OP wonders if she is the AH for not paying rent to her parents

nicholus_h2 · 2022-10-06T19:53:28+00:00

If they called CPS the child would likely be removed from a situation like this, where it is neglect.

This depends highly on the area. In some places, if the kid has a clothes, food and a roof, they'll leave them with their parents. Rehoming a child can be traumatic, and they have more pressing things to worry about than a child who has their basic needs met. Not to say that the kid is necessarily in a "good" situation or doesn't suffer trauma, but that there are other kids in much worse situations who need rehoming worse.

nicholus_h2 · 2022-10-06T19:19:20+00:00

I am so fucking sick of this subreddit. You 137 guys are like a goddamn cult, you have no brains to think for yourselves. "Oh, but render the fat..." you say, because you hear your cultmates say it.

OP, it's all a bunch of baloney. There is absolutely no proof that 137 renders fat so great. Quite frankly, I don't think 137 does even a hair better than my preferred temp, which is 137.

nicholus_h2 · 2022-10-06T19:12:46+00:00

As a B Rob owner no shot he’s in my lineup until at least next week

too soon.

nicholus_h2 · 2022-10-06T15:02:16+00:00

I get what you are saying, but you have to be realistic.

We are being realistic! Why won't a company come, buy a bankrupt company, and restore all of its customers value, at great cost with no incentive or benefit?

No, I don't care that it makes no sense. No, I don't understand bankruptcy. That's not the point! The point is everything is all about me!

nicholus_h2 · 2022-10-06T14:28:31+00:00

no. that's fucking stupid.

Numerical pain scales are pretty bad. When I think about pain, I think more about how it impacts a patient's functioning. If they can function fine without the pain, versus if they have to stop tasks due to pain, or can't start tasks due to pain.

nicholus_h2 · 2022-10-06T14:19:23+00:00

danger Will Robinson, that's Michigan. What OP refers to is the thing that you connect to your computer so you can see what you're doing.

nicholus_h2 · 2022-10-06T06:39:58+00:00

everybody says let the medical director know. That's good.

On a case-by-case basis, I would start asking "did you discuss this case with your attending? Can I talk to them?" - especially if they can't decide whether a fracture is open or not.

nicholus_h2 · 2022-10-06T05:05:51+00:00

First off, who said I don't do both?

Second of all, the rate of success for telling surgeons they are wrong isn't very high.

nicholus_h2 · 2022-10-06T05:04:28+00:00

Sorry, friend, that's a microscope. What OP really means is a class of people who have a net worth of at least 10^6 dollars.

nicholus_h2 · 2022-10-06T01:23:08+00:00

no no that's menopause. OP is talking about a big, tall single piece of stone.

nicholus_h2 · 2022-10-06T01:16:58+00:00

I can’t read! I sign my name with an X! I once tried to make mashed potatoes with laundry detergent! I think I voted for Nader! Nader!!

nicholus_h2 · 2022-10-05T17:03:16+00:00

Why is that stupid?

Why do you think you get to set my bar for what I hate and what I don't hate?

nicholus_h2 · 2022-10-05T14:40:15+00:00

I mean...there's more to a trade than just value.

If he has three WRs better than Cooks, Cooks for Russ results in the loss of a starting player for a backup WR.

Cooks for Cousins should go through, the only thing they might have an issue with is finding a backup QB, depending on what's available on waivers. Try a QB-WR swap?

nicholus_h2 · 2022-10-05T13:02:39+00:00

Not an excuse, but the ex does sound like he's been dealt an absolute shit situation. He treated OOP really shitty. Again, no excuse. But I am really, really glad I've never been in a situation like his, because I am absolutely terrified that I don't have the strength to do any better than he did.

nicholus_h2 · 2022-10-05T05:12:54+00:00

fake it till you make it is real.

if you act sad and upset, you'll be sad and upset. if you act happy, you won't necessarily be happy, but you will feel better.

nicholus_h2 · 2022-10-05T04:04:20+00:00

because making people work 24 hours a day is cruel. and really annoying beyond 12 goes working in a row will probably yield low quality work.

nicholus_h2 · 2022-10-05T00:22:02+00:00

come on dude, don't explain the joke. just let it breathe.

nicholus_h2 · 2022-10-04T17:41:22+00:00

Yeah, of course I can get mad.

Do you ever get consults or referrals, demanding you order specific labs? What is that? If you think you know what to do, then do it. If you want certain labs, and know what you want to do with them, then order them. Don't refer the patient to have me do it. I'm not here to place orders for the surgeon. How disrespectful is that, to treat me like my job is placing orders for surgeons?

nicholus_h2 · 2022-10-04T16:39:07+00:00

I once had a surgeon call me livid because I cleared and didn't treat an asymptomatic patient with antibiotics who had 1+ leuk esterase on a UA that the surgeon himself ordered as a PAT for a non urologic procedure.

I have surgeons who request that I order the UA. I do, because...I want the patient to have surgery. Comes up with bacteriuria and I don't treat. Talk to the surgeon, tell him about not treating asymptomatic bacteriuria. He orders antibiotics anyways!

You could have done that whole fucking rigamarole yourself without involving me, it probably would have been easier for you, me and the patient. Just...why?

nicholus_h2 · 2022-10-04T16:33:52+00:00

Sometimes a consult is a cry of "fine! It's not my time and money!"

The cry is to the patient, of course.

nicholus_h2 · 2022-10-04T16:29:33+00:00

There are bad consults, and then there are BAD consults.

Who else gets a referral as ridiculous as "hey, do this evaluation. These labs and tests are required, please send the results to my office. If any of them are abnormal, please make them normal before I proceed with care that realistically isn't impacted by them. If you tell me this fact, I'll argue, and then I'll just do whatever I want in an attempt to make them normal, anyways."

I can think of very few other referrals that can be summarized as "I don't have the experience / training / expertise / desire to do this evaluation. Please do it for me. Also, make SURE you take these exact detailed steps and respond to abnormalities in the way I want, please send your results so I can monitor your progress."

If you get that referral on a regular basis, then we can talk about bad consults/referrals.

nicholus_h2 · 2022-10-04T15:58:53+00:00

wait...so, the anesthesiologist needs an echo, so they tell the surgeon to give the patient a form to bring to the PCP that says order an echo and send it to the surgeon?

Uh...ok.

nicholus_h2 · 2022-10-04T14:24:31+00:00

The surgeon and anesthesiologist usually have no access to the patient's cath data, echo, etc

Oh, do they not have records request forms in surgery land?

Without this, all they get is a grainy EKG

How will this change by sending the patient to see their cardiologist? Either the latest EKG is in your EMR that you can see, OR they don't use the EMR and you're going to get a grainy EKG back...

for a patient with a bioprosthetic MVR with ongoing dyspnea and no echo to evaluate the gradients, DI, pressure half time, etc.

what the fuck, if you know you need an echo to proceed with anesthesia, then order the echo. Why would you send them to somebody else to order an echo? Is it better / easier for you and the patient to just order the echo, and review the results? Or is it better to refer the patient, have them go make a separate appointment they may not go to, see a doctor who may not order the test you want, make that staff wait for the results and know they need to fax it to you when it comes in, and then actually do it? Like...why would you purposefully add more steps to this process?

nicholus_h2 · 2022-10-04T14:08:50+00:00

To tie this back...the PCP has not control over the anesthesiologist. Having the patient get evaluated before surgery doesn't change that.

nicholus_h2 · 2022-10-04T14:04:13+00:00

Sure, but the question is: do you ever get that referral, along with a form stating all the "required" parts of your evaluation? Labs / tests that are actually irrelevant? And to send these results to their office? And then, when the referring doctor doesn't know what to do with the irrelevant tests you ordered, do they call you to ask what to do? And then when you say "nothing," do they proceed to do what they wanted anyways?

THIS is what grinds my gears. And I can appreciate that maybe you, personally, don't do that. But some of your surgical colleagues do.

If a patient comes over and they need pre-op evaluation, and I just need to check a box that say "do surgery" or "don't do surgery," I can appreciate that. I get it. Yeah, I'm happy to see the patient. If I get all of that other bullshit? Then I'm not so happy.

nicholus_h2

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