If libraries weren’t already a thing and you proposed the idea in today’s political environment, you would be laughed out of the room and called a raging socialist.
This makes no sense. He needs to have another chat with the ID expert or he needs a different consultant. The underlying reason he's got these problems right now is that HIV is destroying his immune function. He can't receive any usual treatment for lymphoma with those numbers. Chemo and/or radiation would probably kill him. There is no reason he can't take HAART and anti-TB medications. They are NOT exclusive therapies. I don't know an ID doctor who would tell a patient with those CD4 values that they should wait to start antiretroviral medications. There are so many options these days that any major issue can be addressed by choosing the medications that aren't contraindicated and avoiding the few that are.
Not an ID doctor either, but in the setting of active TB sometimes they will delay initiation of antiretrovirals until the infection is partially treated, because there’s a high risk of IRIS (Immune reconstitution inflammatory syndrome).
Hematology - “What is causing the thrombocytopenia?” in a patient s/p solid organ transplant on multiple immunosuppressants, ganciclovir, multiple antibiotics including linezolid, who also happens to be septic… the answer is everything. No, I don’t have a more specific answer than that.
Doctor here, I’ve never seen this. Even if someone’s issue is complete bullshit I want them in-and-out as fast as possible. There’s a very good chance I could be even busier later, and if so, then I’ve just made my problem even worse.
Yep, and then you have the patients who will happily spend 20 minutes talking about their weird eye twitch that happens twice a month for 5 seconds, and then on the way out the door they’ll say “oh by the way, I also get this crushing substernal chest pain radiating down my left arm and into my jaw every time I climb a flight of stairs…”
It’s just community acquired pneumonia in a COPD patient, i.e. a run-of-the-mill, bread-and-butter case that a 3rd year med student could easily answer, because they’ve probably already seen a dozen cases of it. It’s one of the most commonly encountered situations in which you’d prescribe antibiotics.
Same, this is honestly really annoying. I spent the entire day greeting everyone only to find out that I can’t complete it because I can’t talk to Robin. It would be such an easy fix, too. I restarted the day over again when I found out I had wasted the whole thing.
Same exact thing happened to me last night. I could have sworn I had played a straight, but when it scored it only scored it as high card and not a straight. Unfortunately that ended my run, which was infuriating.
Doctor here. For the VAST majority medicines and the vast majority of people, generic medicines are exactly the same as the branded version. There are a few, very rare exceptions to this, for example, if someone is allergic to an inactive ingredient (such as coloring dye) that's present in one version but not in the other. But approximately 99.9% of the time (±0.01%) they're functionally equivalent.
Heme/Onc here, I’m currently rotating on an inpatient Oncology service myself. Inpatient oncology is ROUGH. The sad reality is that if you’re sick enough from a solid cancer to be admitted to the hospital, there’s a good chance that you’re sick enough we can’t do anything about it.
Those were always the most awkward patients to have when I worked Med Surg. They’d be otherwise relatively healthy, get admitted, and think their back pain/cough/and pain/whatever was going to be addressed but really they’re just waiting for Heme/Onc to come see them to tell them that they’re dying. You know their entire life it about to turn upside down and, despite knowing the image results, you’d have to just treat them like you didn’t know they were just full to the brim with cancer.
Heme/Onc here. Don't know if you meant this by your comment, but it did touch a nerve with me: before I meet with a patient, they should already have some idea that they might have cancer. I should not be the one who has to blindside them with that, completely out-of-the-blue. If some suspicious masses were found incidentally on a scan, it's the responsibility of whoever ordered that scan to tell the patient "hey, the scan had some findings and we're worried that they might be cancer. We're going to talk to Oncology to get their opinion." (And usually my response will be "get a biopsy and then we'll talk.") It's not my responsibility to tell someone they might have cancer just because something looks suspicious on a scan that I didn't order.
Yep, that is how I see it playing out. Eventually they’ll be cheap enough and there will be enough research showing that they prevent the long-term complications from obesity that it will make financial sense to cover them for anyone with obesity. If we get an oral formulation that’s equally effective, we’ll see even wider adoption, and they’ll probably just become like statins where everyone is on one.
Except they probably wouldn’t be following up with me, so even just me introducing myself isn’t helpful. Literally I have nothing of value to add to the situation.
I can see your point. I will add some context, though, that our service is stretched incredibly thin and I’m already struggling to see all the patients where we’re actually making management decisions, so seeing someone just because it would make them feel better is pretty low on the priority list.
To be fair, most videogames don't bother justifying or attempting to make their respawn systems diegetic, so it's nice that they tried even if it raised a few questions.
I have a long term patient for whom I'm their PCP and treat their HIV as well. Found to have aggressive prostate cancer that rapidly metastasized. He was awaiting appointments with oncology and gone to the ER twice because of back pain due to mets. ER gave him 4 Norco. My collaborative MD had to have a chat with our CMO to basically get permission to write a bridge Rx for pain meds until oncology took over.
Oncology here, if someone needs opiates that badly for cancer pain, they should probably get a referral to Palliative Care along with the Oncology consult. We tend to be more focused on treating the disease itself rather than the chronic pain (although obviously we will attempt to do as much as possible until the patient can see someone who is specialized in pain management).
If everyone pays penalties according to the same formula based on income, how is that unequal? If you want to pay a smaller fee, you’re welcome to make less money.
Serious answer: You know your relationship better than anyone, but I know if it were me I wouldn’t want it to have anything medical-related. Upwards of 95% of my life revolves around work, I don’t want a big personal moment in my life to remind me of work as well. This might be different since you’re both in medicine, though.
First I'm hearing about this game, it looks really promising! From watching some videos of it, it looks like it has the right balance of taking inspiration for the gameplay from Stardew Valley, but still being different enough to be its own game and not coming off as overly derivative.
yes it will be seen like mercury therapy for syphilis or quinine for malaria or just throwing sulfa drugs at people and hoping the bacteria die before organs do.
Agree with the rest of your post, but there’s nothing inherently bad about sulfa drugs. Yes, some people have an allergy to them, but that doesn’t mean they’re bad or dangerous for everyone. If you don’t have an allergy, then there are no issues with getting a sulfa drug. Some of our most effective medicines are sulfa drugs, like Bactrim or HCTZ…
yes, hence my point was that the problem was "throw them at people hope the bacteria die before organs do". Because of their limited efficacy for many of the conditions they were being relied on to treat they had no choice but to use excessive dosing and keep using them despite side effects because they had no good alternatives.
Still not sure what you’re referring to. “just throwing sulfa drugs at people and hoping the bacteria die before organs do.” makes it sound like sulfa drugs are directly toxic to organs… which they’re not. That’s only in very particular situations.
Public Libraries.
If libraries weren’t already a thing and you proposed the idea in today’s political environment, you would be laughed out of the room and called a raging socialist.
This makes no sense. He needs to have another chat with the ID expert or he needs a different consultant. The underlying reason he's got these problems right now is that HIV is destroying his immune function. He can't receive any usual treatment for lymphoma with those numbers. Chemo and/or radiation would probably kill him. There is no reason he can't take HAART and anti-TB medications. They are NOT exclusive therapies. I don't know an ID doctor who would tell a patient with those CD4 values that they should wait to start antiretroviral medications. There are so many options these days that any major issue can be addressed by choosing the medications that aren't contraindicated and avoiding the few that are.
Not an ID doctor either, but in the setting of active TB sometimes they will delay initiation of antiretrovirals until the infection is partially treated, because there’s a high risk of IRIS (Immune reconstitution inflammatory syndrome).
Hematology - “What is causing the thrombocytopenia?” in a patient s/p solid organ transplant on multiple immunosuppressants, ganciclovir, multiple antibiotics including linezolid, who also happens to be septic… the answer is everything. No, I don’t have a more specific answer than that.
Though I’m sure you’ve also heard the term “therapeutic wait?” Prescribed when the complaint is deemed not ED-worthy.
Doctor here, I’ve never seen this. Even if someone’s issue is complete bullshit I want them in-and-out as fast as possible. There’s a very good chance I could be even busier later, and if so, then I’ve just made my problem even worse.
Even at walk in clinics where patients can literally see the progress happening in front of their eyes they wanna complain about waiting.
Yep, and then you have the patients who will happily spend 20 minutes talking about their weird eye twitch that happens twice a month for 5 seconds, and then on the way out the door they’ll say “oh by the way, I also get this crushing substernal chest pain radiating down my left arm and into my jaw every time I climb a flight of stairs…”
They give these out to everyone, don’t take it personally
Anyone want to take a guess at who is treating her HTN with hydralazine monotherapy? FFS.
I’m not a doctor/health care worker, why is this a simple case?
It’s just community acquired pneumonia in a COPD patient, i.e. a run-of-the-mill, bread-and-butter case that a 3rd year med student could easily answer, because they’ve probably already seen a dozen cases of it. It’s one of the most commonly encountered situations in which you’d prescribe antibiotics.
Lmao I got that quest on my vanilla save and I still couldn’t do it because Robin was building stuff for two days 😭
Same, this is honestly really annoying. I spent the entire day greeting everyone only to find out that I can’t complete it because I can’t talk to Robin. It would be such an easy fix, too. I restarted the day over again when I found out I had wasted the whole thing.
How dare you portray Fortune Feimster like that
Same exact thing happened to me last night. I could have sworn I had played a straight, but when it scored it only scored it as high card and not a straight. Unfortunately that ended my run, which was infuriating.
Branded paracetamol and ibuprofen.
Doctor here. For the VAST majority medicines and the vast majority of people, generic medicines are exactly the same as the branded version. There are a few, very rare exceptions to this, for example, if someone is allergic to an inactive ingredient (such as coloring dye) that's present in one version but not in the other. But approximately 99.9% of the time (±0.01%) they're functionally equivalent.
So the range of times they’re functionally equivalent is 99.89%-99.91%? Or did you mean +/-0.1%?
Haha oops, that I did
Needs some allopurinol
Spirit Farer ⛵
All of the other games in this thread that I’ve played made me cry once, maybe twice.
The clip of her in My Cousin Vinny with the caption 1987 is wrong. My Cousin Vinny was shot in 1991, she was 27/26.
The clip is WRAUNG!!
Heme/Onc here, I’m currently rotating on an inpatient Oncology service myself. Inpatient oncology is ROUGH. The sad reality is that if you’re sick enough from a solid cancer to be admitted to the hospital, there’s a good chance that you’re sick enough we can’t do anything about it.
Those were always the most awkward patients to have when I worked Med Surg. They’d be otherwise relatively healthy, get admitted, and think their back pain/cough/and pain/whatever was going to be addressed but really they’re just waiting for Heme/Onc to come see them to tell them that they’re dying. You know their entire life it about to turn upside down and, despite knowing the image results, you’d have to just treat them like you didn’t know they were just full to the brim with cancer.
Heme/Onc here. Don't know if you meant this by your comment, but it did touch a nerve with me: before I meet with a patient, they should already have some idea that they might have cancer. I should not be the one who has to blindside them with that, completely out-of-the-blue. If some suspicious masses were found incidentally on a scan, it's the responsibility of whoever ordered that scan to tell the patient "hey, the scan had some findings and we're worried that they might be cancer. We're going to talk to Oncology to get their opinion." (And usually my response will be "get a biopsy and then we'll talk.") It's not my responsibility to tell someone they might have cancer just because something looks suspicious on a scan that I didn't order.
I’m just kind of combining both hospitalist/HemeOnc in this comment to be honest.
Haha I figured, which is why I prefaced it the way I did
I imagine the financials would make sense to cover it for people with obesity before they develop expensive comorbidities.
Yep, that is how I see it playing out. Eventually they’ll be cheap enough and there will be enough research showing that they prevent the long-term complications from obesity that it will make financial sense to cover them for anyone with obesity. If we get an oral formulation that’s equally effective, we’ll see even wider adoption, and they’ll probably just become like statins where everyone is on one.
That one doesn’t bother me as much.
Except they probably wouldn’t be following up with me, so even just me introducing myself isn’t helpful. Literally I have nothing of value to add to the situation.
Disagree but I understand why it feels that way assuming you’re a fellow or resident.
I can see your point. I will add some context, though, that our service is stretched incredibly thin and I’m already struggling to see all the patients where we’re actually making management decisions, so seeing someone just because it would make them feel better is pretty low on the priority list.
To be fair, most videogames don't bother justifying or attempting to make their respawn systems diegetic, so it's nice that they tried even if it raised a few questions.
Bonus points for knowing and correctly using the word “diegetic”
I have a long term patient for whom I'm their PCP and treat their HIV as well. Found to have aggressive prostate cancer that rapidly metastasized. He was awaiting appointments with oncology and gone to the ER twice because of back pain due to mets. ER gave him 4 Norco. My collaborative MD had to have a chat with our CMO to basically get permission to write a bridge Rx for pain meds until oncology took over.
Oncology here, if someone needs opiates that badly for cancer pain, they should probably get a referral to Palliative Care along with the Oncology consult. We tend to be more focused on treating the disease itself rather than the chronic pain (although obviously we will attempt to do as much as possible until the patient can see someone who is specialized in pain management).
Sorry- There’s this Constitutional thingy about equal protection under the law, no unreasonable punishment, etc. God Bless America! 🇺🇸
If everyone pays penalties according to the same formula based on income, how is that unequal? If you want to pay a smaller fee, you’re welcome to make less money.
Serious answer: You know your relationship better than anyone, but I know if it were me I wouldn’t want it to have anything medical-related. Upwards of 95% of my life revolves around work, I don’t want a big personal moment in my life to remind me of work as well. This might be different since you’re both in medicine, though.
First I'm hearing about this game, it looks really promising! From watching some videos of it, it looks like it has the right balance of taking inspiration for the gameplay from Stardew Valley, but still being different enough to be its own game and not coming off as overly derivative.
I heard many doctors don’t take any oaths anymore. Is that true?
We still take an oath, just not usually the original Hippocratic Oath. Mostly because it's REALLY outdated. For example, the first line is:
yes it will be seen like mercury therapy for syphilis or quinine for malaria or just throwing sulfa drugs at people and hoping the bacteria die before organs do.
Agree with the rest of your post, but there’s nothing inherently bad about sulfa drugs. Yes, some people have an allergy to them, but that doesn’t mean they’re bad or dangerous for everyone. If you don’t have an allergy, then there are no issues with getting a sulfa drug. Some of our most effective medicines are sulfa drugs, like Bactrim or HCTZ…
yes, hence my point was that the problem was "throw them at people hope the bacteria die before organs do". Because of their limited efficacy for many of the conditions they were being relied on to treat they had no choice but to use excessive dosing and keep using them despite side effects because they had no good alternatives.
Still not sure what you’re referring to. “just throwing sulfa drugs at people and hoping the bacteria die before organs do.” makes it sound like sulfa drugs are directly toxic to organs… which they’re not. That’s only in very particular situations.
[удалено]
Racists don't know about