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rev ronin

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rev ronin last won the day on January 5

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About rev ronin

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  1. What's something a patient has told you about their life situation that made you cry--or want to? No identifiers, obviously.
  2. In addition to psych, I am very comfortable doing sleep medicine via telemedicine. Not a fan of trying to deal with acute illness without a physical exam, but Cideous is right--if it's that or nothing, you'll see it used.
  3. Only if you, as the provider, have the right to set what insurances you will see, and your own rules for "collect up front from people who've had payment problems in the past"; otherwise, the practice should assume that risk, not you.
  4. Yes, it's pretty fast. Now that you've GOT an NPI, you will put it on the various applications for medicaid and medicare enrollment, which should ideally be handled by your credentialing people.
  5. In one case, the other provider confessed to schizophrenia, active suicidal ideation, and multiple voluntary psych admissions. This provider was also telling multiple people multiple conflicting stories--as in, things that could simply not possibly be true. That was a "patients aren't in danger, the provider is" referral. Interestingly enough, when I called the impaired provider hotline, I swear the guy on the other end was familiar with this individual based on how he reacted to my report. That is, I suspect someone else had already reported this provider, who may have already been under active supervision, even though I am not privy to whether or not my hunch is correct. In the other case, the provider had been specifically instructed to not prescribe a particular drug as the SP had decided it belonged to anesthesia, not family medicine. I was later told that this provider continued prescribing it against a direct order, but falsified charts to conceal their continued use of this medication. Upon discovery, they were let go from the practice. Upon providing continuing care for the affected patients, I discovered that among the charts that omitted mention of this medication but where patients told me (and PMP query confirmed) that it had been prescribed to them by this provider, was that of a lactating mother, whose status as such was never documented in the charts, either. At her next visit, she confirmed that no discussion of this drug's safety in lactation had been held. In each case, I'd consider that far more than a screw up. I've seen people miss things, and had other people find stuff I missed... but there's a difference between being wrong, and being deceptive, which is the common thread between these two cases.
  6. Yep. My younger son and I were involved in an MVA 18 months ago where the guy who started the chain reaction was in a big truck and getting a field sobreity test while they were planning how to cut the driver out of the miata (or whatever it was, it was small to start with and smaller afterwards...) he hit. Our car was two ahead of hers and still driveable, but the investigating officer followed up and interviewed us again because it became vehicular assault, a felony, once it was clear she had at least one broken bone.
  7. Can we get some authoritative substantiation on this? A website with a regulation, perhaps? I think we have a number of people talking about their own personal experiences and assumptions, which seem to be orthogonal to each other.
  8. If it's our legal duty to report impaired providers, harm to children or other incompetents, or threats of harm to self or others. It's our professional obligation to always act in the best interests of our patients. To NOT act in the best interest of our patients is to place us outside the realm of 'medicine' as a profession, regardless of the personal consequences we might face for acting in the patient's best interest. ETA: I have reported providers before, twice since becoming a PA. One is dead; the other is no longer practicing medicine. In each case it was because of my own direct observations of the conduct in question, in each case which did not result in direct patient harm but was egregious enough to demonstrate a lack of ability and inclination to practice medicine safely, and not as some third-party whistleblower. It was not my job to say "What were you thinking?!!" although I could well have done so, it wasn't appropriate in either case. In neither case was the individual ever brought up before the medical commission.
  9. Yeah, some folks don't read all the rules, or dates, first. Not a bad thread topic to have again, if someone wants to start a NEW one.
  10. By "we" I assume you mean society and/or the medical boards in question? I think the responses here have been pretty fact based and neutrally worded. I know I've been less charitable in past threads on similar topics, but the older I get, the more I trust 'the system' (flawed as it is) work out how to respond to such occurrences.
  11. Oh, and my exit plan has always been as a HIPAA auditor/consultant. I maintain several of my infosec certifications, including an HCISPP. I don't ever expect to pull that trigger, however, I'm not a fan of living out of a suitcase and wearing ties daily--I'll do one or the other, but not both.
  12. Good grief... Sleep Med pays at least as well as family med. Join AASM and do their Midlevel CME, then go shop yourself around. You may be bored doing sleep apnea day in and day out, but it's a safe, low-risk gig that really helps the people involved. Lots of patient ed, coaching, motivational interviewing... Only time anyone in a sleep clinic needs gloves is to use cleaning products. There are no stirrups anywhere in the clinic..,
  13. Get a lawyer. You will probably have to enroll in some sort of substance use disorder monitoring program at the very minimum. If you can truthfully say you haven't ever practiced in a way that risked hurting patients, I think you're going to be better off, but that's really up to the board in GA.
  14. Wow. I even need my DEA for sleep medicine (Lunesta prior to in-lab, sometimes...) and eating disorders treatment. I cannot get through a day of family or occupational medicine without it.
  15. They don't know how to negotiate, they don't know how to say "no", they don't know their own worth, and far too many of them are stuck in one locale and/or only moving with their spouse's job. Of course, that's both 1) a generalization, and 2) the current state of affairs. When they wake up, wise up, and stand up, we're going to see a wave of enthusiasm and righteous anger that's going to totally displace old codgers like us in profession leadership. I hope.
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