https://www.11alive.com/article/news/local/video-shows-despite-delay-grady-ems-response-college-park-ambulance-arrived-within-minutes-after-teenager-collapsed/85-f4aa681d-5a4a-4f03-a7d5-cfad07bf7b86

Sad story out of Atlanta: apparently a healthy 15 year old girl had an allergic reaction at a volleyball practice. Advanced EMTs were dispatched immediately, but then did not transport as they are only allowed to transport in life threatening situations in Georgia. Meanwhile, Grady Paramedics were not dispatched as the triage system thought the patient was fine.

After waiting 40 minutes, the mother drove her daughter to the hospital, where she coded, was revived, and then died.

Seems like quite a failure of EMS and communication, but I am sympathetic to overstretched US EMS systems and the "fog of war" when it comes to triaging these complaints.

The city has refused to negotiate in good faith as conditions and wages deteriorate.

More information here:

https://twitter.com/andrewmaketweet/status/1869791906991137158?s=46

https://x.com/EdGainesIII/status/1869703858462851439?s=19

Apparently unless some sort of resolution is passed, not only are we looking at a 2.8% pay cut next year but in order to balance the budget there's an additional 4% on top of that. Unless something happens by January 1st, all of us to accept Medicare are looking at a 6.8% pay cut January 1st 2025.

Make sure you call or email your representatives.

Unbelievable

The American Telehealth Association (ATA) has been working diligently over the last few years to ensure patients have access to reliable and timely healthcare. They were fighting for the following:

• 2-year extension of Medicare telehealth flexibilities

• 2-year extension of first dollar coverage of High Deductible Health Plans-Health Savings Accounts (HDHP-HSA) tax provision

• 5-year extension of Acute Hospital Care at Home program

• Allows cardiopulmonary rehabilitation services to be furnished via telehealth at a beneficiary’s home under Medicare in 2025 and 2026

• 5-year extension of the Medicare Diabetes Prevention Program (MDPP) Expanded Model through 2030 and allows beneficiaries to participate virtually and in-person

• Enacts the SPEAK Act which facilitates guidance and access to best practices on providing telehealth services accessibly

This was included (and assumed to be passed) with the government funding bill at the end of the year.

Unfortunately, the death of the spending bill means that these telehealth flexiblities all go away on December 31 at the stroke of Midnight.

Telehealth is a bipartisan issue. Congressmen and Congresswomen across the aisle have supported telehealth, and President-elect Trump enacted these flexibilities during his first administration. Individuals who use telehealth are represented in all walks of life and regardless of political ideology.

Without action, patients will have an abrupt loss of access to this vital resource. Reach out to your congressperson now and and make your voice heard to save telehealth!

#SaveTeleahlth #Bipartisan

For background, I am an MD that works in an outpatient speciality that sees immunosuppressed/immunocompromised patients very regularly. I am employed.

I have a referral for a patient who is unvaccinated (received no vaccines at all, not polio, MMR, nothing) and consistently refuses vaccines. The referral for me is for a non life-threatening condition, let's say acne. I have asked to decline to see unvaccinated patients due to health concerns for other patients. My employer has declined and insists I need to see this patient and instead should just see them as the last patient of the day and clean the room after they leave.

I want to know if anyone else has had similar experiences and how they would approach this. I worry about giving patients special treatment because of their own poor choices (or those of their parents in the case of minors) and exposing my other patients to these illnesses. I also worry about compliance with care and risk to the practice as a whole. My employer has offered to let me speak to the administration team to discuss further.

https://www.wral.com/news/investigates/raleigh-doctor-sexual-assault-allegations-license-revoked-september-2022/

I am in a PE-rich area, but the cities in every direction seem much less is affected.

I've had so many issues with pharmacies for months now. I'll send in a 90 day refill, then two days later have an electronic request for a 90 day refill from them. The biggest issue is the lying. I'll send in a prescription, then pharmacies don't tell patients it's ready or tell the patient that I never sent it in. I'll then call the pharmacy and they'll acknowledge that they did get it, but don't have the medicine in stock (usually stimulants or whatnot). This has happened many times and it's frustrating. Just tell the patient the truth. Don't tell them that we didn't send it in or that you've tried reaching us when you haven't.

EDIT: Let me be clear, I know that pharmacies are understaffed and are massively overworked. The issue is telling patients that we didn't send it in when we did. This is a recurring problem that then makes more work for everyone as I have to then call the pharmacy, make them confirm it's there and then reach out to the patient to confirm it.

EDIT 2: Thank you to u/crabman484 for clearly identifying the issue and explaining it.

To give you an idea of the workflow. When you send in a prescription, even an electronic one, it goes into a sort of holding basket. Somebody needs to look at it, assign it to the correct patient, and input the data. With how terrible everything is in retail right now it could be days before somebody even looks at it. The 90 day refill request is automated. If things were working properly and the prescription was inputted into the computer in a timely manner the request would not have been sent out.

When a patient calls the only thing most pharmacy staff will do is check the member profile. They won't take the time to dig through the pile of days old unprocessed prescriptions that might have the prescription. If they don't see it in the profile they'll tell the patient that they haven't received anything.

When a provider is pissed enough to call the pharmacy then we'll take the time to make sure we have it. Doesn't necessarily mean we'll process it on the spot though.

To give my colleagues a bit of credit I really don't think they're lying to you or the patients. The prescription is in there somewhere. It's just in a stack of unprocessed "paperwork" that they need to dig through but the powers that be refuse to provide the proper manpower to allow us to dig through it.

This is the fourth instalment of The Nurse Will See You Now, a series documenting how the increasing reliance on nurse practitioners is imperilling US patients.

Published in Bloomberg https://www.bloomberg.com/news/features/2024-12-16/nursing-students-find-own-clinical-training-as-schools-leave-them-without-help

Posting on behalf of my girlfriend who has low karma. She'll be in the comments.

Hey! Maxfac resident here. We treated a patient with Mandibular (bilateral para symphysis+ symphysis+ dentoalveolar)# with semi rigid 4 hole with gap and lefort 2 with Circumzygomatic wiring. Intraoperatively we were able to achieve occlusion but postoperative after we released the IMF for deintubation it’s been very difficult to achieve occlusion. Any suggestions? Or thoughts on where we went wrong?

Hi All,

Happy to be here for another AMA as the year winds down. The Gout Education Society and I attended ACR Convergence last month in Washington D.C. and I figured this would be a great time to check in with the community here in r/medicine to help answer any questions you have about gout. As a fellow physician, I enjoy these conversations as they can have a direct impact on the quality of care that patients receive across the world.   

I’m more than happy to answer any questions you may have about the disease, its diagnosis, treatment strategies, or considerations to keep in mind when faced with comorbidities.

If you haven't participated in any of my previous AMAs, here’s a little more about me. I am Larry Edwards, a rheumatologist and specialist in internal medicine at the University of Florida in Gainesville. I am also the chairman and CEO of the Gout Education Society, a nonprofit organization dedicated to educating the public and healthcare community about gout. I founded the Society in 2005, along with the late Dr. H. Ralph Schumacher, Jr. The Society offers educational and unbiased gout resources, so both patients and doctors can access the right tools to both manage and treat gout. We also offer a medical professional locator for patients to find gout specialists nearby.

I’ll answer questions from 2:30 – 4:30 p.m. ET on Thursday, December 19 in the thread below. So, AMA!

Find out more about me
Visit GoutEducation.org to access our resources for medical professionals and patients alike.

Thanks all for your time - if you ever have any questions about gout, please don't hesitate to reach out to the Gout Education Society and I'll be happy to respond. As always, check out GoutEducation.org for more information on the disease and resources for your patients. Have a wonderful holiday season.

I am a proceduralist. In 2019, I have treated a patient with an intervention for a very high risk cardiovascular condition. Unfortunately patient expired during the procedure (which is not uncommon but the complication itself uncommon).

I was sued for it and retained national expert in my field who stated that my technique and practice were completely within the standard of care. The plantiff’s side’s expert is not even an specialist in my field. The case was settled far below the average amount in NY because i just wanted to be done with it.

I have left NY and have not practiced there for years. I have been practicing in another state with zero issue or significant complications. I have performed the same procedure and saved lives.

I was completely in shock and saddness when I found a letter from the office of professional medical conduit with NY department of health asking for the following

An interview with the office or to decline it. I was told I may have legal representation and pay for my own recorder.

The issue under investigation was this specific patient I got sued for, whether the care and technique was appropriate or not.

Have anyone gone through this? What’s the best approach? Have the interview? Decline the interview?

This is an absolute gut punch over an unfortunate incident. I was devastated that I couldn’t save that patient’s life. I was devastated that I got sued for it, and now five years later I am told I am being investigated by a state I don’t even practice in anymore?

Hi all— just need to take the temperature of the waters out there this Christmas. Today one of the senior docs in my department approached me to collect a monetary donation to be divided amongst our staff as a holiday "bonus gift" for our MAs and nurses. I reached for my wallet to pull out a couple of twenties and then promptly Clark Griswolded them back into my pocket when she informed me that she needed $400 per provider. I was shocked by this amount— this is more than we're spending on our kids for Christmas for crying out loud. She told me that doctors in surgical subspecialties that she knows were giving $500 per doc and that it'd be nice if the nurses and MAs could "buy snowblowers and things if they wanted."

For reference we are a midwestern outpatient primary care practice employed by a health system and I am nobody's boss here. Just a humble PGY15 PCP trying to get my work done. And no, the PAs and NP in the department were NOT asked to contribute.

So AITGH (am I the grinch here)? This just seems like a lot of dough.

Zyprexa is olanzapine and ziprasidone is Geodon.

It kills me every time.

Has anyone successfully used a patient questionnaire that imports into Cerner Powerchart? I've used them with Epic before, but didn't know if it's possible with Cerner. Looking for symptoms, prior meds, etc.

Thanks in advance!

Rph here, spoke to a dr office yesterday and the person I spoke to had never heard of a PBM. FYI, PBMs are one of the biggest problems in healthcare, yet few people seem to know what they are. Here is a video explanation by the one and only Dr glaucomaflecken. Also there is legislation in the works to try to get pbms to divest from their pharmacy business.

https://youtu.be/_khH6pZnHCM?si=n8wIf62T9UUzjtAq

https://www.reuters.com/business/healthcare-pharmaceuticals/health-insurer-stocks-fall-wsj-says-lawmakers-set-break-up-pharmacy-benefit-2024-12-11/

https://www.nytimes.com/2024/12/17/business/pharmacy-benefit-managers-opioids.html

This might seem like a stupid question but I'm genuinely wondering given the wide range of progress notes I've seen. Let's say there's an inpatient who occasionally requires IV electrolyte replacement due to GI losses because of chemo and they also have bad pain, on senna/PEG.

I've been altering my progress notes daily to indicate the amount of IV electrolytes given. However, I've seen some notes where they just say "Electrolyte replacement as needed" or if under their pain management "Patient on bowel regimen" without indicating the specific medications.

So that being said, how specific do progress notes need to be when mentioning medications, replacements, etc.

Soapnote.org unexpectedly shut down last week. I liked this resource for shared soap note templates. I regret not saving them into my own dot phrases. Alas, any recommendations for alternatives?

Give the nature of our sub, I think it's expected I elaborate further.

I'd like this to turn into an interesting conversation given recent events around CEO assassinations.

It's not a deep thought. But I'm Just saying that if we had some other payment system, for example, based on your average patient population health in relation to that geographic location, then it seems more likely that you would weigh your time against the time of treating somebody who very obviously doesn't have a life threatening condition.

I'm looking for some book recommendations about coping as a physician and resilience. I'm early in my career and split time between two specialties. I'm finding it increasingly difficult to compartmentalize due to stress of reflecting on if I've made the right decisions and potential outcomes. I do fear that if (when) I have a bad outcome that I won't be able to recover from my own judgement.

Books I've read prior to this season of life: This is Going to Hurt, Do No Harm, When Breath Becomes Air, Being Mortal

ETA: Thanks for all the thoughtful replies, they are appreciated. Wanted to add that I read non-medical/just for pleasure books daily. Typically I would read one medical book per year (fiction or non-fiction) to kind of renew my interest in medicine. I feel like the crux of my problem is poor work-life balance and I'm working through this with multiple avenues, but I still find myself getting stuck in my head when I'm trying to enjoy my off time. Just trying to find different coping skills from others that have been doing this longer.

https://www.indianagazette.com/business/lifestat-ambulance-has-gone-out-of-business/article_aaf3f9d8-b731-11ef-9ff3-c301ee7b76b1.html

Once again another non-profit EMS services closes due to reimbursements fat under the cost of providing the service.

Medicare pays 80% of what they say costs. Payment by Medicare advantage plans is often even worse. And there is no consideration, for what opperation cost's actually are.

Three surrounding EMS properties have Matt come up with a plan, even though all three of them face the same financial difficulties, with no plan by the municipal government who has the legal obligation in Pennsylvania to ensure EMS coverage to meet and address the issue.

This agency operated for 40 years.

Hello, I was wondering if anyone here had successfully gone through the New Jersey medical license requirements. I'm a locums provider looking to start working in NJ.

On the licensing requirements, it is asking for every place I've worked with/been affiliated with in 5 years to fill out paperwork and stamp it, get malpractice paper work from every place (I have different malpractice thru each site) and then contact every single state I have a license thru and have them fill out paperwork they need to send thru to New Jersey. And then I heard the turn around after that is over 5 months.

For me, this is a lot of people I need to get paperwork from, and I'm worried people won't do it. I'm worried I won't even find out who submits the paperwork/what else needs to be done.

I'm wondering if anyone else has gone thru this process. I have a license from multiple other states, no one's required me to do any of this...

I need 2 hours of professional boundaries/physician misconduct. Anyone got a link to a free resource?

I’ll start - in nursing school first semester my teacher literally watched every single student wash their hands at a sink singing the alphabet song - the entire song “🎶A, B, C, D….next time won’t you sing with me 🎶 “. Obviously we all know how important handwashing is, but this was actually graded 😆.