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I think that this thread has moved out of the scope of general residency issues, and should be moved to TIH.
private practice, matching issues, midlevels, and more
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don't act like im the representation of these 15,000 residency spots, they will be much like yourselves, more versed and eloquent in the science of medicine. im just one of the outlier country bumpikin style docs that don't like to show off knowledge and like to talk to the patients at a level they can understand as well as to all people, so they can understand and not be way above their heads like most doctors like to sound. to me thats just not my style. but more power to you if you think thats the way all docs should be. but don't be prejudice and try to leave people like me entirely out of the whole system just because im not like the people of SDN. 
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docu, I AM a primary care doctor, who sees general practice patients. I'm board certified by the ABFM and completed an FM residency. And the way you took care of that patient was...not great.
Antibiotics are not the optimal way to treat most cases of sinusitis. And yes, sinusitis is a clinical diagnosis, but you missed a few other diagnostic criteria.
Since you clearly don't seem to understand the pathogenesis behind true bacterial sinusitis, it is a disruption in the muco-ciliary clearance of the sinuses. NOT from bacterial or yeast overgrowth. And trust me, if the Cipro caused a yeast infection that "traveled" to the sinuses, and the patient DID get a fungal sinusitis as a result....they would be pretty sick. Fungal sinusitis is rare. And Ampicillin wouldn't treat a fungal sinusitis anyway.
Which antibiotics are first line for UTIs varies highly by geography. Just because a patient had symptoms after completing Cipro does not mean that the UTI was fully treated - I have had a number of patients with Cipro-resistant UTIs. But you did not get a culture despite a treatment failure, so it's impossible to say whether or not the patient was adequately treated. Your description of your treatment plan and thought process behind it is below the level of what I would expect an FM PGY-2 to know. It's below what I think an FM intern should know.
Just because patients love you does not mean that you are a good doctor. And just because you're "better" than some doctors who push narcotics or an NP or a PA, doesn't mean that you're a good doctor, either.
Antibiotics are not the optimal way to treat most cases of sinusitis. And yes, sinusitis is a clinical diagnosis, but you missed a few other diagnostic criteria.
Since you clearly don't seem to understand the pathogenesis behind true bacterial sinusitis, it is a disruption in the muco-ciliary clearance of the sinuses. NOT from bacterial or yeast overgrowth. And trust me, if the Cipro caused a yeast infection that "traveled" to the sinuses, and the patient DID get a fungal sinusitis as a result....they would be pretty sick. Fungal sinusitis is rare. And Ampicillin wouldn't treat a fungal sinusitis anyway.
Which antibiotics are first line for UTIs varies highly by geography. Just because a patient had symptoms after completing Cipro does not mean that the UTI was fully treated - I have had a number of patients with Cipro-resistant UTIs. But you did not get a culture despite a treatment failure, so it's impossible to say whether or not the patient was adequately treated. Your description of your treatment plan and thought process behind it is below the level of what I would expect an FM PGY-2 to know. It's below what I think an FM intern should know.
Just because patients love you does not mean that you are a good doctor. And just because you're "better" than some doctors who push narcotics or an NP or a PA, doesn't mean that you're a good doctor, either.
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HA! read it and weep!
Antibiotics Causing Sinus Infections
There are two types of bacteria: good bacteria, which lives in the intestines helping to digest food and strengthening the body's immune system, and bad bacteria, which causes illness and infection. Antibiotics can't tell the difference between the two, so taking them before a bacterial infection has been determined causes more harm than good. According to the Annapolis Chronic Fatigue and Fibromyalgia Research Center, short-term sinus infections can be turned into chronic infections by the use of antibiotics. Yeast infections, long associated with antibiotic use in women, can travel to the sinuses. According to Dr. Marjorie Greenfield of the Case School of Medicine and University Hospitals of Cleveland, studies have shown that between 25 and 70 percent of female patients develop yeast infections following antibiotic treatments.
Did you seriously just quote:
A. An ehow.com article?
B. The "Annapolis Chronic Fatigue, Fibromyalgia and Generally Just Bat**** Crazy Research Center"
...to support your assertions?
don't act like im the representation of these 15,000 residency spots, they will be much like yourselves, more versed and eloquent in the science of medicine. im just one of the outlier country bumpikin style docs that don't like to show off knowledge and like to talk to the patients at a level they can understand as well as to all people, so they can understand and not be way above their heads like most doctors like to sound. to me thats just not my style. but more power to you if you think thats the way all docs should be. but don't be prejudice and try to leave people like me entirely out of the whole system just because im not like the people of SDN.
No one in this thread implied that they like talking to patients at a level way above the patient's head.
HA! read it and weep!
Antibiotics Causing Sinus Infections
So are you implying that the cipro gave your patient a fungal sinus infection? Did you treat your patient with an anti-fungal for it?
You got likes and nice comments from people who aren't in medicine and don't know any better. You are getting "derogatory" remarks on SDN because the people on here are in the field of medicine.
According to the Medscape article you quoted: "Empiric antibiotic selection is determined in part by local resistance patterns. In addition, clinicians may wish to limit use of TMP-SMX in order to reduce the emergence of resistant organisms." So the article you are using as evidence actually says that you should use resistance patterns to select treatment...
Furthermore, Gutonc is a physician who completed a residency in internal medicine prior to a fellowship in medical oncology... Not a gut doctor.
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first, lets get it straight that i never once, said that cipro caused a yeast infection in the sinuses...i said it caused a BACTERIAL infection in the sinuses.so don't even say that i said it was a yeast infection or fungal infection. but i could be wrong, i think that cipro actually cures sinusitis so why would it cause it? maybe it was viral and a coincidence while she was taking the cipro, which seems more plausible. but you never know, she was on 7 days of cipro, so it could have caused resistance of bacteria somehow somewhere. you never know, making the infection appear i more immediately than it would have otherwise without the excess cipro.
secondly, you do not know what level i am. i dont think u are correct in what you are telling me yourself, no offense.
A UA was obtained, so there you go for your culture. it showed bacteria. burning on urination (symptomatology) is what she still had. i did continue treating the patient with ampicillin after cipro did not clear the burning. but only because she said she took it before and it cleared it and cipro made her feel awful. i know amp is not used like that but sometimes patients do know their own bodies. but i thought it would dually help the sinusitis if she did have it and the UTIbut yeah i was probably wrong to do that.. this is my first day in the clinic.i do home care which is much more empiric, so its a big change for me and im trying to get used to it. but i also believe that symptoms matter in the treatment of a patient, not just sheer academic numbers, figures, and facts obtained on a urine culture.
This is Uptodate's take on Urine Culture:
Urine culture — The causative organisms and their antimicrobial susceptibility profiles are frequently predictable in women with uncomplicated UTI. However, given the increasing prevalence of antimicrobial resistance among uropathogens, obtaining a urine culture prior to initiation of therapy is warranted if symptoms are not characteristic of UTI, if symptoms persist or recur within three months following prior antimicrobial therapy, or if a complicated infection is suspected
ok so i should get a urine culture since symptoms persisted. i am not used to that,because this never happened to me before.
However,isn't cipro for 3 days? well this NP gave it for 7 days. cipro is more for pyelo than anything else.
i think the main thing is that SDNers hate me and want me to be wrong so find every reason to make me wrong and bad and undeserving and no good, but i dont believe any of the negative things you call me. im much better than that. and i know REAL live people don't think as low of me as you rude SDN people do.
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you didn't give their research a chance so that makes you crazy to think you know something you've never in your life researched before or even looked up. so that mak es you just as bat dung crazy as you say i am.Did you seriously just quote:
A. An ehow.com article?
B. The "Annapolis Chronic Fatigue, Fibromyalgia and Generally Just Bat**** Crazy Research Center"
...to support your assertions?
no need for insults unless you want to stoop to that level.
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A urine dip will indeed tell you if she had bacteria.... But not what kind. As she had failed the first antibiotic, a true culture would have been in order. Not just a dip. You need to know what you are treating, not just treat with an antibiotic you pull out of a hat. Perhaps a Sanford guide should be in your pocket. Or at the very least, consult epocrates. Or your medical school textbooks.
A good true clinician will use appropriate resources. Ehow doesn't make the cut for peer reviewed appropriate resources. Neither does fibromyalgia pain clinic. And especially not for a uti.
And finally, treating for a sinus infection with antibiotics so early on without appropriate conservative measures.... I just can't bring myself to comment on that one. I just can't. There is only so much a person can hear at once.
I also refuse to comment on the nice comments you received on Facebook or twitter or whatever. I don't know the background of the commentators, so any comment about their comments would be inappropriate. They are also not likely to be objective in their support of you as they are friends and/or family so of course I would expect them to support you. That's what they are for. Support. They are not there to give you honest professional opinion.
A good true clinician will use appropriate resources. Ehow doesn't make the cut for peer reviewed appropriate resources. Neither does fibromyalgia pain clinic. And especially not for a uti.
And finally, treating for a sinus infection with antibiotics so early on without appropriate conservative measures.... I just can't bring myself to comment on that one. I just can't. There is only so much a person can hear at once.
I also refuse to comment on the nice comments you received on Facebook or twitter or whatever. I don't know the background of the commentators, so any comment about their comments would be inappropriate. They are also not likely to be objective in their support of you as they are friends and/or family so of course I would expect them to support you. That's what they are for. Support. They are not there to give you honest professional opinion.
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shyrem, i already know that you wait 5-7 days before tx a sinus infection. just that she had a persistent UTI after 7 day course of cipro and she told me that ampicillin helped her last time with her UTI without making her feel so bad, so i was like ok fine here ya go. it is indicated for bacterial infections in general so i dont see any harm done in that...and it is also the drug of choice if one is allergic to tmp smx in pregnancy so i thought why not. i guess she was already on cipro which is for refractory, if it is still refractory what do you do? give cipro again? (she refused to take any more cipro)...also she was allergic to TMP SMX. now thats kind of a tough question that i dont know the answer to. anyone know?
i can't find anything credible but found this little story: not that im against abx (obviously im not lol)
Can Antibiotics Cause Infections?!
A hospital in Glasgow thought so. Faced with having to close down its neuro surgical intensive care unit due to severe cross infections, the hospital elected to discontinue both preventive and therapeutic antibiotic therapy!
Results? First there was an immediate decrease in chest and urinary cross infections. Within 30 days the cross infection rate dropped to zero. Remarkably, the incidence of all infections was reduced; the respiratory infection rate falling from 45% to 15%, and the urinary infection rate falling from 21% to 8%. There were no serious problems related to discontinuing antibiotics--only good results.
Making a decision like this does not come easy. Especially when many of the patients were already on what was considered "life essential" antibiotic therapy. The staff of the hospital is convinced that many infections resolve in spite of--rather than because of-- antibiotic therapy. In other words, that means that your own body is responsible for clearing most infections. Most telling of all, they are convinced that "--the primary cause of many infections (most often attributed to germs or other causes) is in fact the misuse or overuse of broad-spectrum antibiotics".
Now here's the real kicker. This happened in 1971. It's taken more than 25 years for the medical community to wake up and finally admit that the "magic" has gone out of the "magic bullet".
PS: this convo makes me feel like im lecturing my case at a surgical M&M!!!! LOL
i can't find anything credible but found this little story: not that im against abx (obviously im not lol)
Can Antibiotics Cause Infections?!
A hospital in Glasgow thought so. Faced with having to close down its neuro surgical intensive care unit due to severe cross infections, the hospital elected to discontinue both preventive and therapeutic antibiotic therapy!
Results? First there was an immediate decrease in chest and urinary cross infections. Within 30 days the cross infection rate dropped to zero. Remarkably, the incidence of all infections was reduced; the respiratory infection rate falling from 45% to 15%, and the urinary infection rate falling from 21% to 8%. There were no serious problems related to discontinuing antibiotics--only good results.
Making a decision like this does not come easy. Especially when many of the patients were already on what was considered "life essential" antibiotic therapy. The staff of the hospital is convinced that many infections resolve in spite of--rather than because of-- antibiotic therapy. In other words, that means that your own body is responsible for clearing most infections. Most telling of all, they are convinced that "--the primary cause of many infections (most often attributed to germs or other causes) is in fact the misuse or overuse of broad-spectrum antibiotics".
Now here's the real kicker. This happened in 1971. It's taken more than 25 years for the medical community to wake up and finally admit that the "magic" has gone out of the "magic bullet".
PS: this convo makes me feel like im lecturing my case at a surgical M&M!!!! LOL
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You guys realize this clown is just F-ing with you right?
Macrobid is a pretty decent drug for uncomplicated cystitis, with very low resistance. It is rapidly excreted into and highly concentrated in the urine, so rapidly that it is not bioavailable in any body tissues (including the kidneys for that matter, which is why it cannot be used to treat pyelo). This is favorable because it decreases both the development of resistant bacteria and the disruption of normal flora in other systems. Definitely considered by many sources to be a first line rx for simple uti.
Bactrim also a good choice, probably the best. Although resistance is increasing, most women with uncomplicated cystitis have clearance of bacteria and resolution of symptoms on Bactrim EVEN IF their culture grows Bactrim resistant strains. Pretty cool.
Cipro also good first line choice, though it is probably overused. Quinolone resistance in uropathogens is becoming a pretty big problem.
Macrobid is a pretty decent drug for uncomplicated cystitis, with very low resistance. It is rapidly excreted into and highly concentrated in the urine, so rapidly that it is not bioavailable in any body tissues (including the kidneys for that matter, which is why it cannot be used to treat pyelo). This is favorable because it decreases both the development of resistant bacteria and the disruption of normal flora in other systems. Definitely considered by many sources to be a first line rx for simple uti.
Bactrim also a good choice, probably the best. Although resistance is increasing, most women with uncomplicated cystitis have clearance of bacteria and resolution of symptoms on Bactrim EVEN IF their culture grows Bactrim resistant strains. Pretty cool.
Cipro also good first line choice, though it is probably overused. Quinolone resistance in uropathogens is becoming a pretty big problem.
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So like today this one doctor in this one city saw this one patient. I know what early onset Alzheimers looks like and instead of getting this patient (an attending himself might I add) the proper medical care, the other doctor misdiagnosed it.. didn't provide the OP.. err... I mean the patient with the proper care and treated him for erectile dysfunction instead which subsequently caused aneurysms in people trying to decipher an online post by the said patient. This is why the govt needs to make 15,000 new NP/PA spots to fill the doctor shortage instead of replace them with residents and attendings.
O and the usual SDN trademark at the end.. n=1.
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point being made that we need to push for 15,000 residency spots, so we can't have NP's that don't know how things are done, even moreso than even I don't know. You think I dont know anything? what about them??? an NP gave this poor lady 7 days of cipro....instead of 3 days like epocrates says. the lady said it made her feel sick! and cipro has a high side effect profile. its something you want to minimize taking. the NP told the lady she had to get a colonoscopy for hemorrhoids....when its a sigmoidoscopy...i just felt sorry for this poor woman. she knew she wasn't being treated properly by a nurse practitioner and was happy to see a doctor to set her straight. i sent her to see a gen surgeon asap the same day to get her hemorrhoid removed. i looked at it and it was external, not internal like the NP stated. it could just be banded and removed. this poor lady was in severe pain. not to mention she was going to be in a horse show thie next day and had to ride a horse on a saddle!! ouuuuch! well i might be wrong, im not a surgeon. i know the thrombosed hemorrhoid could be diminished nonsurgically in 1-2 weeks with sitz baths and pain meds, but this lady didn't have that kind of time. i was thinking she could get it removed.
we dont need no stinkin nurse practitionerz!
we dont need no stinkin nurse practitionerz!
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Spoken by a pharmacist who's entire life and living primarily depends on a doctor's signature. the more doctors there are, the more business you will get. but i guess you can't see that, ur an ungrateful pharmacist for God's sake. u want more NP's and PA's, well less doctor signatures for you i guess.
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Off topic, but one of my former medical assistants used to think I should get tested for Alzheimer's. She's like maybe you should see a neurologist and be on Alzheimer's medications. People are stupid and don't know anything.
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Spoken by a pharmacist who's entire life and living primarily depends on a doctor's signature. the more doctors there are, the more business you will get. but i guess you can't see that, ur an ungrateful pharmacist for God's sake. u want more NP's and PA's, well less doctor signatures for you i guess.
Nah, its the attitude of certain professions (including my own) that seem to suffer from narcissism and can't come to terms with the fact that there are many tasks that can be delegated to other professions. Like for example, take a vending machine and put pills in the said machine and voila! You have essentially replaced 70% of retail pharmacists.
Also, I couldn't care less about my business. I am more interested in best care for the patient. If costs can be kept down with mid-level help and the patient gets similar quality of care provided by a PCP, why not implement such measures and broaden access in a time when the healthcare system is in dire need of PCP's?
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A doctor is the best PCP you can get. why do you want a lesser version of a doctor if you care so much about the best care for your patient looks like you care more about cutting down costs in someone else's office that isn't even yours. that is not caring about care, that is caring about being a cheapo. I dont mean to insult anyone but NP and PA help out in the office but they can't really take charge or fully own up to things like a doctor can, espeically liability issues. you'll see a doctor correct themselves so much faster and better. They can work for docs and run the office while the doc just signs everything, but other than that, that is all they really can do to the highest capacity. not to be egotistical, but i find this true. NP and PA do not have the same extensive training as a doctor and they are not put to the test like a doctor is, so the care is mediocre to less. I have noticed this. they don't even have to do residency like a doctor. they just go straight out of school to their job. they have never jumped through the hoops a doctor has had to.
I work with a PA and he does bulk of the work, but I still have to see the patient myself in addition to him and sign things and do the prescribing and ordering, that is like doubling up on work, so maybe in fact, it is costing more, but it just makes the docs life easier. I mean this PA is doing the work of a nurse that would cost even less. But maybe because it is a hospital they want him to work as such. i dont get it but thats how it is where i work.
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you didn't give their research a chance so that makes you crazy to think you know something you've never in your life researched before or even looked up. so that mak es you just as bat dung crazy as you say i am.
Just so we're clear...I didn't call you crazy. But you did.
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No arguement from me on the statement that MD's are the best PCP's. Prohibitive cost and access coupled with the PCP shortage warrants some measures that need to be taken. I was never suggesting that the two professions are the same or undergo the same training. I was merely pointing out that certain tasks can be performed by NP/PA's with relative ease given the training they have. I am not talking about cost in an office. My concern is healthcare costs on a macro level.
I have had multiple interactions with MD's and NP's and am well aware of the procedures in place for mid-level help. . Do you need to go to an extensive curriculum to manage chronic conditions like DM, HTN etc. ? Probably not. Would I trust an NP to take care of me if I am in the ICU with something serious? .. **** no... I would want an MD.
sorry docu, but the midlevels I work with are very good, and seem to provide at the very least equivalent care to you. In addition, they come to me if there's anything complex or worrisome, and if I correct their plan, they don't become upset and defensive, something you don't seem to be capable of doing..
Just for your own edification, you are not supposed to treat uncomplicated sinus infections with antibiotics. Take a look at any of the recent sinusitis articles in the last few years. Appropriate therapy is conservative and based around actually draining the sinuses. Cipro, macrobid, bactrim, keflex are all appropriate drugs for UTI's. Your local resistance patterns, allergies, and urine cultures dictate what's appropriate. For instance, where I am, cipro and bactrim are not that great, macrobid and keflex are much more effective.
I will say I've never seen a sinus infection ever caused by an antibiotic in all honesty. The pathophys of sinus infxn's precludes it. Rather, I have seen yeast infections, BV, and C Diff caused by antibiotic use.
Just for your own edification, you are not supposed to treat uncomplicated sinus infections with antibiotics. Take a look at any of the recent sinusitis articles in the last few years. Appropriate therapy is conservative and based around actually draining the sinuses. Cipro, macrobid, bactrim, keflex are all appropriate drugs for UTI's. Your local resistance patterns, allergies, and urine cultures dictate what's appropriate. For instance, where I am, cipro and bactrim are not that great, macrobid and keflex are much more effective.
I will say I've never seen a sinus infection ever caused by an antibiotic in all honesty. The pathophys of sinus infxn's precludes it. Rather, I have seen yeast infections, BV, and C Diff caused by antibiotic use.
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Thanks for the info Rendar5.
I dont think anyone has seen sinus infection caused by an antibiotic or at least has documented it. abx acutally cure it, but who's to say that too much can cause another infection. i looked all over the web and pubmed. the weather has just started to get cold here, so i suspect it must be most likely viral in retrospect since it happened acutely. but who knows, what if it is something new or long existing that needs to be looked into. people sometimes know their bodies very well. the one who suggested the sinusitis came from her cipro was the patient herself lol..she was on 3 extra days than she should have been so she may have developed resistance with that somehow...i never knew it could, but it could be a yet undiscovered possibility. my mind was boggled when she told that to me, i couldn't rule it out. o well. maybe, maybe not. who knows.
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And now you're waffling on the issue.
Before you said "this dumb NP gave my patient cipro for a UTI, then she got a sinus infection that was caused by the cipro."
Now you're saying, "well, she took more cipro than she needed (a valid point...I grant you that...but you'll ignore this, guaranteed), and got sinusitis at the same time which was probably viral but might possibly have been a never before described cipro-resistant, super virulent bacterial sinusitis that I cured with my mighty powers of prescribing a different antibiotic...or maybe it was just viral and got better on its own...who knows. Que sera sera."
Gonad up and own your decision-making or just stop...you're making the NP look better with every post you make.
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I never dared tell that woman the voices in my head. lol. she reminds me of a pitbull always ready to attack and she loved pitbulls that much ironically. im glad she found another job instead of work for me.
oh and guess what else. i have spoken to the angel of death and also to Archangel Gabrelle. Here is the story: initially, i could hear the voice of my supposed soulmate. since that is what a real soulmate is where you hear their voice. and he was about to die so i heard the angel of death talking and i told it not to let him die (and not to let me die too since you die off with ur soulmate), so in order to not let him die the angel turned him into an earth angel, like a human form of an angel. he's actually my distant cousin who's a neurosurgeon somewhere. he's the one i hear in my head.
it was some sort of spiritual message. i think Hades was on earth and heaven was messed up by evil forces and i had to do something to fix it. Angel Gabrielle was putting me through some tough ordeal like making me stay still for long periods of time which i had a really hard time doing. i have no clue what was going on or why he wanted me to do that. i think it was hades on earth and i was destined for hades and had to change my destiny cuz people thought i was bad but i was actually a good person. i dont know if i really did or if any of that part of it was real or some trial they wanted me to go through, but i do know the voices i hear in my head now are actual real entities that i can hear. my cousin the angel was sent by God to protect me from this demon that i keep getting possessed by. and you know the rest of the story i guess, where i have to take psych meds to prevent the demon from hurting me. everytime i stop taking the meds i get these really bad uncomfortable, characteristic chest pains. that's the demon doing that. so im on top of my meds every day running away from this demon that wants to kill me. and it can kill.
im not ashamed of hearing voices at all if thats what you think. i think it is neato and i am totally sane no matter what anyone want to think of me. but yea i wish i lived a normal live like everyone else. but it is cool to have someone to talk to even when ur alone.good for people that are scared of the dark and live alone like i do. lol
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yup, the world may never know. how many licks it takes to get to the center of a tootsie roll lollipop until they run a few clinical trials.
gonad up?
yeah i prefer the word gonad over any other replacable word imaginable. more scientific and less gender specific.i remember the days u were just a wee little fellow. now ur all big attending on campus like i am
LOL
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i remember the days u were just a wee little fellow. now ur all big attending on campus like i am
Are you f***ing kidding me? I'm not hiding behind a title. I'm standing with my training and education. There's no LOL here. You seriously need to get a grip on reality if you have any hope of ever being taken seriously by anybody other than your FB friends.
There was still no need to treat it with antibiotics, that's the wrong medication to use. Affrin for 3 days and then 1 wk f/u with sudafed would've been a more appropriate regimen.
Your attitude, though, is pretty lousy and probably what is keeping you from going as far as you want in this world..
Your attitude, though, is pretty lousy and probably what is keeping you from going as far as you want in this world..
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ok thats what i always used to use. flonase and pseudoephedrine 12 hour otc and , if it gets worse with green sputum in 7 or so days then amoxicillin 500 bid #14.... forgot. its been a while since i ran into a cold. that was last year...
i dont know what you mean by my attitude.
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attending to attending (and yes i am an attending cuz i sign papers that say 'attending').....yes i am kidding you.
u need to get a sense of humor before you die of a heart attack and some humility before you get caught with too big of an ego to be respected.
i mean come on, telling people to gonad up? is that not laughable?
im a lowly gp in a small town of a few thousand. i do act professional for your info.at least my patients and my facebook friends like me and thats all that matters. i could care less what an SDNer thinks of me. if they wanna be rude let it happen,karma is a female dog. bite ya in ur heineken. which i might or might not get to watch.
if im not mistaken, you may be a troll for all anyone knows. whats with all these nonsensical posts of yours?
oh yeah me and my voices are as real as it gets.
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what cases do you see in general practice and how do you treat them?
I wanted to create a thread that is comprehensive so people can refer to it.
I now know UTI and sinusitis.
What about Diabetes? (with the new meds out too) how to calculate insulin doses?
Best way to treat HTN?
what other things do we need to know?
I wanted to create a thread that is comprehensive so people can refer to it.
I now know UTI and sinusitis.
What about Diabetes? (with the new meds out too) how to calculate insulin doses?
Best way to treat HTN?
what other things do we need to know?
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Since people seem to be responding to you as if you are a legitimate poster, I would also like to point out that a colonoscopy is often indicated in patients with hemorrhoids. If the patient with hemorrhoids has blood in the stool, they need a colonoscopy to rule out other causes of GI bleed. Cannot be attributed to hemorrhoids without confirmation.
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Let me sum up what we have thus far and what we can glean from Docu's post-history.
He/She is an IMG who did 1-2 years of residency but "left" after that. I expect he/she was dismissed based on some posts talking about how dismissals are unfair. I'm guessing that it is because of psychiatric issues which sound like need to be treated.
He/she has been trying to get back into residency unsuccessfully and has been railing against the ACGME since. Some group/hospital has given him the opportunity to practice and we see the results on this thread.
Someone please close this thread!
He/She is an IMG who did 1-2 years of residency but "left" after that. I expect he/she was dismissed based on some posts talking about how dismissals are unfair. I'm guessing that it is because of psychiatric issues which sound like need to be treated.
He/she has been trying to get back into residency unsuccessfully and has been railing against the ACGME since. Some group/hospital has given him the opportunity to practice and we see the results on this thread.
Someone please close this thread!
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Not flonase, affrin. Flonase is good for rhinitis though. I never prescribe it as an EP, though. I swear it causes colds, lol. I leave that to the the primaries.
That's the problem that you don't know what I mean by your attitude, you're snarky, and at the same time defensive, thinking you know more than everyone else, don't take criticism well, and instead of correcting behavior, get into further conflict. Doesn't make any educator happy, and makes you very hard to teach. I doubt you even realize you do this fully, or that you realize how much it can impede your career. But I'm sure it already has.
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There is no blood in the stool. it is a thrombosed external hemorrhoid. the blood was in the UA.
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i dont think i know more than anyone else. i just think that NP's don't know as much as most doctors although they can pretend well. u can't get the same care from both. even patients know the difference between a noctor and a physician and can tell they are getting better care. they're not stupid.
I don't think you're teachable at present because of your attitude.
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You already had your chance. Based on what another poster said, you may have had TWO chances. Why do you deserve another? Why take away that spot from someone else?
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i just saw this guy today....wow...he was flushing..he was turning so red...it was scary...i think he has some sort of endocrine tumor like a pheo or thyroid cancer...thank God i found out how to work it up in Uptodate. medscape disappointed me on that one. i was ordering all kinds of tests and referred to endocrinology. now can an NP do stuff like that? if so i would be impressed.
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in residency it is not about teachable. it is about teaching yourself. no one helped me in residency, no one taught. i had to figure stuff on my own..
anyhow, this thread is not really about me. its about congress opening 15,000 residency spots. and whether i get in or not is none of anyone's business.
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that someone else is much less experienced. thats why
why should the world think like you do?
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You're an attending, and you don't know how to use oral antidiabetic agents or calculate insulin dosages, or what drugs are first-line for hypertension? Really...?
well im just a GP attending, nothing spectacular like everyone else. i think i can handle HTN, but Diabetes, i am really lacking.i have been referring to endocrinology every time because i feel so inept at it. can someone teach me how? i looked in books and even up to uptodate and can't find anything simple and straightforward. i know to put them on metformin initially, but what about these new drugs like januvia and lantus...... i have a chart to follow from a journal, but is there a better way? i really dont know how to calculate insulin. well i did know how to do a sliding scale hospital style, but i forgot. its been a while. that would be my #1 thing i truly feel lost at. i am a diabetes flunkie!!! help!!! if no one can help that proves to me that you guys don't know it that well either!!!
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thanks.....sounds like a plan. what the heck is AMF YOYO. is that an insult. because im a mirror and u are glue and every insult you say to me goes back and sticks to you....JLK (just like karma)
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Yes, the NP can easily do that. They can also tell the person to stop taking niacin.
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u think i didn't? i asked him if he was on niacin. thats the first thing that came to mind. but nope he doesn't take it. i even checked if it was any of his other med side effects but nope. u guys just hate me. thats the plain truth. no doubt. u think way to low of me than i really am.
i dont think an np would have the gall to look things up in uptodate. i dont think they'd even understand what they're reading. i bet they would just say o well. they are not as good as an IM person. i did IM partly so my mind is oriented like that to work things up to the fullest to find out whats going on. not to say im good or better or whatever, just that someone that did residency over someone that didn't has an edge over that person.
do you think an NP could have diagnosed erythema nodosum? she would have just called it bruises. im the only doc this girl has ever seen that actually knew what was going on with her leg bruises. and she has been to a lot of docs for it. that's how good i am ;P she was so happy.
do you think the NP and PA standardized licensure tests are equivalent to USMLE step 3? there is NO WAY!!!!
but i do have to admit that the MAs that work in my office are pretty smart cookies. they're running the entire office by themselves and doing a great job and very knowledgeable. i wonder if one day MA's will replace PA's and NP's if there is a PA NP shortage. LOL
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First, you had a shot at residency.
Second, and more realistically, there are literally hundreds of open IM and family medicine slots available today and roughly a thousand right after the match. I don't think that you would be well served by another 15,000 slots if a program would rather have an open slot than take you. There arent enough people to fill those extra 15,000 slots anyway except TWKs.
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Is that a picture of Hopkins?
i once worked there. as a lab tech that is. wrote some papers, but the journals stink! but at least i made some amazing discoveries that no one will ever care about
what's a TWK? the wasted kids? according to the urban dictionary. i dont drink by the way.
i am meeting so many people in my shoes that didn't finish residency that its not funny. most of them ask me for help and i try to help as much as i can.like the blind leading the blind. i think it is a sad thing that needs to be remedied.
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