W. Ryan Neuhofel, DO, MPH. A naive family doc with big ideas. Using #DirectPrimaryCare to grow the #FMRevolution.
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Jan 26, 2021 • 17 tweets • 4 min read
(I’m honestly sick of telling these prescription med pricing stories but here is another for those who enjoy horror genre.)
I saw Jane in clinic just before lunch. She’s a 69 yo F w/ highly suspect DVT. (Blood clot in lower leg) She looked otherwise well and low risk...
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...so we discussed managing this at home without going to the hospital. While not an emergency, she needs to start Lovenox (an injectable blood thinner) ASAP; otherwise risks of clots traveling to lungs go up quickly.
She’s thankful we are avoiding the hospital but...
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May 15, 2020 • 11 tweets • 4 min read
Ok, @US_FDA, I’ve tried to be sympathetic in the midst of this madness, but now I have some major f-ing beef.
Get a load of this y’all...
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Physicians have been told for the past 1+ month that rapid POC (fingerstick device) COVID-19 antibody tests are mostly not approved AND when they are:
Considered “complex” enough that I won’t be permitted to do them by office under a CLIA-waiver.
Rationale for this?
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Nov 21, 2019 • 27 tweets • 8 min read
I know nobody needs another story about how insane health insurance plans are, but I have a story + GIFs for ya...
About 2 months ago, I received a prior-auth request on a patient for gout medication called Urloric.
Backstory: Jimmy is a 30-something y.o. guy w/ bad gout.
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For many years he tried to manage with lifestyle. Despite doing great there (normal weight, eats healthy, improved fitness), he still had high Uric Acid & gets frequent, terrible flare-ups requiring anti-inflammatories & colchicine.
He has bad genes.
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Jun 7, 2019 • 13 tweets • 3 min read
/thread
This might come out wrong, but here it goes...
Most days, being a primary care physician is really hard--humbling is an understatement. Despite 8 yrs post-HS edu + few yrs post-grad training + decade of private practice, I often feel inadequate...
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...to fix my patients' problems.
Why?
First, our growing body of knowledge on diseases/tests/drugs/procedures is mindboggling. The internet gives me access to info but that takes time. Even w/ a good knowledge base, reviewing guidelines/expert opinion/studies ain't easy.
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May 16, 2019 • 21 tweets • 5 min read
1/ If y'all want to know why health care costs are high in America, pull up a chair & pour a stiff drink...
My patient is 67 yo lady (call her Sue) w/ newly diagnosed COPD. She is very reluctant to take meds but I convinced her to at least try an inhaler for relief of symptoms.
2/ In addition to general stubbornness, Sue is also understandably concerned about the cost of the med. I had some Dulera samples so gave her 2 months of that.
Follow-up visit: Sue reports it's working well so wants to continue.
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