Doctor here- love CostPlus drugs for patients and myself! Here's another thought- help Rivian be the rival to Tesla they ought to be. OR buy Tesla- should go for cheap right now and revitalize its brand and make it respectable again. :) Sort of joking-not about Rivian though-they are great.

This is exactly the "loophole" though their language about "medical necessity" clouds that and would make me more aggressive at taking legal action if the opportunity arose. Deciding medical necessity IS a determination that should require specific expertise and knowledge of THAT patient. Hmmm

I can hear and feel it to my core.

got the new edition audiobook. At least there is some comfort in knowing I'm not alone in my disbelief of the level of disdain people have for experts or intelligence.

Starting the book again because... here we go again. I hoped that ignorance on display to such a severe degree would swing the pendulum back to intellectual curiosity and desire for actual knowledge, but it's only gotten worse-. People WANT to be ignorant and want ignorant to lead them.

#DonTCare is still in concept phase.

There used to be honor and decorum. They changed the rules and there is no longer an expectation of fairness and justice prevailing. Protect those who tried to protect us.

He needs to pre-emptively pardon the media, Dr. Fauci, the generals who criticized him, everyone they can think of for any imagined 'crimes', etc- generic blanket pardon for anyone who may be targeted by the new police state with an agenda of revenge for criticizing dear leader.

#periop #periopsky
If anemic (but not prohibitive for surgery) or s/s of GI bleed, we sometimes see rec for scope post op since anticoagulation may not be considered. And definitely can see readmissions for GI bleeding once on high dose aspirin. If signs are there preop, potentially preventable.

Same! One question- quite polite & sincere- poof, blocked me, lol.

hello. 🐌

We need more #periop peeps over here. #periopsky

Most of our usual consultants are amazing and collaborative. Sometimes, maybe b/c we are rural, some city academics seem to think we know nothing and are pretty condescending when we ask for info ="I said the patient was cleared, why do you need to get the echo report, just avoid hypotension". SIGH

Being in a rural setting in the U.S., there are limitations of resources, but trying to turn some of the limitations into advantages is a challenge I love. We are small, so we lack specialty care (disadvantage) BUT we are small so it's easier to work and communicate with other docs (advantage).

Small steps then. If you identify an issue, even if you can't fix it, quick note to the outpatient care team can help the patient and docs going forward. Primary care (hero work) is SO hard with so many issues and limited time, at least here in the U.S., that they may appreciate the information.

Disclaimer: I work in a small, rural hospital with amazing medicine colleagues. We have an easy time collaborating so our services overlap in the best ways. What *I* do may not fall strictly within guidelines because of how we are structured. So I offer my thoughts as an example, not rules.

Patients who have surgery often come back for more surgery. Maybe I see this more being in a small hospital where names will be familiar when I see them again. Next year when they get their other knee done, maybe they WILL have their CPAP and be treated and that's a pretty awesome impact to have.