Paging Dr. Agon

[ashleymd7]

You may not become the best doctor in the world, or this country, this state or city. Hell, you may not even be the best doctor on your street, at your hospital or clinic, or the best doctor on a hospital floor or in a room at a given time. But when a patient comes to you, scared the headaches, the chest pains, whatever they’ve been having for months might be something worse, at that moment, YOU are their best chance for survival. You are that patient’s best hope, and proving yourself worthy of that responsibility is the only title you should ever care about winning.

A practicing physician for 40 years, and one who still hasn’t lost sight of what truly matters in this profession: the patients. (via ashleymd7)

[aspiringdoctors-blog]

Basics for the Wards: How to Read Musculoskeletal xrays

I’m on my radiology rotation right now. At the end is a test. The radiologist said it’s not important that we nail the diagnosis, because we are family medicine residents not radiologists. What he is looking for is an accurate and thorough search pattern so that in the future when we view films we won’t miss anything, even if we don’t know exactly what it is.

So, in keeping with my ABCDE search pattern from chest Xrays, I have the ABCDE of reading musculoskeletal xrays.

Keep reading

[cranquis]

WOOOO! A Sequel!!!

[dragonmd]

Med school exams be like

Question: a patient presents with [very specific set of stereotypical symptoms] ...

Me: YES I KNOW THIS ONE I'M SO GLAD I STUDIED IT

Question: ... and is diagnosed with [syndrome]

Me: oh no

Question: given the likely treatment, what entree should they avoid during their birthday meal ten years from now?

Me: ...

[geekhyena]

Sleep Apnea Not Related to Weight - Scientist Admits to Falsifying Data

http://www.the-scientist.com/?articles.view/articleNo/27316/title/Harvard-prof-falsified-sleep-data/

And yet, how much do you want to bet that people will continue to blame sleep apnea on weight issues, despite the actual data showing the causal relationship is incorrect? (if anything, sleep issues -> weight gain, which we’ve known for years) This is why falsified data is harmful: how many apnea patients were told ‘oh just lose weight’ instead of getting proper treatment?

[mad-dyspunktional]

Science? Falsifying evidence of weight related disease? Shocking.

[quousque]

“oh, it’s probably not sleep apnea, you’re not overweight”

well actually, if you look at your fancy weight standards chart, I am overweight, but since your fancy weight charts are actually just pulled out of someone’s ass and I don’t look like your image of “overweight”, clearly I can’t have sleep apnea. Clearly.

[jabberwockypie]

See, I was/am overweight.  I tried for nearly a year and couldn’t keep the CPAP mask on - either version - overnight - because my nose was too congested and I couldn’t really BREATHE through my nose.

I also had a deviated septum.

The sleep apnea MAGICALLY VANISHED when the deviated septum was repaired with surgery.  Which took almost two years for anybody to investigate EVEN THOUGH you could tell my septum was crooked just by looking in a mirror or sticking a finger up my nose.

Still overweight!  No sleep apnea!

[md-to-md]

Medblr Question: Patient Histories

I just started my first year of Medical School and we are learning how to take patient histories. I noticed that doctors tend to have certain lines or go-to phrases they say when they address different issues in the conversation, so I’m wondering if medblrs can reblog this and add some of the things they like to say when taking a history.

(Nurblr responses are welcome too, as are signal boosts, thanks! 😊)

[slowdownsimplybemd]

I just learned this too!! Would love to hear about other medblrs tips and tricks!! Any advice @wayfaringmd @pedsblr @surrealmeds @cranquis @imaresident @md-admissions @mymedlife and any other medblrs out there?!

[cranquis]

When suspecting prostatitis as a cause for symptoms, I don’t jump to asking questions about erectile dysfunction, loss of libido, and urinary obstructive symptoms right away. First, I ask the guy if he knows what his prostate is, and then I give a brief description of the prostate: “It’s basically a racquetball wrapped around the pee-tube coming out from your bladder, and it’s also next-door neighbors with your rectum. If it’s enlarged or sick, it can block your urine flow, and it can jack up your sex function. So that’s why I’m going to ask you these questions.”

THEN, when they start pinging lots of +’s on the prostate symptoms (and, I suspect, answering them more honestly because they know what I’m getting at), I add this: “Well, sure sounds like your prostate could be the cause of your X symptoms, doesn’t it? So now, we need to feel it and see if it’s swollen or tender. Now that you’re an expert on prostates, can you guess how we examine it?”

Believe it or not, my male patients seem to be overall less embarrassed and apprehensive about digital rectal exams if THEY are the first one in the room to say “finger in the butthole”… because by that point, they understand WHY it’s important to do this. 

[wayfaringmd]

Never ask “are you missing any doses,” but rather “how often do you miss a dose?” Nobody is perfect. Let’s acknowledge that so your patient doesn’t feel like they have to lie.

When you run out of questions or blank out, always feel free to ask “is there anything else you think I should know that I haven’t asked?” It will give you a few more seconds to think.

In regards to pain complaints, always ask “what were you doing when it started?” It may be useless, but you’d be surprised how often you see people for neck pain who have no clue what caused it and when you ask that question they say “painting my ceiling”.

I usually start my preventive care visits with “I’m going to ask you a bunch of nosy personal questions today so I can figure out what sort of diseases you might be at risk for. If at any time you think I’ve gone too far, please tell me, or if you have a question why I would ask about XYZ, please ask.”

When asking about anxiety, I usually ask people how they feel physically when they’re really anxious. I will explain that my heart beats extra hard and fast when I’m anxious, whereas some people get an upset stomach or shortness of breath. Often that helps zoom in on some somatic issues.

If a person has a series of vague complaints or they come in for fatigue, always always ask about sleep habits. Patients will roll their eyes and say they sleep fine and then admit they sleep 4 hours a night because they keep checking Facebook all night.

If you’re asking about a distance, like how far a person can walk before they have to stop and rest, try using relative terms like “from this room to the front desk” or “across the Walmart parking lot” rather than accurate distances like 100 yards or a half mile. Folks often don’t have much perspective on how far 100 feet is.

Also: I second Cranquis’ use of basic, easy to understand terms like “pee tube” and “jack up your sex function”. You and the patient will both know what you mean. However, when a patient uses vague terms like “my down-there” areas or “my privates,” make sure you can get them to be more specific. For example, if a woman complains of pelvic pain, specify is it deep in the abdomen like menstrual cramps, on the skin outside the vagina like a rash, inside the vagina like a yeast infection, etc.

That’s alls I can think of right now.

[drdessertfox]

My addition is related to asking about mental health. My program (stupidly) focuses on not using the words “mental health” or “psychiatrist” when asking about history of depression, anxiety, bipolar disorder, etc. because of the “stigma” associated with having to see a mental health professional. I find this extremely ironic because their approach to lessening the stigma associated with mental healthcare is by trying to tiptoe around it by asking questions like “Have you ever seen anyone for in the past for any sort of anxiety or depression?”

The problem with asking about a mental health history in this manner is that it leaves out a multitude of other reasons someone may have seen a therapist, psychiatrist, or counselor. All aspects of mental health are extremely important, and by focusing on only two diagnoses (anxiety and depression) I feel that leaves out a lot of other conditions my patient might have, ranging from schizophrenia to arousal disorders. 

So, what I usually ask is, “At any point in your life have you seen a mental health professional or counselor for any reason?”

And it shouldn’t be uncomfortable. Not for you. Not for the patient. I have never once had a patient get offended by me asking about their mental health history. I hate this idea that we can’t say “mental health” because of the stigma associated with the phrase “mental health.” We won’t get rid of a stigma by avoiding the phrase entirely. If anything it just worsens it. 

[cranquis]

This thread keeps getting better and better. Check out the entry by @md-admissions in a separate reblog too. 

[whitecoat-bluegown]

This is fantastic! I’ll add some peds stuff because that’s what I’m on right now:
–if your patient is old enough to talk, ask them who they brought with them. Like, point at the adult in the room and say “who is that?” It gives you a ton of insight into their social situation without having to ask awkward questions–for example, the person you may have assumed was mom is actually auntie and now you have a perfect opening to casually ask where mom is. It’s also fantastic because kids will always say things like “that’s Dad,” and you also call the father ‘Dad,’ which is a cheap but effective way to get a laugh out of a school age kids.
–when you’re asking about developmental history, especially in the inpatient/urgent care/ER seeing, ask if anyone has ever been concerned about the child’s growth or development. It’s a quick way to assess for any major issues, then you can go through age-appropriate screening as needed. A surprisingly high number of people have told me that, yeah, little Johnny did need speech therapy for a year now that you think about it. 
–Social history in teens is super awkward, always. I start the conversation by asking about what their friends are doing–kids are much more likely to admit that their friends are drinking than tell you about their own drinking habits. It also gives you a great judgement-free avenue for education–you can talk about stupid things their friends have done while drinking and how to avoid them while still reinforcing to the teen that drinking can be dangerous.

[intrainingdoc]

This is beautiful. Keep on keeping on!

[wheresonichedgehogwnt]

Note to self: If, when I am a Senior or maybe even a more Junior Faculty Member (perhaps a Fellow, I can’t see myself going into academia again), I suspect morale is low and the Interns or Med Students or The Team In General needs to discuss feelings, the most effective way to do this is to find a quiet morning and say “Hey, I haven’t eaten breakfast, and I bet no one else has, either, and I know I could use a little more coffee. Let’s go to the doctor’s lounge and get some free food and coffee before rounds!”   And as everyone lingers there because they are reluctant to get to work because morale is low, jokingly say, “You know, it occurs to me we could sit down and look each other in the eye and talk about stuff as we eat.  I’m told this is a ritual that Humanity finds valuable, and I guess we’re part of Humanity, and I feel like procrastinating for a few more minutes, so how about we give it a go?” And as everyone laughs and gets settled, pick something to bitch about. It doesn’t have to be a big thing. It can be how there’s never any chocolate milk cartons in the refrigerator on weekends. It just has to let people know that you sometimes have not-totally-positive-feelings toward things and are okay with the expression of not-totally-positive feelings. And wow, do the floodgates ever open, and there is a good 20 minutes of venting and feelings discussion and validating the everloving hell out of each other before the pager goes off and everyone disperses to rounds feeling much better about things. And no one knows that you do this on purpose unless they’ve seen it twice before.

[cranquis]

This needs to become a medblr thing – a vow that every medblr will use this tactic when we reach that level of seniority… that we will subtly gift a rare moment of sanity to the residents and interns and students.

[aspiringdoctors-blog]

Yup. Added to goals.

[modernathenamd]

I’m in.

[drdessertfox]

Sometimes I get the enzymes in the steroid genesis pathway switched around, but this is a super simple way to remember the enzyme deficiencies and the related outcomes!

[the-pen-and-the-stethoscope]

This has saved my life on multiple occasions in the last three days…

[apparentlyeverything]

Single payer sounds fantastic but it would be devastating to the US economy in the short and long term and I really can't get behind something like that. That said, what do you think about a public option for people 55 and up? I get hives thinking about what Joe Lieberman did to the ACA in 2009 and truly believe that would be a great way to lower insurance costs. You seem more in touch with this sort of policy so I'm interested in your thoughts on it. Hope you have a great day!

Well, I actually do support single payer for everyone and I disagree that it would be devastating to the economy. While the short term costs would be significant, the long-term savings would be substantial, and frankly, we need it. The US spends more on health care (and when we say that, we’re mostly talking about the people who are paying health insurance companies, so individuals or businesses) than any other country and yet we lag in life expectancy and most measures of health. This is in part because private insurance companies act as gatekeepers to care, and because the insurance system itself provides incentives for providers to overcharge. When you know you’re only going to collect a small percentage from an insurance company, you charge as much as possible. I don’t know if it’s true nationally, but in the state I’m in you can’t change the price of service depending on the method of payment; i.e. you can’t have one price for an insured patient and another price for an uninsured one (though some providers will get around this in a variety of ways). Not to mention that dealing with insurance companies requires providers to spend a great deal on administrative costs. 

But single payer is just an overall better system. I spent a year studying and working in a country with a single payer system and it is far more efficient and equitable. You don’t have people clogging up ERs or trying to do fundraisers for their chemotherapy. People don’t die of easily preventable diseases because they lack the means to pay for treatment. I was glad that the ACA passed because it did expand coverage, but private insurance companies have no other motive than profit, and that is fundamentally incompatible with something as critical as health care. 

As for lowering the age for medicare to 55, which is what a public option for this age range would essentially mean, I guess it might be a decent interim solution on the way to single payer. Honestly, though, by age 55 most people have already developed a number of chronic health issues, often caused by inconsistent preventive medical care. Better public/preventative health is another advantage of single payer, so many of the health issues that we’ve come to associate with later middle age are less acute in a system where people have better access to medical care at all ages.   

The biggest impediment to single payer is political, not economic. There’s a powerful and very wealthy group of interests that benefit from the current system, and they have been blocking meaningful reform for decades. The leftists who cry about Democrats not passing single payer have been willfully ignoring that fact. 

[dragonmd]

LOUDER FOR THE PEOPLE IN THE BACK

[trufemale420]

The medical community on literally every female specific health issue ever: “very common condition” “no known cause” “no known cure” :))))))

[newtonssidedick]

What the fuck is tumblr? Like honestly what is this? Do you guys pull shit out of the inner most depths of your rectum and then just throw it on your keyboard and have it turn into a post???? This site is something else what the fuck is wrong with you people????!?!?

[trufemale420]

Endemetriosis

Vaginal Thrush

Menorrhagia

Polycystic Ovary Syndrome

Fibroids

Very common conditions, causes are unknown or only speculated, long term cures have not been found. Most can cause chronic pain or discomfort, all can seriously impact your quality of life.

[witwitch-deactivated20160508]

Men are so damn privileged they can’t even imagine female bodies have different healthcare needs than theirs and that our healthcare needs are important even if they can’t be affected by one of these conditions.

[hyggehaven-deactivated20200904]

Endometriosis causes excruciating pain and is a leading cause of infertility. Thrush is extremely uncomfortable, and expensive to treat repeatedly; over-the-counter preparations rarely completely eradicate it. Menorrhagia, which I have, makes you anæmic. PCOS causes hormonal symptoms that are socially difficult (facial hair, acne, hair loss, weight gain). Fibroids are so common, and are often treated with a hysterectomy.

Add in fibromylgia, which affects 8x as many women as men, as well as lupus (and almost any other autoimmune condition), systemic exertion intolerance disorder (SEID), iron deficiency anæmia (all of which affect more women than men), and you have well over 25% of childbearing-age women globally living with chronic pain and tiredness.

Chronic pain is overwhelmingly experienced by women, and women are less likely to be taken seriously or given treatment by medical professionals. I went through two years of diagnostics to finally find out I had occipital neuralgia; I felt doubted when I described my pain at every step of the way, but was lucky to have a partner who was persistent in helping me get treatment.

Basically, this is a huge problem, and also one of the reasons I have been considering medical school.

[feminerds]

Don’t forget that most pharmaceuticals go to market without ever having been tested on people with a uterus, lest someone get pregnant… seriously that is the whole rationale behind not testing >50% of the population. This has been legislated against in some countries, but still persists in the of majority drug development because of other regulations, and traditions and laziness. The use of a drug is of course monitored in the population after release, but the people “trying” it in this capacity get none of the insurance, close and regular medical examination or monetary benefit of essentially being in a late stage drug trial. Drugs that are pulled from market after release are sometimes done so on the basis that the dosage is just too high for females/afab people and this is, of course, after they’ve experienced the adverse affects. 

This is why if you get pregnant your doctor will take you off basically any and all medication you’re taking (including mental health medication, can’t imagine any implications/dire consequences there), not because they know it will have an adverse affect on the foetus but because they have no idea. How wonderfully kind of them to prioritise the health and life of an unborn foetus over that of a living person, let’s just hope they don’t become ill whilst pregnant. How charmingly logical it is that they wouldn’t even bother to test drugs in people with a uterus because it’s all too difficult and gosh, darn what an ethical conundrum we’ve been faced with, let’s just not! Which is so in the spirit of capital S, Science!  

Sources: Nature, Nature, Medscape, Biomedcentral.

[prokopetz]

Indeed, the issue is so severe that, in many cases, folks with uteruses are routinely told that their diseases and disorders are not, in fact, disorders at all, and are just a normal part of having a uterus.

Take menstrual cramps, for example. Everybody knows that cramps are a normal part of menstruation, and that virtually all people who menstruate experience them throughout their lives, right?

Except that’s not right at all.

Yes, it’s true that about two-thirds of individuals who menstruate begin to experience menstrual pain during adolescence, but it’s basically a side effect of puberty, and normally subsides by your late teens. Only about 20-40% of menstruating adults experience menstrual pain on a regular basis - and according to some estimates, as much as 80% of that figure is due to undiagnosed endometriosis or some other underlying medical condition.

Yeah, roll those numbers around in your head: if you’re an adult who experiences menstrual cramps, it’s overwhelmingly likely that your pain is a symptom of some potentially serious medical condition.

And yet we tell folks it’s just a normal thing that everybody has to deal with.

[dottewa-deactivated20200728]

Bonus round: Look up PCOS and gender identity.

Then look up PCOS and diabetes.

[thepageofhopes]

Ok, to show how incredibly important this post fucking is, I just looked up endometriosis and I match just about every sympton, and it would explain not just my incredibly painful periods but many other things as well. I had no idea this existed. Please, read this post and reblog this so others can learn.

[philosopher--queens]

I will reblog this every time because my cousin (a cis girl) went through seven years of pain without being taken seriously until SHE suggested it was endometriosis. And that’s not even unusual - that’s the average amount of time it takes between first symptoms and a diagnosis of endometriosis.

[vulpemarshmallow]

Migraines also occur far more frequently in people with uteruses, and are still very poorly understood. My neurologist admitted that there’s still no real answer to what causes them. 

[wayfaringmd]

An All-Inclusive Guide to Making Your First Year in Practice Not Suck As Much As Wayfaring’s

Hi there, just curious if you’d share what things you were looking for in your first job vs what things you value now, now that you’ve been working out there on your own. Anything that must be in the contract that wasn’t there before (or vice versa)? Tips for future graduating residents?

Yaaaaasssss so many advices. So many things. This ask has been in my inbox for months because I have too many things to say about it and I can’t seem to organize it properly. 

Let’s break it down into 3 sections: 1) What I thought I wanted 2) What I needed and didn’t know to ask/look for 3) What I want now. Here goes.

What I thought I wanted:

big dolla$$$

super sweet signing bonus

moving allowance

loan repayment assistance

regular 40 hour work schedule

nice patients

independence / autonomy in decisionmaking

ability to practice the way I was trained - with up to date guidelines and procedures and equipment

What I wanted and didn’t know to ask for:

Supportive colleagues - In your first year of practice out of residency you lose every ounce of confidence that you gained as a senior resident. You question minor decisions and are constantly afraid of killing people or being sued. It is extra hard to practice in a new town when your partners in practice are not supportive. Sometimes you need someone to lay a fresh set of eyes on a wonky EKG or a weird rash, you know? I didn’t have that option. It made me study harder and somewhat be more cautious and definitely more creative in my practice. But having a colleague to commiserate with at the end of the day or to consult on difficult cases would have been really nice. You don’t have to be BFFs with your colleagues, but they have to be people you can agree/get along with and trust to take care of your patients in your absence.

Friends - This sounds obvious, but I moved to a new town that literally has no people anywhere close to my age. Even having one person I knew and could confide in would have been wonderful. One person to go to a movie with or watch a football game with would have been a sanity saver for me. Find a place where you can find other people like you. 

A reasonable amount of time off - I got less time off in my first job than I did as a resident. That was unacceptable to me. This would be fine if my practice didn’t act like they were going to go bankrupt if I took an unpaid day or even a half day to go to the doctor, but they did. You need a place where you can take one week off every 3-4 months if possible, even if all that time isn’t paid. Medicine is such a stressful job. Make sure they’re giving you rest time.

A non-toxic work environment - I knew going into my job that I was replacing a workaholic and that I was joining a workaholic. What I didn’t realize was that I was also expected to be a workaholic and anything less than killing myself was seen as laziness. Pay attention to the culture at your new job. Ask the docs what they do for fun or to relax and more importantly when the last time was they did that thing. If they don’t have any answers, they’re too busy. 

Diversity. This may just be me, but I went into family medicine because I get bored easily. I need variety of patient types and disease types and socioeconomic groups and everything else. I realized quickly in my practice that most of my patients were privately insured elderly white people. As in, the most boring demographic for Wayfaring. 

A Balanced schedule. I figured that when I joined a practice that had been established for 30 years that the workflow kinks would have been worked out and it would run like a well oiled machine. In reality I would have 8 physicals a day and 5 of my most complicated patients in hospital follow ups back to back, all scheduled for just 15 minutes. There has to be balance in the schedule. You have to be able to take a little extra time here and make it up elsewhere. 

What I want now: 

fair dolla$$$. In actuality, what’s fair is actually considerably more than what I was making in my first job. I was grossly underpaid, particularly considering this being a rural area where nobody wants to work (typically those jobs are paid much higher). It’s not about the bottom dollar value for me. It’s about compensating me in a way that is comparable to my peers. 

Colleagues who can be both friends and mentors. See above. 

Good benefits. Two years of no dental or vision sucks when your most expensive problems are dental and vision related. Life insurance and retirement plans aren’t something most 30 year olds think of, but they’re really important, and I didn’t have those to start with. 

A flexible schedule. The whole world doesn’t need to fall apart if I need to switch my regular day off or if I need a half day to go to the doctor. 

Administrative time. Preferably a full week day, but a half day is great too. I’m happy working 4 10 or 12 hour days a week to have one week day off to catch up on work I’m behind on or get my hair cut and get my taxes done and see my psychiatrist, you know?

Knowledgeable and helpful staff. I need staff who don’t perpetuate old wives’ tales and notions like “you need a zpack for that cold”. I need to work with people who will ask if they don’t understand something rather than just make something up and who can help me educate my patients. I need folks who are prompt and who can anticipate some needs. 

To not be responsible for other peoples’ paychecks. In private practice, if I take time off or scale back, the practice loses money and thus our staff lose hours or money too. The staff in my first job were horribly underpaid and I don’t like the idea of the entire burden of the practice’s finances hanging on my shoulders. Sign me up for that hospital-owned practice, please.

To not have to turn patients away based on payer source. This is a national problem and is definitely not limited to my first job. But my first job wouldn’t let me take Medicaid patients at all. It made it completely impossible for me to build any sort of pediatric or OB practice in our town. I don’t like the idea of turning away a patient because their type of insurance doesn’t pay as well. I want to just treat patients and not have to worry about their payments. Hello, single payer healthcare system. Get on it! Obviously I will still have to worry about whether my patient can afford their meds or whether their insurance will cover their meds, but I won’t have to pick and choose what patients I accept based on their payer source. 

To deliver quality, up to date care. To work with people who will back up my evidence-based decisions and not practice based on feelings and patient satisfaction. To work with people who will encourage me to learn more and do new things. 

There you have it folks. A lil summary of what I want, what you might want, and what I’ve learned in these first (almost) 2 years of practice. Here’s to better future jobs for us all!

[doctorkintsugi]

Reblogging for future review…thanks!

[cranquis]

Probably one of the most important #medblr posts you can read while still in med school/residency. Thank you, @wayfaringmd for allowing your suffering to result in potentially-greater job satisfaction for the rest of us.

However: NO thank you, @wayfaringmd, for getting this ear worm of a song stuck in my head.

[15-blade]

Medical residents don’t need ice cream and wellness weeks to survive grueling schedules and the deep trauma of patients and families. We need the wisdom of the Stoics.

There’s been plenty of good medblr discussion on this topic before but this article does a good job showing why ice cream and yoga aren’t going to fix resident mental health.

[larynx-lover]

Excellent article. I think teaching us healthy coping strategies like compartmentalizing is probably better than this whole “wellness” push. I’m a strong advocate for taking care of yourself, but until residencies stop giving us 120 hours of work to do in 80 hours, we’re always going to feel behind, stressed, and lacking time for ourselves. Don’t send us to do yoga for an hour. Teach us how to deal with what we’re facing.

[md-admissions]

Read this article yesterday and have been debating it with lots of people. The range of reactions has been astounding, from confusion to agreement to anger to denial. That said, this piece resonated with me because I have had days like this, and I think most of us have. But when will medicine give its residents to not be okay, to give permission to seeking help without censure? If we can work on that first before giving out massages and ice cream, we will be actually addressing the core stressors and struggles that come with residency instead of trying to pretend that medicine is “just like any profession.” It’s not.

[hostileshrubbery]

Good article, and it applies to more than just residents (I’m looking at you critical care and ED nurses!). I too don’t really believe in ‘wellness’ as conceptualized for medical education. Every time it’s come up in our program I always argue that wellness is not achievable until we work less. The (mostly older) physicians that critique work hour restrictions are a huge part of the problem and almost always are missing the point. (which is that work hours are not about patient safety) The other issue that is often not mentioned is the complexity we deal with for those 80 hours/week. Here’s a gif of medicine then and now:

Turns out it’s exhausting. 

The yoga, ice-cream, and wellness talk is well intentioned. But in the words of Taylor Swift… Band-aids don’t fix bullet holes. 

[doctorkintsugi]

All of that.

[madamethursday]

Can we just admit that obesity is not a neutral term, that it is only ever about demeaning fat people and it’s a word that’s deliberately been positioned to also mean gluttonous and lazy, to mean diseased and hideous?

Just because it’s a medical term doesn’t make it better. Plenty of dog whistle words and hateful language has originated from the way a group of people are described and discussed by medical professionals.

Or: ask anyone who’s a woman, trans, mentally ill, or a person of color.

[uppity-broad]

Obesity pathologizes a body size. It’s used as an excuse for medical neglect and discrimination. Fuck that.

[jo-zee-deactivated20200619]

If you believe that “obesity” is a legitimate medical condition and that there is an “obesity epidemic” then we can’t be friends. I’m sorry that you’re missing out on this experience because I am a fucking delight.

[myfatfuckingface]

I used to do SSDI and DIB appeals cases and let me tell you, if a client was “obese”, that often factored in to a denial of disability benefits they should have received. The Social Security admin judges CONSISTENTLY ignore Social Security regulations on “obesity” which, tho horrible and pathologizing and outdated, encourage awarding benefits if someone is “obese” and has a disabling condition.

So if you’re fat and disabled, your fatness is seen as the cause of your disability and used to justify denying you disability benefits. It’s fucked.

[hostileshrubbery]

Dear Trump Administration

Hello Mr Ryan, Mr Trump, and whomever else this may concern.

(And, if you are an American of any stripe, then as it turns out it also concerns you.)

I am a family physician. I interact with your constituents all day, every day. I hear about their problems, their struggles, and often the limitations they face regarding healthcare. I try to help them when I can. That’s my job in a nutshell.

So let me tell you about one of your constituents who also happened to become my patient. Let’s call him Bob.

Bob is a middle aged man who worked full time at an entry level manual labor type job. The kind of job you spend 40 hrs/wk working but still hover around the poverty line. The kind of job with no benefits. He didn’t go to the doctor and had no health insurance but as far as he knew he also didn’t have any health problems. Until one day he started feeling unwell. This persisted for a few days and he refused to let his wife take him to the doctor. He was worried about the cost and figured he’d get better in a few days anyway. Only he didn’t. He got worse and his wife called an ambulance.

Enter the healthcare system.

Actually, let’s skip ahead to the final diagnosis. Bob has type 2 diabetes. Newly diagnosed. Easy. Boring. Right? Except Bob clearly had diabetes for some time, unbeknownst to him. When he arrived in the Emergency Department he was in septic shock. He was riddled with large abscesses in his internal organs and soft tissues. Both his lower limbs were necrotic. He had osteomyelitis in multiple locations. What’s really amazing though is that he lived. He had both his legs amputated below the knees and was hospitalized for weeks. All told he had 8 or 9 surgeries. He required weeks of additional IV antibiotics. But he ultimately got better. And his diabetes is well controlled now on pretty minimal medication.

During his hospital stay he was enrolled in Medicaid which, fortunately, will pay for all this medical expense. So let’s look at this from an economic perspective for a quick minute. This is a man who very quickly racked up hundreds of thousands of dollars of medical bills for which the government will pay. He is wheelchair bound now and on disability, again on the government’s tab. He will certainly have additional complications during his lifetime including pressure ulcers, infections, chronic kidney disease, etc. All told this one individual is costing/will cost the government millions of taxpayer dollars.

For want of a couple hundred bucks of prevention.

A routine visit to any PCP would have certainly identified his diabetes earlier and, as it turns out, he only needs like $30/month of medication to control it.

This is the tragedy of healthcare in America. That few hundred bucks of prevention is the ‘entitlement’ you and your fellow Republicans want to remove. This is of course saying nothing of the great personal cost to Bob in terms of his quality of life, physical, and psychological well being. Your bill that was withdrawn on Friday was nothing short of an abomination. Now, you might say I have chosen an extreme example to make a political point. Only I haven’t. I have multiple Bob like patients. Ask any PCP, especially in rural and urban underserved America. I promise you they will all know Bob. They will all have multiple Bobs on their panel.

Obamacare is not perfect, but it is progress. You must understand that prevention is cheap and to continue to make progress Obamacare must be augmented and refined, not ‘repealed and replaced’. Anything else is a complete affront to the American people. So please, cut your political BS and draft some useful legislation with input from actual physicians and other folks who understand that yes, healthcare is complicated. Perhaps you could ask Mr. Obama for some tips.

Memento mori,

Hostile Shrubbery

[cranquis]

[firstwavefeminist]

Of course it’s unhealthy to be fat. If you’re fat, you’re going to have a rough time getting health insurance. You probably won’t get regular checkups and preventive care, and any health problems you might have (completely unrelated to your weight) will be a lot worse whenever you finally do see a doctor. Even if you have health coverage, you probably avoid going to the doctor if you’re fat. So you’re in the same situation. Why do you avoid going to the doctor? Every time you walk into a doctor’s office, the first thing they want you to do is step on a scale. Then you get the lecture, or the belittling remark, or worse, the weight loss advice. You figure, as long as you feel okay, why risk it? You don’t pay for abuse in any other setting, right? You value your mental health, so you stay away. If you’re fat and you do visit the doctor, he or she might decide to treat your weight, rather than your symptoms. You get a diet, rather than a diagnosis. The doctor says all your ills are caused by your fat. Six months later, you still have sharp pains in your heel or nasal congestion or shooting lights in your vision. So you find a new doctor. This time you actually get treatment for your plantar fasciitis or your sinus infection or your brain tumor. (These examples are based on actual cases.) Your doctor may not like fat people. A recent study found that fat women are a third less likely to get breast exams, gynecologic exams, or Pap smears. An exception: Fat and thin women get mammograms equally often. (The authors said that doctors may do exams more readily if they don’t have to touch fat patients.) Fat women are at increased risk for certain scary cancers (breast, cervical, endometrial, ovarian). Getting less preventive care, researchers concluded, may “exacerbate or even account for” this increased risk. It’s not the fat that kills us, it’s the fat hatred. this is so powerful. it’s fatshaming/phobia masqueraded in “health concerns”. is misogyny, women are valued for their bodies.

But What About Your Health?

By Marilyn Wann

From Fat!So? Because You Don’t Have to Apologize For Your Size

(via firstwavefeminist)

[intrainingdoc]

Surviving Residency: 5 Tips You Didn’t Know You Already Knew

Residency is hard. Anyone who tells you differently needs a stat GI consult because they’re full of it. You will be tired physically, mentally, and emotionally, regardless of what specialty you enter.

“The first few months of residency are the worst. Everything is brand new and it’s terrifying. But it gets better.”

Internal medicine resident Marc Katz, MD at Drexel University College of Medicine gives advice on surviving (and thriving) during intern year, as part for the March 2017 in-House theme issue “s/p The Match – One Year Later” dedicated to #Match2017.

http://in-housestaff.org/surviving-residency-five-tips-652

[dredsina]

I have no concept of the pain scale, like…I just realized that last week I said I was in especially awful hip pain and when my pt asked to rate it I said “3”. And then this week I said I felt a lot better than last week and when she asked me to rate it I said “3”. I really don’t know what the numbers are supposed to be. I know it’s supposed to be out of ten but like. I think I rate the pain by what time of the day it is. Like “i will rate the pain I’m in at a 5 at the end of the day, so compared to what my pain level will be later, what I’m feeling right now is a 3.” I also think i rate in overall pain rather than specific pain? Like, systemically I’m at a five. Some parts will be worse or better but i just rate it all at five because that’s the average

[clovercoin]

Here’s a pain scale that actually makes sense.

[pir8grl]

MUCH better than those stupid smile faces.

[theadventurepants-blog]

This is amazingly helpful.

[tiptop-and-others-deactivated20]

Please show this to children. I could have used this when I was in the hospital with mastoiditis.

Like your asking a child to tell you what level of pain they are in?? All I know if I want to scream and go to sleep

[fatgirlopinions]

I just realized according to this chart that I’m usually at a 6-8 when I felt like or have actually gone to the doctor/er for pain but I always told them it was like a 5 😩 I feel like my pain tolerance is kinda low so I downplay my symptoms to seem like a more rational person idk

[chronicdharma]

[cervinelich]

this is why its depressing to work in a pharmacy.

[iatrogenic]

I was definitely a profit killer when I worked in a pharmacy (which honestly was my favorite job in the entire world, but it was short-lived and nowadays you can’t work at a pharmacy like that, it’s all tied in with corporate retail and no one should ever trust me with a cash register ever). It was not, however, actually a profit killer for the pharmacy, just for the drug companies, so no one cared. These days I do medical billing, which means I actually bill OUT from hospitals so I’m mostly spending my professional time taking money away from insurance companies. 

I will now impart all of my profit killing resources onto you, in case you don’t know them. I think most of you know them, now. But just in case you don’t.

THIS IS US-CENTRIC. I’M SORRY. 

1. GoodRx - this thing has an app now, so you can look up the best places to get your expensive medicines at the lowest possible prices without insurance on the go, and you no longer have to print coupons because you can just hand over your phone or tablet. Times have changed for the better with GoodRx. Definitely use it before trying to fill your scrip, because it will tell you the best place to go. (You can do that on the website, too.)

2. NeedyMeds - Needymeds is basically the clearinghouse of drug payment assistance. They have their own discount cards, but also connections to many patient assistance programs run by drug companies themselves. They are good assistance programs, too.

3. Ask your county - This is not a link. This is a pro tip. Most county social services will have pharmacy discount programs for people with no and/or shitty pharmaceutical coverage. You can often just find them hanging around at social services offices; you can just pick one up and walk off with it. 

4. Ordering online - There are a few safe online pharmacies. I keep a little database in a text file on my computer. Most of them are courtesy of CFS forums, my mother or voidbat, so a lot of that is a hat tip to other people, but if you’re in need of a place to get a drug without a prescription … first I’ll make sure you 100% know what you’re doing for safety reasons and then I’m happy to turn over a link. 

5. Healthfinder - A government resource that helps find patient assistance programs in your area. This might also point out the convenient county card thing. RxHope is something a lot of people get pointed to via Healthfinder that’s a good program.

6. Mental Health America - Keeps a list of their best PAPs for psychiatric medications, which can be some of the most expensive and a lot of pharmacy plans don’t cover them at all. 

[forevrdreamingofbetterthings]

This is so important ppl.

Signal boost the shit out of it!

[dynastylnoire]

Booooooooooooooooooost

[dysfunctionalqueer]

Good Rx Saved my family a hundred dollars a month while I was getting signed up for CHIP seriously it’s a life savor especially for ridiculously expensive drugs like abilify

[motivation-gems]

Useful info, friends! ;)

[quietborderlineinfo]

Since many of our followers are on medications, I feel like this would be an important resource. -Luna

[will-work-for-spoons]

Also! Some drug companies have patient assistance programs where they send you the drug for FREE if you are uninsured, or if your insurance doesn’t cover that drug.

Do a Google search for “patient assistant programs” + (your med), or search the manufacturers website. Sometimes the info is online; other times you have to call.

Even some of the big name pharma companies have this. It’s certainly not all companies, or all meds, but it is worth a shot.

Before Obamacare, I lost insurance and couldn’t pay for my mood stabilizers (kiiiiinda important to have those when you’re bipolar.) I was on generic Lamictal, but I went to the official Lamictal website, filled out a form with a valid prescription, and they mailed my meds to me every month for free.

If you know anything about bipolar disease, you know that that was a literal life saver. Patient assistance programs ftw!

[girlbossjodiarias]

Sunovion has a PAP discount card for Latuda, which knocks the cost down from $1030/mo to $15/mo. Definitely ask your doctor/psych about discount cards if they want you to take anything that is patented.