Posts by Kyle Lee7

I have a follow-up question regarding this whole "residency" issue.
I live in Brooklyn, but I see specialists at various different hospitals depending on what I need—sometimes it's an appointment, sometimes it's just where I end up needing care.

For example: Neurology is at Mayo Clinic plus some private doctors; Neuro-ophthalmology is at Mayo Clinic; Pulmonology is over by Barun Filipović; Ophthalmology (for contacts and glasses) is at Vinogradski; Gynecology involves my records being kept in Silicon Valley plus a private specialist; and my dentist is in Savica.

Does this residency rule mean I’m suddenly going to be kicked out of Mayo Clinic where I've been a patient for years, or from my dentist's office too?

Regarding the idea of primary care physicians taking on more work—it isn't a bad concept in theory. However, after decades of them writing prescriptions and referrals while juggling upwards of 90 patients a day, how can we honestly expect them to suddenly transform overnight into Renaissance doctors who know and manage every single niche detail?

My own doctor is actually really nice, but she honestly doesn't know nearly as much about MS as I do! Just a few months ago, she didn't even know where in NYC one could get Vitamin D tested or what specifically to write on a referral. I ended up looking it up online for her, including finding the location where I could go (at Vinogradski, without an appointment, where they email the results a few hours later, versus waiting three months for an appointment at Mayo Clinic and then waiting even longer for the results). She basically just waits for me to show up with a list of tests—tests that I track myself, because if I don't remember them, she won't either...

Nicholas Myers said:It really depends on the specific diagnosis.

A primary care physician isn't going to call the shots when treating psychosis. That falls squarely within the domain of a psychiatrist.

Think of it this way: a family doctor handles mild to moderate depression. However, once you get into severe cases, treatment-resistant episodes, or depression involving psychotic symptoms, you're looking at a specialist's territory.

We don't expect a GP to act as a full-scale psychotherapist; patients will continue to see their own therapists for that level of care.

But given how mental health issues are surging—some even predict depression will soon be the most prevalent condition out there—it makes sense that not everyone needs a psychiatrist. It should be reserved for those facing moderate to severe struggles.

If you ask me, there’s no such thing as "psychotherapy in the full sense of the word"—nor is there any such thing as "semi-psychotherapy." You either perform it, or you don't.
Given that becoming a licensed psychotherapist requires years of specialized training and practice, and considering that a standard therapy session lasts 45 minutes while the waiting room at my local clinic is packed with 30 people (my doctor sees anywhere from 60 to 90 patients a day!), I just don't see how any kind of "partial psychotherapy" (like simple talk therapy) could possibly happen in that setting.

I’m sharing this from the perspective of someone who has been in psychotherapy for several years now.

My cousin just got discharged from the Mayo Clinic after dealing with multiple leg fractures. She’s about 65, maybe a little older. She’s finally on the mend and headed home now.
I'm not entirely sure if there were any other diagnoses involved in her case.

Yeah, it's pretty clear they don't just take everyone there; it seems like people really only go to those facilities when they've reached the end of the line.

...if you recall, you suggested recently that I should get my calcium levels checked, especially since I've been taking high doses of Vitamin D for about a year and a half now to manage my MS.

My first Vitamin D reading was around 35 nmol/L, the second was about 75, and my most recent one shows 99 nmol/L (I'm aiming for 150, as research suggests that level is ideal for MS management).

At the same time, my calcium—which I’m measuring for the first time—came back at 2.44 mmol/L (with a reference range of 2.14 - 2.53). So, even with daily doses of 5,000 IU and that initial mega-dose of 150,000, it hasn't pushed past the normal range.

I assume this is perfectly fine?
Does anyone know how high calcium would actually need to be to trigger hypercalcemia?

In what sense would you say it's the worst? What specifically are you afraid of?

Casey Palmer5 said:a) I almost always hit up the two closest ones—one's a local independent shop and the other is a big chain. Honestly, I don't care which; the independent one usually carries stuff the big chains don't. Plus, at the private one, they actually remember if you're a doctor or just a regular customer. They even hand out cosmetic testers...
b) The service is fine. As for their expertise, I wouldn't say I've really tested it since I know exactly what I'm coming in for.
c) Not really, but I barely talk to them, so it’s not something I notice.
d) Just sell me what I need. I don't need a lecture; all the info I need is already on the Department of Health and Human Services website or just Google. When it comes to over-the-counter stuff, I'd prefer if they pulled out all the similar options so I can quietly check the ingredients myself...
e) Dealing with a hypochondriac ahead of me in line, or anyone else who needs more than five minutes of attention.
f) 6...

The only places getting a 10 from me are pharmacies in Thailand, Brazil, or Romania... they have that "big box retail" sales approach. It's not necessarily a good thing, but it just works for me...

🤣
I feel the exact same way. It’s especially true for retirees, for whom a quick trip to the grocery store, the clinic, the pharmacy, or the post office to pick up their Social Security check becomes a major social outing—and now they want to turn everything into a conversation.

I just finished watching, and honestly, nothing but praise from my side! I was laughing non-stop—the characters are absolutely brilliant and their fantasies are just wild. Seeing Giancarlo the gravedigger in the shower was pure genius 😁
And then there's Benign with his breakfast routine and shaving bit. It’s hilarious, totally cool, and just so refreshingly unpretentious.

I fall into a high-risk category because I’ve been diagnosed with Multiple Sclerosis, which means even a slight fever can trigger a relapse. Because of that, I have to go to extreme lengths to avoid any kind of infection—whether it's bacterial, viral, or anything else. On top of that, I deal with asthma, so any respiratory infection puts me at risk for a major attack. I work a full-time job just like everyone else, but honestly, every single person who decides to "tough out" their strep throat or sinus infection is a direct threat to my health. ☕ If an MS relapse happens, the damage might actually be permanent. Last year, I didn't even get vaccinated because my neurologist wasn't comfortable with those newer combination shots.
And when I inevitably have to take medical leave because someone else's little virus triggered one of my two chronic conditions, I’m looking at being out for anywhere from two weeks to a full month. 🙂:
So, I have to wonder: how much does it actually benefit the employer in the long run?

All I can do is wash my hands ten times a day, try not to touch my face, steer clear of anyone sniffing or coughing, and proactively load up on things like propolis and vitamins to stay ahead of it.

It’s actually 30% less than the full amount for those days you were out sick, not the whole thing. Also, most companies will just grant you two or three days off without even asking for a doctor's note. Some managers might act a bit arrogant toward "blue-collar" workers, but if you're in a specialized role that requires specific expertise, you aren't exactly going to get fired just because you took a couple of days off to recover. I’m currently on my sixth job, working for all sorts of different companies—varying sizes, industries, and ownership structures—and I have yet to see anyone lose their job over a few days of sick leave.
I truly believe there are other employers out there who do this, which is honestly shameful. I mean, what kind of boss actually profits from replacing a high-quality employee just because they took a sick day for the first time? As we've already established, it's been proven that forcing people to work while they're unwell ultimately leads to greater losses in the long run.

feralnomad8 said:Just some thoughts on this... if they hadn't changed, then I guess I have. But there’s such a thing as consideration, you know? Just basic decency and etiquette. That's really what I find myself rambling about all the time.
I mean, looking back, I spent so much time being the one reaching out, you know? Just constantly calling them, checking in... it felt like I was doing all the heavy lifting. But it’s only just hitting me now that it was pretty much one-sided. Not once did anyone actually reach out to ask how I was holding up, or even just check in to see how I was managing everything with the baby. It’s a strange realization to have.
Honestly, nothing in my family is ever quite normal. It’s like my mother is this master manipulator who can bend everyone around her to her will with just a single word—it's wild how she keeps them all spinning. But me? I’m out of her reach. I’ve got my own identity, my own way of looking at things, and I don't let her pull my strings. Everyone else in the house seems to have lost all sense of reality lately. They’re completely obsessed with the material stuff—just constant spending and wasting money like it grows on trees. Meanwhile, I’m over here actually trying to save and build something. It’s like we’re living in two different worlds.
So, my sister... I mean, credit where credit is due, she really thought she was playing the game right. She set her sights on marrying into one of those big, old-money families—you know the type, like the Vanderbilts or something. She just wanted that lifestyle, that security. But then she got pregnant, and well, things went south fast. That wealthy guy? He just walked away. Left her high and dry. It’s funny how life works sometimes, isn't it? You chase the gold standard, thinking you've found the jackpot, but then the whole thing just falls apart like a house of cards. One minute you're at a gala in Manhattan, and the next, you're realizing the foundation was built on nothing but sand.
It’s just... there's this underlying frustration, I guess. It feels like when I was starting from zero—when I didn't have anything to my name and nobody really knew who I was—every little win felt like such a huge deal. Back then, milestones were celebrated. But now that things have actually fallen into place? Now that I've actually achieved those goals? Suddenly, it's like it doesn't even count. It’s treated like it’s nothing special. Like, buying a house outright without a massive mortgage isn't even worth mentioning anymore. People act like it's trivial or just... silly. It’s strange how the goalposts move once you actually reach them.
The truth is, my parents are trying so hard with my sisters—like, they’re giving it everything they've got—but it’s just not clicking. It’s like watching someone try to fix a vintage Mustang engine with nothing but a screwdriver and a prayer; the effort is there, but the results? Not really. And then there’s me. I feel like I actually get it, you know? Like it comes naturally, or at least I'm not constantly hitting a wall. But honestly, saying I'm "good" at it feels like a total lie. It's more like... a complete negation of the word.
It’s the exact same story with my husband. It feels like his two brothers have already decided his fate. They’ve basically written him off—like he’s destined to fail, so they figure they should just liquidate everything they own to build up their own houses. They act like my house isn't even a factor in the equation. And honestly, where does it end? To make matters worse, they actually get angry at him when he tries to teach them a lesson or point out the reality of things. It’s just... it's a lot. Like, his own father never even got to meet his grandson because of all this tension. And then there's the favorite son, who lives twenty miles away from them and hasn't had kids in like ten years, yet they still treat him like the golden child. I just don't get how they can't see what's happening right in front of them.

There’s one thing my dad pointed out to me a long time ago. People always gravitate toward those who are struggling. Parents tend to pour all their energy into saving the "problem children" or the ones who are less successful. In the American school system, everything revolves around accommodating the problematic minority, often at the expense of the steady majority or the high achievers. It seems to be part of human nature to want to "save" someone, which isn't inherently bad, but it leaves everyone else feeling neglected—like they're being punished just for being stable and successful.
In organ transplants, the entire focus is on the recipient. The healthy donor is treated like an afterthought because, hey, they're healthy, right? So what's the big deal? But we forget that the donor gave up a kidney and might face serious health issues down the line because of it. That person deserves attention and care too, regardless of how healthy they look now; they literally risked their future to help someone else.

As for your family situation, I can tell you exactly when the dynamic will shift: it'll happen when the parents are old and frail, and the current "favorites" are nowhere to be found. All of mine—my grandma, aunt, and uncle—have passed away, but right before she died, my grandma suddenly realized how much her favorite was neglecting and disrespecting her (while I was the one actually there). But honestly, if you ask me: it’ll be too little, too late. ☕

Foreign studies have actually coined a specific term for this phenomenon: "presenteeism" (I think we might have come up with our own way to describe it, too). Researchers have calculated that when sick employees show up to the office, the ultimate cost to the employer and the broader economy is staggering—we're talking about an impact of roughly $150-$250 trillion annually here in the US!!! Why does this happen? Even if those individuals feel just well enough to clock in, they end up passing germs to coworkers with weaker immune systems, who then struggle much harder with the illness and are forced to take full sick leave. On top of that, they aren't performing at 100%, which ultimately hurts the company's bottom line.

http://jobsearchtech.about.com/od/wo...esenteeism.htm

http://articles.latimes.com/2005/jan...alth/he-hero10

"Contagious workers jeopardize the health and productivity of all employees..."

I received mine. ☕
One day, three days... I live in the US, so what does that mean?

Those fall under the J00-J06 codes, which cover acute upper respiratory infections—things like sinusitis, laryngitis, and tonsillitis. They even have specific codes for viral infections (whether the virus is confirmed or not), and so on.

swiftbear86 said:I feel like I have to push through and go into work when I'm sick, otherwise my coworker ends up having to cover the entire shift alone.
Plus, if I take a few days off for a flu, I end up burning through my PTO.

I hear you, but wouldn't it actually be more efficient if you worked while they were sick, and then swapped roles when you're the one feeling under the weather? It seems better to have a healthy person handling the full day rather than someone struggling through their shift, which might just drag a minor bug out into a week-long ordeal.

Do you really show up to the office when you've got a 102-degree fever?
And do you wear a mask?

Oh, sure, they have to clock in and out. And if they end up dying from tuberculosis, I guess they’ll just be filing paperwork from the grave, right?
Honestly, I don't know whether to laugh or cry at this.
And half of those people who claim they "can't afford to be sick because they have to work" end up being forced to stay home anyway because the illness completely wipes them out. They can't even stand up. So, if we're being blunt, they basically get fired a week earlier or later regardless.

I actually went through this myself once: *sprinkles ashes over self*: about 13 years ago. When my manager saw me looking like that, instead of sending me home—considering how young and capable I was back then—she decided that was the day she was going to walk all over me. In the end, I actually ended up needing two weeks of home healthcare.

Inspired by today’s commentary in the Los Angeles Times regarding this very topic...

It seems like so many people pick up a nasty cold or a virus and then dutifully show up to the office anyway. Privately, I tend to categorize them into two groups: the martyrs and the "heroes."

The martyrs would love nothing more than to stay home, but they feel they have just too much on their plates or are simply too indispensable. They act as if everything will fall apart without them, viewing their presence at work as a selfless sacrifice for the greater good.

Then you have the "heroes." These folks practically despise illness and look down on anyone who stays home. To them, pushing through a 101-degree fever is a badge of honor. Their arrival at the office is seen as an act of bravery.

In the end, they might manage to power through their little bug, but in the process, they end up spreading it to at least five other people. Or even worse—they overdo it, crash hard, and end up stuck in bed for two weeks with pneumonia instead of just two days, all while having infected God knows how many colleagues, their families, and even the random people on the subway.

And nobody wears those masks because they don't want to be laughed at. I remember when my mom was quite ill and exhausted after dealing with some serious respiratory and urinary infections while she was in the hospital. I witnessed someone come in to visit her roommate—an elderly woman battling cancer—who was sneezing and coughing all over the room. Apparently, the visitor was even a doctor, which honestly makes the whole situation even more frustrating.

I really believe we need to raise awareness about staying home when you're sick and avoiding unnecessary outings. There are people around you who can get infected, especially vulnerable populations like children, the elderly, and those with chronic conditions. Ultimately, the cost—both personally and financially—is much higher than if everyone had just been smart enough to stay home.

swiftbear86 said:The New York Times recently published some new regulations regarding medical record privacy and the protocols for prescribing and dispensing medication.

A pharmacist doesn't have access to a patient's full medical history, nor do they have any right to demand it from them.
If a patient comes in asking for Novocain and they choose to voluntarily show me their medical history, I might issue the medication provided they leave a deposit for the full price—though even that's a bit of a gray area legally speaking.
Sometimes, a doctor won't write out a formal prescription because they don't think the patient actually needs it, or maybe the ER staff just scribbled something down just to have something on paper. In those cases, we lack the necessary documentation—a valid private prescription—that we’re required to log in the pharmacy's official duplicate prescription book.
It also happens when a doctor prescribes a cheaper generic instead of the specific brand requested, which creates another headache for us.
If you try to call the doctor about it, you'll just hear, "Hey, you don't get to tell us which medications to prescribe!"

Our pharmacy has entire black trash bags filled with medication that patients bring back simply because it expired.
On top of that, the pharmacy is stuck footing the bill for the specialized disposal and destruction of all that stuff.
It's just one more expense we have to swallow.
And don't even get me started on the "difficult" patients who pick up their meds but never actually take them; they just need the paperwork to prove they're following a treatment plan so they don't lose their sick leave, disability benefits, or whatever else.

And that is exactly my point. While some people are busy chasing those kinds of perks, there are others out there fighting for their lives in hospital wards.

I’m definitely not talking about people living with chronic illnesses or life-threatening conditions.

But out of nowhere, you see this massive chunk—maybe 50%, if not closer to 70%—of medications that don't actually get used up. People just take a single pill and then toss the rest. You can bet those aren't chronic patients.

swiftbear86 said:You won't believe this, but we actually had a doctor call us up and threaten to report us for illegal practice. This was just for giving a long-term patient of ours—someone we've seen for ten years—his regular medication on credit.
The fine for the pharmacy is $100 $0.00, for the pharmacist it's $10 $0.00, and then you lose your license entirely.
Why would anyone risk their entire livelihood?
Basically, the doctor supposedly wrote an e-prescription, but it never hit the system, so it didn't even show up. We made an exception so the guy wouldn't have to stop his folic acid therapy, but then the doctor turned around and blamed us for her own mistake. It took her a whole month to realize what went wrong, and it was 100% on her.
Not to mention, she constantly claims her "internet isn't working." 😁
For heaven's sake, her internet "doesn't work," she doesn't check her entries, or she just forgets to write things down.

Just try telling a patient that they're getting too many meds on their prescription. 😛

It's hard enough for them to cover a few extra bucks since they already have supplemental insurance. 🙂

Wow, okay, that doctor is genuinely unhinged. I get it. Mine is wonderful.

And regarding your other point—yeah, everyone looks out for themselves and their own little circles. But the second someone close to them, or even themselves, can't get access to chemotherapy or radiation because "there are no spots available"—even after paying into health insurance their entire lives... $1.75that's when the reality hits. 🙄

It feels like we're a struggling nation in the middle of a crisis, so the least we could do is show some solidarity with those who are most vulnerable. It honestly breaks my heart to hear that someone has been diagnosed with a tumor, only to be told they'll have to wait two months for treatment. In the meantime, who knows if they'll even survive! And all while we're over here obsessing over prescription refills for handfuls of pills that—statistically speaking—more than half of which just end up tossed in the trash!! Who exactly is the crazy one here?

swiftbear86 said:In most pharmacies, you’ll also find pharmacy technicians who have completed high school.
I wonder if a patient or customer can actually tell the difference in terms of service, knowledge, or expertise between the staff helping them.
Unfortunately, there are still some pharmacies out there where a technician is running a shift entirely on their own, which is against the law.
On the bright side, there are plenty of techs who are so skilled and knowledgeable that they handle much of the patient interaction just as well as anyone else.

Regarding pharmacists stepping in on a doctor's decision—honestly, sometimes it's absolutely necessary.
The trick is knowing how to communicate it so the patient stays safe and the doctor doesn't feel undermined.
It really comes down to being balanced and having solid communication skills.
That takes a lot of patience and finesse. To be fair, we're all different, and it isn't always easy to stay tactful while balancing a doctor's orders against a patient's wishes.
A pharmacist has to be able to judge that fine line between a minor issue and a serious health concern where the patient definitely needs to see a doctor.
We don't exactly love it when clinic staff meddle in our business either, telling patients "just buy it at the pharmacy, you don't even need a prescription anyway" without checking the dispensing rules first. For anything under a prescription regimen, a private prescription is mandatory.

As for that bladder infection case you mentioned—during an after-hours shift, a pharmacist is only authorized to dispense medication if the prescription is marked as urgent.
The pharmacy actually did the right thing here.
To avoid this headache next time, just ask your doctor for a private prescription without a date on it. That way, you won't have to try and explain things or play games at the pharmacy window.😉

I realize they followed protocol—but honestly, nothing would have changed even if she had listened to me. She could have just taken my ID as a guarantee. The only real consequence was that I wasted an extra hour or two wandering into the ER in the middle of the night while my bladder felt like it was on fire, just to get a prescription for the exact same medicine I’d already asked for—medicine I could have easily picked up the following day. Those two hours of misery meant two hours less of sleep, and I had a 6:00 AM drive out to Cleveland and a full day of field work ahead of me. 🙂

It used to be easier to get these things, but now the regulations have become incredibly strict. On one hand, I get it; people tend to pop pills left and right without any guidance, lending medications to friends, taking dosages incorrectly, or stopping treatments prematurely. If I recall correctly, there was even a recent report detailing how more than half of all prescribed medications end up being misused or discarded.

One other thing that really frustrates me—and this isn't about pharmacies—is that you can get a massive amount of medication on a prescription that almost anyone can afford and that isn't life-critical, yet we constantly see headlines about shortages for people battling cancer or other serious illnesses. You know, the ones who need it most. Shouldn't there be some sense of solidarity? Why can't people just pay out of pocket for their own nasal sprays or minor stuff? Or is the mindset that if someone is that sick, they’re going to die anyway, so why bother... ☕

swiftbear86 said:The pharmacy staff actually did everything exactly right here.

I was scrolling through an old thread recently, and it got me thinking. I wanted to bump this topic up to see if everyone could jump in and share their own experiences. I have a few questions for you all:

a) Do you have a "go-to" pharmacy? What keeps you going back—is it the expertise, how friendly they are, or just because it's right around the corner?
b) Are you generally happy with the service and how knowledgeable the pharmacists are?
c) Can you actually tell a difference in the skill level of the staff?
d) What’s your ideal pharmacy experience? Do you want someone who really listens and smiles, or do you prefer they just give you a quick, direct recommendation for one specific product?
e) What are your biggest pet peeves when you walk into a pharmacy?
f) On a scale of 1 to 10, how would you rate your usual pharmacy, and what’s the reason for that score?

If you're feeling ambitious, take a look at these articles and let me know what you think:

a) Almost always, because they are in the building where I've lived since I was five years old. Everyone there knows me, and they're often willing to let me grab something without a prescription upfront because they KNOW I'll bring the script by the next day (this obviously applies to my regular medications; they wouldn't just hand me something totally new if I walked in asking for it for the first time).
b) Yes
c) Huh? I mean, shouldn't everyone working there have completed pharmacy school?
d) Quick and clear advice/recommendations, but above all, I just want them to have what I came in for.
e) Waiting in line, especially during flu season, or when they don't have my specific medication in stock.
f) A 9, refer to point e.

As for other pharmacies, I've had both great and somewhat less-than-great experiences.

There was this one pharmacy on an island we visit; the woman was incredibly friendly and eager to help, but her final advice was actually *not* to go to the clinic, even though my condition was clearly worsening. She had this negative view that they’d just jab me with injections that she claimed were "very harmful." Look, lady, I know they carry risks, but I also know my medical history makes me a chronic patient, and I wasn't about to gamble with an allergic reaction to an insect sting that might pass in three days for someone else but could land me in the hospital.

On the flip side, I had a wonderful experience with a pharmacy in Ozalj. After two or three different places told me the product I needed was out of stock due to a shortage, I called them. A very kind woman (her name is Jane, and I'd like to thank her again here) took it upon herself to call around for me. She quickly found out where they had it in stock and even offered to order it for me so it would be ready tomorrow morning if I couldn't make it in.

Third example: a late-night emergency pharmacy. I was losing my mind from a bladder infection, having just arrived back from a trip, and I already had to head back out at six in the morning. It wasn't my first time dealing with this, so I knew exactly what I needed. I told the woman just to give me the meds—that I'd leave any ID (driver's license, credit card, insurance card, whatever) and bring the prescription in later. But it was a hard "no." No, no, and no. I had to go to the ER. Okay, I get that they have strict rules, but I was dead tired in the middle of the night and had to go to the ER, wake up the doctor on call who gave me a pale look for waking him up over a bladder infection, wait for him to scribble a script and go back to sleep, and then I had to head right back to the pharmacy to get... that.