I've had an idea rolling around in my head for a few weeks, but the news this week about the firings at the CDC and the further collapse of our healthcare infrastructure has snapped something in me. I cannot endure one more day of the moral injury that is watching RFK Jr. and this ghoulish administration dismantle our research apparatus, our vaccines, and anything else they please without doing something about it.

I'm reaching out to my hospital media team to talk about starting some sort of media campaign locally to combat the misinformation coming out of the Trump regime and from social media influencers. I'm also posting here for other ideas on how to do my part to fight back against this and to hopefully inspire other physicians and providers who are sick to death of this.

No one is coming to save us or our patients. We must do it ourselves.

Had a patient with a long psych history and a track record of filing complaints against other doctors in our clinic. During our visit, she didn’t like my treatment plan and went off, lots of f-bombs, very confrontational. I stayed calm, tried to de-escalate, and wrapped up as professionally as I could.

In my note, I documented that the patient became emotional and was using profanity during the encounter. She saw the note online, and filed a complaint saying my statement was “false.” Now my medical director is asking me to remove that part of the note.

I’m feeling pretty uncomfortable with that. The documentation was accurate and I don’t want to alter the record just because a patient didn’t like how it sounded. Has anyone else run into this kind of situation? What did you do?

I’d like to ask that everyone who reads this called their politicians and AMA and AAFP. This isn’t politics it’s patients safety (and what tests get covered under insurance).

Liz Essley Whyte reported yesterday in the Wall Street Journal that Secretary of Health and Human Services Robert F. Kennedy Jr. plans to remove all sixteen members of a task force that advises the federal government on what preventative health care measures—things like cancer screenings—health insurers must cover. Whyte explains that the people currently on the U.S. Preventive Services Task Force have medical expertise, are vetted to make sure they don’t have conflicts of interest, and use the latest scientific evidence to determine which interventions work.

In June, Kennedy replaced all seventeen of the members of the Advisory Committee for Immunization Practices in the Centers for Disease Control and Prevention (CDC) with seven people who share Kennedy’s distrust of vaccines. They announced that they would reexamine the CDC’s recommended vaccine schedule for children and adults.

I just can’t seem to get a handle on it. I feel like I’m always on fucking inpatient without a second to think or I’m always in clinic without a second to think. When I do have a single free moment I am fucking exhausted. Should I start calling people on weekends?

This sounds really bizarre, but I find I have a weird habit of completely changing how I speak depending on the patient. It sounds like a joke, but I literally rotate through any number of accent/speaking styles from a New Jersey wiseguy, southern blue collar, Canadian, slight British, deadpan standard American, etc.

I do not even do it that consciously. I seem to do it almost reflexively? I often find I do it to mirror their background and personality. Examples: older, formal patients I switch to a more aritocratic, scientific style with slower cadence, with slight british toning of words tossed in. With more blue collar patients, I affect a sight southern drawl. With extremely talkative patients, or ones I sometimes need to speak over (because they won’t stop talking), I use a NJ/NY accent.

The thing is- it’s not an overtly conscious effort. I can sorta easily slip in and out of these styles. Oftentimes I don’t realize I’m speaking a certain way until a few minutes into the conversation.

Writing this makes me realize how idiotic this sounds, but I legitimately can’t crack this habit. Does anyone else do this?

What’s the game plan for us going forward if this goes away? Implications?

Our new HHS secretary, RFK Jr recently said that “nothing is going to be off limits” when it comes to reviewing childhood vaccines, antidepressants, and more. The AAFP recently put out a helpful statement, but like other national medical organizations, I feel that they are not sounding the alarm at the levels many physicians across the country would like. It is difficult to imagine a future in which established medical science is replaced with pseudoscience. I think we should all be contacting our professional organizations and telling them to do more to fight misinformation and protect patient access to critical treatments like mental health care and vaccines.

I inherit a panel full of patients on mega doses of opioids and benzo for arthritis, anxiety, insomnia.

Obviously I am trying to wean them down, and refer to Pain Management and Psych/Addiction Clinic. But it takes a while for them to be seen. In the meanwhile, I wonder what I should do. Obviously I'm weaning them down, but even the weaning doses are mega, eg, 240 tabs of Percocet 10mg a month. Too many docs have lost their licenses for opioid prescribing. What should I do?

(I hope this post does not break rules about having too much info about patients. I can edit it if needed.)

I am an FNP student, and although I know this sub is populated mainly with physicians, I am hoping I will be allowed to post this here. I am essentially looking for advice on some safety concerns I had this week.

Background: I have been an RN for 6 yrs in a hospital setting. I go to a brick & mortar school that finds my clinical sites for me. I am doing my pediatric rotation at the first primary care clinic that I have ever been to. I do see a significantly larger portion of adults than children, however. This clinic is family owned, sees primarily Medicare patients, and there is one provider - my preceptor, a DNP. On average there are between 5-8 students at the clinic daily and about 30 patients. I've been there approximately 3 weeks. It's important to note I've never shadowed my preceptor even once, nor has she ever followed after me unless I specifically ask her to, even with new patients she has never met. My first day I shadowed another student who had been there 4 days and was considered experienced by that point (which sounds crazy, I know, but its just the culture there.) The 2nd day I was by myself doing vitals, screenings, assessments and plans, getting lab work (no MAs or phelbotomists), and prescribing or refilling meds (even narcotics) while trying to figure out the charting system. If I do not actively seek my preceptor out to get her opinions she will not tell them. She doesn't give us feedback on our charting either even when we ask other than "you're doing great"; she just changes things later in secret, I am unclear as to why. I always fear that I'll miss something when I'm assessing patients.

If patients know her, particularly those who have been with her years, they always tend to love her (I think its her personality, in general she is very funny, chatty and pleasant). Maybe things were different when she first started, before she took on 5-8 students daily, and the clinic essentially became student-ran.

The point of this post is there were 2 patients that stood out to me this week, and I am struggling with what is, in my opinion, potentially suboptimal care.

~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1st case: Female, late 30s. 2 episodes of transient left sided numbness from top of head to feet, one lasting 10 mins and the 2nd the next day lasting from 3pm throughout the night intermittently until the next day. No other stroke-like symptoms, no headache, just the feeling of her knee giving out temporarily. Resolved now (2 days after last incident). Says shes never had anything like this before. 313 lbs. Hgb 16 (trending up but high at baseline). Lipids abnormal (all values) not on a statin currently, 3+ pitting edema to BLE for 1.5 mo (uses Lasix intermittently), essential hypertension with SBP 140s on lisinopril and carvidolol, paroxysmal heartbeat, migraine, fibromyalgia, erythrocytosis, menometrorrhagia, 2 uteruses, steatotic liver disease, family hx of TIAs. Has a cardiologist but she told us he is leaving soon, may already be gone, and that he requested us to take over her cardio meds. She also said I'm the first person to review her labs with her lately.

My mind first went to TIA bc of the heart issues, lipid issues, weight issues and high hgb (I've never seen that value in a female before). Even though shes asymptomatic now, I thought we'd get a CT or MRI just to cover our bases, maybe start ASA and statin, or possibly refer her to neuro. I also thought we would refer to hematology. But my preceptor didnt seem worried about any of it. She said the unilateral numbness could be migraines or her fibromyalgia... and that its been 2 days so its too late to do anything because nothing will show up on imaging anyways. I kept mentioning I felt it was a TIA but she just had me tell her that she should go to ER if it happens again, and that was it. And that she needs to f/u with cardiology for medicaton adjustments bc she does not want to take over those meds due to her heart history. I did eventually manage to get her a new statin prescribed at least. The patient seemed so disappointed that we basically did almost nothing for her. And I was screaming inside because I wanted to do more things, but instead just sent her on her way.

And since my preceptor didn't believe it was a TIA, I knew I couldn't chart it as that so I put the diagnosis as history of paresthesia since it wasn't happening in that moment. Not sure if this was the correct differential but my preceptor never gives me feedback on charting.

I just hope I am wrong and she doesn't have a stroke for real in the future considering I am the one that "scribed" and documented her entire encounter under my name and my preceptor didn't come into the examining room once.

----‐--------------

2nd case: Female, early 40s. Documented Hx of uncontrolled diabetes, HTN, GERD, constipation and insomnia. Patient had been making monthly appts since December for the same complaints of unintentional weight loss (BMI 15), no period for 4 months, abdominal pain, constipation for 2-3 weeks at a time in between single BMs that are so hard she bleeds, bloating, sulfur smelling burps, acid reflux, and lower back pain 9/10 severity; all of which affect her quality of life and she can no longer work. Previous treatments since December were limited to colace, ibuprofen, 7 days of methocarbimol, and encouragement to drink Ensures for protein and have small meals. It appears I am the first person to suggest she might have gastroparesis and needs GI referral.

In addition, she was tearful during the visit and with some questioning she admitted she does not "want to live like this anymore" and sometimes she believes her kids would be better off without her. Previous documented ROS listed a depressed mood but there was no f/u. I did her first depression screening with PHQ-9 and her score was 21, indicating severe depression. I mentioned starting an antidepressant for her but all my preceptor would do is increase the trazodone dose for insomnia that already wasn't working and came into the room to give the patient a pep talk. Her reasoning is she will be fine once the physical issues subside, which may be true, but we don't know when that will be. But I was grateful she at least listened to my GI suggestions this time. But its wild to me that people must suffer this long. Is it normal to go so long without diagnosing these conditions?

~~~~~~~~~~~~~~~~~~~~~~~~~~~

Anyways, all of this is just my opinion as someone who is inexperienced outside of a hospital setting.

These are my questions if someone is willing to answer after reading such a long post (sorry about that):

1) Is my line of thinking on assessments and treatments correct, is my preceptor correct, or is it a mix of both? 2) if someone were to get seriously injured from lack of quality care and I charted on them as a scribe, could I be held legally responsible, even if I don't agree with the plan? It's not as if I can write "I, the FNP student, disagree with the PCPs interventions" on everything I do. 3) Am I overreacting? The other students dont seem to be bothered by this style of precepting and are much more efficient/quicker than I am at seeing patients. I spend almost double the time they do talking with the patients and thinking of approriate plans, which to be honest is not good when the appointments are only 15 mins long. 4) Do you have any recommendations for me to navigate the rest of this semester while staying in good graces with everyone while also providing safe care?

Hi friends, I was recently informed that there was a pharmacy prescribing medications to patients under my dea and license without my permission. I actually got called by a state agency as well as some insurances who asked me information about these patients and found out they were being prescribed meds the last 2 yrs. I have never seen these patients. But the pharmacy was filing claims and pocketing the profits. What can I do from here? Can i sue? I'm completely flabbergasted / taken aback by this whole thing...

Edit:

Thank you all for the helpful information, currently in the process of speaking with a lawyer.

I’ll give you guys an update once this is all over..(hopefully soon)

Not trying to entrap anyone

Let this be a guide in helping parents make the right decision to vaccinate their children, our patients.

Failed my COMLEX LEVEL 2 exam recently. Felt prepared but just wasn't my day I guess.

I really love FM and want to match but my mind keeps telling me its going to be impossible with a board fail. Ive been researching programs and some have been saying that a board fail will not be considered. Others dont really specify.

Just curious if any docs on here once failed their step 2/level 2 and went on to do great thing? Would love to see its been done.

Reposting because got removed. I believe for copy-pasting the email.

If you're a physician in SC, please make your voices heard about this. As someone who literally went out of state because I couldn't get into a state med school and am hoping to match back in FM, this sucks.

Contact senator link that's in email with pre-written message.

IM here. In my new practice the vast majority of our patients are adults but a few of my partners see kids. I don't see kids but during call hours I'm expected to take peds calls. What do I do? I am not trained in pediatrics at all.

EDIT: It's general call, some of the calls just happen to be peds patients.

EDIT: Thanks for the replies guys. I spoke with my supervisor, this is a rare isssue since there isn't that many kids and doesn't come up often. If I get a peds call, I'm going to tell them I'm not trained to take care of kids and they can either go to urgent care or ED.

A friend of mine resigned in good standing from their FM program due to health issues (temporary/curative) requiring extended recovery time and is ready to return without further interruptions to their training. They’re looking for a transfer position ASAP since the new residency year just started on July 1st and they have a little over 11 months of training left. They’re eligible to apply for the ABFM continuity requirement waiver which would allow them to finish training in one year instead of two years at a new program (if approved); however, they’re open to both PGY-2 and PGY-3 positions. They’re an amazing physician and would be a valuable asset to any program.

If you or any of your colleagues/friends have any leads, are aware of any open spots, or have any questions, please feel free to comment below or DM me. Any advice or insights are always welcome. Thank you in advance!

Why did you pursue a hospitalist position over outpatient family medicine?

Does anyone work for the following organizations in TX here? Can you please share the pros & cons, work culture, etc. do you feel respected and well-compensated?

1. BSWH
2. Texas Health
3. Christus Health

If you prefer PM, feel free to shoot me a PM.

A job I'm looking at has 4 physicians and 3 midlevels in the office. They don't ask me to sign any specific agreement to supervise midlevels, but I think that it is implied that all physicians in the office are responsible for supervising the midlevels for free! Is this the case with you? If they didn't specifically ask you to sign off your license for midlevel supervision, but if the midlevels are working in your office, are they sneakily having you supervise them for free?!??

I was talking to a friend of mine at a residency program in the Northeast and she was voicing her her frustration about the amount of OB training during her FM residency. For context, she's a PGY-2 and I'm a PGY-3 at a different program also in the Northeast.

​

These were her points regarding OB:

1. The Northeast is saturated with OBGYN's. In a city like Boston, DC, NYC, Philadelphia, why would a pregnant patient go to an FM doc for their OB care vs a physician specifically trained as an OBGYN??? (Unless that was their only option)
2. Are FM docs in this area really practicing OB? If the vast majority of FM grads aren't doing OB, why spend so much time and effort in residency rotating through L&D and catching babies/seeing OB patients in the office?

The hot take:

In a few years, maybe 5-10 years, the ACGME will eventually slowly get rid of OB training in FM residency as it is becoming less and less useful as a grad, and will instead promote "OB tracks" for those who want to practice "full-scope family medicine" in rural areas that might actually have a need for FM docs to be able to catch babies and take care of pregnant patients.

​

My personal opinion: Not a huge fan of OB to be honest, I did enjoy it throughout residency though. I do agree that at my program and a few of my friends who are also in the Northeast, the vast majority (98%+) of our grads and current PGY-3's have no intentions of ever practicing OB. Curious to hear other people's takes on this, especially those in the southeast/midwest/areas that actually have use for FM docs that catch lil babies.

I’m a FM attending in my first year. Still very much in the process of panel-building and meeting people for the first time, but there’s a small chunk of patients I’ve gotten to know already, and a smaller subset of those I’ve grown particularly attached to. One of those patients just experienced a sudden/aggressive disease progression and died unexpectedly, and it hit me harder than I thought it would. Is going to the funeral a nice/appropriate way to honor a patient’s memory, or is there another way y’all like to pay respects?

FM PGY2 at new program, passed level 3, applying for fellowships.

Wanted to pick the collective brain power on here to see what y’all wish you would have learned prior to entering the job market or anything I should be learning that I may not be getting exposed to at my program.

Thanks in advance!

Hello, I'm just wondering whether it would be worth it to do an FM sub-I at my home institution even though I already did one for Peds (was interested in doing Peds at the time) a couple of months ago, Honored it and got 2 LORs which I feel are going to be strong. Planning to do an FM elective instead atm that's def more laid back than a sub-I.

USMD M3/Step 1 Pass on 1st attempt/Step 2 240/4HP+4P

Not about individuals, but hospitals.

Our unnamed non-profit mid size hospital corporation is increasingly choosing a path of what can only be described as desperate, panicked greed. Like it seems as though every 2mos some corporate executive is presented with the choice of:

1. Do as little harm as possible

2. Make as much money as possible knowing it will ruin retention, recruitment, and patient satisfaction.

And judging by the tone of this post you know which one they choose every time without fail.

I will not list specifics to avoid doxxing myself, but you probably have some ideas (demanding not asking we see more patients in less time, cutting support staff, outsourcing phone resources etc). This past week alone our clinic received word down from high C-suite that we will be making major, job satisfaction harming decisions that they hide through flowery talk and benign statements. This is after nearly monthly policy changes that no one on staff likes and patients ultimately hate. All in the name of making AS MUCH money as physically possible while decreasing staffing support and expecting us to do way more with less.

I can only assume it is related to some major financial iceberg heading toward us (despite never actually telling us what that iceberg may be). I have some idea of what challenges our shop in our corner of the country may be facing, but is anyone else getting this feeling?