Is gastroenteritis that difficult to diagnose clinically....or does EVERYONE need a CT abd/pel?

[RustedFox]

I must have zoned out while going through this thread. :O

Happens to me all the time, bro.
I think that I say something novel and BOOM, 7 posts above me, same thing.

---

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[WilcoWorld]

It was covered by The Expert Witness newsletter a few days ago.

Chiro settled.

Moral of the story, if the patient is young and survived with catastrophic injury, settle. This is like that EVAC/Bert Fish/premature delivery case where the ambulance company was hit for $10 million and almost went bankrupt. Instead of taking a settlement offer for insurance limits, they asked why it was their fault for relying on the EM physician's pelvic exam? Don't matter, baby has cerebral palsy and will require life long care. Someone has to pay... that care isn't going to be free.

Locked-In Syndrome [Chiropractor Adjusts Neck]

Case #131

expertwitness.substack.com

This is a good case demonstrating that if we made care more affordable, malpractice costs would go down.
Death is much cheaper than disability, so awards for death are much lower than cases where the patient needs ongoing care.

 

[turkeyjerky]

This is a good case demonstrating that if we made care more affordable, malpractice costs would go down.
Death is much cheaper than disability, so awards for death are much lower than cases where the patient needs ongoing care.

I agree costs need to come down, but what's your suggestion to make long term 24/7 care more affordable? Or are they factoring in the expected costs of innumerable ER visits and ICU stays for the inevitable decubs, line/urosepsis, PEs, "he just doesn't look right today" and other eventual complications?

The thing about the scribe documenting a normal exam is alarming. It looks like he didn't sign the note until the next day and that was somehow construed as a nefarious act. I can only imagine that this guy was slammed at 5pm on the tail end of a busy 12 hr shift and then this train wreck comes in. He's running around making a ton of phone calls, intubates and taps the patient, and then leaves 1.5 hrs after he was supposed to. Next morning logs in and corrects the scribe's template. Then the "expert" jagoff somehow construes this as malicious?

Also, what does calling the neurologist prior to the official report being in have to do with anything? When I get a call w/ a critical finding, I call the relevant specialist all the time prior to the official report.

Seems to me that the wording of the radiology report was highly problematic. Why not write something like, "minimal filling of the R vertebral artery. While this could be a congenital finding, in the right clinical context this could certainly represent obliteration secondary to a dissection."?

 

[WilcoWorld]

I agree costs need to come down, but what's your suggestion to make long term 24/7 care more affordable? Or are they factoring in the expected costs of innumerable ER visits and ICU stays for the inevitable decubs, line/urosepsis, PEs, "he just doesn't look right today" and other eventual complications?

The care I meant to refer to was actually about caregiving, e.g.: eldercare, childcare, etc. We have a superficially paradoxical situation in the US where caregiving is undervalued and also extremely expensive. Caregivers in our culture are seen as expendable (when they're even noticed) and care is expected to be given for free (childcare, care of the aging). As a result, wages are crap for daycare workers and home health aides. But the care remains financially out of reach for many of us. Nursing home fees bankrupt upper middle class people who lived responsibly every day. And many people with decent but not great jobs can't afford to work because childcare is too expensive.

As for the "innumerable ER visits and ICU stays for the inevitable decubs, line/urosepsis, PEs, etc..." that's a related, but distinct problem. Because we don't value eldercare culturally, we pawn it off on others. Because we hide our elderly and dying from public view, we have a mortality ignorance in our culture. I think that if we saw more of death and dying, and actually cared for our parents when they got old, we'd see a lot fewer families opting for a fourth ICU admission for grandma.

 

[WilcoWorld]

I'm not a policy maker, so this is pretty off the cuff:

To make 24/7 care more affordable we need to do a few things:
-Venerate caregiving so it's not something we leave to the invisible members of society
-Require employers to have better benefits for family care leave (as is done in Scandanavia)
-Put an end to keeping debilitated people with no quality of life alive being our default setting - this should be something people have to opt into rather than opting out of
-Give patients an insurance break for completing advanced directives and keeping them updated

 

[chudat]

Ok guys, I tried to take what everybody said in this thread to heart. But today's been another one of those days.

37 yo Pt seen by NP in ER yesterday for abdominal pain; elevated lipase, ct read as interstial pancreatitis. Was told by NP to come back if pain got worse.

Pt's pain worse. Came back. Rescanned by NP. Read by me as no change. No necrosis, cysts, etc....plus you not gonna see it after one day.

37 yo got scanned twice in two days for pancreatitis.

 

[CoolDoc1729]

Ok guys, I tried to take what everybody said in this thread to heart. But today's been another one of those days.

37 yo Pt seen by NP in ER yesterday for abdominal pain; elevated lipase, ct read as interstial pancreatitis. Was told by NP to come back if pain got worse.

Pt's pain worse. Came back. Rescanned by NP. Read by me as no change. No necrosis, cysts, etc....plus you not gonna see it after one day.

37 yo got scanned twice in two days for pancreatitis.

The thing about the scribe documenting a normal exam is alarming. It looks like he didn't sign the note until the next day and that was somehow construed as a nefarious act. I can only imagine that this guy was slammed at 5pm on the tail end of a busy 12 hr shift and then this train wreck comes in. He's running around making a ton of phone calls, intubates and taps the patient, and then leaves 1.5 hrs after he was supposed to. Next morning logs in and corrects the scribe's template. Then the "expert" jagoff somehow construes this as malicious?

This is why I don’t want scribes. It doesn’t take me that long to write a chart and I’ve seen they write random inaccurate stuff. Also maybe once a month I add a test or a med as I’m charting because it jogs my mind to sit down and type the chart.

 

[RoyBasch]

This is why I don’t want scribes. It doesn’t take me that long to write a chart and I’ve seen they write random inaccurate stuff. Also maybe once a month I add a test or a med as I’m charting because it jogs my mind to sit down and type the chart.

Yeah, I feel the amount of time I would spend trying to delete problematic scribe documentation that would be malpractice self destructs (see my post about nurses being court room stenographers and writing **** people say verbatim) is longer than it takes me to write my own notes from scratch.

 

[maxxor]

Ok guys, I tried to take what everybody said in this thread to heart. But today's been another one of those days.

37 yo Pt seen by NP in ER yesterday for abdominal pain; elevated lipase, ct read as interstial pancreatitis. Was told by NP to come back if pain got worse.

Pt's pain worse. Came back. Rescanned by NP. Read by me as no change. No necrosis, cysts, etc....plus you not gonna see it after one day.

37 yo got scanned twice in two days for pancreatitis.

This sounds like burnout talking tbh.

 

[RoyBasch]

This sounds like burnout talking tbh.

I mean, scan x2 in 24 hours for confirmed pancreatitis is some dumb bull****.

 

[turkeyjerky]

This sounds like burnout talking tbh.

Or just legitimate exasperation over brainless, dingbat practice of ‘healthcare’

 

[Rekt]

Ok guys, I tried to take what everybody said in this thread to heart. But today's been another one of those days.

37 yo Pt seen by NP in ER yesterday for abdominal pain; elevated lipase, ct read as interstial pancreatitis. Was told by NP to come back if pain got worse.

Pt's pain worse. Came back. Rescanned by NP. Read by me as no change. No necrosis, cysts, etc....plus you not gonna see it after one day.

37 yo got scanned twice in two days for pancreatitis.

What we're talking about applies to physicians. Not these cancerous clueless low level providers. As time goes on outside of residency and the more of them I interact with it's incredibly mind blowing how we got to this point. I expect a continued national decline in US life span that solely can be contributed to these clowns.

 

[emergentmd]

This is a Troll post, don't feed it. If Er doc stop overordering then their pay drops with an overabundance of Radiologist then you will see Rad groups coming to the Er to buy us dinner.

I didn't read any of this but I say, "suck it up, read it, and you have been consulted". If you don't want to then tell the hospital you won't read for them and see what happens.

 

[RustedFox]

This is a Troll post, don't feed it. If Er doc stop overordering then their pay drops with an overabundance of Radiologist then you will see Rad groups coming to the Er to buy us dinner.

I didn't read any of this but I say, "suck it up, read it, and you have been consulted". If you don't want to then tell the hospital you won't read for them and see what happens.

Broh.
He has a valid point.

 

[gruemd]

Is human illness this hard to manage at home or does everyone need to come to the ED?
Is human illness this hard to diagnose clinically or does everyone need a test?
Is human illness this hard to treat on your own or does everyone need a consult?
Is human illness this hard to consult and discharge or does everyone need admission?

I was burned out once too. Then I discovered a little trick where I put the patient first and forget about everything else. Now I consider it a privilege to go to work and see every single patient within 5 minutes while my consultants take 1-2 hours to work on their imaging reports and consult notes. This is not sarcasm by the way, I'm serious.

Tell me more of this being happy at work you speak of, I've heard only whispers of such things. Is it possible to learn this power?

 

[WilcoWorld]

Ok guys, I tried to take what everybody said in this thread to heart. But today's been another one of those days.

37 yo Pt seen by NP in ER yesterday for abdominal pain; elevated lipase, ct read as interstial pancreatitis. Was told by NP to come back if pain got worse.

Pt's pain worse. Came back. Rescanned by NP. Read by me as no change. No necrosis, cysts, etc....plus you not gonna see it after one day.

37 yo got scanned twice in two days for pancreatitis.

You aren't crazy. As you describe it, that is inappropriate.

 

[GonnaBeADoc2222]

You can talk to us about inappropriate scans when you guys drop the contrast induced neuropathy and contrast allergy nonsense.

 

[RustedFox]

You can talk to us about inappropriate scans when you guys drop the contrast induced neuropathy and contrast allergy nonsense.

Contrast allergies definitely exist.
It's the "shellfish/iodine" thing that doesn't.

 

[Siggy]

Contrast allergies definitely exist.
It's the "shellfish/iodine" thing that doesn't.

Someone still has to explain how people with functioning thyroids and eat American salt are allergic to iodine.

 

[RustedFox]

Someone still has to explain how people with functioning thyroids and eat American salt are allergic to iodine.

I really used to champion this; telling every muggle that has "iodine" in their allergy list: "That doesn't exist."

No matter what I said, they were incapable of understanding.

Most muggles really are an unterklasse of brainpower. Worse yet; they vote.

 

[WilcoWorld]

Contrast allergies definitely exist.
It's the "shellfish/iodine" thing that doesn't.

Contrast reactions exist, but it isn't a true allergy. It's anaphylactiod rather than anaphylactic - meaning there isn't immune system "memory". Furthermore, pretreatment for reactions has only ever been shown to reduce mild reactions. No mortality benefit.

Adverse Reactions to Contrast Material: A Canadian Update​

 

[RustedFox]

Contrast reactions exist, but it isn't a true allergy. It's anaphylactiod rather than anaphylactic - meaning there isn't immune system "memory". Furthermore, pretreatment for reactions has only ever been shown to reduce mild reactions. No mortality benefit.

Oh, I'm an expert on this. Someday, I'll let you all know just exactly why.

 

[WilcoWorld]

Oh, I'm an expert on this. Someday, I'll let you all know just exactly why.

Oh man, is it "the case"?

 

[RustedFox]

Oh man, is it "the case"?

Maybe.
Lets just say that you can tell a doc that your listed allergy is wrong and then change your mind later once something totally (and prove-ably) unrelated happens.

 

[maxxor]

You can talk to us about inappropriate scans when you guys drop the contrast induced neuropathy and contrast allergy nonsense.

you guys really should talk to nephro and perhaps cardio about CIN. I don’t think it’s real. In fact, too high vancomycin troughs also cause elevated creatinine but I don’t see people worrying about giving that. Most rads would love to stop the CIN fear.

Legit Contrast allergy is real. I make sure any allergy patients know what agent they get so they say that instead of “contrast”.

Iodine/shellfish/povidone are not cross reactive and I scan all these patients.

 

[southerndoc]

You can talk to us about inappropriate scans when you guys drop the contrast induced neuropathy and contrast allergy nonsense.

I like what you did there. LOL

I think you meant nephropathy.

 

[wareagle726]

“Bowel wall edema that could be infectious vs inflammatory vs ischemic in etiology” is my favorite.

Followed by CTA ordered because the patient is a bazillion years old and has afib and belly pain
Followed by CT tech calling to say "We can't! Their GFR is 20!"

Thankfully my rads guys are across the board awesome and give me no pushback with this stuff

 

[2brads]

Rad here. I can’t wait for the hammer to drop on the insane ED outliers ordering all these garbage studies. There’s usually one at every hospital and one of our ED MDs orders 2-3x more studies than the CLOSEST provider. She’s insane. Everyone knows she is insane. I just need CMS to tell her she’s insane and can no longer work in the ER.

Appropriate Use Criteria Program | CMS

Current StatusAs announced in the CY 2024 Physician Fee Schedule (PFS) Final Rule, effective January 1, 2024, CMS has paused efforts to implement the AUC program for reevaluation and rescinded the AUC regulations at 42 CFR 414.94. See pages 79256-79265 of the final rule.

www.cms.gov

As far as the argument that we need to just STFU and do our job because you’re making us rich, the random vagrant being pan scanned for the 3rd time in as many days does not, in fact, pay all that well.

 

[thegenius]

Rad here. I can’t wait for the hammer to drop on the insane ED outliers ordering all these garbage studies. There’s usually one at every hospital and one of our ED MDs orders 2-3x more studies than the CLOSEST provider. She’s insane. Everyone knows she is insane. I just need CMS to tell her she’s insane and can no longer work in the ER.

Appropriate Use Criteria Program | CMS

Current StatusAs announced in the CY 2024 Physician Fee Schedule (PFS) Final Rule, effective January 1, 2024, CMS has paused efforts to implement the AUC program for reevaluation and rescinded the AUC regulations at 42 CFR 414.94. See pages 79256-79265 of the final rule.

www.cms.gov

As far as the argument that we need to just STFU and do our job because you’re making us rich, the random vagrant being pan scanned for the 3rd time in as many days does not, in fact, pay all that well.

That's fine man...so there are a handful of ER docs or midlevels out of thousands that order too many imaging studies with impunity. As your colleague said above, we are all in this together and we are trying our hardest. There are a handful of radiology docs who I don't trust, but I'm not on your forum complaining about that and hoping that they stop practicing radiology or get in trouble.

Just a few days ago, there had to be a radiology overread on a serious miss of spinal cord pathology. I had a pt in the ED with weakness in his legs and non-localizing asymmetric, objective paresthesias and paresis going up to the mid abdomen. The initial prelim read on an MR Thoracic Spine w/wo Contrast was "Syrinx within the spinal cord spanning T3 through T6 approximately 8.6 cm and 2 mm in AP dimensions." and the reread in the morning was "Abnormal T2 hyperintense signal extending longitudinally within the ventral aspect of the spinal cord bilaterally and centrally with enhancement from approximately the T3 vertebra to the T6-7 disc level. No discrete mass lesion is identified. Differential considerations include a nonspecific demyelinating process, transverse myelitis and ischemia." The reread occurred because I initially saw the MRI and the read didn't make sense, I notified the Neurologist to discuss it as he had seen the patient as well and confirmed his neurologic findings, and the Neurologist spoke to Rads the next morning. Turned out those lesions were ischemic as we later discovered he had been stroking his C-spine, Brain (and T-spine) for the last 2 weeks or so. Had silent pAF as the source, which was finally picked up briefly on telemetry while in the hospital.

 

[2brads]

That's fine man...so there are a handful of ER docs or midlevels out of thousands that order too many imaging studies with impunity. As your colleague said above, we are all in this together and we are trying our hardest. There are a handful of radiology docs who I don't trust, but I'm not on your forum complaining about that and hoping that they stop practicing radiology or get in trouble.

Just a few days ago, there had to be a radiology overread on a serious miss of spinal cord pathology. I had a pt in the ED with weakness in his legs and non-localizing asymmetric, objective paresthesias and paresis going up to the mid abdomen. The initial prelim read on an MR Thoracic Spine w/wo Contrast was "Syrinx within the spinal cord spanning T3 through T6 approximately 8.6 cm and 2 mm in AP dimensions." and the reread in the morning was "Abnormal T2 hyperintense signal extending longitudinally within the ventral aspect of the spinal cord bilaterally and centrally with enhancement from approximately the T3 vertebra to the T6-7 disc level. No discrete mass lesion is identified. Differential considerations include a nonspecific demyelinating process, transverse myelitis and ischemia." The reread occurred because I initially saw the MRI and the read didn't make sense, I notified the Neurologist to discuss it as he had seen the patient as well and confirmed his neurologic findings, and the Neurologist spoke to Rads the next morning. Turned out those lesions were ischemic as we later discovered he had been stroking his C-spine, Brain (and T-spine) for the last 2 weeks or so. Had silent pAF as the source, which was finally picked up briefly on telemetry while in the hospital.

This isn't about misses/mistakes. Every doc in every specialty makes mistakes and has misses; those aren't going away. Ever.

This is about an obvious problem with test/imaging volumes getting out of hand in the ER. And it's not just me that's saying this is a problem. The federal government knows that some providers are way out of line and it is going to bring its regulatory power to bear on the worst offenders. I, and most of my colleagues are looking forward to it.

 

[thegenius]

This isn't about misses/mistakes. Every doc in every specialty makes mistakes and has misses; those aren't going away. Ever.

This is about an obvious problem with test/imaging volumes getting out of hand in the ER. And it's not just me that's saying this is a problem. The federal government knows that some providers are way out of line and it is going to bring its regulatory power to bear on the worst offenders. I, and most of my colleagues are looking forward to it.

BTW that link you provided discusses that at the time of ordering an imaging study, the practitioner ... will be required to consult a qualified Clinical Decision Support Mechanism (CDSM)"

This is already done at my hospital. I have to go through a CDSM every time I order anything but an xray or US in our EMR.

 

[Rekt]

BTW that link you provided discusses that at the time of ordering an imaging study, the practitioner ... will be required to consult a qualified Clinical Decision Support Mechanism (CDSM)"

This is already done at my hospital. I have to go through a CDSM every time I order anything but an xray or US in our EMR.

Yeah and it's entirely useless. I pre copy paste my reasoning (which I actually type out to help rads out, small hx, exam) and click reasoning not found and can free text and just paste my own reasoning. The CDSM is a complete waste and has never ever changed my decision to image someone or modality.

 

[GonnaBeADoc2222]

This isn't about misses/mistakes. Every doc in every specialty makes mistakes and has misses; those aren't going away. Ever.

This is about an obvious problem with test/imaging volumes getting out of hand in the ER. And it's not just me that's saying this is a problem. The federal government knows that some providers are way out of line and it is going to bring its regulatory power to bear on the worst offenders. I, and most of my colleagues are looking forward to it.

Waaaaaaah

Keep screaming at the clouds.

 

[VA Hopeful Dr]

This isn't about misses/mistakes. Every doc in every specialty makes mistakes and has misses; those aren't going away. Ever.

This is about an obvious problem with test/imaging volumes getting out of hand in the ER. And it's not just me that's saying this is a problem. The federal government knows that some providers are way out of line and it is going to bring its regulatory power to bear on the worst offenders. I, and most of my colleagues are looking forward to it.

I always enjoy when this happens.

Federal Government: patient satisfaction is very important and we are going to increase it's weight in your overall quality scores

Also Federal government: order less imaging.

I'm not EM (outpatient FP), and I will freely admit to overusing imaging. I'm sure my local radiologists hate me for all the pointless x-rays I order. But patients want imaging. Doesn't matter how sure I am about what's wrong, they want pictures. And so long as I'm partially paid on making patients happy, they are going to get whatever test they want unless it's actively harmful to them.

 

[2brads]

BTW that link you provided discusses that at the time of ordering an imaging study, the practitioner ... will be required to consult a qualified Clinical Decision Support Mechanism (CDSM)"

This is already done at my hospital. I have to go through a CDSM every time I order anything but an xray or US in our EMR.

Yeah, it's a govt website, so not exactly user friendly, but in the original legislation it says essentially,

"Upon full implementation, claims for the affected imaging services will be denied if they do not contain information regarding the ordering professional’s consultation with CDSM, or exception to such consultation. The ultimate goal of the program is to identify professionals with outlier-ordering patterns and require those practitioners to obtain prior authorizations for these tests."

The government doesn't care if you click all the right boxes in the AUC software. They just want the data to hammer the proud nail, as it were. Basically, if you are in the top 5% of advanced imaging ordering, you will need supervision to order those tests for Medicare patients. Which means that if you're an ER doc, you're screwed.

 

[southerndoc]

BTW that link you provided discusses that at the time of ordering an imaging study, the practitioner ... will be required to consult a qualified Clinical Decision Support Mechanism (CDSM)"

This is already done at my hospital. I have to go through a CDSM every time I order anything but an xray or US in our EMR.

I'm on the lower end of utilizers of CT in my ED. If I have to go through a CDSM, I'll call the radiologist with every study I'm about to order to find out the most appropriate study. I'm not using a computer algorithm to determine what study to order.

 

[southerndoc]

This isn't about misses/mistakes. Every doc in every specialty makes mistakes and has misses; those aren't going away. Ever.

This is about an obvious problem with test/imaging volumes getting out of hand in the ER. And it's not just me that's saying this is a problem. The federal government knows that some providers are way out of line and it is going to bring its regulatory power to bear on the worst offenders. I, and most of my colleagues are looking forward to it.

Not to ruffle the feathers of one of the posters that frequently likes to accuse us of midlevel bashing, but there are studies that show that midlevels order more imaging studies than board-certified emergency physicians. Maybe we should start there by having appropriate oversight of our midlevel colleagues in the emergency department instead of allowing them to function autonomously.

 

[RustedFox]

Not to ruffle the feathers of one of the posters that frequently likes to accuse us of midlevel bashing, but there are studies that show that midlevels order more imaging studies than board-certified emergency physicians. Maybe we should start there by having appropriate oversight of our midlevel colleagues in the emergency department instead of allowing them to function autonomously.

I had a PLP last month call in the helicopter to transfer a 88 year old male who was septic because "he's unstable!"

He was stable. He was also DNR.

We had words.

 

[DoctorMD1]

You guys invented real life x-ray vision PLUS a way to make a s* *t-ton of money by looking at pictures without having to interact with humanity. You should be jumping up and down for joy, popping champagne bottles, celebrating that the plan workout, NOT complaining because the plan worked too good.


"Up in the hot tub, poppin' bubbly...
...I don't wanna be a player no more
I'm not a player, I just crush a lot" - Big Pun, Still Not A Player

that is pretty much what I do. LOL

 

[rickylafleur]

Not to ruffle the feathers of one of the posters that frequently likes to accuse us of midlevel bashing, but there are studies that show that midlevels order more imaging studies than board-certified emergency physicians. Maybe we should start there by having appropriate oversight of our midlevel colleagues in the emergency department instead of allowing them to function autonomously.

You see there it goes.
There was some truth but it was all too blame sharing for egos here
It’s universal. Not just midlevel
But anytime some of the blame is shared here it becomes uncomfortable for the physicians and all it takes is a shift in the blame to mid levels based on “some studies” and it all feels better.
Followed by some fun mane calling like pretend level provider

 

[rickylafleur]

I had a PLP last month call in the helicopter to transfer a 88 year old male who was septic because "he's unstable!"

He was stable. He was also DNR.

We had words.

Moderator note: content removed due to TOS violations

 

[Birdstrike]

that is pretty much what I do. LOL

Still a playa

 

[CoolDoc1729]

Moderator note: content removed due to TOS violations

Are you .. for real?

 

[southerndoc]

You see there it goes.
There was some truth but it was all too blame sharing for egos here
It’s universal. Not just midlevel
But anytime some of the blame is shared here it becomes uncomfortable for the physicians and all it takes is a shift in the blame to mid levels based on “some studies” and it all feels better.
Followed by some fun mane calling like pretend level provider

This reads like an extended Haiku. Love it.

 

[rickylafleur]

This reads like an extended Haiku. Love it.

Haha I came in a little hot there but…oh well
I’m not going to be a cry baby here but particularly this issue is shared. We all can be guilty of over using resources.
But pointing fingers and saying they do it more seems kind of schoolyard to me

 

[rickylafleur]

Are you .. for real?

I am for real real coolio.

 

[CoolDoc1729]

I am for real real coolio.

But this is a place for the ER docs to converse and commiserate. Here’s a thread with rads complaining about us ordering too many tests. We can’t point out that more than their share are ordered by the mid levels ? To each other?

If you’re one of the better ones, then you know it’s true !

 

[GonnaBeADoc2222]

Yeah, it's a govt website, so not exactly user friendly, but in the original legislation it says essentially,

"Upon full implementation, claims for the affected imaging services will be denied if they do not contain information regarding the ordering professional’s consultation with CDSM, or exception to such consultation. The ultimate goal of the program is to identify professionals with outlier-ordering patterns and require those practitioners to obtain prior authorizations for these tests."

The government doesn't care if you click all the right boxes in the AUC software. They just want the data to hammer the proud nail, as it were. Basically, if you are in the top 5% of advanced imaging ordering, you will need supervision to order those tests for Medicare patients. Which means that if you're an ER doc, you're screwed.

LOL bro. You really have no idea.

 

[GonnaBeADoc2222]

Moderator note: content removed due to TOS violations

Sigh. I've asked this before but I'll ask it again. Why can't we ban these midlevel accounts? Do they add to the discourse or just throw inferiority complex gas on the fire?

 

[rickylafleur]

Sigh. I've asked this before but I'll ask it again. Why can't we ban these midlevel accounts? Do they add to the discourse or just throw inferiority complex gas on the fire?

Sounds like the pot calling the kettle black.