I rather doubt that we will ever get back