Ye

[BobSaget]

Ye

[camoman1234]

There is no top 20 as FM means you know a little bit about everything, but a master of none. I will tell you what I see on a weekly basis: HTN, DMI/DMII, hyperlipidemia, CHF, A-fib, AAA, carotid stenosis, migraines, depression, bipolar, GAD, SLE, RA, OA, chronic pain in every joint possible, gout, fibro, uti, renal caculi, thyroidism, obesity, tobacco abuse, vertigo, bronchitis, PNA, sinusitis, allergic rhinitis, epistaxis, obstructive and restrictive pulm disease, AOM/swimmers ear, all kinds of DERM (AKs, SKs, SCC, BCC, vitiligo, tinea (all of them), exanthematous rashes, dermatitis), wound care (DM ulcers, arterial/venous ulcers), cerumen impaction, lymes, rocky mountian spotted fever, ehrlichiosis, tularemia, OSA, ingrown toenails, felon, paronychias, herpes zoster, DVTs, fractures, strains/sprains, acl/pcl/mcl/lcl/meniscus tears, PCOS, genetic testing, allergy testing, dehydration, chest pains, afib with rvr, stemi/nonstemi, a-flutter, hypoglycemia, laceration repair, suicidal ideations, IDA, B12/vit d deficiency, rectal bleeding, hemorrhoids, peptic/gastric ulcers, UC/crohn's disease, dental abscesses/thrush. Thats what I have seen this month plus I know I left some out. Read uptodate. Ask questions a lot. 

P.S. I did not even put down the procedures I do either. Good luck!

[rev ronin]

32 minutes ago, camoman1234 said:

There is no top 20 as FM means you know a little bit about everything, but a master of none. I will tell you what I see on a weekly basis: HTN, DMI/DMII, hyperlipidemia, CHF, A-fib, AAA, carotid stenosis, migraines, depression, bipolar, GAD, SLE, RA, OA, chronic pain in every joint possible, gout, fibro, uti, renal caculi, thyroidism, obesity, tobacco abuse, vertigo, bronchitis, PNA, sinusitis, allergic rhinitis, epistaxis, obstructive and restrictive pulm disease, AOM/swimmers ear, all kinds of DERM (AKs, SKs, SCC, BCC, vitiligo, tinea (all of them), exanthematous rashes, dermatitis), wound care (DM ulcers, arterial/venous ulcers), cerumen impaction, lymes, rocky mountian spotted fever, ehrlichiosis, tularemia, OSA, ingrown toenails, felon, paronychias, herpes zoster, DVTs, fractures, strains/sprains, acl/pcl/mcl/lcl/meniscus tears, genetic testing, allergy testing, dehydration, chest pains, afib with rvr, stemi/nonstemi, a-flutter, hypoglycemia, suicidal ideations, IDA, B12/vit d deficiency, rectal bleeding, hemorrhoids, peptic/gastric ulcers, UC/crohn's disease, dental abscesses/thrush. Thats what I have seen this month plus I know I left some out. Read uptodate. Ask questions a lot. 

Bacterial Vaginosis, Yeast infection.

Fibromyalgia, chronic fatigue syndrome, and lyme's are 90% garbage diagnosis that someone else stuck on a patient with depression who didn't want to believe they had depression.  Know how to find the 10%!

DM I is much more rarely managed in FM than DM II.  DM I often sees endocrine, who don't want to see DM II unless they're actually compliant AND still having problems.

[camoman1234]

I have done several lymes test that were showing 5/10 or 6/10 bands + with repeat in 6-8 weeks with the same results. Also, DMI is managed in house as we are a RHC with no access of care so no one will drive 70 miles to see an endo when I can manage it. 

[rev ronin]

1 hour ago, camoman1234 said:

I have done several lymes test that were showing 5/10 or 6/10 bands + with repeat in 6-8 weeks with the same results. Also, DMI is managed in house as we are a RHC with no access of care so no one will drive 70 miles to see an endo when I can manage it. 

Yeah, I should have differentiated Lyme from "Chronic Lyme".  Also, cool that you manage DM I.  In suburban family medicine, I see no OB, little GYN, little peds and most of that adolescents.  When specialists are a 1+ hour drive away, you definitely see a wider scope.

[VictoriousSecret]

Any other resources? I would to know as well

Sent from my ONEPLUS A5000 using Tapatalk

[corpsman89]

On 4/19/2018 at 9:44 PM, camoman1234 said:

There is no top 20 as FM means you know a little bit about everything, but a master of none. I will tell you what I see on a weekly basis: HTN, DMI/DMII, hyperlipidemia, CHF, A-fib, AAA, carotid stenosis, migraines, depression, bipolar, GAD, SLE, RA, OA, chronic pain in every joint possible, gout, fibro, uti, renal caculi, thyroidism, obesity, tobacco abuse, vertigo, bronchitis, PNA, sinusitis, allergic rhinitis, epistaxis, obstructive and restrictive pulm disease, AOM/swimmers ear, all kinds of DERM (AKs, SKs, SCC, BCC, vitiligo, tinea (all of them), exanthematous rashes, dermatitis), wound care (DM ulcers, arterial/venous ulcers), cerumen impaction, lymes, rocky mountian spotted fever, ehrlichiosis, tularemia, OSA, ingrown toenails, felon, paronychias, herpes zoster, DVTs, fractures, strains/sprains, acl/pcl/mcl/lcl/meniscus tears, PCOS, genetic testing, allergy testing, dehydration, chest pains, afib with rvr, stemi/nonstemi, a-flutter, hypoglycemia, laceration repair, suicidal ideations, IDA, B12/vit d deficiency, rectal bleeding, hemorrhoids, peptic/gastric ulcers, UC/crohn's disease, dental abscesses/thrush. Thats what I have seen this month plus I know I left some out. Read uptodate. Ask questions a lot. 

P.S. I did not even put down the procedures I do either. Good luck!

How I imagine you typing this. 

[lkth487]

Yeah it's crazy the variety you see.  I would be overwhelmed in FM.  I've heard that prepping with MKSAP type questions are very helpful.  I used them for my medicine shelf in med school and it was very useful then.  

But my advice for you is just read a lot.  It just takes a lot of time and experience.  

[camoman1234]

On 4/20/2018 at 8:46 PM, corpsman89 said:

How I imagine you typing this. 

HAHA!!!! That is awesome, but it took me about 5 mins to type that as I was thinking of the last month of what I saw. Family Medicine is not easy, but enjoyable. 

[Joelseff]

On 4/19/2018 at 9:49 PM, rev ronin said:

Yeah, I should have differentiated Lyme from "Chronic Lyme".  Also, cool that you manage DM I.  In suburban family medicine, I see no OB, little GYN, little peds and most of that adolescents.  When specialists are a 1+ hour drive away, you definitely see a wider scope.

LOL Rev I was about to say. Lyme is real Chronic Lyme is what my Dr. Google pts present with along with adrenal fatigue etc. Though I will say I have 1 or 2 FM pts who do have active trigger points in the FM pattern/distributions and do not have much or any sxs of Depression. I will agree that *Most* are anxiety and depression pts who love coming to see me and portal message me about every little thing going on in their life. These ones don't really need a clinician, they need a friend ?. That's what "Functional Med" referrals are for! 

[rev ronin]

9 hours ago, Joelseff said:

These ones don't really need a clinician, they need a friend ?. That's what "Functional Med" referrals are for! 

EVERYONE needs a friend, clinician and patient.  As a provider, I can't really be a friend to my patients, but especially in my Occupational Med/long term folks, I make it a point to do several things:

- Ask about their family.  Encourage them to stay connected!

- Talk about their other health problems.  Even if I can't document and bill for that, I do see some of those patients on their private insurance for other problems, so I make sure they get good care every appointment.

- Get their feedback on the specialists I've sent them to.  Make sure they know their opinion matters.  I also warn them of e.g. surgeons with good skill but iffy bedside manner.

For folks with long-term issues, basically everyone else in their life will have stopped caring about their 'issues.'

[Joelseff]

8 hours ago, rev ronin said:

EVERYONE needs a friend, clinician and patient.  As a provider, I can't really be a friend to my patients, but especially in my Occupational Med/long term folks, I make it a point to do several things:

- Ask about their family.  Encourage them to stay connected!

- Talk about their other health problems.  Even if I can't document and bill for that, I do see some of those patients on their private insurance for other problems, so I make sure they get good care every appointment.

- Get their feedback on the specialists I've sent them to.  Make sure they know their opinion matters.  I also warn them of e.g. surgeons with good skill but iffy bedside manner.

For folks with long-term issues, basically everyone else in their life will have stopped caring about their 'issues.'

That's what i meant as "friend." the visits I have with these pts are usually us just talking. They're already on pain meds/gabapentin/pregabalin/Cymbalta etc or seeing Pain Mgmt. I refer them to fxnl med because they tend to give them other things to focus on like vitamins diet yoga etc and actually our fxnl med guy (formerly a Neurologist) spends an hour with these pts. Time I frankly don't have in my practice. Fxnl Med is a great place to send these pts if you have a good one to refer to. The pts who I have referred and have responded well seems to have focused on the relational aspect of seeing a specialist who "understands" or "hears" them and they focus their attention on these modalities which anecdotally helps. Perhaps placebo but who cares as long as it helps. PT/OMM etc helps too but I find pts get "tachyphylaxis" to these modalities since their issues are not simply msk. FM is a biopsychosocial disorder. 

[camoman1234]

1 hour ago, Joelseff said:

That's what i meant as "friend." the visits I have with these pts are usually us just talking. They're already on pain meds/gabapentin/pregabalin/Cymbalta etc or seeing Pain Mgmt. I refer them to fxnl med because they tend to give them other things to focus on like vitamins diet yoga etc and actually our fxnl med guy (formerly a Neurologist) spends an hour with these pts. Time I frankly don't have in my practice. Fxnl Med is a great place to send these pts if you have a good one to refer to. The pts who I have referred and have responded well seems to have focused on the relational aspect of seeing a specialist who "understands" or "hears" them and they focus their attention on these modalities which anecdotally helps. Perhaps placebo but who cares as long as it helps. PT/OMM etc helps too but I find pts get "tachyphylaxis" to these modalities since their issues are not simply msk. FM is a biopsychosocial disorder. 

Why wife is a functional medicine FNP. Their clinic is very successful in helping these kinds of patients you listed above, but also very successful/highly educated patients that do not get their fulfillment from their PCP. I agree, they are a great resource to "refer or pawn off your patients on to" :) (I get it, I do it as well!)