Depends on the patient. Cipro and bactrim are best to penetrate kidney too. Macrobid is a good choice as well. I have been seeing lots of drug resistant bugs in symptomatic elderly women lately. Very scary. Many can only be treated with macrobid or IV abx. I culture everyone.
Yes, have to look at costs and compliance and allergy profiles. Either work well. We start with how we are trained.
I don't practice in Oregon. I do locums in TX, OR, WA, and NV. I go where they need help.
Ah yes, I see the "rent-a-doc" thing now. Why do you practice that way, if you don't mind?
I get paid by the hour, no one owns me. I take what vacation time I want. I have the choice of what sites I go to. I can leave if I hate it. I don't have to go to any meetings. I don't have to "play by the administration rules". "They" can't tell me how many patients I "have" to see in a day. I am the relief help therefore the site should be happy that I am there, if not and they give me any grief I move onto the next site.
Like a boss lol! That's great doctor. Thanks!
Something I am sincerely trying to avoid in the future. This set-up sounds like something I would love to do. Could this way of practicing be done by all specialities (hopefully not a horrendous question...)?
There are locums positions for nearly every specialty. Primary care is the hot commodity right now especially if you are versatile and are willing to just "fill the void" without too many demands. FP, ER, IM, PEDs, Anesthesia, Hospitalist are the big ones right now.
Thanks, doc. 🙂
Guys... I'm back stronger than ever!
I was just gonna quit sdn but I think I'm addicted to it now. I'll stay on for a little more until I have things to do. And i think my posts give some laughter or something to wait for, for some people.
and thanks @AlteredScale for that link. Now it makes some people on this website more authentic/whotheysaytheyare.
I read all of your criticisms and ridicules. And i see the point in many of them. and cabin it seems like @cabinbuilder is a good (if not great) physician (food, shower, cab.. etc). Some of you guys are pretty funny, to say the least.
However, my views/thoughts/opinions do not change. Maybe it is my stubbornness? But you guys are pretty stubborn also...
I get that you have to generalize. That how most of us learn new things. We learn the general things and then learn the specifics in most cases. Sometime it's the reverse. Don't you agree?
But how do some of you not see the problem with saying "Treat with clindamycin at any sign of facial swelling.". How more blatant can someone say something?
(and I have no idea whey cabin changed abx back to clindamycin but...)
REALLY, I get the point of generalizing.
If someone has a right lower quadrant pain, it's generally something wrong with the appendix. Agree? Generally (I'm sure you can thing of many more things wrong in the RLQ). And we will order a CT of the abdomen.
But what if that person had an appendectomy in the past? It may be "rare" or it may be unlikely that a person who had an appendectomy will have RLQ pain but do you just go ahead and put them through radiation just because in most cases/in most people it's something wrong with the appendix? (not saying cabin doesn't look at patients' histories.)
Do I make myself clear?
I'm not saying you should question a physician ordering a CT to rule out an appendicitis but question him/her if she hasn't even looked at the person's history.
Am I so wrong to say you should consider things by case by case basis?
Cabin was generalizing patients with a symptom but giving out a specific method to treat a symptom.
As rude/bad/sarcasm as Dr. House may seem, he asks his members for opinions and thoughts on most, if not all cases (yes, he shoots most of them down but...). Even if he or someone thinks it's a common symptoms for a disease/ailment, he doesn't just jump to conclusion (I know this is a made up TV series...).
Some of you guys seem to live in some kind of a hierarchy society or something. Sure, what cabin said has much more value and insight in to medicine than what I had said. And maybe I am being nitpicky about what she said. Maybe I was just picking out that 1 "wrong" things (at least in my point of view, and some of you did agree in some sense) out of 1 million "right" things she said and went "extreme", which I do not think so because I was just pointing out that you can't just assume someone is not allergic or has bad reaction to (which is basically being allergic) a SPECIFIC antibiotic she mentioned to use in ANY circumstance involving facial swelling in a patient with dental pain.
"Antibiotics do not fight infections caused by viruses like colds, flu, most sore throats, bronchitis, and many sinus and ear infections. Instead, symptom relief might be the best treatment option for viral infections.
Get smart about when antibiotics are needed—to fight bacterial infections. When you use antibiotics appropriately, you do the best for your health, your family's health, and the health of those around you."
- http://www.cdc.gov/features/getsmart/
Yes, I know clindamycin is an appropriate abx in the cabin's situation and tooth pain isn't a viral problem but I saw a problem in the way she said to use a SPECIFIC abx quickly and many patients can become septic. More relevant things on the link. Not to mention overprescribing abx has lead to superbacteria/drug-resistance bacterias (along those lines...) becoming more common. That's part of evolution.
And the whole, taking things to extreme with giving out pain medication like candy. Do you guys not get sarcasm... I mean look at my avatar...
Not to point out that overprescribing pain medication is a HUGE problem in medicine.
"In a period of nine months, a tiny Kentucky county of fewer than 12,000 people sees a 53-year-old mother, her 35-year-old son, and seven others die by overdosing on pain medications obtained from pain clinics in Florida.1 In Utah, a 13-year-old fatally overdoses on oxycodone pills taken from a friend’s grandmother.2 A 20-year-old Boston man dies from an overdose of methadone, only a year after his friend also died from a prescription drug overdose.3
These are not isolated events. Drug overdose death rates in the United States have more than tripled since 1990 and have never been higher. In 2008, more than 36,000 people died from drug overdoses, and most of these deaths were caused by prescription drugs."
- http://www.cdc.gov/homeandrecreationalsafety/rxbrief/
I saw a problem in what cabin said and point out a problem that I thought would add to the conversation.
But you guys are the one who took things out of proportion and to extreme to say I am telling cabin how to practice. I'm wasn't and I'm not.
However, I would rather be stingy with pain medication (or any medications) and try to help patients otherwise.
Where did A.T. Still's philosophy go? Aren't most of us on this forum going to be OSTEOPATHIC physicians? Don't we learn that there is more to it than medications and surgeries?
Did I ever say you shouldn't learn how to splint? or you shouldn't use xray to r/o constipation? I didn't because I didn't see a problem in that. But I saw a problem in generalizing everyone to be the same and a problem about "not being stingy" with pain medications. I am sure I could have worded my original post to make it sound more appropriate.
I'm not trying to fight with you guys. And I'm sorry if you guys thought I was trying to be "that" pre-med. Trust me, I wasn't and I could do better if I wanted to.
I'm not here to tell physicians how to practice.
But I believe we all have the right to voice our opinions and thoughts. In an online setting, things don't reflect one's thought as accurately. I think we all know that.
Let me just finish my point with this EXTREME example that may or may not be relevant (this is going extreme).
Hundreds if not thousands of little kids are sexually molested by adults (even Catholic priests) every year. But (at least from what I know/read/heard) many of them never mention it or say something to anyone else because they believe what is done to them is okay since the molesters were older/"higher" than them.
They don't speak out and many of them are afraid to. They remain silent until it's too late to punish the molester.
Now, many of you guys will say "wtf? is he joking? what is wrong with iwilloneday?"
But please read between the lines.
My point is, just because someone is "higher" than you, has more experience, older, or has more authority doesn't mean you can't question them or point out wrong things.
I don't want my future colleagues, coworkers, staff, attendings, or students to think they can't voice their thought. Just like how you guys try to go against the requirements that hospitals put on you or your parents put on you.
Let the ridicules begin.
I will accepted constructive criticism but please READ it before you respond. and can we be more "civil" about this? Come on, seriously? You guys are just going to jump on the bandwagon?
What has this thread turn into...
This is almost like cyber bulling... 🙁
View attachment 186171
Thanks for reading. Love you guys.
Chill with the God thing. I get the feeling if you ever become a doctor you would correct a patient for thanking God you finally showed up to treat him. Let it go...
Chill with the God thing. I get the feeling if you ever become a doctor you would correct a patient for thanking God you finally showed up to treat him. Let it go...
Yes, we know you're atheist. You're the author on the 'manifesto' on being an atheist during medical school, everybody here remembers. It's cool to be atheist, but remember you will be looked up by the future population you may treat, if they feel you are condescending towards their beliefs your clientele will dwindle.
That's always a difficult balance to have. For things that are possibly of a criminal nature (for example, abuse) I think it is a doctor's duty to try to council their patient and notify the police (if any physicians want to correct my view, go ahead, I'm open to it). For harmless things (the potato on the neck) I would personally let it go. If it isn't causing harm to the patient, there is no issue.
"I will have a problem with patients who thank god that they are cured instead of thanking physicians who actually did work"
Guys... I'm back stronger than ever!
I was just gonna quit sdn but I think I'm addicted to it now. I'll stay on for a little more until I have things to do. And i think my posts give some laughter or something to wait for, for some people.
and thanks @AlteredScale for that link. Now it makes some people on this website more authentic/whotheysaytheyare.
I read all of your criticisms and ridicules. And i see the point in many of them. and cabin it seems like @cabinbuilder is a good (if not great) physician (food, shower, cab.. etc). Some of you guys are pretty funny, to say the least.
However, my views/thoughts/opinions do not change. Maybe it is my stubbornness? But you guys are pretty stubborn also...
I get that you have to generalize. That how most of us learn new things. We learn the general things and then learn the specifics in most cases. Sometime it's the reverse. Don't you agree?
But how do some of you not see the problem with saying "Treat with clindamycin at any sign of facial swelling.". How more blatant can someone say something?
(and I have no idea whey cabin changed abx back to clindamycin but...)
REALLY, I get the point of generalizing.
If someone has a right lower quadrant pain, it's generally something wrong with the appendix. Agree? Generally (I'm sure you can thing of many more things wrong in the RLQ). And we will order a CT of the abdomen.
But what if that person had an appendectomy in the past? It may be "rare" or it may be unlikely that a person who had an appendectomy will have RLQ pain but do you just go ahead and put them through radiation just because in most cases/in most people it's something wrong with the appendix? (not saying cabin doesn't look at patients' histories.)
Do I make myself clear?
I'm not saying you should question a physician ordering a CT to rule out an appendicitis but question him/her if she hasn't even looked at the person's history.
Am I so wrong to say you should consider things by case by case basis?
Cabin was generalizing patients with a symptom but giving out a specific method to treat a symptom.
As rude/bad/sarcasm as Dr. House may seem, he asks his members for opinions and thoughts on most, if not all cases (yes, he shoots most of them down but...). Even if he or someone thinks it's a common symptoms for a disease/ailment, he doesn't just jump to conclusion (I know this is a made up TV series...).
Some of you guys seem to live in some kind of a hierarchy society or something. Sure, what cabin said has much more value and insight in to medicine than what I had said. And maybe I am being nitpicky about what she said. Maybe I was just picking out that 1 "wrong" things (at least in my point of view, and some of you did agree in some sense) out of 1 million "right" things she said and went "extreme", which I do not think so because I was just pointing out that you can't just assume someone is not allergic or has bad reaction to (which is basically being allergic) a SPECIFIC antibiotic she mentioned to use in ANY circumstance involving facial swelling in a patient with dental pain.
"Antibiotics do not fight infections caused by viruses like colds, flu, most sore throats, bronchitis, and many sinus and ear infections. Instead, symptom relief might be the best treatment option for viral infections.
Get smart about when antibiotics are needed—to fight bacterial infections. When you use antibiotics appropriately, you do the best for your health, your family's health, and the health of those around you."
- http://www.cdc.gov/features/getsmart/
Yes, I know clindamycin is an appropriate abx in the cabin's situation and tooth pain isn't a viral problem but I saw a problem in the way she said to use a SPECIFIC abx quickly and many patients can become septic. More relevant things on the link. Not to mention overprescribing abx has lead to superbacteria/drug-resistance bacterias (along those lines...) becoming more common. That's part of evolution.
And the whole, taking things to extreme with giving out pain medication like candy. Do you guys not get sarcasm... I mean look at my avatar...
Not to point out that overprescribing pain medication is a HUGE problem in medicine.
"In a period of nine months, a tiny Kentucky county of fewer than 12,000 people sees a 53-year-old mother, her 35-year-old son, and seven others die by overdosing on pain medications obtained from pain clinics in Florida.1 In Utah, a 13-year-old fatally overdoses on oxycodone pills taken from a friend’s grandmother.2 A 20-year-old Boston man dies from an overdose of methadone, only a year after his friend also died from a prescription drug overdose.3
These are not isolated events. Drug overdose death rates in the United States have more than tripled since 1990 and have never been higher. In 2008, more than 36,000 people died from drug overdoses, and most of these deaths were caused by prescription drugs."
- http://www.cdc.gov/homeandrecreationalsafety/rxbrief/
I saw a problem in what cabin said and point out a problem that I thought would add to the conversation.
But you guys are the one who took things out of proportion and to extreme to say I am telling cabin how to practice. I'm wasn't and I'm not.
However, I would rather be stingy with pain medication (or any medications) and try to help patients otherwise.
Where did A.T. Still's philosophy go? Aren't most of us on this forum going to be OSTEOPATHIC physicians? Don't we learn that there is more to it than medications and surgeries?
Did I ever say you shouldn't learn how to splint? or you shouldn't use xray to r/o constipation? I didn't because I didn't see a problem in that. But I saw a problem in generalizing everyone to be the same and a problem about "not being stingy" with pain medications. I am sure I could have worded my original post to make it sound more appropriate.
I'm not trying to fight with you guys. And I'm sorry if you guys thought I was trying to be "that" pre-med. Trust me, I wasn't and I could do better if I wanted to.
I'm not here to tell physicians how to practice.
But I believe we all have the right to voice our opinions and thoughts. In an online setting, things don't reflect one's thought as accurately. I think we all know that.
Let me just finish my point with this EXTREME example that may or may not be relevant (this is going extreme).
Hundreds if not thousands of little kids are sexually molested by adults (even Catholic priests) every year. But (at least from what I know/read/heard) many of them never mention it or say something to anyone else because they believe what is done to them is okay since the molesters were older/"higher" than them.
They don't speak out and many of them are afraid to. They remain silent until it's too late to punish the molester.
Now, many of you guys will say "wtf? is he joking? what is wrong with iwilloneday?"
But please read between the lines.
My point is, just because someone is "higher" than you, has more experience, older, or has more authority doesn't mean you can't question them or point out wrong things.
I don't want my future colleagues, coworkers, staff, attendings, or students to think they can't voice their thought. Just like how you guys try to go against the requirements that hospitals put on you or your parents put on you.
Let the ridicules begin.
I will accepted constructive criticism but please READ it before you respond. and can we be more "civil" about this? Come on, seriously? You guys are just going to jump on the bandwagon?
What has this thread turn into...
This is almost like cyber bulling... 🙁
View attachment 186171
Thanks for reading. Love you guys.
You should really exit the thread. Derailing threads is against the TOS. What could have been a good thread has ground to a halt because you won't stop spouting your beliefs, ironically in the face of people who had real world experience to contribute to answering the OP's question. Get back on topic before this thread gets locked.
Ironic when you consider the venom he has towards religious people who do the same. Imagine that.
You should really be PMing him to ask that.
If I got asked that I think I'd **** bricks and just leave the interview. Truthfully I'd just respect the patient's wishes, because the patient always comes first.
I'm not sure what you want me to say about religion. I was not brought up in any faith so I don't have a concept of what religion is supposed to do for me. I do understand that most people believe in a religion and I am ok if it works for them in the healing process. Healing is all about the power between mind and body so If one believes that their religion will heal them, then it will. Do I agree with that approach? No. But I am not one to dispute or argue about what an individual believes.
That's just it. I didn't have any specific questions. Thanks for clarifying, doc.
I will say that I go to a locums site to WORK. I request a minimum of 50 hours a week. If I'm going to be away from home then I want all the hours I can get. I am not there to sightsee. I am there to fill the gap and make money. Most times I work 70 hours a week. Just FYI. But I am not the norm.
How would you describe the "norm"?
Well, most doctors want a "life" and work a 40 hours week and be able to "sightsee" at the location they are placed. That is not my goal, mine is solely to make money. I could care less about where the location is.
Most places I work at do have the CLIA waived rapid strep test. Of course that test only covers Group A strep. As many may not know there are other strep types that will come back positive on culture 3-4 days later. Groups B,C,D,F,G. I have seen all strains. Comes down to experience and looking at a person's throat and knowing the difference between bacterial, allergic, or viral pharyngitis. Anyone who has a fever, looks sick, throat has beefy red appearance, swelling of uvula, and/or exudates gets treated even if the rapid A is negative since 95% of the time the culture will be positive for a different strain. Same goes for UTI. I have rapid UA but cultures come back in 3-4 days.
