Has EM gotten so bad that now you guys want to invade my field (pediatrics)?

[GeneralVeers]

Even for androgenic alopecia? I've gone to a few derms to talk treatments and they all just kinda eyeballed my hairline from their stool. Don't want to marginalize your specialty, I just figured stuff like dxing MPB and writing a Rx for finasteride required little clinical judgement and therefore one of the appropriate uses of telemedicine

You don't need alopecia. Most propecia now is preventative in patients with a strong family history. Start taking it in your 20's before you hair starts falling out.

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[VA Hopeful Dr]

You don't need alopecia. Most propecia now is preventative in patients with a strong family history. Start taking it in your 20's before you hair starts falling out.

I generally suggest waiting until you notice some kind of change, generally just very early thinning at the hairline.

 

[Dr Mantis Toboggan]

You don't need alopecia. Most propecia now is preventative in patients with a strong family history. Start taking it in your 20's before you hair starts falling out.

Where were you 20 years ago?!?

 

[GeneralVeers]

I generally suggest waiting until you notice some kind of change, generally just very early thinning at the hairline.

It's often too late by then. The drug is pretty well tolerated in most people with no side effects. Why risk it? Also it keeps your prostate small.

 

[VA Hopeful Dr]

It's often too late by then. The drug is pretty well tolerated in most people with no side effects. Why risk it? Also it keeps your prostate small.

Its too late if you notice "Hey, my hair seems thinner at the front than it did last year"? That's just not true at all.

And its not zero risk, finasteride is known to decrease sperm counts in men with abnormal sperm counts. Giving it carte blanche to a bunch of men in their 20s because they MIGHT lose their hair seems unwise, unless you're getting a semen analysis on them first to make sure they have normal counts as finasteride doesn't seem to affect men with normal counts.

 

[Old_Mil]

. I honestly don’t known that physicians really have a future. Hard to say what medicine looks like in 20 years. We’ll see I guess.

You've hit on a very important point here. Increasingly, every sector of the American economy is dominated by large, management heavy businesses. Such organizations like to engage in what I call "the procedurilization of competence". They hire an army of middle management types whose job is to churn out reams of bureaucracy that attempts to take as much independent thought as possible out of the hands of front line workers. The whole idea of an educated, skilled, independently practicing physician making 200,000 a year is antithetical to this model. They would much rather have an NP strictly following decision trees for 90k a year...or even better, an RN for 50k a year simply doing what a supercomputer told them to do without trying to engage their brains at all.

 

[Birdstrike]

You've hit on a very important point here. Increasingly, every sector of the American economy is dominated by large, management heavy businesses. Such organizations like to engage in what I call "the procedurilization of competence". They hire an army of middle management types whose job is to churn out reams of bureaucracy that attempts to take as much independent thought as possible out of the hands of front line workers. The whole idea of an educated, skilled, independently practicing physician making 200,000 a year is antithetical to this model. They would much rather have an NP strictly following decision trees for 90k a year...or even better, an RN for 50k a year simply doing what a supercomputer told them to do without trying to engage their brains at all.

This is true. It sounds stark, but it's true. For all you pre-meds out there, if this sounds too dystopia to be true, you haven't been paying attention.

 

[Tipsy McStagger]

You've hit on a very important point here. Increasingly, every sector of the American economy is dominated by large, management heavy businesses. Such organizations like to engage in what I call "the procedurilization of competence". They hire an army of middle management types whose job is to churn out reams of bureaucracy that attempts to take as much independent thought as possible out of the hands of front line workers. The whole idea of an educated, skilled, independently practicing physician making 200,000 a year is antithetical to this model. They would much rather have an NP strictly following decision trees for 90k a year...or even better, an RN for 50k a year simply doing what a supercomputer told them to do without trying to engage their brains at all.

*sigh* oh what to do... fight the power and suffer, or just consume the Soma and embrace some Huxleian mediocrity where at least there's no pain.

 

[GeneralVeers]

*sigh* oh what to do... fight the power and suffer, or just consume the Soma and embrace some Huxleian mediocrity where at least there's no pain.

Or just resign en-masse and let the Providers Provide.

 

[Tipsy McStagger]

Or just resign en-masse and let the Providers Provide.

One downside to starting medicine later in life is that I am nowhere close to being able to realistically do this. They've got me, I have no choice but to work (unless I win the lottery which I'm not counting on as I don't play). I'm just their bitch now, and they know it. Fortunately (for now - as there are no more guarantees in this world) I don't have to work in the ED anymore. Probably by the time I'd need to, there wouldn't be any jobs for me anyway.

 

[Birdstrike]

I honestly don’t known that physicians really have a future.

Physicians definitely have a future and it's a future with significant positives. It's just not the one sold to us, or the one we imagined. It's not one where we're anything special. It's one where we're just one of many replaceable assembly line workers, that just so happen to make a little bit (or maybe even a lot) more money. It'll be a career with an upside, just not one worth making great personal sacrifices for. It won't be a career worth being chronically tired for or ever being at work between the hours of 6pm and 6am. It won't be a career with missing a single kids game or birthday party for. It won't be a career worth taking emotional landmines for. Some like me, would say it's already not. Our future is now.

 

[Matthew9Thirtyfive]

Our future is now.

 

[Birdstrike]

View attachment 338010

It's true, if you think about it. You can never go to the past and the future is always yet to come. Once you think you reach it, it's no longer the future. It's the present. The only experience we can ever have, is here and now, in the present.

 

[doctalaughs]

Even for androgenic alopecia? I've gone to a few derms to talk treatments and they all just kinda eyeballed my hairline from their stool. Don't want to marginalize your specialty, I just figured stuff like dxing MPB and writing a Rx for finasteride required little clinical judgement and therefore one of the appropriate uses of telemedicine

Well I suppose an eyeball from the stool or over video you probably will be right 85% of the time and statistically can just assume everything is just male/female pattern. After all, most hair loss cases that I see have already been assumed to be androgenic and treated that way for a long time.

That being said, it takes a closer look to diagnose the other 20 or so types of hair loss (except maybe obvious alopecia areata) and a photo or video won’t do it.

Luckily, it’s not high risk or high stakes if you call everything androgenic— which is why people probably do. Not like they are dying from misdiagnosis. That being said - it’s not great care.