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  • MaxPower
    replied
    Originally posted by CordMcNally View Post

    Did you cardiovert first and hope that the jolt also makes the hip go in?
    Definitely cardiovert first so you don’t jolt and make the hip go back out!

    Leave a comment:


  • CordMcNally
    replied
    Originally posted by The White Coat Investor View Post
    Just wanted to provide a counterpoint. Recently I saw a patient in the ED who was at the hospital getting a COVID test for an upcoming cardioversion. When she went back to her car, she slid in funny and dislocated her artificial hip and ended up in the ED. I figured, if I'm going to sedate her, why not do both procedures at once? So I did. Sinus rhythm and successful reduction, all in less than two minutes. Saved her another trip to the hospital, going NPO, and getting charged a bunch of hospital fees. Yes, I stole the procedure from the cardiologist (I called to make sure he was all right with it, and he was perhaps because he was in Maui taking my call), but the patient saved a second set of hospital fees, which are usually far larger than my own procedure fees. She was thrilled.
    Did you cardiovert first and hope that the jolt also makes the hip go in?

    Leave a comment:


  • The White Coat Investor
    replied
    Just wanted to provide a counterpoint. Recently I saw a patient in the ED who was at the hospital getting a COVID test for an upcoming cardioversion. When she went back to her car, she slid in funny and dislocated her artificial hip and ended up in the ED. I figured, if I'm going to sedate her, why not do both procedures at once? So I did. Sinus rhythm and successful reduction, all in less than two minutes. Saved her another trip to the hospital, going NPO, and getting charged a bunch of hospital fees. Yes, I stole the procedure from the cardiologist (I called to make sure he was all right with it, and he was perhaps because he was in Maui taking my call), but the patient saved a second set of hospital fees, which are usually far larger than my own procedure fees. She was thrilled.

    Leave a comment:


  • Eye3md
    replied
    Originally posted by Dontgetthejab View Post
    I see local physicians as patients...they get special service as I understand the demands of their professional lives

    Same here. If a local physician calls me up and says he/she (or their spouse) is having a significant retina worry/problem, I will see them ASAP.

    Leave a comment:


  • Dontgetthejab
    replied
    I see local physicians as patients...they get special service as I understand the demands of their professional lives

    Leave a comment:


  • childay
    replied
    Originally posted by Lordosis View Post
    I have several physician patients. I don't see them too much. They are healthy and only come in when I am really needed. Usually to fill out a form :/
    That's a 99215 visit though right?

    Leave a comment:


  • Lordosis
    replied
    I have several physician patients. I don't see them too much. They are healthy and only come in when I am really needed. Usually to fill out a form :/

    Leave a comment:


  • childay
    replied
    Originally posted by Lithium View Post

    So, I’m not looking for a PCP now, but where I live, a good PCP in an employed system that’s been established for many years is going to have a full panel and isn’t going to be taking new patients. Could I try pulling some strings through colleagues? I guess. But as a hospital based psychiatrist, I’m in a bit of a bubble. I’m not much of a referral source and not sure how I’m in a position to grant many favors in return.

    and like I said, the scenario I’m thinking of is mainly several decades down the road when I’m sicker, have left practice, and am even farther removed from general medical knowledge and my professional connections. I’m not so sure I can count on the medical profession to be very generous with its time unless I pay a premium for it.
    I would gladly pay for concierge medicine, depending on the price, if I actually had a current need for PCP. Currently & thankfully not particularly needed. I think we are of similar age. Probably should recheck my lipids though.. and apparently gonna need that colonoscopy sooner than expected..

    Hospital bubble also appreciated. If I'm ever admitted there I'm sure I'll get good attention. I always provide professional courtesy to professionals and curbsides to anyone who called. On occasion had to set limits though with the phone calls..

    Leave a comment:


  • childay
    replied
    Originally posted by Bdoc View Post
    yea, probably too vague, I dont have any in depth diagnostic criteria unfortunately. Here is an update which makes me even more sketched out to be honest:

    I got my gums lasered and I got a bill in the mail for 600$. I called them and they said dont worry about it, it was taken care of. I asked my dentist(very nice guy), and he says he just writes it off. Was the laser indicated? noone i know has ever had their gums lasered so no anecdotal reports. I have no bill so dont care too much and dont own my own practice, so not sure if this is common place.

    on top of that, my fiance goes to a dentist last month and her new dentist(bc has new insurance) finds 7 asymptomatic cavities("2 big ones, 5 small ones")! She gets a 2nd opinion at her old dentist who only finds 1. WTF! That discrepancy is too big imo. Someone has to be lying right or are cavities that subjective?
    I'll let the dentists respond or not. There was previous thread on this. But when our dentist retired / sold out to PE I made sure to ask around. Same as I would do for any other doctor.

    Never heard of gum lasers. Seems like everyone has lasers these days we're living in the future I guess. But no flying cars..

    Leave a comment:


  • toofy
    replied
    Originally posted by Bdoc View Post
    yea, probably too vague, I dont have any in depth diagnostic criteria unfortunately. Here is an update which makes me even more sketched out to be honest:

    I got my gums lasered and I got a bill in the mail for 600$. I called them and they said dont worry about it, it was taken care of. I asked my dentist(very nice guy), and he says he just writes it off. Was the laser indicated? noone i know has ever had their gums lasered so no anecdotal reports. I have no bill so dont care too much and dont own my own practice, so not sure if this is common place.

    on top of that, my fiance goes to a dentist last month and her new dentist(bc has new insurance) finds 7 asymptomatic cavities("2 big ones, 5 small ones")! She gets a 2nd opinion at her old dentist who only finds 1. WTF! That discrepancy is too big imo. Someone has to be lying right or are cavities that subjective?

    First, make sure you go to a practice where the dentist's name is ON THE FRONT DOOR and has ownership in the practice. There are many corporate offices now that hire new grads fresh out of school, treat them poorly, and have a revolving door of a new dentist every 6 months. The corporate places won't waste money re-painting the front door every 6 months. They hire a "treatment coordinator" that modifies the treatment recommended by the dentist. The dentist says you need a $200 filling and the "treatment coordinator" changes it to a $1200 crown. It should be illegal and I don't know how they get away with this.

    The corporate places used to be easy to spot because they were all called Monarch, Aspen, etc but now they use "branding" to hide themselves. They each have a localized name like Jonesville Family Smiles (I made that up) or similar.

    Dental caries is a spectrum. It starts small (undetectable on xrays or the naked eye, but present) then enlarges as it decalcifies tooth structure and begins to create larger areas of damage which are eventually visible on an xray and later visible to the naked eye. The eternal question is when do you intervene? It depends on if you prefer under-treatment or over-treatment. Treat it too soon at the first radiographic sign and you are gonna be drilling out lots of tooth structure that may have been radiographic artifact. But you will not be missing any disease. If you wait too late, then the filling gets larger and may even need a crown and it may spread to the adjacent tooth and will be more expensive. But at least you didn't drill out healthy tooth.

    Leave a comment:


  • Bdoc
    replied
    yea, probably too vague, I dont have any in depth diagnostic criteria unfortunately. Here is an update which makes me even more sketched out to be honest:

    I got my gums lasered and I got a bill in the mail for 600$. I called them and they said dont worry about it, it was taken care of. I asked my dentist(very nice guy), and he says he just writes it off. Was the laser indicated? noone i know has ever had their gums lasered so no anecdotal reports. I have no bill so dont care too much and dont own my own practice, so not sure if this is common place.

    on top of that, my fiance goes to a dentist last month and her new dentist(bc has new insurance) finds 7 asymptomatic cavities("2 big ones, 5 small ones")! She gets a 2nd opinion at her old dentist who only finds 1. WTF! That discrepancy is too big imo. Someone has to be lying right or are cavities that subjective?

    Leave a comment:


  • toofy
    replied
    Originally posted by Bdoc View Post
    So this is stemming from my recent visit to the dentist and my reading the many discussions here about dental xrays and possible un-needed procedures. i would first like to say this is not a dig against only dentists as I trust my fellow MDs just as much.

    First i will talk about my fellow MDs. Orthos have been the big culprit for myself and my friends. I know multiple experiences where myself and other people have gone to orthos with MRI results already done of either a shoulder or back for chronic pain and without even seeing the doctor, the office demands an xray. This is a complete money grab that even my non MD friends can identify and im honestly appalled. (one payed 300$ out of pocket for it bc he doesnt have insurance).

    Now, onto my recent experience at the dentist. I am not the most compliant dental patient but have never had a cavity or any surgery. They did xrays and found an asymptomatic cavity(great! Fix it before it becomes a problem) Now here is where i become skeptical. The hygenist recommends a "deep clean" that is conveniently not covered by my insurance and costs 1800$ out of pocket. My initial reaction was wow, my teeth are disgusting and i should definitely do it, but then i thought about it. Medicine/dentistry is now a business. $$ trumps everything and they might be possibly trying to gouge me. That realization really bothered me and which is why im posting here. I truly did not trust her recommendation. Does anyone else feel this way?


    Also, they are doing a laser clean next week. I have never heard of it but maybe thats the new standard and i dont go to the dentist enough to know.
    I haven't read all the posts, but you didn't state your periodontal pocket depths among other parameters. Diagnostic info is needed.

    Leave a comment:


  • Lithium
    replied
    Originally posted by Bellescamp View Post
    You are a psychiatrist? This is easy. Ask around and find the best PCP in your area. Go in for well visit. Talk about what you do. I guarantee any PCP would love to have you as a resource and would reciprocate when you ask a favor. They would likely ask for help in the future. You have not had this relationship in the past? It is very common around here
    So, I’m not looking for a PCP now, but where I live, a good PCP in an employed system that’s been established for many years is going to have a full panel and isn’t going to be taking new patients. Could I try pulling some strings through colleagues? I guess. But as a hospital based psychiatrist, I’m in a bit of a bubble. I’m not much of a referral source and not sure how I’m in a position to grant many favors in return.

    and like I said, the scenario I’m thinking of is mainly several decades down the road when I’m sicker, have left practice, and am even farther removed from general medical knowledge and my professional connections. I’m not so sure I can count on the medical profession to be very generous with its time unless I pay a premium for it.

    Leave a comment:


  • Bellescamp
    replied
    You are a psychiatrist? This is easy. Ask around and find the best PCP in your area. Go in for well visit. Talk about what you do. I guarantee any PCP would love to have you as a resource and would reciprocate when you ask a favor. They would likely ask for help in the future. You have not had this relationship in the past? It is very common around here

    Leave a comment:


  • Lithium
    replied
    Originally posted by Bellescamp View Post

    I don’t get this. If you are a physician you should be getting some degree of “concierge” care when you interact with your pcp. That’s just respect and goes both ways. If you are asking about a non physician person the - “it depends” would apply
    Well, I haven’t had to deal with any acute or chronic medical conditions yet, so I dunno. But I ask this in large part because I’m just a dumb psychiatrist and by the time I need extensive medical care I may have punched out of working in health care for decades - thus I don’t know how much professional courtesy I can really expect.

    Leave a comment:

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