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thinkertdm last won the day on October 20

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About thinkertdm

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  1. I don’t know. But here’s a bit of advice. The bits I highlighted up there tell people you don’t really want to be whatever you are discussing at the time. You make time for what’s important to you. Period. writing down vitals and carrying patients is nice. But showing that you can assess and then act on that assessment-ie, paramedic, or even an emt, goes a long way. You do not have the time to give it your best? An athlete should understand this, more than anyone else. Do you do half of your training, and expect a one hundred percent result? Lets look at it another way. At some point, you are going to enter the medical system as a patient. Could be tomorrow, could be in eighty years, but count on it. Do you want the pa taking your history to say “welp, didn’t have time for it!”? The radiologist just looking at one lung? If you choose to do one thing, then do it.
  2. I usually don't shake hands at the beginning but shake hands at the end. A firm handshake and look 'em in the eyes. I feel it tells patients there is a human being, not a machine taking care of them. It gives them confidence. That they aren't in a vacuum, or alone. When you are stricken down with a disease, any disease, you feel alone. More alone than anything. Many patients are worried that this is the end, especially having nothing else to fall back on. Letting them know they are not alone, that you are with them is very therapeutic. True, hands spread disease. That's what pants are for, to wipe your hands on. All joking aside, it's just a thing. A cold isn't going to take you out, and when you are seeing fifty patients a day, no need to shake everyone's hand. I actually don't see that many with colds, most of my patients are vets who benefit from long term relationships. You don't even need to shake their hand. Turn away from the computer, and look at the patient, in their eyes. Nod your head, like you're listening. Ask questions. Administrators and retail medicine have taken away the most important part of medicine, the human part. Any schmoe can prescribe a medicine. But very few can actually say, "I hear you. You are suffering, and I feel that. Hell, I've been there too. I want you to know, it won't last forever, and I will do what I can to help you".
  3. I see an MD, who was recommended by an MD colleague. Very good, knowledge wise; he was able to explain some concerns to me. Respectful. I refuse to see an NP after a few bad experiences with multiple NP's. In general, I feel pretty much the same way as you. Don't dismiss my concerns, even if they are the craziest thing you've heard all day. Acknowledge my feelings, then do your best to explain them without making me feel like an idiot.
  4. He was flat out bullying you. Tell this POS cmo you’re out. He literally is making money off of you, with zero- zilch, none, nada-risk to him. One slip up, you are gone, and he’ll still be there. You are the money making fall guy. Has any one, ever, said “hey, the cardiologist is leaving, you want to take over cardiology for a wee bit”? No. And pain management is a specialty in its own right. He’ll say no repercussions but there will be. The second the tiniest thing happens, he will be all over you.
  5. When I worked at one medical, there was at least one pa who worked in another country as a telemedicine provider. That’s pretty much all I can remember. The only restriction I know of is prescribing narcotics, and the law that addresses this is the Ryan Haight Act Ryan Haight Act at the dept of justice.
  6. After working for the VA for nearly four years, I have no clue how people get in my door. What seems true for one person is not so for another. In fact, the one thing that seems consistent is that the people most successful at getting anything are the ones who keep asking, because eventually you will get to the person who knows how to get it done; people who don’t know just say “no” whether it’s true or not. Talk to a service officer about the forms you need ; they are found all over the place. Some states even hire them; colleges have them; there is an office at your local VA medical center with a SO. If you just want to get in, bring your dd214 (and probably a whole lot of other paperwork I don’t know about) to the benefits desk at your local med center. The service connection will take a bit more footwork.
  7. With the $25k “leaving the practice fee” it seems like they make more money from people leaving than people staying and seeing the patients. There’s a definite reason for trying to lock you in like this, and it is not good.
  8. A couple of thoughts, because it's still early- and this is purely from a primary care perspective. First, when I'm in the room with a patient, I use every tool at my disposal. That includes a couple of rubber tubes hanging around my neck. Second, the stethoscope was derived as an extension of ears, to amplify. I can see this technology as doing the same thing. C, The most important tool is between my ears. Always. A stethoscope or portable ultrasound or X-ray vision doesn't mean a thing if you don't know what to do with that information. Too many times I have seen "no m/r/g" and wonder if they actually knew what they are listening for. Fourth, consider if the additional cost of these gizmos is warranted, in a primary care setting, especially if all you want to do is use the latest and greatest. See number C. If it helps you change their life, then haul it out. If it doesn't, or won't, then don't. Auscultation used to be a fine art, much like handwriting. Now that texting and type came along, people's hands cramp with writing a sentence, let alone a book, yet this is how we used to communicate, with beautifully written letters. A hundred years ago, a physician could auscultate and use that skill alone; now people just get an echo.
  9. This statement: Shows how out of touch the authors are. The fact that they posed a question-"gosh, is our health care system broken?" Leads me to suspect this was written by someone with a looming deadline. And what's up with this asshat? This sounds like an ass kissing administrator. The system currently looks like an inverted triangle, with more administration at the top than boots on the ground. Just my simple opinion.
  10. Excellent point. Also remember, however, that you are interviewing them. You don’t want to see them at their best, you want to see them- the office, the internal workings- and how you fit it. I went to an interview once - I didn’t sit in with any patients, but I was sitting with one of the md’s, who was showing me their emr. The phone rang, I think it was a medical assistant or receptionist- and was rude to them on the phone. My belief is look at how people treat other people whom they don’t need to treat well. i made my exit and never called back. It wasn’t for me.
  11. It’s probably just shadowing. I can’t imagine any workplace allowing a non employee on the work floor. Do they ask crane operators to come on down and take the cranes for a spin, before they are hired? What if you had a needle stick injury? Not covered under workers comp, because you are not a worker. “Hey, Dr Jones, let’s have you come in for a ‘working interview’ in surgery, see how things work out”. Malpractice lawyers would start planning their retirement. You already have (or will have) two things that attest to your skill and knowledge and competency. One is your certification. The other is your state license.
  12. The beauty of templates...guide you through a 99213 vs 99214. It’s all on how you document. I spent an hour talking to a patient about their back pain, surgeries, pain treatment options...lots of ways to code it, I suppose, but I put it down as 99215, “greater than 50% of this 60 minute visit was spent in a face to face discussion and coordination of care”.
  13. I found this on the aafp website: Rules of thumb for 99214 Think 99214 in any of the following situations: If the patient has a new complaint with a potential for significant morbidity if untreated or misdiagnosed, If the patient has three or more old problems, If the patient has a new problem that requires a prescription, If the patient has three stable problems that require medication refills, or one stable problem and one inadequately controlled problem that requires medication refills or adjustments. https://www.aafp.org/fpm/1999/0700/p32.html even a viral uri can be a 99214, if you prescribe tessalon perles and write something like “history and physical exam suggestive of a viral etiology; while the differential includes x,y,z I have a low suspicion for strep, mono as there was no fever or lad; etc. today I prescribed tessalon perles and cautioned about...”. You reviewed prior medical records. If they have diabetes, write that you cautioned it might cause a slight elevation in his blood sugars,.
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