My pathetic week.

[NotaK(l)eenEye]

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Get this. I worked an overnight shift 2 nights ago. A memorable patient at 3am was the 38yo M where I plucked out a microscopic curly hair from his conjunctivitis eye. Instant relief! No real oozing or pus. Didn't think much of it at the time.

Then next day I woke up with unilateral painless conjunctivitis, no vision changes. Mild/moderate yellowish discharge. I self-prescribed some polytrim without any improvement. Then I squirted some of my wife's breastmilk in my eye with transient relief. Hey! It worked on my baby.

2 days later, I get urethral discharge! WTF? And my eye isn't better. Jesus, did I just contract GC from a patient encounter? Apparently I have to be more careful when using the slit lamp! What to do?

I'm thinking I need some ceftriaxone, but I can't call this in. Also my wife convinced me that self prescribing ceftriaxone doesn't fall within the ethical guidelines of self treating for "short term, minor problems."

My insurance is crap, I have a $2600 deductable, and I don't have a PCP yet because I just moved here. I called everyone that's within my network and no one can see me tomorrow. So I call some local urgent cares. One will see me for ~$80. I bite.

The doctor gives me 250mg IM ceftriaxone and doxy 100mg bid x3 weeks. I ask about erythromycin ointment for my presumed gonococcal conjunctivitis and get denied. His rationale is that he wishes to treat the possible gonococcal conjunctivitis systemically. I went home. I can always pick up erythromycin ointment if I need to.

When I get home, I look up the CDC's recommendations:
http://www.cdc.gov/std/treatment/2010/gonococcal-infections.htm
Gonococcal conjunctivitis -- 1 gram ceftriaxone IM. Add the doxy for chlamydia coverage x1 week. though recent evidence points towards Azithro single dose being better.

I call the Urgent Care up and say, "Hey, maybe I was underdosed according to the CDC. Any chance I could get the full gram?" The doctor talks to me after checking the CDC's recomendations. He tells me to come back for the extra 750mg. No extra charge! Great! When I get there, he changes his mind and says that actually his original line of thinking is valid. His thinking is such that he was treating 4 different entities:
Gonococcal urethritis -- ceftriaxone 250mg IM
Gonococcal conjunctivitis -- doxy x3 wks
Chlamydia urethritis -- doxy x3 wks
Chlamydia conjunctivitis -- doxy x3ks

I thought that we don't treat gonorrhea with doxy anymore because of resistance issues. I bring this up, and he says that his newer guidelines from 2014 confirm that Doxy is OK in this regimen. I ask what guidelines he's using, and he changes the subject.

In the end, I was charged an extra $36 for the additional 750mg because it was deemed "extra" and not within his plan of care. I thought about protesting, but my wife convinced me not to. I can't help but feel he was letting pride get in the way of patient care. Or maybe he knows something I don't?

I ended up prescribing myself 1 week of Doxy, as it costs $20/week BID. I didn't feel like shelling out another $40 towards 2 weeks worth of unsubstantiated thinking.

One thing's for certain: Last time I pluck a pube from some dude's eye.

 

[The White Coat Investor]

Hmmm....did you get your wife tested? What about your other partners? 🙂

 

[gutonc]

Dear Penthouse,

I never thought I'd be writing this letter but...

 

[NotaK(l)eenEye]

I haven't had sex in about a year.

 

[Doctor Bob]

It seems like that's the bigger problem...

 

[NotaK(l)eenEye]

I knew this thread would turn into this...

 

[Spinach Dip]

 

[Birdstrike]

Get this. I worked an overnight shift 2 nights ago. A memorable patient at 3am was the 38yo M where I plucked out a microscopic curly hair from his conjunctivitis eye. Instant relief! No real oozing or pus. Didn't think much of it at the time.

Then next day I woke up with unilateral painless conjunctivitis, no vision changes. Mild/moderate yellowish discharge. I self-prescribed some polytrim without any improvement. Then I squirted some of my wife's breastmilk in my eye with transient relief. Hey! It worked on my baby.

2 days later, I get urethral discharge! WTF? And my eye isn't better. Jesus, did I just contract GC from a patient encounter? Apparently I have to be more careful when using the slit lamp! What to do?

I'm thinking I need some ceftriaxone, but I can't call this in. Also my wife convinced me that self prescribing ceftriaxone doesn't fall within the ethical guidelines of self treating for "short term, minor problems."

My insurance is crap, I have a $2600 deductable, and I don't have a PCP yet because I just moved here. I called everyone that's within my network and no one can see me tomorrow. So I call some local urgent cares. One will see me for ~$80. I bite.

The doctor gives me 250mg IM ceftriaxone and doxy 100mg bid x3 weeks. I ask about erythromycin ointment for my presumed gonococcal conjunctivitis and get denied. His rationale is that he wishes to treat the possible gonococcal conjunctivitis systemically. I went home. I can always pick up erythromycin ointment if I need to.

When I get home, I look up the CDC's recommendations:
http://www.cdc.gov/std/treatment/2010/gonococcal-infections.htm
Gonococcal conjunctivitis -- 1 gram ceftriaxone IM. Add the doxy for chlamydia coverage x1 week. though recent evidence points towards Azithro single dose being better.

I call the Urgent Care up and say, "Hey, maybe I was underdosed according to the CDC. Any chance I could get the full gram?" The doctor talks to me after checking the CDC's recomendations. He tells me to come back for the extra 750mg. No extra charge! Great! When I get there, he changes his mind and says that actually his original line of thinking is valid. His thinking is such that he was treating 4 different entities:
Gonococcal urethritis -- ceftriaxone 250mg IM
Gonococcal conjunctivitis -- doxy x3 wks
Chlamydia urethritis -- doxy x3 wks
Chlamydia conjunctivitis -- doxy x3ks

I thought that we don't treat gonorrhea with doxy anymore because of resistance issues. I bring this up, and he says that his newer guidelines from 2014 confirm that Doxy is OK in this regimen. I ask what guidelines he's using, and he changes the subject.

In the end, I was charged an extra $36 for the additional 750mg because it was deemed "extra" and not within his plan of care. I thought about protesting, but my wife convinced me not to. I can't help but feel he was letting pride get in the way of patient care. Or maybe he knows something I don't?

I ended up prescribing myself 1 week of Doxy, as it costs $20/week BID. I didn't feel like shelling out another $40 towards 2 weeks worth of unsubstantiated thinking.

One thing's for certain: Last time I pluck a pube from some dude's eye.

Omg lmao

 

[ballinsncbirth]

you probably got it from sitting on a tractor.....

 

[Rendar5]

How did you get your eye goop in your urethra? ...i'm not sure if there's a natural pathway for that when you don't have disseminated gonococcal infection. Although perhaps the lack of sex with your wife for a year could be some indication of the route.


Though in all seriousness, the thought of Reiter's syndrome crossed my mind

 

[SkiingDocMD]

I think the natural path is being male and doing the "Al Bundy". Has anyone else heard of this route of exposure before in adults? I know it's well documented in children and adolescents, especially in 3rd world countries. Also any word on doxy x3 weeks as a treatment for G+C? Seems bogus to me.

Reiter's syndrome would make more sense if there was a component of arthritis. Good thought.

I have nothing against tractors.

I am the OP. I am not trolling. I made a new account for anonymity. It may appear that I am full of it, but think of me as the 70 yo whose UDS is positive for amphetamines because of antiparkinsonian agents. Please don't be that psych nurse that says I'm high on meth.

 

[Old_Mil]

So I call some local urgent cares

Mistake #1.

When I was in residency, an urgent care noctor sent me a college athlete who was getting a physical. For some reason she got an EKG which showed clear early repol. She panicked and sent him to the ED for "a cardiac workup". This consisted of my getting an HPI doing a PE, getting a second EKG on this completely asymptomatic patient and cutting him loose.

if you bave strep/otitis/uti, they make decent antibiotic dispensaries but otherwise look out.

 

[Psai]

Mistake #1.

When I was in residency, an urgent care noctor sent me a college athlete who was getting a physical. For some reason she got an EKG which showed clear early repol. She panicked and sent him to the ED for "a cardiac workup". This consisted of my getting an HPI doing a PE, getting a second EKG on this completely asymptomatic patient and cutting him loose.

if you bave strep/otitis/uti, they make decent antibiotic dispensaries but otherwise look out.

oh i have this
i was trying to figure out why my ekg had this weird st elevation in the precordial leads even though i'm asymptomatic
thanks man

 

[SkiingDocMD]

Mistake #1.

When I was in residency, an urgent care noctor sent me a college athlete who was getting a physical. For some reason she got an EKG which showed clear early repol. She panicked and sent him to the ED for "a cardiac workup". This consisted of my getting an HPI doing a PE, getting a second EKG on this completely asymptomatic patient and cutting him loose.

if you bave strep/otitis/uti, they make decent antibiotic dispensaries but otherwise look out.

How is going to an urgent care a mistake? Remember, I was looking for an antibiotic dispensary. Seeing a PCP wasn't an option because no appointments were available. Going to an Emergency Department doesn't make sense financially, and it's not clinically warranted. This is clearly something that can be handled as an outpatient.

BTW, next time you can skip the 2nd EKG.

 

[GeneralVeers]

So many trolls here.....it's like visiting the kitschy house of a 70-year old Midwestern grandmother.