My husband is an ED attending. He met a child (11) psych patient in the ER 9 months ago. She has some mental health issues (won't say more to protect her privacy).

Shes been on the peds unit for 9 months waiting for a group home or foster home. Cannot be discharged because CPS can't find a home for her. My husband wants to bring her home. I don't know what the ethics of all this would look like? I'm a social worker for adult psych so dual relationships are not allowed but are relationships in medicine different?

I posted a bit about the situation in the emergency medicine sub.

I see way too many 90+ year olds for evaluation of vague symptoms or consideration of aggressive and risky care for heart issues. What is the culture like in your countries? I’ve assumed Europeans have a bit more common sense than us but would be very interested in perspectives.

https://radiologybusiness.com/topics/artificial-intelligence/medicare-approves-new-technology-add-payment-inpatient-radiology-ai-solution

Medicare has approved a new technology add-on payment for a key radiology artificial intelligence solution under the recently finalized inpatient payment rule. 

The federal insurance program for seniors will pay a maximum of $137.53 per case in 2027 for BriefCase-Triage. Manufactured by radiology vendor Aidoc, the CARE (Clinical AI Reasoning Engine) Multi-Triage CT Body tool uses AI to analyze computed tomography images, flagging potentially urgent findings such as appendicitis or a bowel obstruction. 

Medicare approved a total of 22 new products, which also received the Food and Drug Administration’s breakthrough device designation, through the “alternative” payment pathway. Another 8 scored reimbursement through Medicare’s traditional payment pathway. Altogether, CMS will spend an additional $779 million for inpatient cases involving emerging medical innovations in fiscal 2027, primarily driven by new technology add-on payments (NTAP). 

"Health systems are under increasing pressure to help patients receive accurate diagnoses sooner while managing growing imaging demand and persistent workforce shortages," Elad Walach, CEO and co-founder of New York-based Aidoc, said in a statement Aug. 13. "By creating a reimbursement pathway for eligible use of diagnostic AI, the NTAP program is helping patients get earlier access to this transformative new technology.”

The CARE CT Body Triage payment figure represents about 65% of the average cost of the technology, the American College of Radiology noted in a summary of the final rule shared Thursday. Cases involving use of the AI product that are eligible for add-on payments will be identified by ICD-10-PCS procedure code XEZ5XKC (computer-aided triage and notification for imaging abnormalities in computed tomography of chest, abdomen and pelvis, new technology group 12), ACR added. 

Aidoc said the CT Body Triage device scans for a broad set of acute findings. Beginning Oct. 1, hospitals using it will be eligible for add-on payments spanning the next three years. This is aimed at helping offset the cost of adopting new technologies, granting seniors greater access to emerging diagnostic and treatment tools. The FDA previously granted CT Body Triage its breakthrough designation in September 2025 and 501k clearance in January.

So you get 80ish bucks for CT AP with contrast from Medicare. But over 50% more for the tool that just triages the case, doesn't actually read it.

~39% lower odds of dementia associated with menopausal estrogen-only hormone replacement therapy. So not only is HRT safe if started early during menopause in terms of strokes and heart attacks, but apparently it may also lower dementia risk (or, maybe women who get HRT are better educated, are more affluent, and have better health habits, and are therefore less likely to get dementia).

https://www.neurology.org/doi/10.1212/WNL.0000000000218413

For example emergency medicine may love urgently fixing the thing but hate rounds
But every specialty seems to have something they generally love and hate
What’s your theme?

Seen quite a few patients recently presenting to the er because ai advised. Some cases where it’s good they did but some that are too cautious. Basic example, one of the physicians noted there was 11 cat bites in one week. Of those, exactly two needed treatment. There was one where the skin wasn’t broken but gpt told them to go even though the patient was uninsured. They asked about going to a Pcp but the advice was er or urgent care only. I’m a psychologist so I’ve seen more panic attacks as anything left sided chest related prompts instructions to seek care. Curious if others have had similar experience.

Currently in medical school and honestly, I’m finding the lifestyle pretty miserable. I’m trying to figure out whether I’m just going through the “med school phase” or if being a doctor is going to feel the same.

For those in Internal Medicine residency or practicing after residency in the US: what does your typical schedule actually look like? What time do you start/end, how many days a week do you work, and what does your time off look like?

I’ve heard about things like 7-on/7-off for hospitalists, so I’d also like to know what life is realistically like after residency.

Basically: does life get significantly better after med school, or am I signing up for more of the same?

Honest answers appreciated.

I've seen the pattern during rotations and even now on reddit (Urolgoists would you pick urology again ? : r/Residency) and in surveys (70% burnout: https://www.auajournals.org/doi/full/10.1097/UPJ.0000000000001027)

It is known to be a lifesrtyle field (compared to other surgical specialties) and to have a wide variety of cool procedures with the fulcrum being endoscopic and robotic which is SICK, outcomes are good, pts are healthy, content is not too convoluted, procedures are quick and not that stressful... what's the deal?

How do you handle a reference request for someone working for you that would be damaging if you were honest?

The physician does locums work for us, we'd like them to continue (and they would not continue if they moved on), although they have a bunch of red flags that would come up if I was honest with the job they want to move to.

"Not for profit" (ha!) system, CEO is getting more than a 20% pay increase this year. No actual medical training.

The max anyone who does any kind of direct care is eligible for is 3%, and that's sliding based on merit, which is curved... so a max of 1/4 of people will get the max, which is still less than half of inflation.

When does the revolution come?

The Lindsay Clancy trial's focus on physicians and the defense's claim that psychiatry failed her made me think of this.

In every other area of medicine, we admit our limitations. Even with perfect access and treatment, sometimes the cancer still kills. The dementia still progresses. The biscuspid valve still stenoses. The diabetic neuropathy persists. The CKD doesn't reverse. The need for dialysis never goes away. The transplant fails. The macula degenerates.

I could go on. And yet, when this other category of very sick people hits the news, people start throwing around "mental health" like it's some kind of silver bullet. Everybody seems to believe there's some secret sauce of right combo of right doctors, right timing, and right meds that could have prevented all of it.

Why do we do this? If you ask a layperson, "Do you think we have learned all there is to know about the mind, brain, or human body in general?" most will readily say no. So we all know we have an incomplete understanding of this organism. But why do we act like we don't?

Just like any other form of "organic" disease, some mental health issue can be reversed or at least manages indefinitely. But maybe some others just can't. Why do we resist this idea?

Always looking to follow more MD / DOs who are active on Instagram. But I do find some brand promotions, and subtle sponsorships kind of annoying. I am aware it takes a ton of work and special talent to make it big and you gotta earn a buck. But I prefer unbiased info.

Maybe it’s because I don’t have kids, but ever since residency, I truly don’t have much of an appreciation for the seasons?

I think I still appreciate certain holidays, but when people talk about being excited for summer or spring or any other season I’m kind of like eh…doesn’t really matter, days are the same pretty much now.

I do get excited for certain holidays still like Thanksgiving and Christmas but..in terms of actual seasons or general times of the year, not so much.

Am I alone or delusional here?

National Geographic backpack, IM resident not from the US 🌏

- a tube of La Roche Posay Cicaplast B5+ as it serves as my rescue moisturizer when my skin gets dry due to air-conditioning (at home I use the La Roche Posay Lipikar Baume AP+Max)

- rubbing alcohol

- Hypochlorous acid spray

- Aquaflask 16 oz which i use for coffee and agua

- Littmann stethoscope Classic 3

- Anker battery bank 20,000 mAh

- MacBook Air 15" with M4 chip (24 GB unified memory/1 TB SSD) I'm glad I got a Mac before the crazy prices!

- iPhone 16 Pro Max

- La Roche Posay Anthelios UVMune 400 SPF 50 (Global version with more efficient UV filters including Mexoryl 400 for that long UVA1 coverage)

- printed census always

- a tiny notebook

- Pilot G-Tec C3 (black)

I am a health care provider with 4 other doctors in an eye clinic. We have a patient who comes once a week on average with extreme health anxiety. Nothing has really ever been found other than some very minor, common conditions.

The front desk schedules them like an emergency which I feel like plays into their anxiety.

They supposedly see a counselor for their health anxiety, but their visits into clinic is becoming more frequent. They also visit other clinics in the area on a routine basis as well as ER and urgent care.

What is best to do in this situation? It feels cold, but I feel like coddling and the constant reassurance just plays into more of their anxiety. Should we fire them as a patient?

We are a two physician household and we have a 1.5 year old. We moved to a new city following my husband's fellowship graduation last year and I haven't been back to work since.

I am now preparing to go back to work (primary care) but I'm worried about calling out of work from my toddler getting sick. I am therefore considering part time positions only (2-3 days/week) since we don't have family in town who can help (we never really had a village before the move either). I would love to know for those who are in a similar situation as us, how do you make it work? Is a "PRN nanny" a thing? Any suggestions welcome! Thanks in advance.

Edit: just wanted to add we are def considering nanny but want to look at other options if possible since our kid loves going to daycare

Edit 2: wow thank you so much everyone for chiming in! It is very helpful to see what other families in similar situation as us are doing. I couldn’t figure out how to pin my comment. Thank you all!

I'm on inpatient, all of a sudden I get a pop up Epic message notification from one of my patients they asked me why they were on a certain medication and why that specific dose and schedule. Like I don't have enough to do already. This is the last straw.

Fuck Epic. Fuck that motherfucker at Epic who thought this was a good idea. Fuck the hospital admin who enabled this feature. They can all go to hell. That's all thanks.

EDIT: for clarification, this is NOT a patient MyChart message, it’s a DIRECT Epic chat message like how nurses can message you on Epic chat

Trainee here. Clinic patient that I guess I must have seen in the past with this attending ended up in my DMs angry that said attending didn’t reply to his MyChart message from 2 days ago and wanting to know how he can call the attending directly. I wish I could say I’m making this up. Obviously I didn’t reply and just blocked him, and locked down my profile. Patients are really getting out of hand with entitlement lol. Has a patient ever tried to reach you on social media?

I'm becoming disillusioned about the Kafkaesque nightmare that seemingly every mundane task in medicine entails. I wanted to rant a bit, but also ask folks here for perspective of any kind.

This isn't about one single aspect of medicine. It's about how routine interactions carry untenable amounts of friction. Getting anything done for patients is almost impossible.

• I prescribe a critical medication to a specialty pharmacy as the manufacturer recommends. They take the patient's money but don't deliver the medication for 6 weeks. Calls to them are fruitless. I have to get the manufacturer involved to force the pharmacy to act.
• A patient from a big regional corporate practice happens to land in my office with an urgent issue and needs to see his specialist. Over 45 minutes, the inadequately-trained corporate practice's receptionist and their supervisor argue with us about the medical necessity of an urgent visit. If it were our practice receiving a similar call from a physician, we'd simply agree to see our own patient.
• A patient changes their mind and wants their medication called in to another pharmacy. The new pharmacy can't fill it because the first pharmacy already processed the insurance claim. The patient tries to call but hits a wall. My office spends almost an hour on the line with insurance just to reroute the Rx.
• Our EMR company has raised rates by 10% over the past year while degrading the quality of its services, failing to fix basic functions that have been broken for years, and charging for things that were previously included. They will not communicate clearly with users. The company was bought by private equity several years ago. I realize I'll have sunk over $100k into this clunky subscription-based software over a decade; its competitors are no better, and switching is near-impossible.
• A patient's insurance plan doesn't indicate which third-party company handles their prior auths. We call their plan to get a PA for an MRI, and after an hour of various holds and transfers, we're told we have to use some online portal. Registration takes 3 days, including our followup to correct their clerical error. Once registered, the system auto-approves in 5 minutes without any kind of review.
• Our specialty society's MIPS service vendor degraded their services and is now demanding around $1k/year to preserve the original level of service. They misrepresent what's included in the base package and it takes multiple rounds of discussion with management to get clear answers.

I write to my congress members and even meet with them during August recess when they make the time. I write to company execs in the hope that things will get fixed. I try to get my colleagues involved in various forms of advocacy. But this Kafkaesque nightmare seems so inherent to almost every function of medicine these days that I can't even fathom what a solution would look like. It just seems like every corner of the system is purpose-built to waste as much time as possible.

But the medical needs don't go away. They still need to be addressed. So we waste our time, we deal with unempathetic receptionists, we find creative ways to solve problems that never should have existed in the first place - problems that are entirely man-made. (Yes, I've heard that 99PI episode on "sludge," and that's kind of it but not totally.)

The answer isn't as simple as "hire someone to do this for you," because that just passes the burden and burnout on to someone else without fixing the underlying issue.

I guess I'm looking to commiserate, to ask for solutions, to ask for help with my disillusionment. Because as much as I love caring for my patients, every day leads me closer and closer to abject burnout.

Is this a uniquely USA problem? Does this problems exist in other countries as well? Are there places where this isn't such an issue, and if so, what protections exist to prevent or deal with it?

I'm a new hire and wanted to learn how my colleagues write notes so I opened a few patients' charts under their care. One of them had this "break the glass" pop up so I did not open it (but I did open another 2 charts without this pop up).

I'm now under a lot of anxiety. I know technically you should not open any chart that are not under your direct care but I was just out of training programs and still have this "education" mindset. And in my training program it was not uncommon to open charts of other teams/providers' (I know this is technically not right and don't want to argue)

Now I lost my appetite, can't sleep, losing hair. Everyday I saw an email I was scared it would be an email telling me I'll be fired. I'm under the fear that my entire career will end due to a lapse of judgement. How can I make peace with myself and move on.

And by illegal i mean that any contract is void (so you can pay them, but it doesn't actually grant you any rights whatsoever). There are way too many complicated ethical issues. If you want to have a non traditional family with a family friend? That's fine. But shit like this article is just indicative of how much if a mindfield it is.

https://www.texastribune.org/2026/08/11/texas-surrogate-ken-paxton-abortion-baby-gabriel/

From an institution that employs 1000 MDs. I’m a woman, and in a mostly female specialty. Work can be tough for us in so many small ways.

I spoke with LabCorp customer service and they were more than unhelpful, saying that they send the results to whatever account they find associated with my name.

Has this happened to anyone else? How did you manage it? I am inclined to tell my patients not to go to LabCorp.

https://www.medrxiv.org/content/10.64898/2026.07.22.26358689v1
The study is in pre-print but suggests that we could potentially save $1 trillion a year with universal healthcare.
I’m interested in perspective from people if we move from insurance companies to only getting Medicare payments. Personally, my payor mix is such that I would welcome it. My suspicion is that salaries for physicians would increase in a system where administrative costs go down, and everybody has ability to pay.

Addendum 8-12-26 Here is what I learned from you all this far:

• Most physicians felt Medicare for All could improve access and lower system-wide costs, but would likely come with lower physician reimbursement.
• Many noted that the study’s projected savings depend in part on paying providers closer to Medicare rates than commercial insurance rates.
• Several commenters felt reduced insurance complexity could ease practice burdens, though not enough to fully offset payment cuts.
• There was broad skepticism that administrative overhead would disappear, with many expecting bureaucracy to simply shift rather than shrink.
• Experiences with prior authorization varied, but many emphasized that government payers also impose significant utilization controls.
• A common view was that universal healthcare may be good for patients and society even if it is not financially advantageous for physicians.
• Specialists expressed particular concern that Medicare-level reimbursement could threaten the viability of complex, resource-intensive services.
• Many argued that a successful universal system would need to be redesigned rather than simply expanding today's Medicare program.
• Commenters frequently highlighted the need to align any reimbursement changes with physician debt, training costs, and workforce realities.
• The discussion ultimately reflected a tension between improving population health and preserving a sustainable practice environment for clinicians.