833 comments posted · 103 followers · following 11

135 weeks ago @ Crasstalk - Push It Along Open Thread · 4 replies · +18 points

There are not that many primary care doctors that can manage to deliver personalized care in a modern "retail medicine" environment.

For those that insist on trying, many burn out -- as one of my co-workers just did about two months ago. She was a very dedicated family medicine doc who I respected a great deal. She knew all her patients in detail, even the most complex ones. Actually, I should say ESPECIALLY the most complex ones. I've inherited about half her patients, and her finely detailed patient narratives are a marvel to behold. Back when I first started, I didn't see how it was possible for her to keep up with everything, and in the end it seems she couldn't -- by the time she departed, it was common for her to be 1-2 hours behind schedule by the end of the day, every day.

Now, the highly efficient docs in the group? The ones who never catch grief from impatient parents in the waiting room, or from the administration wanting the late paperwork completed yesterday? Most of them produce the most disorganized pieces of crap, relying on the EMR to produce a perfectly bill-able but completely gibberish mess of auto-generated text, created from check-boxes and drop-downs. I've too often seen patient records where anything not auto-generated was simply strings of the same note cut-and-pasted with barely anything updated. Patient walks in, they do a quick exam based entirely on pattern-recognition, then slap the patient into a template.

Your best bet for an medical experience with a personal touch? Well, there are "Concierge Medicine" doctors, who will give that sort of treatment, at a high price. To find someone who takes ordinary insurance though, you'll have to do a lot of searching to find someone not too ambitious, not too well advertised, practicing in some niche that's sheltered enough to allow that un-optimized style to survive.

And oh yes, I turned in my 90-day resignation notice already as well. I'm quitting too.

140 weeks ago @ Crasstalk - Winter Weekend Open Th... · 2 replies · +36 points

Shit. I was giving a patient a referral to a urologist and didn't quite manage to suppress a giggle when I said "Dr. Whang".

143 weeks ago @ Crasstalk - Baby Name Battle Royal... · 0 replies · +2 points

What happens if the final is Clara vs. Clara?
This outcome is reserved for the "secret hidden evil twin sister" scenario.

154 weeks ago @ Crasstalk - Chug Along Open Thread · 1 reply · +24 points

Just reminding everyone, we are ALL gonne die.
I am soooo ahead of you guys, I've been dead inside for years. Dead before it was popular.

Hipster Dead.

161 weeks ago @ Crasstalk - Weekend Open Thread · 0 replies · +4 points

I just open the door. I am not a risk taker in any way -- I just have relatively little instinct for self preservation.

162 weeks ago @ Crasstalk - Humpty Open Thread · 1 reply · +3 points

Oh good. Ciprodex is actually better than Cortisporin for a couple of reasons -- most significantly because of better safety profile in event of a perforated eardrum; also more convenient dosing schedule. It just happens to cost a whole lot more because it is brand-name only, so some insurances don't cover it.

Did you get a copy of the manufacturer's copay assistance card for some savings? Note that some insurances are not compatible with copay assistance cards, most significantly Medicare and Medicaid. https://www.ciprodex.com/patients/ciprodex-otic-e...

162 weeks ago @ Crasstalk - Humpty Open Thread · 4 replies · +3 points

Uh, did I just say Polysporin-HC earlier? Sorry, I meant Cortisporin (Neomycin-Polymyxin B-Hydrocortisone).

162 weeks ago @ Crasstalk - Humpty Open Thread · 4 replies · +5 points

This is the version with hydrocortisone? Also, if your ear canals are swollen to the point where they are shit closed, you'll need ear wicks put in.

162 weeks ago @ Crasstalk - Humpty Open Thread · 1 reply · +11 points

I had a professor who did some clinical and epidemiological work on asbestos.

He used to tell this story about one part of his research, how they quantified the asbestos fiber load in a deceased patient. During the autopsy, they'd remove the lungs and cremate them. Afterwards they'd sift through the ashes and recover a perfectly intact little pile of asbestos fibers, from some guy who might have worked in a shipyard or such, several decades ago.

162 weeks ago @ Crasstalk - Humpty Open Thread · 13 replies · +9 points

If you ever feel one coming on, a 50/50 combo of vinegar and rubbing alcohol works great. A couple drops in each ear after you swim really helps.
And much cheaper than the commercially prepared "Swimmer's Eardrops". But would not recommend using until after the current infection is resolved and ear canals are healed up, as the mix will probably be too irritating right now.

Also, with regards to antibiotic/corticosteroid combination eardrops, Polysporin-HC is usually much cheaper than Ciprodex.