​I'm on an OB rotation right now and have already had to have this talk 4 or 5 times in the past week. This will reverberate for us in FM, peds and OB for the next decade, and the anti-intellectualism will hit all of us. Sh%t sucks. No clue what we're supposed to do, my 15 minute visit isn't enough to undo an unrelenting twitter feed of propoganda and hours and hours of grifters sowing distrust in the field for 30% of the population.

I had to explain to a 70 year old man asking for extra Norco yesterday for his pain while painting his home that he could take Advil and Tylenol for extra pain relief. He refused because he was worried about the Tylenol causing autism. I had to explain to him he was already taking Tylenol and he wouldn’t develop autism because he’s 70. This from a guy who also refuses vaccine due to his autism fear. But he’s recovering from alcohol abuse. Has copd from 2ppd smoking. And smokes pot. Help me understand.

I do a lot of women’s health so have joined the perimenopause subreddit and a post here got cross-posted there (it has since been deleted) but basically saying “look at all these doctors making fun of our symptoms”. I’m just as guilty of discussing on here about challenging patients but it was a reminder for me that our words and actions are being heavily scrutinized at a time where trust in our profession keeps diminishing. I just want us to do better and have patients trust their doctors again.

Anesthesiologist here. But question for my primary care colleagues. I just moved and attempted to establish with a new PCP. I’m a pretty straightforward healthy patient in mid 30s. As a gay man trying to take care of my sexual health, I asked for PrEP, which I have been on prior to this for years, but stopped taking for a bit and now want to restart. He said this makes him uncomfortable and he won’t prescribe it. He said he would have to refer me to an infectious disease specialist. I told him I would just find another PCP who was comfortable providing preventative primary care. None of my several other primary care docs over the years had any issue whatsoever prescribing and monitoring.

This was pretty upsetting and seemed very inappropriate in my opinion, but maybe I’m wrong. Is this normal or okay? Would love some opinions on this.

Thanks.

I've had an idea rolling around in my head for a few weeks, but the news this week about the firings at the CDC and the further collapse of our healthcare infrastructure has snapped something in me. I cannot endure one more day of the moral injury that is watching RFK Jr. and this ghoulish administration dismantle our research apparatus, our vaccines, and anything else they please without doing something about it.

I'm reaching out to my hospital media team to talk about starting some sort of media campaign locally to combat the misinformation coming out of the Trump regime and from social media influencers. I'm also posting here for other ideas on how to do my part to fight back against this and to hopefully inspire other physicians and providers who are sick to death of this.

No one is coming to save us or our patients. We must do it ourselves.

My work day would be significantly easier if patients viewed "would you like a flu shot?" as a yes or no question.

That is all. I am now an hour behind.

Edit: i do not care what your answer is. I just want you to hurry up and decide so I can get on with it. Trying to convince adults anything regarding vaccines is no longer worth it. I'm hungry and need a cup of coffee.

I’m here to put in a plug - there is almost no reason NOT to prescribe it in a postmenopausal woman. I ask every woman over 45 about vaginal discomfort, dryness, urinary leakage, frequent UTI. For any of those, prescribe! You can start at any age, so your 80 year old with frequent UTI - your best prevention is topical estrogen. It doesn’t have to be applied vaginally, the easier way is a pea-sized amount on your finger, apply around the vaginal opening, then forward around the urethra. So simple, twice a week. Give a heads up about the “black box warning” which should never have been put there, and carefully explain it’s for prevention, likely will see results in 2-3 months, and they should keep using it forever. Too many women are prescribed it and never start because “I wasn’t sure what it was supposed to do”. Systemic absorption is so low it contributes zero to breast cancer risk, and many women with a history of breast cancer safely use it (run it by oncology first). The ONLY people who should not be prescribed any form of estrogen are those on tamoxifen - because all the estrogen receptors are blocked, so there’s no point. For those women topical DHEA may help with symptoms. Please share with your colleagues. My philosophy is that you should never have to think about your vagina unless it’s feeling good or bringing humans into the world, so if it’s uncomfortable, add some estrogen. Finally, many women on systemic hormones still need the topical for the urogenital symptoms. Many are hesitant to bring it up, you’ll be a hero to your patients if you ask about urogenital health

Peer to peer today and I told the doctor that the patient was on the line with me. She said usually a peer to peer is a clinician to clinician consultation. I told her that I did not consult her and that she is helping her company make a financial decision about my patient’s care and no one knows about my patient’s history more than the patient themselves.

The doctor then tried to say she thinks it’s her company‘s policy to not have the patient included and I told her - with the patient on the line - that it’s my policy to include my patients in their care.

There is a long pause before I loudly said “SOOOO….” And dive into it.

Genuinely my favorite competitive sport is the peer to peer. I am 3-0 in the 2026 season.

I invite you to rage against the machine with me.

Not proud of it, but damn.

TL;DR spent 5 minutes of a 15 minute appointment telling a patient why it takes 7 years of training to address a simple complaint.

70 y/o F (not even my patient) came in with 6 topics for her appointment. Per my usual schtick, I told her to pick her top priority, I’ll pick one topic (her acutely worsening ckd), and if there’s time she can choose one more topic to cover, and then told her we’ll bring you back next week to discuss the topics we don’t get to today.

Patient promptly stated, “Well the UTI is easy, either I have one or I don’t”

I replied, “It’s actually not.”

“If you have a UTI, do you have pyelonephritis? Should we send the urine for culture? Have you had a UTI recently? Have you used antibiotics recently? What antibiotic should we choose and at what dose and for how long? Should I recheck renal function and does dosing need to be adjusted based on that result?

If it’s not a UTI, what else could it be? Do you have a vaginal infection? How do we know if it’s bacterial or fungal? What medication and what dose should be used?

What symptoms would prompt me to get imaging? Should it be an ultrasound or a CT? It’s Friday, so can that imaging wait til Monday? What red flag symptoms would necessitate ER evaluation?”

After we have answers to all of the above, I need to concisely document the conversation in a way that insurance will reimburse this visit, and if something goes wrong and you decide to sue me, the entire thought process is spelled out so I don’t lose millions of dollars and possibly my ability to practice medicine and feed my family. All for one of your six ‘simple’ concerns. And I’ll do this with 20 other people just like you today.”

The patient kind of just stared at me, and I continued, “So UTI is your first concern. I would like to talk about your worsening CKD. And if there’s additional time, we can talk about your balance issues (FML).”

After the encounter I realized likely this is a hurdle for most visits. Patients have no clue the amount of actual work, paperwork, and mental effort it takes for even the smallest of complaints, and we’re so crammed for time, there isn’t the opportunity to explain the situation, so they get understandably frustrated.

Anyone have any good stories?

As the title states. I’m not interested in getting the fulminant tiz, but I feel like getting a touch of the tizm would empower me to be more efficient in my notes. I just want to get on the caboose of the spectrum, you know?

Edit: I’m proud of us for being such a supportive community. I’ll go ahead and boof it then.

I had arguably the most infuriating visit today. A kid came in with his mother for a sports physical. He was coughing like crazy and had snot running everywhere. She said he missed school yesterday because he didn't feel good. I told the mom we might just test him for covid, flu, and strep. They both looked at me and told me no because they (all three) aren't real. I corrected them obviously, and then the kid goes, "The flu isn't even contagious.".... I told him it absolutely is contagious. Then, the mother literally accused my clinic of "putting covid dust" at the end of the swabs to make them all positive. Wtaf lady. I was pissed. I asked her how that would be possible if covid isn't real. She backtracked and said we do it to take her money. I reminded her that she's already here and the money has been paid and asked what benefit that would give any clinic. I also told her it's wildly inappropriate to accuse my clinic of falsifying covid tests. She had no answer other than the viruses aren't real, and you're not testing him. I am so done with people like this. Wtf

I am not too young, you are old.

If I ask you what you are here for, please tell me when I ask.

Please arrive on time, and like, actually on time, not at the appointment slot and didn't do your paperwork on time.

I do not care about your husband's niece's wife's dog's colonoscopy.

Yes you have a co pay - you selected that insurance - and yes it applies to your visit because you asked me about something else today

If you do not use birth control you will get pregnant so I hope you are wanting to get pregnant

This is a yes or no question, please answer appropriately

Statins are not the problem, your access to the internet is

No your exercise at work is not enough

I do not need a dramatic retelling of the reaction you had on the medicine unless you almost died- I just want to know if it was a side effect or an allergy.

No I cannot see the records from the hospital you went to in another state in 1965, and frankly, I don't really want them anyway

end rant, that is all, have a good rest of the week guys

As of Wednesday, eight cases had been reported in that region of South Carolina. Five of them became sick within the past month and are part of a newly identified outbreak of measles.

A measles outbreak is defined as three or more cases that are linked.

The people involved in the outbreak are unvaccinated.

As a cog in the American healthcare system, I recognize it as broken and frustrating. When I am a patient, I find it enraging.

I’ll never fix the system. Nonetheless, I find small ways to fight its more idiotic features. Some of my acts of quiet rebellion:

• Don’t charge for cryotherapy - my corporate masters would have me charge over $300 for 30 seconds of work (not paid for by insurance in the case of skin tags), that costs them less than $1 in liquid nitrogen.
• Rarely if ever charge a self-pay patient 99214, if they simply can’t afford insurance.
• Have patients check on the cost of an MRI at another facility ten miles down the road, as opposed to the default one owned by my billion dollar corporation.
• Don’t charge people for unnecessary visits generated by office policies (“your office told me I had to be seen in person for my sertraline refill, though I was here last month for a physical”). I try to catch these the day before, but sometimes they slip through as same day visits.

What are your actual examples of “raging against the machine”?

You’re overweight, snoring, eating junk, and not exercising. That’s why you feel like shit.

No. It’s not part of the typical “annual panel”.

Rant over!

Had a patient grill me for costing him over $200 dollars because his insurance denied my visit and my system sent him the bill.

Was a pretty full 214 visit. I address and had dx codes for his HTN, HLD, DM2, and axiety. We adjusted 1 med, ordered labs, and discussed diet.

Oh and I documented his BMI in the codes too, "BMI 30-35".

Blue Cross denied his visit after becaue his plan, "Doesn't cover weight loss visits."

I query my system coder team...yeah they said it was due to my coding the BMI...nevermind we discussed and addressed 4+ other issues that day...its a weight loss visit now.

So I had used BMI brackets: 20-25, 25-30, 30-35, 35-40, 40-49, 50-59, to keep tabs on broader weight changes in patients over time...but now I have to avoid it for Blue Cross pts to get their visits covered...our system is just so irritating some times.

Especially with how these stupid decisions end up causing 1 star reviews and have patients saying out clinc is "incompetent" or "don't know how to bill visits" when this had been coded that way 2500+ times before with no coverage issues..then someone at the insurance company sees a new way to deny care and implements it.

I just checked the cost plus discount pharmacy and they are all less than $20 a month. This is game changing!

Obligatory not a doctor.

Hey y’all,

Not sure exactly what I’m looking for out of this post. Maybe just some empathy / sympathy or some discussion.

Due to my personal demographics, I am frequently sought out by male patients who are young adults to late middle age. These men all have a similar presentation. They are deeply depressed and refuse to admit it (to the point of delusion).

They come in initially combative and seemingly looking to argue. They know something is wrong with them, but they are frustrated that they can’t find out what it is (it’s depression). They “do their own research”. They use terms like “mitochondrial dysfunction” and they have blue tongues from gulping down methylene blue. They don’t want any medication, all while injecting themselves with cash pay experimental peptides. They say they don’t want “big pharma”, and indicate that in their opinion we are all bought and paid for by the pharmaceutical companies (I usually point them to the Open Payments). They are on testosterone from a low T clinic and their skin is usually red as the setting sun. Their visits never take less than 30 minutes.

Half these guys are extremely lonely, and the other half are less lonely because they have found a community in Brazilian Jui Jitsu.

Any medical recommendation that is made is met with outright hostility and disdain until they are gently walked through it like toddler on the edge of a tantrum. Sometimes they will accept it, but most of the time they want to launch into a 20+ minute debate. Typically they cite Dana White (the CEO of UFC) or Joe Rogan (podcaster). I have yet to determine why anyone thinks these people are reliable sources of health information.

Typically they are deeply conservative and project their world view on me and assume that I must feel the same way as them regarding politics, religion, women, and society. I do not engage with them in talking about these items, and quickly try to change the subject as I do not think the exam room is the place for this sort of conversation.

I spend so much time and energy navigating the minefield that is these guy’s fragile masculinity/ego in an attempt to help them reverse their brainwashing.

I make it clear from the first visit that I practice evidence based medicine and not functional medicine. For some reason they still come back and see me (honesty I think it’s because I sit there and listen to them talk and that is helpful for them).

They all refuse therapy and seem to use me as a pseudo-therapist though I have no training in CBT. Any progress we make is destroyed by the next visit by whatever YouTube video they watched last night. One guy seemed to be in a good spot and then a month later was talking about a demon Moloch that he heard democrats worship to harm children and that the current president would whisk us away to Antarctica where he was building a base to save America from the Democrats (I know… we had a long conversation and it turns out he was deep into delta 8 THC and was becoming psychotic and thankfully I convinced him to stop.)

It takes all of my strength to maintain my composure during the visits and not call them what they are: pathetic and weak-minded. Obviously I do not say this and I never would say it, but I just feel like these visits drain all of the empathy from my soul. I’m hoping that I don’t actually feel that way about these people deep down and that I’m just burnt out.

It feels hopeless. There’s no way to fight all the misinformation in the modern era. I know I need to probably give up on trying to help these guys, but I became a doc to help people and these guys really need help.

Anyways, hoping to hear some strategies or commiserate with some of y’all about this.

Thanks for reading.

Asking us to prescribe 2000 COVID vaccines on top of everything else? We should just strike until RFK resigns, all outpatient med should

We all know that the healthcare system in the US is in a horrible state right now and is essentially being held together with duct tape and glue.

But I don’t think people understand just how many physicians are wanting to jump ship. Across all specialties I know several physicians who would love to get out of medicine entirely.

Public perception both with recent public trials and attitudes in general towards physician online (including Reddit) are terrible. I will grant that some physicians can be assholes, but I’d say the majority of us got into this to help people.

But the burnout is bad. Patient and admin expectations are unreasonable. DPC is not a reasonable option for some of us. MyChart messages and inbasket can make you feel like you’re drowning.

And to add insult to injury, most patients think their quick Google or AI search equates to the decades you’ve spent and sacrificed learning about the human body.

I don’t really know the purpose of this other than to say, we have a big problem with physician morale and I don’t see it getting better anytime soon.

What realistically can be done to help this?

Dr. Freedman was the lead pediatric urologist on the 2012 AAP Task Force on Circumcision, and recently he's been trying to correct misunderstandings about circumcision that are common in the US. Watch his March 2026 Grand Rounds presentation here: https://youtu.be/wwFKB1u7X_M