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Is this even medicine?


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My first patient of the morning had a televisit a month prior to today.  

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History: The patient complains of coryza, congestion, sore throat, post nasal drip and productive cough for 12-14 days. The patient denies a history of chest pain, dizziness, nausea, shortness of breath, vomiting, weakness and weight loss and denies a history of asthma. Patient does not smoke cigarettes. OTC medication use for current symptoms advil He is seen with his mother on the video visit.

(side note: isn't coryza congestion, sore throat, post nasal drip, and cough?)

Here is the physical exam:

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Video examination of the patient: looks tired 
Throat is red no visible exudate
 
ASSESSMENT: 
viral upper respiratory illness and sinusitis

"looks tired".  Note that the history has nothing about the sinuses.  Here's the treatment:

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PLAN:
Antibiotic therapy: amoxicillin 7 days .
Symptomatic therapy suggested: push fluids, use ibuprofen prn and push fluids,rest,return office visit prn if symptoms persist or worsen.  Call or return to clinic prn if these symptoms worsen or fail to improve as anticipated.

It's not even the right antibiotic for sinusitis.  (it was amox 500 mg tid x 7 days.)

Why did this fellow take what, 7 years in med school for this?  There aren't even vitals.  I'm going to write that for my objective from now on.  "looks tired".  Next!  I'm a little surprised, I kind of thought zpacks were indicated for "looks tired".

 

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Yeah I had a pt recently who was "seen" over the PHONE by a tele-doc with her insurance company. Diagnosed with STREP PHARYNGITIS......OVER THE PHONE....and given, guess what, a Z-Pack.
 
I couldnt believe it. 
 
Also:
 
 
co·ry·za
 noun
MEDICINE
 
  1. catarrhal inflammation of the mucous membrane in the nose, caused especially by a cold or by hay fever.
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I see this quite often.

Established patient of mine, who has frequent migraines for decades. She has some that last 2-3 days. She lives 100 miles away from me, so it's not easy for her to get here for acute treatment. But, on her second day of her last migraine she went to see the NP at her PCP. She reported, "This is one of my typical migraines. It is in the second day. I have sensitivity to light and vomiting. No fever, no URI symptoms."

The NP says, "Migraine cannot last more than 1 day. This is a sinus infection. I will prescribe a Z pack."

Mike

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2 hours ago, jmj11 said:

The NP says, "Migraine cannot last more than 1 day. This is a sinus infection. I will prescribe a Z pack."

The Z-pack's job in this scenario is to strengthen the presumed sinusitis bacteria and make them more resilient because as all us awesome PA's know: "Macrolides (clarithromycin or azithromycin), trimethoprim-sulfamethoxazole, and second- or third-generation cephalosporins are not recommended for empiric therapy because of high rates of resistance of S. pneumoniae (and of H. influenzae for trimethoprim-sulfamethoxazole) [4,5]." From: Uptodate.com 

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On 1/31/2018 at 3:16 PM, jmj11 said:

I see this quite often.

Established patient of mine, who has frequent migraines for decades. She has some that last 2-3 days. She lives 100 miles away from me, so it's not easy for her to get here for acute treatment. But, on her second day of her last migraine she went to see the NP at her PCP. She reported, "This is one of my typical migraines. It is in the second day. I have sensitivity to light and vomiting. No fever, no URI symptoms."

The NP says, "Migraine cannot last more than 1 day. This is a sinus infection. I will prescribe a Z pack."

Mike

 

WHAT???

 

I truly think there should be a way to report STUPID medical decisions to some board somewhere that then will go "talk" with the provider

 

on one local phone call I had an ER provider tell me

"can't be an abscess, no white count"

"we can rule out abscess with and xray"

and about 5 other things that left me speechless....  they we just flat wrong (for a guy with acute swelling of forearm, failed on Bactrim for infection, and 3/4" measurable girth difference of the forearm and him saying "there is fluid in my arm"

 

 

 

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3 hours ago, ventana said:

 

WHAT???

 

I truly think there should be a way to report STUPID medical decisions to some board somewhere that then will go "talk" with the provider

 

on one local phone call I had an ER provider tell me

"can't be an abscess, no white count"

"we can rule out abscess with and xray"

and about 5 other things that left me speechless....  they we just flat wrong (for a guy with acute swelling of forearm, failed on Bactrim for infection, and 3/4" measurable girth difference of the forearm and him saying "there is fluid in my arm"

 

 

 

The provider is probably one of those who would stick an 18 ga. needle into the swollen space and say that if the individual doesn't fly around like a balloon with air escaping out that there can't be a compartment syndrome concern either.

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A smelly heel?  A scaly heel?  Some sort of fishy parasite in the heel?  An infected fish bite?
MM
One of my PSRs was trying to spell fasciitis... Another one said "bronchotits" lol I wish I had a screenshot of that. I was thinking "dinosaur breast issue?" hahaha

Sent from my SAMSUNG-SM-G891A using Tapatalk

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On 2/3/2018 at 7:43 AM, ventana said:

 

WHAT???

 

I truly think there should be a way to report STUPID medical decisions to some board somewhere that then will go "talk" with the provider

 

on one local phone call I had an ER provider tell me

"can't be an abscess, no white count"

"we can rule out abscess with and xray"

and about 5 other things that left me speechless....  they we just flat wrong (for a guy with acute swelling of forearm, failed on Bactrim for infection, and 3/4" measurable girth difference of the forearm and him saying "there is fluid in my arm"

 

 

 

One can use an x-ray to evaluate for abscess although not an imaging of choice, it can also  be very helpful to look for osteo

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