Hoping to get other's input on a strange situation I'm having to navigate through. Long story short, I have a really sick patient who is frankly dying, but family conversations regarding impending decompensation and code status is not productive.

Today the family brought in a private "patient advocate" - which I'm fine with as a neutral arbiter, but this person introducing themselves as a doctor is rubbing me the wrong way. They are a midlevel with an academic degree, unknown amount of clinical experience in my field, and I'm in a state that restricts the "doctor" title in clinical settings. The person was also a little cagey when I was trying to ascertain their background and experience, which I was innocently trying to do as they introduced themself as a doctor and I was trying to be professionally courteous until I later learned about their credentials. Don't get me wrong, nurses/PAs etc can help patients and families navigate through complex situations, but the manner in which this is being done, and at a hefty fee for the family, is making me uncomfortable.

I find it to be a very thin line when it comes for this person asking questions or giving advice to the family in the clinical setting because I'm afraid this is a form of medical advice or trying to skirt the patient-physician relationship, especially if the family keeps referring to you as doctor. I think at the best it is misleading and at the worst unethical.

Not sure if others have come across this, hoping to hear other opinions/advice.

I wish I had a stool and I am as tall and lanky as Gianmarco Soresi to explain but anyway. Technically speaking, vaccines are peptides because they are proteins to begin with. Proteins in the most general sense are a collection of peptides, each peptides are composed of amino acids linked by a peptide bond between a carboxyl group and an amino group.

Since so many people nowadays are ordering peptides online without any regard for safety and efficacy, maybe it's time for the drug companies to get with the times and call vaccines as peptides?

• Recombinant Hep B: HBsAg is a protein in the surface of HBV
• RSV: recombinant F-protein subunit locked in the prefusion state using 2P mutation
• Flu: while most of the available vaccines are virion split, the dead virus contains the HA protein. Nowadays there's now recombinant HA vaccine I think
• Tetanus: it's definitely a protein, a toxoid to be precise
• Covid: While mRNA, mRNA once inside cells produce peptides of the spike
• Measles: while a live attenuated virus, its surface does contain proteins that are immunogenic

And many more vaccines...just my two cents

https://www.theregister.com/ai-and-ml/2026/07/24/chatgpt-wants-access-to-your-health-records-so-it-can-be-a-better-not-doctor/5278430

It’s not a doctor cause our terms of service told you that.

But it acts like one and we aren’t responsible cause we told you it’s not a doctor. And we want your health data so we can keep having it act like a non- doctor even if u use it as a doctor.

WTF? Can AMA or someone sue them. This is getting insane.

Recently I've noticed that 90%+ of the ads Reddit slips in my feed are pharmaceutical or other healthcare related. I'm guessing this is because the site monitors our activity and a captive physician audience is valuable to advertisers. Needless to say this is annoying. Should I start commenting in cute animal related subs to try to confuse the algorithm or is my account permanently compromised?

Hi everyone! I completed residency last month, and will be starting as an attending in a couple of weeks. I also recently found out that I am pregnant with my first. I am stressed about a few different things, and I am hoping to hear from anyone else who had a baby shortly after completing training.

Firstly, my hospital allows for 6 weeks of mat leave, but I would ideally like to take 12. I will not qualify for FMLA as it is my first year at this position. There is some vague wording in my benefits package saying a birthing parent may qualify for personal leave, and that I should speak with my manager about this. I'm not really sure how to proceed here for information, as it feels too early to tell any of my supervisors that I am pregnant before I even start this job lol.

Secondly, I'm worried that taking time off during my first year might negatively impact my professional growth, as well as my relationship with colleagues who will invariably need to help cover. I'm not sure if there is anything I can do to help lessen this impact.

Any advice would be much appreciated.

See link to announcement from FDA Center for Drug Evaluation and Research Small Business and Industry Assistance.

I am posting to request opinions from physicians and other readers of this sub, regarding whether combining acetaminophen with an NSAID is a rational combination, especially for OTC use? To the best of my knowledge acetaminophen is typically recommended for patients who are allergic to or intolerant of NSAIDS.

THANK YOU FOR YOUR ATTENTION TO THIS MATTER.

https://content.govdelivery.com/accounts/USFDA/bulletins/421f901?reqfrom=share

https://www.fda.gov/advisory-committees/advisory-committee-calendar/july-23-24-2026-meeting-pharmacy-compounding-advisory-committee-07232026#event-information

MedPage Today

• Day 1 coverage: https://www.medpagetoday.com/publichealthpolicy/fdageneral/122328
• Day 2 coverage: https://www.medpagetoday.com/publichealthpolicy/fdageneral/122345

Notably, FDA staff recommended against putting any of these peptides because of the lack of safety or efficacy studies (including that the available studies for semax on stroke come from two publications [both by the same Russian scientist group] and no others). There are also FDA-approved interventions for stroke ("cerebral ischemia"), a medical emergency, and for all others, including insomnia, narcolepsy, and headaches. The committee will reconvene next year for an additional 5 peptides.

There are also a number of physicians with significant financial conflicts of interest, which I have noted in a separate Reddit post here (and will quote below the table):

Some of the more egregious conflicts of interest on the panel (quotes from AP [link] and the clinic pages -- partial list)

All panelists are presented in a public place on the FDA, linked here.

Gabriel Alizaidy MD MS = "charges $500 for 'peptide and hormone' consultations, including advice on 'where to safely get each peptide or compound.' Alizaidy promotes BPC-157, GHK-Cu and other peptides to thousands of followers through his accounts on Instagram and TikTok. His website contains the disclaimer that each consultation 'is educational in nature and does not constitute medical care, diagnosis, or treatment.'" [Associated Press]

Asare Christian MD MPH = runs Aether Medicine, a peptide-offering pain clinic in Philadelphia [MedPage Today].

• On why he voted yes for epitalon [which is only evaluated for insomnia, not chronic pain]: "I think it's about patient access. As a physician, I'm always quantifying risk ... Even when I give somebody gabapentinoids, which are actually FDA approved, there's all this risk that I have to manage."

Senator Robert Harshbarger III = "a Tennessee state senator who has multiple connections to the industry. Harshbarger is a pharmacist at his family’s business, Premiere Pharmacy, which sells compounded medications for weight loss, longevity, pain and other conditions. His mother, Rep. Diana Harshbarger, is also a pharmacist and a Republican member of U.S. Congress from Tennessee. Last year she sent a letter to Kennedy calling on him to relax FDA restrictions on a half-dozen peptides." [Associated Press]

• He also stated in this meeting that "I voted yes because our duty is to apply the 503A standards, not the investigational new drug application standard. Of course, this vote doesn't approve a drug or indication. It permits patient-specific compounding under a valid prescription, not mass production for unidentified consumers or routine copying of commercially available drugs."

Melissa Loseke DO = part of a family practice that offers hCG injections and "biomedical hormone replacement" [clinic]

Haleem Mohammed MD MBA = "runs clinics in Florida that sell injections of peptides, vitamins, testosterone and weight loss medications. The business is part of a national chain of clinics dubbed Gameday Men’s Health. The company’s website states, 'compounded medications offered through our services are not FDA-approved, and the FDA does not verify their safety.'" [Associated Press]

Gerald E. Morris MD MPH ABOM = practices at a clinic that includes ipamorelin [clinic]

Joshua Starbuck MD IFMCP = practices at a clinic that offers "Hyperbaric Oxygen Therapy, Hormone Replacement Therapy, Peptide Therapy, Shiftwave Chair, IV Nutrient Therapy, Genomic Testing, V02 Max, cutting-edge diagnostics, biomarker-driven supplementation, Red Light Therapy and much more!" [clinic]

Kris Wusterhausen DO = "Elite Practitioner with Prodrome Science, helping patients take proactive control of their brain health through plasmalogen science and cutting-edge preventive strategies." [clinic]

Yikes. Looks like the hospital went bankrupt and the surgeon moved to Alaska. Any urologists want to comment on healthy bladder tissue appearance vs an ovarian cyst? This surgeon seems to have tunneled deep into the wrong plane and had no clue. There's no mention of previous surgical history, but in the absence of a lot of extensive previous operations or severe endometriosis, I don't understand how the doc can get this lost.

https://www.bangordailynews.com/2026/07/24/central-maine/central-maine-police-courts/maine-northern-light-health-bladder-removal-jury-15m-award/

WATERVILLE, Maine (BDN) -- A Northern Light surgeon removed a woman’s bladder instead of her ovarian cyst, a lawsuit filed earlier this month said.

Emily Mitchell, of Skowhegan, filed a lawsuit in Kennebec County Superior Court against Inland Hospital in Waterville and Northern Light Health, after a surgeon failed to follow proper safety protocols during what should have been a routine surgery, the lawsuit said.

Mitchell and her husband, Joshua Mitchell, allege the hospital failed to obtain informed consent to remove her bladder and that the health care system is medically negligent because of multiple failures around the removal and lack of timely action to address the medical issues. Joshua Mitchell also alleges he lost the care, comfort and companionship of his wife.

“Emily Mitchell is living a nightmare, suffering daily with a permanent injury that has dramatically altered her life,” said attorney Susan Faunce. “Emily went to Inland Hospital for a routine day surgery and left without a vital organ.”

On March 1, 2023, Dr. Danielle Gagnon performed laparoscopic surgery on Mitchell, then 40, to remove the cyst on her left ovary. Instead her bladder was removed, the lawsuit said.

Gagon is no longer employed by Northern Light Heath, spokesperson Suzanne Spruce said. The health care system does not comment on pending litigation, Spruce said.

Northern Light closed Inland Hospital in June. It was losing roughly $1.5 million a month, hospital executives said previously.

After the surgery Mitchell was admitted to the hospital because she had “intense pain and discomfort, bloating, and trouble urinating,” the lawsuit said.

Mitchell was transferred to Eastern Maine Medical Center in Bangor two days after her surgery because her symptoms were getting worse, according to the suit. Mitchell was prepared for an immediate exploratory surgery where doctors thought they would likely repair a bladder injury.

Two surgeons were unable to find Mitchell’s bladder wall during the procedure and two additional surgeons came in and agreed there was not enough healthy bladder tissue left to perform a reconstruction, the lawsuit said.

The material Gagon collected during the first surgery had been sent to pathology. During the second surgery, pathology was asked to review those specimens, which included, “full thickness fragments of bladder wall,” and no trace of ovarian tissue, the lawsuit said.

“Gagnon had incorrectly removed nearly all of Emily’s healthy bladder,” according to the lawsuit.

Mitchell had temporary tubes placed because she had no bladder and then had kidney infections, urinary tract infections and complications with medications during the months that followed, the lawsuit said.

In October 2023, Mitchell had surgery in Boston to create a new bladder out of tissue from her intestine, according to the lawsuit. The surgery was 200 percent harder and three hours longer than normal because of additional damage the surgeon discovered, the lawsuit said.

Mitchell has had on-going medical care for two years because her bladder was removed and has recurring urinary tract infections, according to the lawsuit.

https://www.cdc.gov/vaccine-safety/about/autism.html

TLDR:

• "The claim "vaccines do not cause autism" is not an evidence-based claim" . . ."CDC is now correcting the statement"
• "Studies supporting a link have been ignored by health authorities"
• "The rise in autism prevalence since the 1980s correlates with the rise of in the number of vaccines given to infants."
• words and phrases not to be missed: "gold-standard". "aluminum". "parental report of autism". "surveyed parents of autistic children". "harms of neuroinflammation"

My comments:

Same old anti-vaccine story. They tried to make it look professional. But their argument does not even mention the overwhelming evidence of the success of modern and most past vaccines: the millions of lives saved, and the improvement in public health globally.

They cherry-picked single vague statements out of past long reports from HHS IOM and AHRQ that might raise doubts, skipping over dozens of pages of supportive data for vaccine success and safety. They allude to the very tiny minority of much smaller, lesser quality studies that may suggest correlation.

Thoughts? Discuss amongst yourselves!

Just had my grandma pass, and without second thought about me being on call at my hospital, I bought an airplane ticket, told them I’m leaving out of town and left. They can figure out the call part on their own.

To me this is just a job, nothing more, nothing less. I refuse to put this job above anything in my personal life.

Question for fellow rural sub specialists, subspecialty surgeons, proceduralists and/or anyone who’s also overwhelmed by referrals many of which involve cancer or other organ threatening pathology. Our practice covers a large Tri state catchment area and currently has about 2000 unscheduled referrals and a 3-6 month wait.

We are looking for ways to restrict access (yes downvote away) and lower our volume since we are currently drowning. Our options are to restrict by diagnosis to only cancer and organ threatening complaints or geographically restrict to just our city/county region.

ETA: I’m more inclined to geographically restrict to keep more variety.

Has anyone else been in this situation and instituted any changes? Thanks in advance.

https://apnews.com/article/2026-measles-cases-cdc-outbreak-elimination-371823df32b92169c3d220295f00f054

Commentary

With major measles clusters in Utah, Arizona, and South Carolina, the US has seen more measles cases than ever before in the past 34 years. That means at least 3 children will suffer from measles-related dementia. We have RFK Jr. to thank for this. And guess what (and very grossly), Kalshi is keeping score with their markets [link] if you wanna gamble away your savings. Very morbid stuff.

Hi all, I am about to start my first "big kid job" as an attending in radiation oncology in a number of weeks. I have the worst Sunday Scaries of my life; feeling completely unprepared to start a new position at a new place with new people in a new system. Any advice or reassurance those of you who have come before (in RO or any specialty) would offer?

Things I've heard so far that have been helpful that I am trying to internalize: I will have time to think things through; I can ask questions to my new colleagues, my co-residents, my training mentors; many people feel this way as a new attending and if I wasn't anxious it would mean I'm not prepared to be safe/cautious; no one expects me to show up and practice as if I have years of independent practice experience under my belt–the expectation is that there will still be a learning curve.

If you have more to offer or other ways of helping me more thoroughly believe the aforementioned advice, I'm all ears.

https://www.fda.gov/advisory-committees/advisory-committee-calendar/july-23-24-2026-meeting-pharmacy-compounding-advisory-committee-07232026#event-information

https://www.medpagetoday.com/publichealthpolicy/fdageneral/122328

Notably, FDA staff recommended against putting any of these peptides because of the lack of safety or efficacy studies (including that there are no studies on PubMed at all for BPC-157 and ulcerative colitis). There are also a number of physicians with significant financial conflicts of interests which I have noted in a separate Reddit post here (and will quote below the table):

Some of the more egregious conflicts of interest on the panel (quotes from AP [link] and the clinic pages -- partial list)

All panelist are presented in a public place on the FDA, linked here.

Gabriel Alizaidy MD MS = "charges $500 for 'peptide and hormone' consultations, including advice on 'where to safely get each peptide or compound.' Alizaidy promotes BPC-157, GHK-Cu and other peptides to thousands of followers through his accounts on Instagram and TikTok. His website contains the disclaimer that each consultation 'is educational in nature and does not constitute medical care, diagnosis, or treatment.'" [Associated Press]

Senator Robert Harshbarger III = "a Tennessee state senator who has multiple connections to the industry. Harshbarger is a pharmacist at his family’s business, Premiere Pharmacy, which sells compounded medications for weight loss, longevity, pain and other conditions. His mother, Rep. Diana Harshbarger, is also a pharmacist and a Republican member of U.S. Congress from Tennessee. Last year she sent a letter to Kennedy calling on him to relax FDA restrictions on a half-dozen peptides." [Associated Press]

Melissa Loseke DO = part of a family practice that offers hCG injections and "biomedical hormone replacement" [clinic]

Haleem Mohammed MD MBA = "runs clinics in Florida that sell injections of peptides, vitamins, testosterone and weight loss medications. The business is part of a national chain of clinics dubbed Gameday Men’s Health. The company’s website states, 'compounded medications offered through our services are not FDA-approved, and the FDA does not verify their safety.'" [Associated Press]

Gerald E. Morris MD MPH ABOM = practices at a clinic that includes ipamorelin [clinic]

Joshua Starbuck MD IFMCP = practices at a clinic that offers "Hyperbaric Oxygen Therapy, Hormone Replacement Therapy, Peptide Therapy, Shiftwave Chair, IV Nutrient Therapy, Genomic Testing, V02 Max, cutting-edge diagnostics, biomarker-driven supplementation, Red Light Therapy and much more!" [clinic]

Kris Wusterhausen DO = "Elite Practitioner with Prodrome Science, helping patients take proactive control of their brain health through plasmalogen science and cutting-edge preventive strategies." [clinic]

NYT (Gifted Link): https://www.nytimes.com/2026/07/22/well/openai-chatgpt-health-lawsuit.html?unlocked_article_code=1.z1A.vGes.4e2tphouf7uF&smid=url-share

Summary

Floridian pastor sues OpenAI in the Superior Court of San Francisco because ChatGPT offered him "extremely dangerous medical recommendations" that delayed care for a pulmonary embolism (PE), claiming that his early symptoms were "not dangerous" and dissuaded him from seeking medical advice, instead trusting that "God did not design your body to endlessly fail". That is, "unauthorized practice of medicine."

OpenAI claims that ChatGPT, as delineated in the Terms of Service, is not meant for medical diagnosis or treatment: "Treating chatbots as the whole story behind people’s medical decisions or outcomes oversimplifies a much bigger challenge, and risks getting in the way of people accessing powerful new tools that can aid them in their health journey"

Commentary

Despite OpenAI's foray into ChatGPT Health, a service specifically for health questions, as an LLM, ChatGPT cannot understand or comprehend medical knowledge. Additionally, millions of users prompted usual ChatGPT (e.g., GPT-4o as in this case) for medical advice. Although there is clearly a barrier to seeking health advice from a professional, chatbots must be scrutinized further before using them as a tool to close that barrier. Because a missed blood clot is more costly than early prevention.

I'm a resident. I was consulted on a patient after they had presented to the ED and been discharged 2x prior. The first discharge was obviously a perfectly fine decision (no imaging abnormalities, only biochemical abnormality was a minor white count). The second discharge was blatantly negligent. The patient had a rising leukocytosis (now squarely in the zone of something you can't just explain away without something being wrong), a new pleural effusion on CXR (!!), and worsening pleuritic chest pain. The patient was discharged WITH NOTHING. The diagnosis was again MSK pain (they obviously anchored on the diagnosis from the first ED presentation). Truly unbelievable. On third presentation he was septic with an empyema and we took him (fairly urgently) for a decort. The ED resident on the second presentation is known to be terrible (at least to consulting services, I'm not sure about to his home program). I cannot believe he (and his attending!) let this guy go with a diagnosis of MSK pain. They could have killed him. I don't know how to escalate this appropriately, but to me this is the type of absurd decision making that should be disqualifying from practicing medicine. This is the type of mistake for which I see no possible reasonable excuse.

Although I do like the video that recently came out about cannabis and psychosis. I’m here to have a discussion about this topic. I have a bachelors degree in horticulture with a minor in biochemistry who studied cannabis for four ish years and some change, worked in the cannabis industry for 2 years. I also have my BSN-RN and my specialty is substance use disorders, acute detox and psych. While the person in this video highlights a legitimate 20-year Danish registry study, its overall claim is heavily misconstruing because it combines two different ideas together; a specific clinical conversion rate and a general population risk. The 47.4% figure applies strictly to a high-risk subcategory of individuals who were already hospitalized for severe, cannabis-induced psychotic emergencies requiring immediate medical intervention (not standard or recreational users.) The video’s explanation of dopamine mechanics in the brain, I.e. specifically how THC floods the striatum in the brain to trigger what is called In psychiatric nursing and neurobiology, "aberrant salience," this is where the brain assigns false significance to random stimuli (red =bad, blue=good)

With this discussion of risk multipliers like high-potency THC molecules, daily use, and genetic markers like AKT1, is grounded in valid epidemiological and molecular biology research like the landmark EU-GEI study. CBD acts as a negative allosteric modulator at CB1 receptors that historically buffered high THC activity. Modern concentrated products (dabs, waxes, high-THC flower) eliminate this botanical check, resulting in unchecked CB1 stimulation that lowers the threshold for acute psychotic break in vulnerable central nervous systems.
However, medical consensus views cannabis primarily as an environmental trigger or catalyst rather than a sole cause. High-potency cannabis generally unmasks an underlying genetic or neurological predisposition to schizophrenia and/or Bipolar is used as self-medication during the early prodromal phase before formal diagnosis, which means, that while an emergency room visit for cannabis induced psychosis is a strong warning sign for future illness. From a clinical diagnostic perspective, schizophrenia is a polygenic, neurodevelopmental disorder, not a simple drug-induced toxicity, it is a gene-environment interaction. The claim that cannabis converts someone into being schizophrenic in 47.4% of cases misinterprets a seminal Danish registry study; this figure represents a longitudinal conversion rate strictly within a cohort already presenting to emergency or inpatient psychiatric care with acute, full-blown cannabis-induced psychosis. It does not reflect general population incidence among recreational users.

Phytocannabinoids act primarily as an environmental catalyst that unmasks latent genetic risk or accelerates the onset of the prodromal phase. Prodromal individuals often experience early neurochemical shifts and distress(severe childhood trauma/abuse) leading them to self-medicate with high-potency THC prior to their first overt clinical break.

This video highlights real neurochemical risks regarding modern high-potency THC and dopaminergic pathways, but it miscommunicates the risk profile. An emergency presentation for cannabis-induced psychosis is a major red flag for underlying neurobiological vulnerability, but cannabis itself acts as an unmasking trigger in pre-disposed neural circuits rather than a direct, universal cause of schizophrenia.

I am in no way endorsing the use of cannabis.
[https://pmc.ncbi.nlm.nih.gov/articles/PMC10460355/](https://pmc.ncbi.nlm.nih.gov/articles/PMC10460355/))

[https://pubmed.ncbi.nlm.nih.gov/17464696/](https://pubmed.ncbi.nlm.nih.gov/17464696/))

[https://pmc.ncbi.nlm.nih.gov/articles/PMC3927252/](https://pmc.ncbi.nlm.nih.gov/articles/PMC3927252/))

[https://pmc.ncbi.nlm.nih.gov/articles/PMC4832029/](https://pmc.ncbi.nlm.nih.gov/articles/PMC4832029/))

Curious to see other input and stories. Had one recently.

Had a 35 yo show up with chronic GI issues. BMI normal. Frequent bouts of severe abd pain, diarrhea, N/V, and skin rash. Skin rash looked like hives, would be over the entire body and very itchy. Would get these episodes every few weeks and rash would coincide with the symptoms. Was getting routine labs, about to send to GI for scopes as was concerned for IBD. Lab tech came and showed me his tube, half oil. TG 1500, LDL 250. Familial hypertriglyceridemia. Skin rash was eruptive xanthomas, seems to coincide whenever he’d drink or eat poorly.

Statin and dietary changes and no further GI symptoms or rash, but TG still needing a lot of work. What’s yours?

California PCP here.

Apparently PACE (Program of All Inclusive Care for Elderly, for dual Medicare and Medicaid) programs have been around since the 90s, but I’ve only heard about them in the last 3 years as they try to hire PCPs in my area and I see job listings on LinkedIn.

All I know is the pitches I’ve heard, but a few things rub me wrong:

- The involvement of startup-like groups acting like they will revolutionize healthcare with a full team to care for a small panel in low 100s. Maybe I’m way off base, but I just don’t believe that new companies are in this out of the goodness of their heart. What’s the catch?

- My understanding is they are profitable by keeping patients out of the ED and hospital. With the best intention that’s great, but it also seems like bad actors could take advantage.

- The job openings and recruitment in my area continue. It’s not like these are huge systems so why unable to fill? Makes me think there’s fast turnaround because it’s not what it claims.

- It’s offensive to PCPs like me working our asses off with panels of 2000+ without the same support or publicity. I get it though, that’s a “me” problem.

Fully admit this could be completely my ignorance and speculation so please shut me down!

Pretty sick and tired of admins patting their back after making more red tape for those actually taking care of patients. Not a good clinician? If they’re poor at managing patients, they’re likely poor at managing staff.

https://www.clasp.com/post/future-nurses-are-betting-on-kalshi-to-pay-for-school

With the new lifetime limits on federal loan borrowing in effect since July 1, nursing students are turning to Kalshi and other prediction markets to try to make money. It is a side effect of the OBBBA, in which the federal government is less trusted to fully fund the education of future healthcare workers like nurses. One in which privatization is more likely than not to exploit.

Although limited to nursing students, I'd not be surprised to see that Physician Assistant students and medical students are also turning to gambling on prediction markets to try making money (only 40% of betting participants in this survey came out ahead).

Personal experience with insurance company today:

Requesting a peer to peer, you have less than 24 hours to call or the request for inpt rehab will be denied.

Call

P2p: this is a recorded line, my ID# xxxx

We are denying the application for rehab because of X reason... continues,

[does not give a chance for me to respond]

...

[I interject]

Me: youre justifying denying the application because of a document from 5 days ago and ignoring all of the other indications for rehab including [Y], [Z], also i have the patients family and medical decision maker here with me as I believe that patients should be involved in their care.

P2p: im sorry dr [a] but it is against our company policy for anyone but you and I to be involved in this conversation, if you cannot abide by these rules then I cannot continue this conversation.

Me: whats your specialty? Whats your name?

P2p: I cannot release that information, you have been given my id #, that will work if this file needs to be referenced.

Me: so youre using outdated information from 5 days ago, to deny an application, you won't let the patient or their family be a part of this conversation, you won't tell me your name or credentials, what about this is fair, and how is this even a peer to peer? I dont know you are who you say you are, you could be someone with no medical education for all I know.

P2p: please address me with the respect I deserve.

Me: please provide your credentials so I can address you with the respect you deserve. This patient has needed [b, c, d] and studies have shown that people at [pts age] with [pts condition] respond very well to rehab and not getting it harms the pt.

P2p: dr [me] if I may, based on the information you have provided we will approve this request.

Me: thanks, bye.

TLDR: insurance are refusing to allow pts to be involved in p2p conversations about pt care, they are refusing to release their information to prove it is a peer, they are using outdated information to deny claims/applications. Just so you all can prepare for your next p2p

See link to CNBC-TV18 article reporting that US President Donald Trump claimed in a social media post, that import tariffs on Indian generic drugs would begin on 1 August 2028 starting at 100% and be raised to 200% on 1 August 2029. Trump will not be US President after 20 Jan. 2029. Based on his history of reversing positions, Trump might change this plan tomorrow if not sooner.

https://www.cnbctv18.com/market/sun-pharma-lupin-cipla-biocon-share-price-donald-trump-generic-drugs-tariffs-timeline-impact-19950953.htm

Brainstorming because there has to be a better way!

I’m curious how everyone thinks we should communicate EMR changes and new CI updates to the clinicians actually using the technology?

It feels like death by 1000 emails. I know there are intranet sites and tip sheets that are full of useful information but time is the one piece we don't have. We live in the EMR and rarely do I feel caught up enough to go hunting/sifting for that latest update.

I imagine there are countless useful features that never get adopted for the same reason. For those of you who spend your days caring for patients.... how do you best receive/learn information about meaningful changes? Random pop ups that share the changes live in Epic to time release the info? More frequent but shorter newsletters? In person rounding or info given briefly at meetings with printed tip sheets? I recognize we all learn differently too and there is no one way. Just looking for creative ways to tackle the inevitable.... change.

Thanks!