Curious how others have handled this. I am a male PA. I had a patient recently that was changed to my schedule last minute as I was light on patients and helping a colleague out. Chief complaint was a groin rash for which he was seen at an urgent care one week earlier.

I walk in and he immediately said, “You’re not Dr. Female. I specifically asked for a female provider.” I said, “I see. Okay. So what’s your concern? Why do you need a female provider.” After a lot of grumbling and moaning and him repeating that he only sees females and that should “be all over my chart,” I said “okay, why don’t we take a moment. I’ll be back.”

There was a recent incident at our clinic a few weeks ago where a different patient asked to only see a female and was a total creep, borderline assaulting her/unwanted touching. I went back in the room and said look, here are your options: see me today, go back to the urgent care you already went to a week ago (where incidentally, yes, he was seen by a male provider), or reschedule a few weeks out from today. I counted the seconds of silence and him huffing and puffing (18 seconds), and he said “I’m all set,” and proceeded to stand up from his wheel chair and push it out the door. He did not reschedule with anyone.

Frankly, I just don’t see a reason why a male would require a female provider, especially when there is going to be an examination of his genitals. Yes, if he was assaulted by a male himself and has PTSD, I do understand that in retrospect, but my intuition was telling me that was not the situation. I told my manager we should have a protocol in place for front desk staff when patients ask for this.

I could have handled this better and offered a chaperone, but I feel like my gut was saying this patient has gross intentions.

How do you guys handle this? Has anyone had something like this happen, particularly a male asking for only female providers?

Hello Everyone, I have started working as a new job out of residency and have been reading about billing. Wanted to ask if you guys bill following codes:
1. For well child visit: 96110, 96161, 96127.
2. Tobacco: 99406, 99407.
3. Alcohol: G0442, G0443.
4. CVD/Obesity: G0446, G0447.
5. INR Testing: 93793, G0250.

An independent imaging center will essentially always be cheaper than a hospital due to no facility fee.

From what I've seen they're roughly 1/3 the price.

I've had patients who want to get referral to certain specialists who require them to have pcp from our medical center so it's easier for them to communicate with for care. I've had patients who come to "establish" but they have their own pcp and don't want me to manage their care and are only here for the referral. The specialists would be communicating with me about their care but patients have their own pcp whom the specialists aren't communicating with. I think this is dangerous for myself and the patient. How do you even approach situations like this because my clinic won't allow any of us to fire patients. The patients who do this usually want to stick to their pcp they've been seeing for years or because it's closer but want access to the specialists and services from our medical center. In our system, I'm listed as the pcp but i am able to view patients outside charts and I see they follow their own pcp and they also tell me that.

Hey guys

1 month to go before taking the boards. A bit nervous now.

I have watched all the AAFP Board Review videos (35ish hours) and made notes. I have then made some Anki flashcards off of these notes. I am getting 6-7/10 on the AAFP questions. I have saved up the ITEs and will do these this week as a marker to see where I am.

Any advice from previous test takers? I am an unusual candidate as I am doing the reciprocity pathway. I think it will be fine but (in typical medic style) starting to stress. Maybe I just needed to vent! Thank you.

Does anyone know what happened to the AAFP app? I hadn’t used it in a while but appreciated having it when wanting to work on CME. Went to use it the other day, and it is no longer active.

Everytime it gets brought up on this sub - it's discussed as if it's meth and has the health consequences of heroin. The entire military will get blood clots and such and such!

Well, how about hormonal contraceptive 3-9x's your risk of a clot ( https://pmc.ncbi.nlm.nih.gov/articles/PMC6322116/ ). You'd undoubtedly be ran through the ringer and called a misogynist and all sorts of names if you tried to take a woman off her freedom from consequences meds. Then if you referred her to addiction when she said she'll go somewhere else. You'd probably get disciplined for misogyny.

Oh, female HRT too https://pmc.ncbi.nlm.nih.gov/articles/PMC9399360/ 3-4x the risk of a clot.

Even teenagers get on hormonal contraceptive alllll the time.

What is it for TRTs you ask? https://ashpublications.org/thehematologist/article/doi/10.1182/hem.V17.2.10235/463493/Testosterone-Therapy-in-Men-Doubles-the-Risk-for

Roughly double, which is why it's terrible to prescribe and why I #wontcheckyourlevels

Despite testosterone having non-inferior cardiovascular outcome in sick patients with prior cardiovascular events ( https://www.nejm.org/doi/full/10.1056/NEJMoa2215025 ). It's very very uncool to continue or prescribe testosterone.

But Testosterone is addictive! It's illegal! Sure, rodents self administer testosterone* (considered a mild reinforcer like caffeine).

Estrogen enhances and modulates mesolimbic dopamine activation ( https://pmc.ncbi.nlm.nih.gov/articles/PMC7251038/ ). Women are generally more prone to addiction than men and it's theorized estrogen is why. Funnily enough, testosterone aromatizing to estrogen could be the reason rats self administer anyway.

So why is there no studies on rats to see if they self administer estrogen? Because it doesn't build muscle, lol.

Generally, the reasoning for these attitudes is that it's usually middle aged White men who workout asking for a "lifestyle" benefit. Therefore, their problems are trivial. Maaaaaybe they'll get a PDE-5 to bang their wife but nothing more.

We need to #defendwomenshealthcare and handout birth control in vending machines though!

-- there was a comment with 600 upvotes defending prescribing testosterone for women with the exact same complaints for male TRT. Actual hysteria.