Non-Traditional Family Structures

So we as family physicians see all sorts of interesting family structures. Some memorable ones:

  • Guy gets his girlfriend pregnant, then marries her mom before the kid is born. Makes him father AND grandfather.
  • Kid being raised by his aunt, but he been told she's his biological mom, even though biological mom lives nearby. Mom is aunt, and aunt is mom. I was told it's a family secret. "Don't put it in the medical records."
  • Long-time married patient couple of mine get an acrimonious divorce. I see them separately for a while, hearing both sides of the battle. I even start treating guy's 2nd wife. Until they bump into each other in the waiting room. They both fire me for treating the enemy.

I am not making light of these situations. They are just so different from my own upbringing that I feel like I was born on another planet sometimes.

Any other interesting non-nuclear family structures you can share?

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▲ 316 r/medicine

The ERs that can turn patients away — and are reaping millions

This is a great piece of investigative journalism:

The ERs that can turn patients away — and are reaping millions

Or, here's the short version of how to get rich in scamming people in healthcare:

  1. Open a free-standing ER that doesn't take Medicare or Medicaid
  2. Pretend you're really an urgent care
  3. Claim to take a patient's insurance (in print, even) though you don't
  4. When someone wants a Covid test via the drive-thru, do it and send a bill later for $4,000 or more. It's an ER, right?

Here's an excerpt:

>The first thing Tim Roe asked when he walked into Post Falls ER & Hospital in Post Falls, Idaho in 2024 was whether the hospital was in-network with his health insurer, UnitedHealthcare. The receptionist said yes, so he stayed, he recalled. 

>A mechanic, he’d been grinding metal at work, and a piece of debris landed in one of his eyes. After filling out the necessary paperwork, he was taken to an exam room, where a doctor placed drops in his eye and shined a flashlight. The doctor said there was nothing in there, and Roe left. He guessed he was at the hospital for 15 minutes. 

>Not long after, the bills came in totaling roughly $6,000, of which Roe was on the hook for about half. It turns out, the hospital did not have a contract with his health insurance. 

If you are interested in the full thing it's behind a paywall. There's an archive.ph version, though...

u/Apprehensive-Safe382 — 6 days ago

Fix&Go: One of these is for the compressor to put out air. The other is for sealant. Choose wrong it will cost you $45.

Not a fan on the Fix&Go in my 2025 Sport-L. The first time I needed it six months in, it didn't work. Defective. Honda placed it free of charge. Second time, I had wrong setting, pumped out sealant instead of air, given the two choices above on the side of a busy highwwy. Once the latex is in the tube, it seals. Nowhere to buy the sealant, except Honda.

Point is: test your Fix&Go pump, and be familiar how to use it before a crisis.

u/Apprehensive-Safe382 — 28 days ago
▲ 308 r/medicine

FDA is okay allowing BP-measuring rings for "wellness", not for medical purposes

From StatNews, sorry it's STAT+ so is partially pay walled:

Blood pressure tech floods the market after FDA relaxes wearables oversight

>One thing FDA clarified in the updated guidance is that companies can release products that use sensors to “estimate, infer, or output” blood pressure and blood glucose readings without approval, if they are intended for wellness purposes. In a speech at the Consumer Electronics Show the day the guidance was announced, the FDA commissioner at the time, Marty Makary, said his agency would “get out of the way” of products that weren’t making medical or clinical claims. “This reduces the amount of subjectivity by regulators and guesswork by developers,” he said.

So, according to the FDA, there is this concept called "wellness", which apparently means ... for entertainment purposes only?

I've already had people coming to my office concerned about the blood pressure readings from their Oura rings. As an ex-engineer, I can't imagine how one can get BP from a rigid band around a finger. Not to mention that even if technically possible, a device on the finger is prone to user error. If one decreases elevation of the finger by 13.6cm (5.25"), SBP goes up 10 mmHg due to hydrostatic pressure changes alone.

Just want you all to be prepared for people coming in with the "wellness but not intended for medical use" BP readings.

u/Apprehensive-Safe382 — 1 month ago

Podcast about how drugs are named

Apparently 75% of drug names are from one marketing company. Interesting bits of pharmacology lore. Here's an example: AMBIEN. AM = "morning". BIEN = "good" (well, kinda). So Ambien means "good in the morning." Too cute.

From the 99% Invisible podcast.

99percentinvisible.org
u/Apprehensive-Safe382 — 2 months ago
▲ 204 r/pharmacy

I've accumulated a few Epic SmartPhrases (little text snippets) that I put into prescription "comments" to reduce what are otherwise inevitable calls from y'all:

  • Cephalexin - "I am aware of PCN allergy"
  • Spironolactone - "I am aware of interaction with ARB/ACE-I, recent potassium was 3.4"
  • Levothyroxine - "OK to use any manufacturer"
  • Albuterol - "can use name brand or generic for ProAir, Ventolin or Proventil"
  • All - "Pt does not need right now. He/she will contact you if and when wants prescription"

I'm still flummoxed by my state's Medicaid, which sometimes prefers name brands. Wondering if there are any more you think I should start using?

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u/Apprehensive-Safe382 — 2 months ago
▲ 893 r/medicine

RFK's denial of germ theory is nothing new to most of us. Mainstream media's apparent disinterest in the fact that RFK's science is taken from the 19th century is probably due to the fact that he is deliberately coy about it.

It appears that only Beth Mole (a reporter with a PhD in microbiology) decided to write about RFK Jr.’s rejection of germ theory debunked in Senate hearing. Well worth a read, but here are some highlights:

>"Kennedy wrote about his germ theory denialism explicitly in his 2021 book The Real Anthony Fauci. In it, Kennedy maligns germ theory as a tool of pharmaceutical companies, scientists, and doctors to promote the use of modern medicines. Instead of accepting germ theory, Kennedy promotes a concept akin to the discarded terrain theory, in which diseases stem not from germs, but from imbalances in the body’s inner 'terrain.' ... As Kennedy describes in his book, his preferred theory 'emphasizes preventing disease by fortifying the immune system through nutrition and by reducing exposures to environmental toxins and stresses,'—not using vaccines or advanced medicines to fight off specific pathogens as suggested by germ theory."

A quote from his book: "A doctrinal canon of the germ theory credits vaccines for the dramatic declines of infectious disease mortalities in North America and Europe during the twentieth century. … Most Americans accept this claim as dogma. It will therefore come as a surprise to learn that it is simply untrue."

The interesting part is when the Senators called out this BS:

>[Sen. Bernie] Sanders pointed out a 2024 study led by the World Health Organization and published in The Lancet that found that since 1974, vaccines had saved an estimated 154 million lives, including 146 million children under the age of 5—or, as WHO put it, vaccines saved the equivalent of six lives every minute of every year over the past 50 years.

>“My question is a simple one,” Sanders said, “do you still believe that one of the central tenets of the germ theory, that vaccines sharply reduce infant mortality, is quote-unquote simply untrue?”

>Kennedy responded first by trying to discredit the WHO study, noting that it was based on modeling. Using a common tactic of anti-vaccine advocates, he instead redirected to one of his preferred, cherry-picked studies, which was a 2000 study in the journal Pediatrics with lead author Bernard Guyer. The study, “Annual Summary of Vital Statistics: Trends in the Health of Americans During the 20th Century,” also included estimates and algorithms in its analysis.

But, as [Sen. Bill] Cassidy noted during the hearing, it’s not all that the study found. Cassidy looked up the studies Kennedy raised and read through them during the hearing. The Guyer study highlighted that vaccination did not become widely used until after the middle of the century, thus it cannot account for mortality declines prior to that. But it concluded, as Cassidy read out loud at the hearing:

>The reductions in vaccine-preventable diseases, however, are impressive. In the early 1920s, diphtheria accounted for about 175,000 cases annually and pertussis for nearly 150,000 cases; measles accounted for about half a million annual cases before the introduction of vaccine in the 1960s. Deaths from these diseases have been virtually eliminated, as have deaths from Haemophilus influenzae, tetanus, and poliomyelitis.

RFK. Cherry-picking from cherry-picked studies. If you're interested in a deep dive on RFK's shenanigans, the blog Respectful Insolence has been documenting it for over 20 years.

u/Apprehensive-Safe382 — 2 months ago