He actually said “that’s not the topic of our conversation today” despite it, in fact, being exactly the topic of our conversation. - ThreadSky

shematologist.medsky.social • 106 days ago

He actually said “that’s not the topic of our conversation today” despite it, in fact, being exactly the topic of our conversation.

Reposted from Shematologist, MD

One time I had to do a “peer to peer” because the patients insurer insisted on choosing the patient’s anticoagulation.

I asked the guy, who clearly wasn’t my peer, to tell me what he knew about Vitamin K epoxide reductase but it turns out he wasn’t too interested in that.

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stayhungry23.bsky.social•105 days ago

Wow. That’s not what someone says who is looking out for the patient. And totally infuriating. And rude.

davidsas.bsky.social•105 days ago

Mine usually go like this:

"Peer:" Dr. Sas, to be honest, before reviewing this patient, I'd never heard of cystinuria (or any of the rare diseases I treat).

Me: So what did you learn about this disease while reviewing?

"Peer:" Oh, I didn't read anything. 1/2

davidsas.bsky.social•105 days ago

Me: So you'll approve tiopronin, then?

"Peer:" Yes, after all, you are the expert!

Me: That should have been evident 8 months ago when I first prescribed the medication. 2/2

mogasaurus-rex.bsky.social•105 days ago

Wait until he hears about pharmacogenomics!

drjoe2003.bsky.social•105 days ago

I know about Vitamin K epoxy reductase! But I still don’t think that makes me your peer in hematology!

jmksnow.bsky.social•105 days ago

I’ve not even had to get into any weeds:
Me: This test I want to do has a class I indication in the ACC/AHA guidelines

Them: but, not in *our* guidelines

rnflex.bsky.social•105 days ago

If I could change one *big* thing about prior auth/denials it's this. If there is good evidence like ACC/AHA, KDIGO, ADA etc by law they shouldn't be able to deny treatment/"have their own guidelines"

whatfreshhellnow.bsky.social•105 days ago

I had to do peer to peer for an MRI because I had not documented “a change in the patient’s headaches”
First line of my note “These headaches are new and worse than any headache they’ve before”

lilycrue.bsky.social•105 days ago

I had a palliative care NP call me and ask what I knew about my dad's swallowing?
I started to explain his intubation injury from recent surgery.
She interrupted me and said, that is a different topic.
We are not talking about that now...
We were indeed talking about how he acquired dysphagia...

lilycrue.bsky.social•105 days ago

She then began to chant robotically,
Your dad can't swallow and he aspirates over and over again.
I had told her, I am a dysphagia expert and diagnose and treat swallowing and feeding difficulties.
She told me my dad wants to die and I needed to let him die.
He wants to go home.

lilycrue.bsky.social•105 days ago

Situational depression is common when hospitalized.
His condition is temporary and is improving.
I ended up yelling NO NO NO NO on the phone.
I did not want her to remove treatments and provide comfort care!
She said, she was going to hang up because I was yelling at her.
She would not listen to me

lilycrue.bsky.social•105 days ago

I question how many people she stopped treatments that would have improved and gone home to live their lives?
She did not appear to know that dysphagia can be temporary and will improve.
I have never been so livid in my life.
Yelling NO NO NO was the only thing that registered with her!

advod.bsky.social•105 days ago

Someone posted this here on a forum, patient is 2-year-old, not symptomatic. Doctor said maybe it's "an asymptomatic viral infection" or iron deficiency. It's obviously not ID. Does this look to you like an asymptomatic viral infection is a possible cause? Is this a case for pediatric hema/onco?

shematologist.medsky.social•105 days ago

I’ve seen cbcs like that from viral suppression. Would be helpful to have a retic

advod.bsky.social•105 days ago

Look at the RDW. Retics are going to be low, Have you seen asymptomatic viral suppression like that?

shematologist.medsky.social•105 days ago

Yes

advod.bsky.social•104 days ago

The iron panel didn't look like chronic inflammation (TIBC normal, saturation normal). Does that indicate anything? (as in: if this was Leukemia, there'd 99% be an inflammatory iron picture)

shematologist.medsky.social•104 days ago

You cannot say with certainty based on these values that it’s not leukemia. Or that it is. What are the platelets?

advod.bsky.social•104 days ago

I'm glad that's a possibility

quicktolaughter.bsky.social•106 days ago

It blows my mind that you are in that position, ever.
I wonder far back in time has this hard-to-believe reality existed.

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