soft sweep

@STLD98 @BroBobbyFan @FEMMY466 A CT is actually *not* indicated or appropriate in this scenario! gravitas.acr.org/ACPortal/GetDa…

@BroBobbyFan @FEMMY466 “I treated them for a migraine because they said it feels like a migraine and I decided not to investigate or ask further questions” doesn’t hold up as a defence in court

My head hurts and it feels like a tight band around my head My head hurts on one side and I feel like throwing up My head hurts and it's the worst headache of my life My head hurts and I'm hypertensive but not taking my medication Different diagnoses, different treatments

@PstafarianPrice Hopefully went into urology

Lived next to a family with the last name "Dick" Before graduating medical school, their son legally changed his name to "Richardson"

@CyborgPeds "Doc, be honest... How bad is it?" "Well, let's just say I won't be seeing you at another follow-up appointment." "Oh my goodness, I'm gonna die that soon?" "Die? No. But your BMI now puts you in a higher risk and lower reimbursement class."

Correct. The doctors would fire all their sick patients.

@cocomarvgrows If a kid is regularly getting ticks and the parents knew guidelines we'd sometimes give them doxy to have on hand so they wouldn't have to keep coming in every time. Obviously it is bad to belittle patients and parents. Do you not have a pediatrician who knows you?

56 ticks last year from clothes, hair, between toes, the dog. & the ones we tested are Lyme +. & sometime you miss them in the soft fold of an ear or the inner bit of the belly button. Point is, I knew what I was doing, I knew the guidelines & I was belittled. THAT’S the point.

I guess if you're getting ticks all the time and don't check then it can be an issue. Most cases I've dealt with are like, "my kid went out in the woods and I found a tick on him when he came home, then we removed it. Does he need doxy?" Which, probably not. If a parent pushed then I reviewed risks of doxy and am generally happy to prescribe. Yeah the timelines are arbitrary, but they're probably conservative given low lyme risk within several days of bite.

@DeeSnutts6 @softsweep Yes. You can’t tell how long a tick has been attached. Not to mention, the most recent research shows these timelines are largely arbitrary.

When my toddler was bitten by a confirmed Lyme-positive tick I was told to stay off Dr. Google when I insisted on a course of antibiotics.

@cocomarvgrows But that is annoying behavior, I welcome patients googling. If a patient even knows what meds they're taking I get excited.

@cocomarvgrows You don't need antibiotic prophylaxis if the tick is removed within 36 hours

@selentelechia I love zofran, frequently prescribe it, wish it were OTC, and my fiancée uses it regularly. It can increase risk for dangerous arrhythmia. I am not prescribing it without offering an EKG if no recent one is available to review.

when I wanted zofran during my last pregnancy I took my other kids in during the baby's nap time and when the doctors tried to make me go through some rigamarole first I asked loudly and repeatedly over a cranky baby "is there a medical reason you can't just give it to me now" until they wrote me a prescription so that's one method

@corsaren I had the same issue but was helped by accidentally forcing myself to have a hard deadline. Engagement ring (which financée designed...) was unexpectedly finished less than a week before we left for vacation abroad.

The Helen DeWitt drama has me thankful that I’ve chosen to marry a type A bitch with 95th percentile conscientiousness Unfortunately the marriage part is contingent on my 2nd percentile ass planning the proposal, so…

@shakoistsLog @StatisticUrban We can easily avoid letting babies die in the street. Can we avoid giving boomers 4x more out of medicare than they paid in while still allowing them to age and die with dignity?

@StatisticUrban i think the real ascended take here is that 'human right' is an ill-posed concept.

At a certain point you simply have to say to the libertarians "no, wrong." An orphaned baby does in fact have the human right not to starve to death in the street. Any form of society that can't guarantee that right is bad.

@ad0rnai Not uncommon for overnight coverage

ICU with a telehealth doctor is crazy who is putting in the PICC lines?? or doing arterial punctures?! omg

@realKalos "The Democrats are the real infidel, Pete"

"Mr. President, Lord Netanyahu needs you to sign The Total Goyim Extermi- ❗️" "Glory and praise be to You, O Allah. Blessed be Your name and exalted be Your majesty, there is none worthy of worship except You." "MR. PRESIDENT, WHAT ARE YOU DOING" "Pete... Start bombing Tel Aviv."

@FrenlyOfficer The truke is that med school should be harder

With an MCAT of 498-501, the odds of progressing past M1 (the biggest barrier) are 94%. There are a lots of applicants who can very likely handle the curriculum who aren’t being given a chance. The solution is more schools. The current barrier is clinical placement for M3’s

@northwoods1980 @AmineKorchiMD @agtenc That would require rads to grow spines though

@AmineKorchiMD @agtenc What happens when rads refuse to give cheap over reads and refuse to take on any legal liabilities and it's ALL on the system-AI company marriage or, it's developed and owned solely by the system?

CEO of America’s largest public hospital system says he’s ready to replace radiologists with AI… radiologybusiness.com/topics/artific…

@anshulkundaje Took us 7 months from "accepted in principle" to publication!

Yes after recent experiences, definitely plan to abandon Nature Genetics. And hopefully soon (within 2 years) all journals. I'm like so done with this shit.

@Duderichy American doctors work more than doctors in many of those countries though, so it's likely not as much of a difference in doctor productivity.

WE NEED MORE DOCTORS Also the population is aging and we’re going to need more people to care for them

@idobadtakes Performing plasmapheresis without proper indication seems like something one maybe should lose their license over.

Every day I feel like such a sucker for practicing good medicine knowing I could rake in millions at anytime by doing grifts like this

@stanfordNYC Does voluntary manslaughter have to be caused by actual provocation or only perceived provocation? Because he apparently thought the victim was looking at him funny

The biggest problem here seems to be not the judge but the statutes. I've attempted a look at how each contributed. Antoine Watson was charged with first degree murder, second degree murder, involuntary manslaughter, and aggravated assault. The jury acquitted on the murder charges, which sounds pretty bad, but looks like it might be correct based on the actual required elements. This would have turned on whether Watson had malice (implied by an "abandoned and malignant heart") when he ran up to and shoved Vicha Ratanapakdee. The California pattern jury instructions require that the perpetrator be aware that "the natural and probable consequences of the act were dangerous to human life in that the act involved a high degree of probability that it would result in death." Is that actually true of running up to and shoving a person? Probably not. Though attacking a stranger that way is an evil thing, most of the time a person so shoved will not pass away as a result. So murder, though it was charged, was probably off the table from the beginning. Turning to voluntary manslaughter, it's narrowly defined in California as a killing in the heat of passion caused by a provocation. But there was no provocation here. So involuntary manslaughter was charged, which was what was convicted. Involuntary manslaughter can have a sentence of 2, 3 or 4 years, and in this case, there were enhancements (due to the age of the victim) available that allowed for a 5 year extension. So the longest possible sentence was 9 years imprisonment. As a violent offender, Watson would need to serve 85% of the sentence before getting automatic parole, or about 7 years and 8 months. He had already served about 5 years and 2 months before and during trial. So he served about two-thirds of what he would have served with the harshest possible sentence, and the way the California statutes and instructions are, that 7 years and 8 months is probably the most time he could have conceivably served for running up to and shoving a random stranger, resulting in brain injury, coma and death. In my opinion, if California is going to have such narrow criteria for murder and voluntary manslaughter, the sentencing range for involuntary manslaughter has to run MUCH higher than 4 years. So the judge did have some latitude, but in the maximum case could have added only about two and a half years of additional time in custody.

@Jeffery1313 @CoffeeBlackMD It matters if the PBM gets revenue based on discount amount rather than absolute drug price though

@CoffeeBlackMD It matters if Big Pharma is gouging. Not a PBM issue tell them to lower the price for Americans. The rip off is the FDA not having generic Flovent. The other inhaler are just old drugs repurposed in multiple forms. Screw the patent lawyers! Cut it out.

When the out of pocket portion for a medication is $1800 per month for a patient, insurance doesn’t actually cover that medication, no matter how much they are covering. Read that again if you find it confusing.

Unloading dishwasher, trying figure out where to put the oddly shaped spatula. Put it in a drawer with other oddly shaped kitchen implements. Fiancée stops me, "it doesn't go there; that's the specialized tool drawer." "Okay, where does it go then?" She gestures to another drawer. "Here, in the hyperspecialized tool drawer."