u/askimbebe

I unfortunately saw an advertisement for this company on Instagram, and it was one of their creators (Manoj Arachige, MD) ranking different types of lab tests. I can’t find the advertisement anymore, but basically he ranked lipid panel as low tier and hormone testing as high tier. His reasoning for ranking hormone testing high was because they weren’t being tested enough. Massive eye roll.

I really hate when medical doctors leave clinical medicine and create a startup and decide their advertisement tactic is to start seeding doubt into the general population’s brain about the legitimacy of evidence based medicine and community doctors, so that THEY can make money. Like bro, do you not remember where you came from? It’s this type of propaganda that patients see very readily, which bleeds into our workday and seeds more and more distrust.

Check these reels out if you wanna get irked today:

https://www.instagram.com/reel/DSpv9l8CmjP/

https://www.instagram.com/reel/DSc3tW9iPt3/

https://www.instagram.com/reel/DSXt460FXdp/

“Follow up with PCP” - said and accepted by all specialties.

BUT GOD FORBID a PCP ask a patient if they can follow up directly with their specialist who started the medication on them regarding specifics on how to wean off the medication (that again, PCP didn’t play any role in)… yeah, I’ll probably get a negative review for that one. Ha!

The only thing getting me through this time period of building my panel is reminding myself that I need to draw those boundaries now so that those who mesh well with me can stay and those that don’t like it can leave. Please, please leave.

I’m reduced FTE but I still need to log on on my days off. Why? It’s Monday, I open up my computer and I have 40-50 inbox tasks to complete. Some of these are non-urgent results from last week that I just didn’t have time to get to (since almost every minute of our day is booked with seeing patients…) or I was still waiting for all of them to return back.

I’m also still building my panel so half of my patients are new patients so a lot of these are labs to go through… I’m trying to start ordering labs beforehand for my known patients, to create less work on the back end.

We do have a team of MA’s & nurses who filter out the messages, too.

I just don’t understand how I’d be able to clear this out without working on my days off! Otherwise it’s going to sit there and my days working will be an absolute shitstorm. What am I missing here?

Would love to hear if, how, and when you prescribe HRT for osteoporosis prevention. I prescribe it for bothersome menopausal symptoms, but I was never taught in residency to do it for the purpose of preventing osteoporosis, despite it being one of FDA approved indications.

Do you discuss it only to patients who bring it up/ want it? Or do you initiate the conversation when someone is in menopause? How do you determine which patients should be offered it (how do you stratify their bone risk? FRAX score?)

Up to date says “Nevertheless, most experts no longer recommend estrogen as first-line therapy for prevention of osteoporosis, given the results of the WHI.” But I get the sense the pendulum is swinging the opposite direction now

I have a bunch of new patients on my panel who are transferring care from another local healthcare system

For one of them, I didn’t realize he was due for a follow up CT on a prior lung nodule until another specialist had recommended it. He doesn’t meet smoking criteria, but had gotten imaging based on previous abnormal imaging for something else…

He has multiple other chronic medical conditions which I was managing, which took up our previous visit times, so I didn’t realize it.

Now that makes me concerned for all the other things I’ve missed.

When you guys chart review for these new patients, how deeply you dive? Could use a little help here as I feel like I’m drowning already