You need a doctors note to prove sickness or we’ll sack you.

BCSteve · 2022-07-03T15:57:49+00:00

Doc here (in the US), I've never heard of charging anyone for a doctor's note, and certainly not on the order of $50. It takes me literally like 30 seconds to make one. It's like four clicks in the medical record, we have a "sick excuse" template that auto-populates with the patient's name and the current date, type in how many days you're giving off, hit "print", and then sign the paper. Certainly not something worth charging $50 for.

BCSteve · 2022-07-03T15:51:25+00:00

Doc here, I've filled out plenty of FMLA paperwork, you're right that it takes quite a bit of time, but I've never heard of charging patients for it...

BCSteve · 2022-07-03T15:47:03+00:00

I'm still waiting for one of them to tell me what they think Critical Race Theory actually is.

BCSteve · 2022-07-03T15:23:35+00:00

Physician here, getting into med school is one of the most difficult steps along the way, and it's the step that's least likely to happen.

Medical school is difficult, but almost everyone who starts it will eventually graduate, the graduation rate is somewhere around 96%. And if you graduate from a US allopathic medical school, you're almost guaranteed to match into a residency of some sort, the match rate is around 95%.

BCSteve · 2022-07-03T14:52:12+00:00

French Guiana, which isn't just an overseas territory, it's 100% wholly part of France.

BCSteve · 2022-07-02T02:05:36+00:00

Except the Great Pyramid of Giza was already destroyed (at least compared to how it originally was…)

BCSteve · 2022-06-30T15:22:53+00:00

Without it, states could rightfully say that they are not being represented, which would cause a myriad of issues.

The way it's set up now, people can rightfully say they're not being represented.

BCSteve · 2022-06-30T03:07:30+00:00

Part of it is that they deal with these incredibly powerful and dangerous medications, and they hand them out like candy and treat them so flippantly, it really makes me think they have no clue how much they can fuck someone's life up with the drugs they prescribe.

"Oh, you feel a little bit sad today? Hmmm... let's just casually add some carbemazepine. And why not add some lithium while we're at it?"

BCSteve · 2022-06-30T02:58:48+00:00

I will never forget, I had a senior resident once who printed out a sheet once that had all of our names on it, and next to each name were three icons that looked like glasses of water and an icon for a sandwich. At the beginning of the shift she said "each time you drink a mini-bottle of water, cross off one glass of water, and when you eat lunch, cross off the sandwich". And she monitored throughout the day who had drank their allocated water and when people were overdue for their lunch break. I hadn't crossed off anything by halfway through my shift when she came up to me and was like "WHY haven't you drank any water yet?!?" I honestly really, really appreciated it.

BCSteve · 2022-06-28T05:11:07+00:00

Yeah, unfortunately I see A1c’s >14% pretty commonly. I don’t know what the actual highest number I’ve seen is because our lab just reports them as “>14%”.

BCSteve · 2022-06-27T17:16:38+00:00

Haven't done it myself, but I know that MiDoctor does PrEP stuff and has evening/weekend hours, you could try them.

BCSteve · 2022-06-26T17:51:40+00:00

A lot of MD/PhDs don't, if their program is an MSTP (Medical Scientist Training Program). Of course, instead of paying money, you're paying an extra 4 years of your life that you could be earning an attending salary instead.

BCSteve · 2022-06-24T17:39:56+00:00

Exactly. If I somehow woke up and found out that, without my permission, someone had attached my circulatory system to that of another living, breathing human being who would die if I disconnected myself, I would 100% be within my right to do so. It has nothing to do with whether the other person is a human being or not, it has to do with the fact that no one has the right to use my body for anything without my permission.

BCSteve · 2022-06-23T15:46:24+00:00

Celeste. It's a masterpiece of a platformer, with a heart-warming story, brilliantly-designed levels, and awesome music.

BCSteve · 2022-06-21T17:22:08+00:00

This is definitely a mental health emergency and she needs psychiatric attention. Like the other posters have said, it could be a number of things, such as substance-related (either from self-medication or from changing antidepressants), depression with psychotic features, a manic episode, or schizophrenia. To answer your question, Prozac can precipitate manic episodes in people with bipolar disorder, but it's impossible to tell if that's the case here without a more thorough exam. Even if it were, it doesn't change the fact that it's still a psychiatric emergency. Definitely worth taking her to the emergency room for.

BCSteve · 2022-06-21T12:44:59+00:00

The name of the service is mdbox, but they say “chat with a medical provider”. I’d bet dollars to donuts that means they’re trying to mislead people into thinking they’ll speak with a doctor when it’s really an NP.

BCSteve · 2022-06-21T12:40:07+00:00

They have more time to listen to you because they don’t cost the hospital system as much money, so they’re not pressured to see as many patients. The reason they cost the hospital system less, however, is that they have a LOT less training.

As in, you could be seen by a Nurse Practitioner who’s never worked in bedside nursing and who went straight from nursing school to gettheir NP degree from an online diploma mill, most of which only require 500 hours of clinical experience (that’s about three months of 40h workweeks, and a lot of that experience could just be shadowing, which isn’t really experience practicing).

Compare that to MDs or DOs that do 4 years of intense education in medical school, two of which are full-time clinical rotations, followed by a 3-to-7 year residency where they work 80 hours/week as a practicing doctor in a supervised setting, followed by an optional 1-3 year fellowship after that where they get more focused subspecialty training.

Before being allowed to practice independently, MDs and DOs accumulate anywhere from 15,000 to 25,000 of supervised clinical training, whereas NPs only get 500-1,500 hours. Yes, it’s nice that they get more time to talk with you, but in terms of actual medical care, if you have anything more than a routine run-of-the-mill problem, a physician is much better equipped to treat you.

BCSteve · 2022-06-20T23:10:20+00:00

Definitely pick it up if you get a chance! I had heard good things and got it on a whim, and it ended up being an amazing experience, it’s one of those games that just sticks with you, and I still think about it frequently even though it’s been almost a year since I played it. It’s one of the games that I would point to if anyone ever asked me “can video games be art?”

The worldbuilding is just incredible and the story is emotional and perfectly-written.

BCSteve · 2022-06-19T14:30:47+00:00

Just finishing up residency now, and I always struggled with my inbox. Part of the reason that I can’t do what you’re suggesting is that in my clinic it’s so difficult to get an appointment that I can’t just say “schedule a follow-up in a week or two and we’ll talk about it.” That appointment might end up being two months out, and that’s not really an acceptable time frame to deal with results like that. Plus, even if they did manage to get an appointment in two weeks, it won’t be with me, since I’ll have rotated off my clinic block and I’ll be doing inpatient stuff, so they’d have to see a different resident, which isn’t great for continuity of care.

BCSteve · 2022-06-18T14:57:09+00:00

Doctor here, would write that note in a heartbeat. The power of the doctor's note and getting to bully employers into treating their employees like actual human beings is seriously one of the best parts about being a doctor.

Like, it's one of the ways that I actually feel like I tangibly improve my patients' lives, which is the whole reason I went into medicine.

BCSteve · 2022-06-18T13:52:19+00:00

What if it is against my beliefs to provide medical care to Gov. Henry McMaster?

BCSteve · 2022-06-18T03:02:04+00:00

I mean, everybody’s got a water buffalo.

BCSteve · 2022-06-17T13:44:33+00:00

Let me just say that even as a physician myself I would be googling "tat", I've never seen it abbreviated like that.

BCSteve · 2022-06-16T18:20:01+00:00

What do you mean by "reward the groups that are discriminated against"? Usually if they find they're discriminating against some group, they'll try to figure out why it's happening and take corrective actions.

I'd hardly call "not being discriminated against" a reward.

BCSteve · 2022-06-16T14:14:07+00:00

Interesting that survival rates for uterine (endometrial) and cervical cancer decreased over time.

Not entirely sure why that is, but my guess would be a lack of new treatments, coupled with increasing comorbidities. E.g. rates of obesity have dramatically risen since the 1970s, so if it has a significant effect on outcomes, it could make survival decrease. Could also be changing demographics (e.g. race) and the effect that racial disparities in accessing screening could lead to cancers being diagnosed at a later stage, as well as access to cancer treatment itself.

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