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About LMV

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    Hive Mind Worker Bee
  1. In the past JCAHO could grant Medicare certification but Medicaid was more complex in some states. That changed in 2010 with MIPPA. CMS is now the Medicare authority. Medicaid is still regulated largely at the state level and several states do not recognize JCAHO for state facility licensure.
  2. My husband actually did the bulk of Thanksgiving this year. I worked a physician overnight shift in the ED 11/22 into 11/23. It was a really busy night and pretty much everyone truly needed to actually be in an ED (or ICU). Somehow everyone survived. I left the hospital and went to run a Turkey Trot with our daughters. I came home, showered, and went to sleep. DH did pretty much all of Thanksgiving Dinner except some of the pies I made ahead of time. Also when I got up and felt human again I pulled together a quick spinach lasagna to go along with the rest of the meal (a tribute to my Italian heritage and a kindness to one of my vegetarian colleagues who was joining us). He also supervised the kids (including DD2 and DD5) while I was sleeping. I’m sure he delegated some but I’m still pretty thankful to have him.
  3. I'm sorry for whatever else is difficult and complicated in your life. I think I would impose consequences for taking/destroying her sister's things. In our family, while we encourage sharing and helping, we do respect our children's right to have choose not to share some possessions and in some contexts and situations to choose not to help. Generally they do choose to share with and help their siblings. For example, when our current DD17 and our eldest daughter were both living at home they did share clothes some [as possible---our eldest is quite tall so some things were just not shareable] without any issues. Fast forward four years and now they are college freshman/first year medical student attending the same institution and sharing clothes again at least somewhat which is kind of sweet.
  4. We have adopted through foster care and we had guardianship of my husband's godson (his late father was one of DH's best friends) while he aged out of foster care in our home. Having said that, I truly see myself as a mother of ten. Although I have different connections to and special relationships with all of my children I see that as the reality that they are all unique and special individuals. Each of them bring something different, yet very beautiful, to the fabric of our tightly woven family. Half of our children are my biological offspring, 60% of our children are my husband's biological offspring, but they have all grown into our hearts in a way that has certainly changed us, and our collective family, for the better.
  5. We have a large walk in pantry off of the kitchen. Our chest freezer is in there. We also have a smaller chest freezer in our root cellar.
  6. I agree that you can be grandparents without taking custody. Our DD13 and DD9 have a strong relationship with their biological MGF who has really become a part of our extended family [ie he was recently here to celebrate our biological daughter's second birthday with the rest of the family]. This grandfather actually briefly raised DD13 when she was four right after her parents' death and then in quick succession after the death of his wife and her grandmother. He had a MI and many complications and as there really wasn't any other family to care for her she went into emergency foster care and then when her infant sister was released from the NICU they both went into a foster adopt home. By the time their grandfather was out of the hospital and physical rehab the girls had just turned five and one and the foster parents were working towards adoption. Those foster parents were not interested in him having contact with the girls as they believed it would be confusing and he says that hurt him but he was led to believe they were happy in their new home so he felt he should try to respect their new parents. For various reasons the foster adopt placement was not a good fit for DD13 and the adoption never happened because the court would not separate the girls adoptions. We started taking DD13 as a respite child when she was seven and then ended up with her after the foster parents abandoned her at our house. They took DD9 with them when they fled the state. When they were apprehended a few months later DD9 (who was four at the time and traumatized) was placed with us as well. Ultimately we have managed to adopt both girls and allow them to re-establish a relationship with their biological MGF.
  7. To verify board certification check with the relevant board. In your case, this would be the American Board of Psychiatry & Neurology. If the physician happens to be a DO then they may be boarded through the Osteopathic board (although many DOs are allopathically boarded or also allopathically boarded). In 2020 all GME will be fully merged everyone finishing residency then and beyond should be allopathically eligible.
  8. 1.) I have never looked at reviews. Verify no disciplinary action and current board certification if it is an unfamiliar physician sure. I personally also make sure that my child will be seen by a physician at least for part of the visit. [so I am ok with physicians who do use NP/PA as physician extenders but still examine all patients and sign off on the plan but not physicians who supervise only retrospectively.] 2.)If I had personal safety concerns with the area then I would avoid for that reason. Otherwise, no, my eldest daughter's unsung hero of a pediatrician worked in an FQHC and was amazing. 3.)Child/Adolescent is a subspecialty fellowship off of Psychiatry. With a teen I think if you have CAP availability you can/probably should start there but if you don't have CAP availability and have general psychiatry comfortable with teens that could be a good option. In your case I would call the office and ask if they would be comfortable. I personally wouldn't put much stock in online reviews but if you have had good success picking physicians via review sites then maybe that is a good approach to continue.
  9. With all of the push for independent practice from NPs (and even PAs sadly) I don't think this is a safe assumption. Regardless unless the physician is also seeing the patient on the same day then the supervision is retrospective and will be more on the order of identifying mistakes after the fact rather than ensuring quality care is delivered in real time. Additionally if the supervising/collaborating physician never sees the patient at all but just looks at the NP/PA documentation then it may look like acceptable care but in reality the diagnosis may be completely incorrect and critical exam findings may be overlooked.
  10. Eclectic thoughts: -Driving impairment in states that opt to legalize concern me greatly. -Adolescent brains (for some this probably extends up to age 23-25) are particularly vulnerable to drugs including THC and alcohol. -THC can cause acute psychosis. This is more common when there is already a family history/genetic predisposition towards mental illness especially schizophrenia but can/has been seen in those without this history. Chronic THC use is associated with increased depression rates. -We are seeing a lot more (or perhaps just diagnosing a lot more) Cannabinoid Hyperemesis Syndrome. -The medical evidence for THC is not very compelling. -Synthetic THC products like Spice can be deadly. I've "saved" a few lives after Spice misadventures but ultimately they survived with deficits (and colleagues across the country are reporting deaths).
  11. Tapentadol works on the Mu opiate receptors so addiction issues are certainly a concern and a reality for some. I think the DEA was doing the right thing when they classified it as a schedule 2 drug.
  12. Oral ketorolac does exist and actually has been shown to have similar/superior in some studies efficacy to hydrocodone/acetaminophen.
  13. Statistically where I practice this is the case but the issue is a bit more complicated and multifaceted than that. A lot of communities now are also seeing heroin contaminated with fentanyl, and carfentanil which are increasing the overdose and death rate.
  14. I can agree with a lot of your post. Unfortunately, I do not think Suboxone is the answer so many believe it will be. I do not favor increasing suboxone caps or allowing non physician members of the healthcare team to prescribe.
  15. I had one cesarean section and four vaginal births. Three were VBACs. I didn't take narcotics after any of my births. I think that was probably a bit atypical in the initial twenty four hours after my cesarean and I won't say I wasn't in pain but it was manageable albeit not completely eliminated with non narcotic options. Interestingly after the birth of our final daughter a little under two years ago the nurse I had in post partum was aghast that the only thing my OB had written for pain was ibuprofen. She made a big deal of paging and "advocating" for me to get something (while ignoring my attempts to explain my OB probably knew I didn't want anything else and if I was in sufficient pain to need something else then I was probably having some horrible complication and needed re-evaluation much more than narcotics). I don't disagree that physicians need to take responsibility for what/when they prescribe. However, I think there are some regulatory and reimbursement scenarios that penalize physicians who do prescribe responsibly. I don't offer that as an excuse because I firmly believe that when you are sacrificing your clinical judgment for external forces and pressures then it is time to stop practicing. I stand by that and I know I am fortunate to work for a medical director and healthcare system that respects my profession and my professional judgment. Not all physicians are so fortunate and some of that is part of our physician shortage. Then of course there is last week's tragedy in Indiana. At this point the opioid epidemic is shifting back into heroin partly because it truly has less street value than prescription opiates. [based on my statistics as a toxicologist not personal experience.] Controlled substance restrictions are also making prescription opiates harder to procure which contributes to the shift.
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