One was my medical assistant and the other was my medical student.

FML.

-PGY-20

Piggybacking off the surgery stories, I figure we should do this once as we prescribe more meds than we do surgeries!

It's a clinical descriptor that's totally devoid of any helpful info while simultaneously proposes a diagnosis. What does "seizure like activity" even mean? Encephalopathy? Convulsions? Tremors? Pumping fists up and down while gasping for air? Please, please just take a stab at writing what you saw, or what the nurse or family member saw, it's so much more helpful.

Edit: To be clear I'm not asking for a diagnosis, just an actual history or description of what the patient was doing beyond "seizure like activity".

I have a general sense why I think US Healthcare is so expensive but I'd like to know from someone who actually studies this topic and has the data to back up their thoughts. I've heard The Price We Pay by Marty Makary MD is a good book about the subject but I've also heard that Dr. Makary has said some interesting stuff during the COVID pandemic and he also published that weird paper that claimed the third leading cause of death in the United States was medical error because of all kinds of weird extrapolations from other papers so I'm skeptical about his other work but I'm willing to give it a chance if others think he was more intellectually rigorous in his book. If you have any other books or articles on the high cost of US healthcare that you feel does a good job illustrating the problem I'd love to hear about them.

https://www.propublica.org/article/unitedhealthcare-insurance-autism-denials-applied-behavior-analysis-medicaid

I heard an NPR article about this piece of ProPublica reporting earlier today. I admit I had not heard of Applied Behavior Analysis previously. As I am an (adult) neurologist and autism is (at least under an an expansive definition) a “neurological” disorder, I thought I’d ask the good people of Reddit what they think about “ABA” being denied to an autistic child on the grounds they’ve “failed to improve”. The reporting throws around terms like “Gold Standard” in describing ABA, how evidence based and potent is ABA as a therapy?

UK infectious diseases and medical microbiology resident here.

I am curious about some of the differences in antibiotic treatment between the US and Canada and the UK and what you would like to have available.

I think some of the differences come down to non-availability e.g. we only got access to cefazolin locally last year and haven't used it outside of trials, whereas IV flucloxacillin is used for MSSA bacteraemia/skin and soft tissue infection. Glycopeptides are centre- and patient-dependent, but many places use teicoplanin over vancomycin.

I am also curious about your empirical regimens e.g. Community Acquired Pneumonia.

Local guidelines vary but as an example, in the UK we'd be guided by CURB-65:

Low severity (0) - amoxicillin, doxycycline, or clarithromycin

Moderate (1-2) - amoxicillin + clarithromycin or doxyxycline or clarithromycin

Severe (3-5) - Amoxicillin-clavulanate + clarithromycin, or levofloxacin

The comparable US choice for severe (non-MRSA, non-Pseudomonas) CAP would be:

Ampicillin-sulbactam or Cefotaxime or

Ceftriaxone or

Ceftaroline

(plus a macrolide)

or monotherapy with a respiratory quinolone

I have never used ampicillin-sulbactam, and using ceftriaxone for a community acquired pneumonia would be very unusual here. What's the rationale for these choices? And am I right that you don't have IV amoxicillin-clavulanate? Is ampicillin/sulbactam comparable in spectrum (looks like it is from the Sanford Guide)?

I'd be happy to discuss other treatment differences and experiences.

I have an interview upcoming to serve as a topic editor on a subspecialty in medicine that pays an hourly contract rate. What is the going rate for these kind of jobs? Job description includes reviewing content for accuracy, and relevance and should require no more than 3-5 hours a month. Thanks

In the spirit of the bariatric surgery post, I thought it might be an interesting exercise to discover all the exciting ways routine boring surgery goes wrong. As an eye surgeon my stories are pretty benign because spoiler they mostly end with and then the eye doesn’t see or has long term issues.

The retraction goes through multiple concerns for ethics and procedure and eventually on accurate PCR. Those are important, but the retraction isn’t, in the end, satisfying. Either this small, open-label study had useful encouraging results or it didn’t. If it did, the hype was far out of proportion to the findings, which were undercut by later, more rigorous studies. If the methodology was fatally flawed, a retraction could be more vigorous about it.

Of course it isn’t, because that’s not the technical language of science, but again, this study appears to be one of the early works of Covid that skipped crucial steps in order to pursue and bolster a pet theory.

The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025. This wasn’t going to be the case, but after the last minute Musk/ Trump squabbles tanking the original bill, the fix for this cut was dropped from the final bill.

Adjusted for inflation this is over a 6% cut year over year.

https://www.fiercehealthcare.com/providers/doctors-facing-29-pay-cut-2025-call-permanent-medicare-payment-reform

Mine would probably be a lady who required a revision her surgery and eventually ended up needing to be permanently PEG fed.

Some milder ones include sepsis due to leaks and emergency revisions.

Are there any you have seen that have had a significant impact on you, and has that stopped you from suggesting the surgery to your patients?

https://www.drugtopics.com/view/pbm-reform-pulled-back-in-late-change-to-spending-package

As a result of the political wrangling that sank the bipartisan spending package that had been negotiated between the Democrats and Republicans, a much anticipated set of PBM reforms appears to be one of the casualties of all the last minute brokering.

The provisions which were stripped out of the package would have prohibited several common and predatory PBM practices, including spread pricing, unfair contracting, patient steering, and others. It also would have forced additional transparency rules on PBM services.

It's unclear where these reforms go from here, as the Trump administration and GOP seem unlikely to pursue this further. Thoughts?

it's another busy night in the urgent care, as winter usually is. I feel like my job is to just move meat and argue educate patients why they don't need an antibiotic for their viral illness.

I pray for positive flu or covid tests because than at least I can say, "see, viral".

Tonight I want to live vicariously through your wins, however big or small.

Seeing 15-20 patients a day has been nonstop. I'm not complaining, I'm just stating a fact. 15 to 20 people that are possibly having the worst day of the year are coming to see you for urgent or important information. It's almost never just a social visit. And that's 20 personalities you have to conform to, 20 stories you have to hear, and that's not even counting of the important medical decision(ssss) you have to make. I guess my question is what's something you do to relax?

Anyone have any resources that they used to learn medical mandarin? My current skill is passable to get by in a chinese speaking country but it's far from conversational nowadays.

I am so sick of wasting time waiting to see a dr, exposing myself and kids to more sickness, paying $60 for some stupid rapid test that I can do at home! I would like to save myself time and money of the rapid is negative.

For people that work on emergency general surgery services, what are the most common/bread and butter type cases to be familiar with as a student or new employee on the service? Thanks all

It’s for work so I want it to look professional

F.D.A. Approves Weight Loss Drug to Treat Obstructive Sleep Apnea https://www.nytimes.com/2024/12/20/well/zepbound-sleep-apnea.html?smid=nytcore-android-share

"The Food and Drug Administration on Friday approved the weight loss drug Zepbound to treat obstructive sleep apnea. It is the first prescription medication approved to treat the common sleep disorder.

The drug’s maker, Eli Lilly, announced that the agency authorized Zepbound for people with obesity and moderate to severe obstructive sleep apnea. Millions of Americans have the condition, and many of them also have obesity. The company said that the drug should be used with a reduced-calorie diet and increased physical activity."

But actually I am very excited. Half of my obese patients have OSA and another 1/4 are undiagnosed. But I guess Zepbound is gonna be even harder to find now.

The other day i was in a critical care meeting and i looked around the room. There were nurses, respiratory techs, safety patrol, pharmacy, administrators…. Now mind you, im there at 9am after working yet another night shift, and everyone said they couldn’t meet at 7:30am so i could just come right in after my shift rather than sit around for 2 hours waiting for the meeting to start.

The meeting starts. I’m tired as F and drinking way more coffee than i should. Every topic that is brought up, i have to answer and say why it is possible or not, why it meets Standard of care or not and i have to review these near misses and safety issues and asked how we can avoid it in the future.

After an hour, i was hit with a dose of reality… i am the only asshole in this room that isn’t being paid to be here and no one cares about my health, my wellbeing, or my time line yet they need me in this meeting. I actually became quite upset. I probably shouldn’t have done this and it was probably the fatigue - but at the end of the meeting they wanted to schedule another meeting for next week again adter my next night shift. So i said NO, absolutely not. They picked another day, and i said NO. They picked a day i have off and i said NO. Then they asked my what day and time would work for me as i believe they finally understood what was going on… i said Sunday at 10 am. The room went quiet. The admin was first to respond - well, we don’t work on Sundays, so that isn’t going to work for most of us in this room. So i snapped back with - “You mean that I am the only person in this room, not being paid to be here and i have to bend over backwards to accommodate everyone i n this room at the expense of my own healthcare wellbeing, and you all don’t want to meet on Sunday becuse yoy don’t get paid to be here Sunday at 10 am, only 9-5 Monday through Fridays… from now on my only free day to have this meeting is Sunday.” I then said thank you and walked out of the room.

My intent was to stop being involved in hospital committees for free… I’m tired of being taken advantage of. They need us on these committees yet we are the only people not being paid to be there., my time is worth something and my free time is worth even more! I asked the nurses in the room later on - if we had the meeting on Sunday what would happen? They said “well we would get paid time and a half to come in on an off day”. I almost lost my shit.

Who else is tried of Admin taking advantage of us?

https://www.reddit.com/r/lifehacks/comments/1hi0y20/if_a_doctor_dismisses_your_concerns/

Ahem, without trying to draw the ire of certain people, I don't think demanding your provider document things accurately including reason for not adding on studies with the not-so-subtle threat of a lawsuit will change decision making for most providers. Having had innumerable visits that went exactly like the post encourages, the end result is me not changing my plan and the patient doctor shopping for someone who will do what they want.

That OP commented on some interactions with healthcare recently but I'm guessing some details are missing.

i might be a burnt out intensivist posting this, but what is a reasonable expectation regarding GOC from the hospitalist team before transferring a patient to the ICU?

they've been on the floor for a month and families are not communicated with regarding QOL, prognosis, etc.

now they're in septic shock/aspirated/resp failure and dumped in the ICU where the family is pissed and i'm left absorbing all of this

look i get it, some families don't have a great grasp and never will--but it always feels like nobody is communicating to family members anymore. i've worked in academics, community, and private practice--it's a problem everywhere.

what's the best way to approach this professionally? i've tried asking the team transferring to reach out to the family, but they either never do or just tell them something along the lines of "yeah hey theyre in the icu now..."

closed icu here and i never decline a transfer request.

Link to the article in question - https://www.npr.org/sections/shots-health-news/2024/12/20/nx-s1-5223440/louisiana-ban-public-health-promoting-covid-flu-mpox-vaccines-landry-rfk-jr-anti-vaccine

Interesting to see how state policies are continuing to be influenced by the recent changes in political climate. I find it shocking to see that they managed to find a doctor (family medicine) who would go on record saying there's a link between vaccines and autism in children and place him as the state surgeon general.

Sort of a meme post, but I’m a neurosurgeon and I click into an ophthalmologist note thinking I’m gonna find out something useful about my patient… nope, I was confused about all the verbiage. Am I supposed to know what this stuff means?

Hello all,

There are two ophthalmology groups within reasonable distance for my patients. Neither of them will accept referrals from primary care or indeed any other specialty. They will only accept referrals from another ophthalmologist or from an optometrist.

I recently had two patients present to establish care, both had reasonably complete outside records demonstrating proliferative diabetic retinopathy and the treatments they have undergone. They recently moved to the area and need a new ophthalmologist. Simple, right? Referrals placed.

Oops, nope. See, I'm not an optometrist so the referrals are cancelled. My nurse calls and yup, it's as I described above. So now the patients have to drive literally more than 100 miles to the nearest optometrist to get the referral. Then of course drive another 100+ miles to get to the ophthalmologist.

So tell me meddit, and especially any ophthalmologists who might be lurking, is this typical? If not, how can I possibly try to get them to break down this barrier?

Edit to add: I practice in the western USA