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probasestealer

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  1. Hi there, did you already sell your Cme4life study material?

  2. probasestealer

    Weird stuff today that brought up questions

    Yeah, that is a difficult personality type. Just stick to your guns. Glucose ok?
  3. probasestealer

    Threshold for "firing" patients

    I would recommend discharging her for not following medical advise, I can see your level of discomfort.
  4. probasestealer

    Weird stuff today that brought up questions

    How about a direct LDL? Takes trigs out of the equation.
  5. probasestealer

    Influenza: Do you care, and do you require this....

    Nobody has mentioned Tamiflu prophylaxis for spouse, kids, etc.. I usually swab all patients who have "flu" symptoms and if positive discuss the options risks/benefits of Tamiflu.
  6. I'm in solo practice I've found everything to be much more complicated with extra hoops to jump through at every turn (IT, prior-auths, EMR, etc). Can't beat the other perks of a small office. Your situation sounds like a nightmare. I think you really have 2 choices, leave or learn to deal with the chaos. I would certainly STOP doing her job for her, but I realize that your personality problem won't allow you to not do things the right way...
  7. Insightful. I certainly wish you luck on the upcoming PANRE. I took the PANRE in April and agree with the obscure questions. I found myself scratching my head mainly on content that I'm most comfortable with, noting there were 2 correct or NO good answers. I specifically remember a few questions where I couldn't ascertain what they wanted (likely throw out questions). I'm still in general practice with autonomy so I see a wide variety and am constantly looking things up. Not sure how you specialty guys/gals would even approach a general exam without a Blueprint.
  8. probasestealer

    Xarelto and DOT exams

    Awesome response.
  9. Interesting topic. I've been in OP family medicine for 7 years now and have contemplated hospital medicine when I see job vacancies. I guess I've become a little too "comfortable" in the outpatient world. Obviously inpatient patients are a bit more ill. In making the switch I'd certainly have to study fluids, IV treatments, etc. Not sure what I'd do being able to get tests done quickly and results promptly. I once talked to an ER doc about switching from family medicine to ER. He thought it would be a very good switch as I've had years of experiencing identifying patients that "don't look right". But, I like seeing the PE, pancreatitis, appendicitis, MI and acute arterial patient and calling 911 knowing that someone else is in the ER to escalate care. Sorry, not really an answer.
  10. I have John Bielinski's CME4Life PA-Prep Focus for sale. I just took the PANRE and did well. I think I paid $175 at a conference for the book with the 16 CDs. Looking for $95, according to my wife the book is in "excellent used condition with a small bend in the cover". I did not write in the book. Let me know if interested. Thought I'd post here prior to listing on Ebay or Amazon.
  11. I agree with this. For most prior authorizations we will have the patient call the insurance company to request the appropriate paperwork. (Mostly medication) We've implimented the protocol of the patient calling insurance for any problems for the past 2-3 years, amazingly they are pissed at insurance 80+% of the time and not us. We do lose and anger a few patients, but in primary care it's nearly impossible to call the insurance company. Of course we still have to call for imaging. Interestingly I've found that if your staff or the patient will ask the name and credentials of everyone making the decision, you tend to get things "approved" quickly.
  12. I haven't heard anyone make this mistake in years, but I think it is due to confusion with Toradol. Both can be used for pain, but the MOA is completely different. Or that is my best guess...
  13. probasestealer

    hypertriglycemia - fibrate vs fibrate + statin

    I've seen limited benefit with Lovaza, in fact in the past year haven't used it at all. I have also seen very little true rhabdo with statins, fenofibrates or the combination. Many of the patients who report "myalgias/arthralgias" will RTC with inconsistent symptoms and the "I've been hearing a lot of bad things about these statin drugs". Normally CPK and/or any autoimmune tests will be negative (athough not usually needed). I have had a few people complain of fatigue, confusion, abdominal pain. At that point we will usually stop the statin see if symptoms improve. It is important to remember the two types of statins, both hydrophilic (crestor, pravachol) and lipophilic (lipitor, zocor). Then there is always the new kid on the block, Livalo, which I have had great success with. If a patient truly needs a statin there is often times another dosing regimen to consider, such as every 2nd or 3rd day. Statins do have a decent half-life and I've had success with MWF dosing in select patients. Zetia dose provide a nice LDL drop, but is often times too costly for many of my patients. Cost is also a factor with Crestor and Livalo to be fair. Although not ideal, I will use fenofibrates and statins together and actually see many patients managed by their cardiologist return on the combination. Just this week I had a patient with a triglyceride level of 423 and a direct LDL of 88 currently on Pravastain 40mg. His options are stronger statin (Crestor, Lipitor) which may help further reduce triglycerides, addition of a fenofibrate or fish oil/Lovaza. He chose fenofibrate and a chart review revealed he was once on Tricor with no problems. We'll follow-up in 4-6 weeks to recheck and likely include a CPK with any complaints. From Dynamed, “combination of statin plus triglyceride-lowering drug (fibrate or niacin) may be more effective for improving lipid profile than monotherapy (level 3 [lacking direct] evidence), but associated with increased risk for myopathy (level 2 [mid-level] evidence) “
  14. This will eventually get better. I remember getting asked, "how old are you" and "where is Dr B" a lot. These questions lasted about a year and as a rule people were just happy someone could see them. I have found the above quote to be very true.
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