Jenny McJennyson, at it again.

[RustedFox]

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Jenny McJennyson sent me these two gems over the weekend:


1.) 2 year old male child has a simple febrile seizure. Mom says that they called their doctors office, and spoke with Jenny McJennyson, who directed them to the ER after telling mom that the child would need a CT of the brain to rule-out brain tumor. No joke. Thankfully, mom was reasonable. Kid is totally fine. Afebrile. Playful. We spared him the radiation after a good heart-to-heart. I asked mom: "I'm sorry, who did you speak with at your doctor's office again?"

"Jenny McJennyson."

I recognized Jenny's actual name. Mom saw the look on my face and asked me to just say what it was that was on my mind.

I actually said: "Yep. I know this person. Allow me to be impolite for a second, but honest?"

*Mom nods*.

"Jenny McJennyson is proof that you can be a unintelligent, and have an NP degree."

Mom looked back at me and nodded in agreement.

"Yep. That's what I thought. We've gotten to know this person, and were very suspect of her knowledge base. Thank you."


2.) Jenny McJennyson calls from the local memory care unit. Says that despite one week's worth of lovenox, that this 96 year old female's DVT was only getting worse, and that she needed to be admitted for heparin and a vascular consult. I told her that we don't have vascular surgery at this facility, and to keep that in mind when deciding where to send this patient.

Nevermind that, Jenny sent Grandma to us anyways, of course, at 9:45 PM. No ultrasound reports accompanied the patient, just the face-sheet and the DNR.

"Get Jenny back on the phone, please", I said to my unit clerk.

"Jenny here!"

"Hey, RustedFox here; I have no radiology reports here whatsoever. I can't act on this without knowing what I'm getting into. Can you please have Death Acres Memory Care Unit send me the ultrasounds?"

"Uhmmm. Okay!"

One ultrasound gets sent from 10 days ago, confirming DVT in the LLE.

Family has now shown up. I ask them when the second ultrasound was done to confirm that the DVT failed to respond to therapy.

"Uh, no. Only one ultrasound was done."

"Get Jenny back on the phone, please."

"Jenny here! What seems to be the problem?!" (Audibly pissy that I have called her again.)

"Where's the follow-up study confirming propagation of the DVT? I only have one ultrasound."

"Uhmm.... we didn't do one."

"So, you called me earlier to say that the patient needed to be admitted for services that I told you we don't have at this facility because of a propagating DVT, but you didn't do a second study? How can you know that the clot burden is worse if you didn't repeat the study!?"

Well.... the leg just didn't LOOK any better. It was Dr. El-Kaboom who told me to send her.

"Get Dr. El-Kaboom on the phone, please."

I had the exact same conversation with Dr. El-Kaboom, who was pissy as well.

"How can you send a patient for failure to respond, when you don't know that they've failed to respond? That's called LYING." (I actually said this)

"What; you can't get an ultrasound?" (Ignoring my question altogether).

"US is not in-house. This poor family is going to have to wait a long time for US to come in, do the study, have rads read it; and this patient may not even have needed to be sent to me!"

"Oh, robbledy-robble-robbl-"

"Fine. I'll take care of them."

*Click*

....


Two hours later:

"Negative study for DVT."

 

[TooMuchResearch]

You did the right thing for the patients and maybe family 1 will avoid Jenny going forward.

 

[RustedFox]

You did the right thing for the patients and maybe family 1 will avoid Jenny going forward.

Thank you.
This particular Jenny needs to not go anywhere near patients in a "provider" (there's that WORD!) role.

 

[sylvanthus]

Be lucky you don’t have naturopathic docs ( who is the pt primary physician) prescribing fluconazole for “systemic hives” sending their pt to the Ed for LFT check after a night of drinking. I refused to do lab work, gave zofran, po challenged, told pt to avoid antifungal medications prescribed from naturopaths, sent home.

Result? Huuuuugggeeee pt complaint about failure to treat, dismissive attitude etc, letters written, mult phone calls, and drama ensued.
Fuk guess ill just do the damn lft unneccessarily next time.

 

[pkwraith]

At least they had a DVT at some point.

I had 2 patients sent in over the last month for "DVT" on US (Uh okay, you can also write anticoagulation Rx as well). I review US report. "Superficial vein thrombosis of X/Y/Z. No acute deep vein thrombosis."

"Sorry, your doctor does not know how to read English"

 

[Tenk]

This will never change until you write them up formerly and then tell the patients family to send a formal complaint. Only complaining changes things nowadays. It’s one of the reasons crap like this continues. People are either too busy or nice to complain.

 

[TheSingularity]

At least they had a DVT at some point.

I had 2 patients sent in over the last month for "DVT" on US (Uh okay, you can also write anticoagulation Rx as well). I review US report. "Superficial vein thrombosis of X/Y/Z. No acute deep vein thrombosis."

"Sorry, your doctor does not know how to read English"

No, they know how to read. They just don't know medicine.

 

[RustedFox]

At least they had a DVT at some point.

I had 2 patients sent in over the last month for "DVT" on US (Uh okay, you can also write anticoagulation Rx as well). I review US report. "Superficial vein thrombosis of X/Y/Z. No acute deep vein thrombosis."

"Sorry, your doctor does not know how to read English"

I had one of these this month, too.
Sent in for anticoagulation by Jenny.

 

[VA Hopeful Dr]

No, they know how to read. They just don't know medicine.

UpToDate isn't that expensive. No one can know everything but you have to know where to find what you don't know.

 

[deleted109597]

Don't worry. No warnings.

We have a different perspective than many other docs. We get to see the dying misses, as well as the complete ****up non-misses. I'm not sure what god we pissed off to get both ends of this spectrum, but here we are.

Keep doing what's right. Read some stoicism. Read some buddhism. Read some Mark Manson.

But keep doing what you're doing. It's important, and what you do matters.

 

[Birdstrike]

Every ER doctor has their own Jenny (or Johnny). Not only is it frustrating, it makes it hard because just when you think they'll never send in anyone sick, they drop an A bomb on you, but they present it like another pointless referral.

My own Johnny McJohnnyson, after sending in an endless stream of un-sick patients over several years, called and said (insert bizarre vocal inflections), "I'm sending you an 18 year old guy. He's actin' wild, real wild."

Me: "Uh...lol. 'Acting wild, really wild,' doesn't help me much. Could you be a little more specific, J O H N N Y ?"

Johnny, "Yeah, he's just wEYELd, real wEYELd. We gotta get 'em outta here." >click<

The guy comes by ambulance, confused, screaming and yelling, and this otherwise previously healthy 18-year-old turned out to be near death with a Hgb of 2.0.

There's nothing you can do. You can't make the Johnny McJohnnyson's go away. There's always one, and there's a factory somewhere making more of him to replace him when he's gone. All you can do is try to stay focused, and do the best thing for the patient who invariably thinks Dr. McJohnnyson walks on water and is the the greatest doctor in the World, Galaxy and all possible Universes, because....wait for it...


"He cares so much!"

Of course, he does.

Just as a broken clock is right twice per day, the Jenny's and Johnny's of the world will make your life harder, not only by sending patients they don't need to send, but by accidentally being right once in a while.

Just keep being an awesome doc, and everything else will sort itself out.

 

[TooMuchResearch]

Someone sent them in for an easy test. If I decide to question their trust in the third party that sent them, which I usually don't since I've only just met them, I still offer to do the test.

Be lucky you don’t have naturopathic docs ( who is the pt primary physician) prescribing fluconazole for “systemic hives” sending their pt to the Ed for LFT check after a night of drinking. I refused to do lab work, gave zofran, po challenged, told pt to avoid antifungal medications prescribed from naturopaths, sent home.

Result? Huuuuugggeeee pt complaint about failure to treat, dismissive attitude etc, letters written, mult phone calls, and drama ensued.
Fuk guess ill just do the damn lft unneccessarily next time.

 

[jw3600]

Someone sent them in for an easy test. If I decide to question their trust in the third party that sent them, which I usually don't since I've only just met them, I still offer to do the test.

I would have done the CMP. I also would have said for the love of god put down the fluconazole.

 

[deleted859535]

Someone sent them in for an easy test. If I decide to question their trust in the third party that sent them, which I usually don't since I've only just met them, I still offer to do the test.

I do something like this also.

"I don't think it's going to show us anything, but okay, let's make sure."

I pick my battles very carefully. The almost certain viral but omgmybabyhaspinkeye conjunctivitis. The sprained ankle XRs. The doubtful DVT ultrasounds. We have a tough enough job as it is, and the more I argue on hills not worth dying on, the fewer people I see / more bull**** complaints I have to deal with on my days off from people who have no grasp of NNT/NNH or any other aspect of medicine / etc.

I enjoy it only for the small handful that are actually appreciative of the negative testing reassurance. The rest of the time, it's just a part of the gig. The faster I square away those cases, the sooner I can see someone who actually does need my services.

 

[Birdstrike]

the more I argue on hills not worth dying on, the fewer people I see / more bull**** complaints I have to deal with on my days off from people who have no grasp of NNT/NNH or any other aspect of medicine / etc.

I enjoy it only for the small handful that are actually appreciative of the negative testing reassurance. The rest of the time, it's just a part of the gig. The faster I square away those cases, the sooner I can see someone who actually does need my services.

Some people see the nothingomas as either, 1) quick, easy cases requiring little thought that act as mental breaks between stressful cases, or as, 2) insulting, unforgivable abuses of the ED, that are the bane of ones existence.

Clearly, #1 is the better choice if you're able to make it. But sometimes, when the patience is running thin, it can be easier said than done.

 

[MechEDoc]

Be lucky you don’t have naturopathic docs ( who is the pt primary physician) prescribing fluconazole for “systemic hives” sending their pt to the Ed for LFT check after a night of drinking. I refused to do lab work, gave zofran, po challenged, told pt to avoid antifungal medications prescribed from naturopaths, sent home.

Result? Huuuuugggeeee pt complaint about failure to treat, dismissive attitude etc, letters written, mult phone calls, and drama ensued.
Fuk guess ill just do the damn lft unneccessarily next time.

Reminds me of a nice patient complaint that I got from a patient with terrible athlete's foot and onychomycosis. The patient was older, in poor health, drank heavily, and had no primary care physician. I discussed with him the need for oral anti-fungals and the need for follow-up to check liver function (I was thinking of Terbinafine).

The patient immediately proceeded to the "Dumb and Dumber" urgent care clinic staffed by NP 007 and PA 007, who promptly prescribed an antibiotic.

"That mean doctor did not prescribe what I needed! I needed an antibiotic!"

Why did I bother with medical school?

 

[bravotwozero]

This will never change until you write them up formerly and then tell the patients family to send a formal complaint. Only complaining changes things nowadays. It’s one of the reasons crap like this continues. People are either too busy or nice to complain.

Have you actually attempted this? How did it work out for you?

 

[Tenk]

Have you actually attempted this? How did it work out for you?

It works. Just has to be a more than one time thing.

 

[GeneralVeers]

I just tell patients "I don't think you need this test, but I'll order it, and when it's negative I'll discharge you". Only 10% of the time do patients actually request I don't do the test.

They love the garbage phrase "Just to make sure!". For some reason that phrase irks me, and is like being jabbed with a hot needle at the base of my skull.

 

[Birdstrike]

I just tell patients "I don't think you need this test, but I'll order it, and when it's negative I'll discharge you". Only 10% of the time do patients actually request I don't do the test.

They love the garbage phrase "Just to make sure!". For some reason that phrase irks me, and is like being jabbed with a hot needle at the base of my skull.

Because it implies that you as a doctor, were to dumb to consider “making sure” they were okay. As if doctoring is simply a choice or clicking either the “make sure patient is okay” or “don’t make sure patient is okay” buttons, and that you needed their help to decide which one to click.

.

 

[Zebra Hunter]

Some people see the nothingomas as either, 1) quick, easy cases requiring little thought that act as mental breaks between stressful cases, or as, 2) insulting, unforgivable abuses of the ED, that are the bane of ones existence.

Clearly, #1 is the better choice if you're able to make it. But sometimes, when the patience is running thin, it can be easier said than done.

I cycle between these two all the time depending on the request from mid-level or physician. However, unnecessary MRIs (I will not hold up a bed in my ER for a minimum of 8 hours for chronic back pain w/o red flags), admissions, antibiotics, IV anti-hypertensives for asymptomatic HTN, or consults I refuse and generally will not budge unless the mlp or doc calls me up themselves and can give a rational reason for the request. I do not make the attempt to contact them, unless they first made the attempt to contact me or if I believe there is important information not being relayed by the patient. They can deal with their upset patient later.

For everything else that just requires something like lab work or CT, I usually try to convince them they don't need it, and if I fail at convincing I just order it.

 

[Janders]

We have one of these where I work. Local provider, works full time in a UC that refers to our ED. Everybody in our ED knows their name. Their referrals range from conservative-but-reasonable to absolutely insane harmful wastes of resources, time, money and radiation exposure.

I mostly just deal with it happily, try to talk the 14yo CTs off the radiation ledge, and otherwise get the stupid labs/xray and keep things happy. Probably 20% of the patients figure out the gig, despite my poker face. Its ok though, it pays the bills, almost all the patients are really nice people, and they were told by a healthcare professional to come to my ER. Can't fault them!

However, the issue is I can read this UC provider's notes. And they are borderline insane. 24yoM with epigastric pain after night of drinking beer. Differential includes gastritis, cholecystitis, aortic dissection, PE, epidural abscess, ovarian torsion and ebola. Recommend ALS transfer to ED for CT, CTA, MR, MRA, U/S, Labs, and further testing. Patient refuses ALS will drive self.

Woof. Formal complaints have been made about these specific referral notes (in that they are... unnecessary and raise everyone's risk). Its like someone learned the 20-things-that-kill-you-dead! and put them in every differential.

Needless to say the formal complaints just blew up in our face, and irritated higher up powers I only vaguely knew existed. We are "mean" and "spiteful" and said provider "cares about patients".

So what do you do? Rule #1... do what's right for the patient. Talk to them. If they need a rather meaningless test for peace of mind? Go for it. If you think you are going to harm them with a ridiculous request... lean in. Engage them. 90% of the time, they will hear you and you can do what is right for them.

Every once in a while though, you just have to order that CT.

 

[deleted836128]

PA here so maybe I am Jenny McJennyson to some of you (ha) but I have my own Jenny McJennyson story from today.

Lady with chronic back pain with a Dilaudid pump (!) comes in with a history of six to eight weeks (timing is crucial to note here) of occasional fecal and urinary incontinence (“sometimes I don’t make it to the bathroom”). No other new symptoms - no numbness, tingling, weakness; she admitted it “doesn’t feel different down there when I wipe.” Totally normal neuro exam. I did my rectal exam; normal sensation and tone. Post void residual is, like, 30 cc. She said she came to the ER because yesterday her pain management NP Jenny had told her she may have cauda equina syndrome. I look at the records of Jenny’s note and she mentions the patient could have cauda equina syndrome possibly and was told this “could be” emergent so she might want to consider going to the ER (!). So the lady sees her PCP this morning for a “second opinion” because she clearly doubts Jenny and the PCP sends her to the ER for a STAT MRI to rule out cauda equina. Patient comes in with a stack of records that her PCP got faxed from pain management INCLUDING an MRI with and without contrast done on February 7th prior that just showed some disc bulging. Ironically the MRI was ordered by Jenny. Ironically when she talked about cauda equina syndrome as a possibility in her chart she didn’t even happen to reference the MRI of the spine she had ordered just days prior that showed no evidence of this. Ironically the PCP didn’t even bother to look at the records and see an MRI had already been done, and was embarrassed / confused when I called to ask “is there something I am missing?” The lady laughed when I told her things looked okay from an ER standpoint and then waltzed away to eat cheeseburgers in the hospital cafeteria...

 

[deleted836128]

Some people see the nothingomas as either, 1) quick, easy cases requiring little thought that act as mental breaks between stressful cases, or as, 2) insulting, unforgivable abuses of the ED, that are the bane of ones existence.

Clearly, #1 is the better choice if you're able to make it. But sometimes, when the patience is running thin, it can be easier said than done.

I usually see these as #1. Honestly during a day of really complex or sick or needy patients, sometimes it’s nice to just do the stupid test they were sent in for and then discharge them. Also, from a patient perspective, someone they probably trust has likely instilled in their mind that they need this test and if you don’t get it, they’ll be worried about it or worse, their primary care doctor will call back in a rage.

I once had an urgent care doctor get furious at me and call me out in person for failing to work up possible ovarian cancer in the ER. The 60 year old lady came in with lower abdominal pain, diarrhea and bloating ... and urgent care sent her in. Her CT showed thickening of the colon, looked like colitis. I discharged her. Urgent care doctor calls me a few hours later telling me the lady could have ovarian cancer because she has complained of bloating and said that the patient’s sister had ovarian cancer. She said based on the bloating (NOT noted on exam at all) and family history I should have gotten a pelvic ultrasound. I explained that 1) I had a reason for the patient’s pain (colitis, thought to be infectious; looked to be resolving on the CT) and 2) there was no need for further work up based on benign belly exam and normal labs and 3) cancer work up isn’t really an ER work up so if she continues to have bloating and pain after her colitis resolves she needs to see her PCP for further investigation. Also nothing suspicious for cancer showed up on the CT. The urgent care doctor was so pissed and just didn’t get my reasoning.

 

[EctopicFetus]

My experience today. 42yoM to the ed for sob and leg swelling. Tachy to 120s. Sats ok. Sob Worse with being supine. Dyspnea with exertion.
I eval the patient. Tell him and his wife. Listen I know what is wrong. You have heart failure.
Earlier today patient sees Jenny at urgent care. Told sob is due to anxiety. Wtf. Wife sees how I think someone who has even scant experience in medicine can make this diagnosis.
She says to me. We don’t have any good healthcare in our town. My response “based on who you saw today I can’t disagree”. Honestly my ed nurses can make this diagnosis. It’s pathetic and why I think often times patients would be better off having less access to care when the noctors know so little they can kill people.
Oh and guy has an insane family history of heart issues in people in their 40s and 50s.

 

[TheSingularity]

We have one of these where I work. Local provider, works full time in a UC that refers to our ED. Everybody in our ED knows their name. Their referrals range from conservative-but-reasonable to absolutely insane harmful wastes of resources, time, money and radiation exposure.

I mostly just deal with it happily, try to talk the 14yo CTs off the radiation ledge, and otherwise get the stupid labs/xray and keep things happy. Probably 20% of the patients figure out the gig, despite my poker face. Its ok though, it pays the bills, almost all the patients are really nice people, and they were told by a healthcare professional to come to my ER. Can't fault them!

However, the issue is I can read this UC provider's notes. And they are borderline insane. 24yoM with epigastric pain after night of drinking beer. Differential includes gastritis, cholecystitis, aortic dissection, PE, epidural abscess, ovarian torsion and ebola. Recommend ALS transfer to ED for CT, CTA, MR, MRA, U/S, Labs, and further testing. Patient refuses ALS will drive self.

Woof. Formal complaints have been made about these specific referral notes (in that they are... unnecessary and raise everyone's risk). Its like someone learned the 20-things-that-kill-you-dead! and put them in every differential.

Needless to say the formal complaints just blew up in our face, and irritated higher up powers I only vaguely knew existed. We are "mean" and "spiteful" and said provider "cares about patients".

So what do you do? Rule #1... do what's right for the patient. Talk to them. If they need a rather meaningless test for peace of mind? Go for it. If you think you are going to harm them with a ridiculous request... lean in. Engage them. 90% of the time, they will hear you and you can do what is right for them.

Every once in a while though, you just have to order that CT.

Pediatrics do not get unnecessary CTs from me. I do not care how much the parents jump up and down and scream. I do not irradiate a child for no reason.

 

[killerleaf]

I just tell patients "I don't think you need this test, but I'll order it, and when it's negative I'll discharge you". Only 10% of the time do patients actually request I don't do the test.

They love the garbage phrase "Just to make sure!". For some reason that phrase irks me, and is like being jabbed with a hot needle at the base of my skull.

For sane patients, and I realize you don't get that many, there is a real thought process going on here: We just saw someone who supposedly knows what they are doing, and they said/referred us to you, and now we are scared to death. For you to say, "just to make sure", it means that you are going above and beyond to take care of us, and whatever is going on will be figured out. If we are asking for something "just to make sure" it is not because we are devaluing your decision, it is because we are scared to death, and at this moment, the logical, reasoning part of the brain is cowering in the corner, and the "WE ARE GOING TO DIE" panic monster is loose. When you tell us that that test is not going to prove anything conclusive, we are fine with that answer. Or if you tell us that needs to be followed up with primary, we are relieved. That means that "actively trying to die process" is not in gear.

Again, this is just how I know that my husband and I view things. We feel that you guys are awesome, and we hate to add anything stupid to your day. And we believe in treating you with respect.

 

[Dr Mantis Toboggan]

Yup ditto the hand written prescription for a lumbar puncture that is not indicated. Nope.

Pediatrics do not get unnecessary CTs from me. I do not care how much the parents jump up and down and scream. I do not irradiate a child for no reason.

 

[GeneralVeers]

When you tell us that that test is not going to prove anything conclusive, we are fine with that answer. Or if you tell us that needs to be followed up with primary, we are relieved. That means that "actively trying to die process" is not in gear.

Again, this is just how I know that my husband and I view things. We feel that you guys are awesome, and we hate to add anything stupid to your day. And we believe in treating you with respect.

Thanks for the sane reply. I wish the general public could be more aware as well. We have to watch every single thing we say to patients, in case it's taken as a slight, or insult thus generating a complaint or a job loss. People say all sorts of mean things to us on a daily basis. Most of us have a lot of training and tons of experience. I've seen 30,000 patients in my time, so I know in advance if a CT scan will likely show anything or not. When I give my recommendation, explain why the CT is not needed, and patients say "Let's get it just to be sure!", they are de-valuing my experience and training. It's definitely insulting and demoralizing.

 

[killerleaf]

GV, that sucks. I have seen the posts here on this forum, and I know the residents from our institution are facing the same issues. I hear it from my family and friends, too. I don't know how many times I have told them to settle down; that it was good news they weren't going to have to pay for a CT or MRI because it was not needed; the doctor was looking out for them. And they weren't given antibiotics because they did not need them. And why did you go to the ED anyway for a freaking cold? Of course, there are now a couple that don't talk to me, which is fine!

 

[TooMuchResearch]

At least one of the hospitals we cover the vast majority of patients get turfed between PA/Naps that aren't great and are at best loosely supervised by aggressive pill prescribers who should be long retired. I feel pressure to get it right the first time, more than when I work in a place with great follow-up. I can seriously get these people set up with cardiology (MD/DO) easier than good primary care follow-up.

My experience today. 42yoM to the ed for sob and leg swelling. Tachy to 120s. Sats ok. Sob Worse with being supine. Dyspnea with exertion.
I eval the patient. Tell him and his wife. Listen I know what is wrong. You have heart failure.
Earlier today patient sees Jenny at urgent care. Told sob is due to anxiety. Wtf. Wife sees how I think someone who has even scant experience in medicine can make this diagnosis.
She says to me. We don’t have any good healthcare in our town. My response “based on who you saw today I can’t disagree”. Honestly my ed nurses can make this diagnosis. It’s pathetic and why I think often times patients would be better off having less access to care when the noctors know so little they can kill people.
Oh and guy has an insane family history of heart issues in people in their 40s and 50s.

 

[rokshana]

We have one of these where I work. Local provider, works full time in a UC that refers to our ED. Everybody in our ED knows their name. Their referrals range from conservative-but-reasonable to absolutely insane harmful wastes of resources, time, money and radiation exposure.

I mostly just deal with it happily, try to talk the 14yo CTs off the radiation ledge, and otherwise get the stupid labs/xray and keep things happy. Probably 20% of the patients figure out the gig, despite my poker face. Its ok though, it pays the bills, almost all the patients are really nice people, and they were told by a healthcare professional to come to my ER. Can't fault them!

However, the issue is I can read this UC provider's notes. And they are borderline insane. 24yoM with epigastric pain after night of drinking beer. Differential includes gastritis, cholecystitis, aortic dissection, PE, epidural abscess, ovarian torsion and ebola. Recommend ALS transfer to ED for CT, CTA, MR, MRA, U/S, Labs, and further testing. Patient refuses ALS will drive self.

Woof. Formal complaints have been made about these specific referral notes (in that they are... unnecessary and raise everyone's risk). Its like someone learned the 20-things-that-kill-you-dead! and put them in every differential.

Needless to say the formal complaints just blew up in our face, and irritated higher up powers I only vaguely knew existed. We are "mean" and "spiteful" and said provider "cares about patients".

So what do you do? Rule #1... do what's right for the patient. Talk to them. If they need a rather meaningless test for peace of mind? Go for it. If you think you are going to harm them with a ridiculous request... lean in. Engage them. 90% of the time, they will hear you and you can do what is right for them.

Every once in a while though, you just have to order that CT.

love it when the Ddx includes ovarian torsion in a cis male....

 

[GeneralVeers]

love it when the Ddx includes ovarian torsion in a cis male....

Hey it's the cis-male's right to have torsion if zhe believes zhe has it.

 

[Birdstrike]

Hey it's the cis-male's right to have torsion if zhe believes zhe has it.

Furthermore, I'd say that if I "identify" as a 5-star Press-Ganey doctor, then I am one, and anyone saying otherwise is a bigot.

 

[GeneralVeers]

Furthermore, I'd say that if I "identify" as a 5-star Press-Ganey doctor, then I am one, and anyone saying otherwise is a bigot.

Right? I identify as a physician making $500/hr who is immune to patient complaints.