A letter to the SEC. anything I should add before sending??

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Pharmacist here - I posted several months back about starting a pharmacy geared toward lowering the cost of meds by filling just generics and pricing them just above my cost + a dispensing fee. Many showed interest. We are up and running in Virginia. AMA

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  1. If your response to a positive anxiety screen is to Rx a benzo then there are bigger problems than the USPSTF recommendations.

  2. What are the recommendations of that screen positive? I can’t access the actual document now, but I’m sure send to psychiatry. Today, most are NP, and all recommend drugs. Just what I have seen. Doesn’t mean it’s right or wrong, just where medicine is.

  3. In pediatrics I would be expected to properly assess for an anxiety disorder, make a diagnosis if appropriate, and discuss SSRI +/- psychology. Psychiatry is reserved for a small minority of cases. I assume FM is the same.

  4. Great, you discuss SSRI, they come back next week, it’s not working, even though you told them, 6 weeks trial minimum. We need something quick. How about some Xanax ? 😋

  5. I should add they had a plain film XR of pelvis and bilateral hips the day before as well as a CT pelvis w/bilateral hips. All of which had reports with relevant findings.

  6. Nurse - Doc, left leg pain, can I order an xray” Doc - Right Order- right leg xray, he did say right

  7. PTO off I have seen but that’s unacceptable to me. We have let the suits boss us around

  8. Agree with what others have said, absolute must on the 2hr preshift nap. Only thing I have to add is I go for an evening run before my shift. Even just 20 mins. I find it wakes me up pretty well, along with the shower. I bolus 200mg caffeine on the way in, redose around 2-3AM.

  9. It sounds like Caffeine, exercise, will be best help

  10. Full time nocturnist for 6 years- sleep late day of first shift. Don’t do anything too strenuous that day- light workout or yard work, relax. Dinner before shift - eat light as heavy meal will make you sleepy. Sugar free monster or this stuff I got from GNC “Neuro Lean”. After shift, breakfast, melatonin, bed.

  11. I was thinking about melatonin, that is great advice.

  12. That's a good setup. Our ER has too much turnover unfortunately (all of our departments do, no one wants to stay here). People who are new to our hospital don't always feel comfortable putting in a PRN Zofran or Tylenol unfortunately. If I ask for it explicitly they will but it can be hard to remember when you're being woken up for the third time since midnight at 2:30 in the morning.

  13. It definitely adds up. It makes no sense for you to do admissions, when they have someone already up doing the work and much shorter interval. I understand the turnover, but the problem is, if you don’t have the CEO and other management input, will be hard to make change.

  14. An order set is a good idea. Our old EMR from the 80s had limited ability to do sets but we recently moved a new one that would be able to do it.

  15. Admissions from 7 am to 7 pm go to the Hospitalist. After 7 pm, they get “tucked” in. It’s not that rigid, we are available for phone until we go to sleep mode I suppose. If there are critical patients or really sick patients that need an MD, I am happy to come by and help out, but generally if they are that sick, the Ear will transfer to higher level as we don’t have specialist all the time. We had them doing both inpatient and Er over the years, and so they have a grasp on both sides. Nurses just know not to call me, after 9ish. It has worked for me.

  16. Oh. I'm not sure. Now that you mention it, it's probably being paid for by the state . . .

  17. I have noted that a lot of hospitals were using government resources for staffing, because that cuts their overhead. Its all about profits !! The admin stopped caring about patients long time ago.

  18. I would disagree, if you are in the northeast, I can potentially see the issues. In the Midwest, south, it appears to be easier to get in.

  19. I complete these all the time in rural ER and don't get push back.

  20. ER physician, technically EMTALA requires medical stabilization for an emergency. If you show up with a tooth ache, and I examine you and determine this is not going to kill you. I can just document that, I am under no obligation to treat you.

  21. None of the things you said would immediate indicate a front line doc would be better at the job . I’m assuming you have no actual experience running a massive business with millions in revenue and thousands of employees while dealing with the labyrinthine rules/regulations of healthcare . Please correct me if I’m wrong and you’ve actually worked your way up and have been a CMO for the last 10 years.

  22. Those are solid points. Politics has its own mess.

  23. It’s bad everywhere. Hospitals don’t care about employee safety. I got the privilege to see all the patients when all the clinics decided their safety was more important than mine and all patients were sent to me to see. I didn’t have equipment, or safety stuff. Bought my own supplies on the black market.

  24. Do you use your MRI in the ER for non urgent issues like that? We don’t.

  25. No, but we do get patients sent over for non urgent issues to get MRI, because they can’t get prior authorization or don’t want to and we are expected to order them. Patients come expecting it all the time

  26. The problem stems from other providers sending patients and telling them what we will do. I have had arguments with them stating don’t create expectations. I will order what I feel is appropriate, or you can order on your license. Hasn’t stopped people.

  27. Is Wells Fargo ever not under investigation. I'm surprised people still bank with them, I left as soon as their first shit came out.

  28. This is why people should review online banks more often for better/cheaper services; especially those that rarely use branches or in-person services.

  29. Can’t do everything at online banks. Lots of restrictions. I had online banks just close my account, randomly. Need to send wire transfers, receive large amount of money etc etc. can’t do that online.

  30. It’s sad, they will ignore this. We need major change in the country, with all the politicians that are bought and sold, change won’t happen unless our own stand up.

  31. Saw one and admitted, it’s like the old COVID, multifocal pneumonia, elevated dimer, the whole 9.

  32. Generally, you buy land, that’s how I understood it.

  33. Again….. Just because someone has worked for a consultancy at some point in their business career, doesn’t mean that they are part of a grand conspiracy to take down businesses.

  34. True, but why take a risk when you have better options

  35. Hey, love the concept and idea. Would love to get involved. You want to expand to Colorado, or Wyoming?

  36. They can make our training as long as they want. It won’t reflect in better salary. The hospitals will continue to pay the NP/PAs, they cost less and are able to bill. Especially, they will order any test known; more revenue for hospitals. If anyone thinks the hospitals care about outcomes, you are kidding yourself .

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