I’m not sure how well this is going to go over but figured I’d post it. Throw away alt account. And to add this has not been my experience with community medicine rotations that I had during residency. Fresh out of training, first attending job. Trained at a large academic center that has every kind of transplant and sent absolutely nothing out. Great specialists. Everyone was up to date, including the in system PCPs. Midlevels were involved a lot but the care still seemed great. First job is in an academic affiliated community health system as a IM trained PCP. Great access to specialists and resources. Partners are great and seem to be up to date on the standard of care. That’s not the issue. The issue is that there are tons of mid levels managing care independently and even the attending care is just wild. generally when I’m precharting im like actually saying what the fuck are we doing out loud to myself. The care difference between what I was seeing in residency and here is just stark and frankly concerning. I’m really not trying to shit on community medicine but like at the same time there have been a dozen instances where I have considered messaging the provider in question. I’ve only been here for a few weeks. For example: cards NP dropping someone’s diuretics completely even though their BNP is increased from the hospitalization they are following them up for, new EF drop with WMA on the echo that nobody addressed during hospitalization or at the cards follow up in a patient with known CAD. They were concerned that he had pneumonia, didn’t order any imaging and just punted to “pcp follow up” even though they acknowledged the pneumonia in their notes. Attending physicians not checking LFTs on a patient with HH for years, doing thrombectomy for minor dvts, etc. I know not my monkey, not my circus. I’m really not trying to seem like I know everything. I ask my partners for advice several times a day. Just the whiplash between the level of care has been stark and I’m looking for some advice on how to navigate it a bit better or if I should just do my best and let what other people do happen.   submitted by   /u/Ornery-Narwhal708 [link]   [comments]