I notice the younger, healthier patients of mine have low threshold to go to ER. They go in for simple stuff like URI which turns out to be flu that requires no hospitalization, back pain, rashes, or just want to get checked out. I think there's a layer of anxiety worsened by these social media/self diagnosis which makes everyone think they're dying. For example, I give them a plan to treat their rash and they try for 6 hours then go straight to ER for steroids because it's so itchy. It's an extreme example but not far from what I've seen. Maybe it's the instant gratification generation that they need something strong now to make everything better? To top it off, some of the time they come back to my clinic requesting for x weeks off work or fmla because of this condition.

After spending time talking through a prednisone script for an asthma flare up a patient finished with “I thought you were going to give me something to help me today.” Established patient, seen her for years, not the first time we’ve prescribed prednisone, decent health literacy. Some days it be like that …

Last week I had someone complain about vibrations in the body being a directed 5G attack. Discussed medical work up. Then I started hypothesizing how we could test it. Gave an open ended question of “what if you went to an area where there is no cell service? You could see if you still had symptoms there?” She looked at me like I was crazy. Oh well, I think it would’ve been an interesting experiment.

In our EMR we can see when meds were dispensed by the pharmacy to the patient, and most local pharmacies and mail order pharmacies show up in that database. I have a patient that consistently uses the same local pharmacy, so I have no reason to doubt the fill history dates. However, the patient has lied about refilling their BP meds saying the fill history must be wrong... And this isn’t a chronic med that they would have a stockpile of, it was just started a few months ago as a 30 day supply, and pt missed follow up appts. Of course, their BP is uncontrolled at home and in the office. How do you all handle these situations aside from “please pick up a refill on your way home, go home and check your pill bottles and let’s get on track xyz”? Not taking their meds is one thing, but lying about it makes my job even harder and wastes their time and my time

Salaried physicians: Why does visit coding matter if we’re not paid based on RVUs?
I’m an outpatient primary care physician on a straight salary, with no RVU-based compensation or productivity bonuses.
Management has been emphasizing the importance of coding visits appropriately, particularly 99213 vs. 99214.
My question is, if my compensation is fixed regardless of how I code my visits, what incentive do I personally have to focus on maximizing billing levels (assuming documentation supports the code)?
I understand that higher-level codes generate more revenue for the practice, but if that revenue doesn’t translate into increased compensation for me, what difference does it make from the physician’s perspective? I literally lock my AWV’s. I’m not adding any codes or anything. I just want to close my notes. Am I’m being screwed here? I just don’t see all the fuss with coding.my salary is my salary.
Are there other ways visit coding can affect salaried physicians that I’m overlooking? I’m genuinely curious how this works at other practices.

How are calls different as a new physician than as a resident? Do you have to document it? If so, how Is the documentation different? What do you make sure to include? What should new attending watch out for and what advice do you give to new attending?

Also, what's your call schedule and how often are you taking it?

Well, my kid 1 yo , and we switched Peds bc of location. I went to visit, which ended up sick visit (was short a couole days for regular check up) and got flu shot.
- private (hospital) sponsored insurance, top tier what hospital could offer.
- we got bill back with explanations. $700+ for moderate level billed sick visit+ vaccination. Flu vaccine+ administration = $140, the rest visit fee. Insurance applied some discount but good chunck was paid by insurance and im about paying $40 copay.
- i work in healthcare , i get that im happy to pay that copay. However, i hear a lot of complaints that Peds r underpaid. How come?
- peds clinic is an outpatient and their flagship hospital is located like 50+ mi away (clinic is not attached to hospital)
- does this bill seems high?
(FYI; we r happy to pay and always grateful)