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  • Originally posted by Lordosis View Post
    I have definitely pissed off a lot of people by not giving them what they want. I really don't see how this ivermectin nonsense is any different.


    There are a lot of convos going on here, so I don't know which ones you are referring to. But in the cases that have gone to court that I'm aware of, no doctor is forced to order ivermectin. They find a doc who wants to prescribe it and let them do to. Often this involves granting them credentials at the hospital that they would have been otherwise qualified to receive but don't have at the moment.

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    • I’m glad I don’t deal with life and death situations. I truly appreciate other colleagues who have to deal with covid every day.

      My concern is setting a legal precedent for the future. If a patient doesn’t like certain treatment recommendations, he can now sue to force the hospital to provide an alternative/unproven treatment. This is a slippery slope.

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      • Originally posted by Lordosis View Post
        I am not very flexible and rarely do anything I do not agree with. I do applaud those who can be more flexible and do what they feel is right even if it doesn't go along with what they know is right. There really must be a good balance struck here. Unfortunately I think more often than not people are just lazy and don't want to Rock the boat.
        I try to remain flexible and open IF patient preference falls into a gray area but I am not willing to prescribe something that is completely inappropriate. I’m all for the therapeutic alliance however I think that is over used by those who don’t have the back bone to encourage patients to explore what is flawed logic. If more were willing to do the right thing which is often not the easy thing I might not have to constantly decline to prescribe inappropriate benzos, stimulants, pain meds, testosterone…then again I think you can google up telemedicine on demand for all of the above so maybe I won’t see this as often until the wheels inevitably fall off the car.

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        • An attending once told me during residency years ago "do not let patients intimidate you into practicing bad medicine".

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          • Originally posted by Rando View Post

            The x-axis is political, so it's hard to say it's not political. I'll say up front I think Trump's management of COVID was mostly awful, and I'll say the same for many GOP governors as well. But speaking as someone who spends way too much time on Twitter these types of graphs or studies are usually used to "own" one side or the other, and are often constructed with that goal in mind..
            Well said. It's disappointing that some people have turned Covid into a partisan issue.

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            • Originally posted by Perry Ict View Post

              Well said. It's disappointing that some people have turned Covid into a partisan issue.
              Are you talking about this board :-)

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              • Originally posted by Kamban View Post

                Are you talking about this board :-)
                No, of course not

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                • The local school district has thrown in the towel with its mask optional stance after over 700 covid infections in 2.5 weeks of school and are now suing the governor for the right to have a mask mandate. Meanwhile, my children's private school with mask mandate in force remains in single digits for total cases, with no class having more than 1 case. The public school system is bigger, but the per capita case count is >8x as high. Multiple other public school systems have switched to remote learning due to extremely high absenteeism due to quarantines, but I don't have the case numbers for them.

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                  • My system is refusing to mandate vaccination for healthcare workers and will not accommodate patient requests for vaccinated caregivers. I have a couple of procedures coming up.

                    WWYD?

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                    • Originally posted by snowcanyon View Post
                      My system is refusing to mandate vaccination for healthcare workers and will not accommodate patient requests for vaccinated caregivers. I have a couple of procedures coming up.

                      WWYD?
                      I'd find another system to have those procedures done in. And I'd tell your current system why you are making that choice.

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                      • Originally posted by pulmdoc View Post
                        The local school district has thrown in the towel with its mask optional stance after over 700 covid infections in 2.5 weeks of school and are now suing the governor for the right to have a mask mandate. Meanwhile, my children's private school with mask mandate in force remains in single digits for total cases, with no class having more than 1 case. The public school system is bigger, but the per capita case count is >8x as high. Multiple other public school systems have switched to remote learning due to extremely high absenteeism due to quarantines, but I don't have the case numbers for them.
                        That's pretty striking and certainly makes a case for school mask mandates. I still don't have a good intuitive understanding of masking. That Bangladesh study really didn't show a benefit to cloth masks - was your child's school encouraging high quality masks or were they mostly simple masks? My thought has been good masks are effective, cloth ones not so much.

                        I keep thinking back to that Marin County school report where they had a mask mandate but the teacher took off her mask to read to the class. About half the class caught COVID despite being masked. I know the thought has been all along that masks mainly protect others from exposure but my guess is most parents think they're also protecting their child to an extent. Masks did not seem to protect that class from an exposure. I also question whether the teacher would have spread the virus even if she had been wearing a cloth mask, given how transmissible Delta is.

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                        • Originally posted by Lordosis View Post
                          Which has more harm? Giving ivermectin to a covid patient and you don't expect it to help or giving isithromycin to a sniffle that started 2 days ago?

                          It seems like everybody's last doctor gave them antibiotics for everything. But we try our darndest to follow the data and do what is actually right. I have definitely pissed off a lot of people by not giving them what they want. I really don't see how this ivermectin nonsense is any different.

                          I am not very flexible and rarely do anything I do not agree with. I do applaud those who can be more flexible and do what they feel is right even if it doesn't go along with what they know is right. There really must be a good balance struck here. Unfortunately I think more often than not people are just lazy and don't want to Rock the boat.
                          I don't think any of these meds kill the targeted pathogen that people intend. Instead, these meds while "safe" for animal cells, probably transiently disrupt/damage/impair enough of the immune cells, as to improve immunologic symptoms, which is what we feel for most infections. On top of steroids, you could probably throw chemo and every biologic autoimmune med at COVID(or infection of choice) and a subset of people will get some improvement. It's sort of like kicking a broken tv and having it work. It works not scientifically satisfying for the credentialed people.

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                          • Originally posted by artemis View Post

                            I'd find another system to have those procedures done in. And I'd tell your current system why you are making that choice.
                            My insurance only covers my health system (it's a system similar to Kaiser). I filed a grievance with my insurance company asking to go out of network, and they rejected my plea.

                            So my only choice is the unvaccinated system.

                            I can
                            1. Quit my job and get ACA care in a different network
                            2. Skip procedures and wait and see if they ultimately mandate vaccination (they won't)
                            3. Have the procedure

                            Comment


                            • Originally posted by snowcanyon View Post

                              My insurance only covers my health system (it's a system similar to Kaiser). I filed a grievance with my insurance company asking to go out of network, and they rejected my plea.

                              So my only choice is the unvaccinated system.

                              I can
                              1. Quit my job and get ACA care in a different network
                              2. Skip procedures and wait and see if they ultimately mandate vaccination (they won't)
                              3. Have the procedure
                              1. I thought you were looking for a new job already?
                              and
                              3. If you're vaccinated, don't worry about it. Get a booster if you need extra reassurance.

                              Comment


                              • Originally posted by snowcanyon View Post

                                My insurance only covers my health system (it's a system similar to Kaiser). I filed a grievance with my insurance company asking to go out of network, and they rejected my plea.

                                So my only choice is the unvaccinated system.

                                I can
                                1. Quit my job and get ACA care in a different network
                                2. Skip procedures and wait and see if they ultimately mandate vaccination (they won't)
                                3. Have the procedure
                                I understand it is the principle but don't fully get why paying out of pocket for a significant preference when you can afford it involves so much consideration.

                                Comment

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