care guidelines

Things to make your pet happy! 🐾

🐾 Pick them up and let them cling to you.
🐾 Lots and lots of cuddles.
🐾 Use nick names when talking to them.
🐾 Saying good boy/girl/pet and always giving praise.
🐾 Good morning messages.
🐾 Let them curl up on you and nuzzle into you.
🐾 Tell them you love them.
🐾 Encourage their ideas.
🐾 Head petting.
🐾 Collars/ears/tail

anonymous asked:

Hello, I realise this blog is mainly for trans teenagers however a few months ago my daughter recently came out to me as trans and has since been asking if she could buy a binder. I want her to be happy but I have done some research and have seen some horror stories detailing the dangers and harm that they can cause, I wanted to know how much of this is true. Thank you

Lee says:

Unfortunately, the horror stories you’ve heard are likely true. Binding unsafely can damage ribs and is dangerous. People who bind with ACE bandages or duct tape and similar unsafe materials can hurt themselves, and even some binders are unsafe to wear because the material isn’t stretchy enough. If you wear a binder from a good company for too long or while doing vigorous exercise, you could get hurt. That’s why you sometimes hear of people getting hurt in commercial binders more often than people getting hurt in DIY binders; they’ll buy a binder and then wear it all day and night.

However, if you are careful to follow our guidelines for safe binding and you have a binder from a reputable company and not a cheap one, binding should be safe. Personally, I have been binding since I was 15 (I’m currently 18) and I have not experienced any negative side effects from binding, and I haven’t ever had any injuries to my ribs or anything else. Phoenix, the trans guy who created this blog, has been binding since 16 and he’s 23 now and doing okay I believe. I know a lot more people who haven’t gotten injured than people who have been hurt, and I know a lot of trans people. 

I think that it is safe to purchase your child a binder, and I know that binding can really help a trans person experiencing dysphoria feel better and improve their mood, which makes it worth it. I was so happy when I bought my first binder! I finally felt like my body looked like it should be, and it made me a lot more comfortable with myself. However, I will be honest- binding unsafely can be dangerous, and you can’t ignore that. But making sure they are aware of and following the guidelines listed below should make binding a whole lot safer!

Sidenote: I’m so pleased you’re doing this research to help your child! This is such a wonderful thing to see, and you really are a good parent for trying to accept this change and adjust to make them happy and safe. Having unaccepting parents is very hard on a trans person, and can send them into depression (which we already suffer from at higher rates than non-transgender people until we’ve been allowed to transition) and I think open communication within a family about what’s going on and how they feel is incredibly important. 

Binding info:

GC2B and Underworks are the most popular and reputable binder companies. I personally prefer gc2b, but both companies should be safe to purchase a binder from. All gc2b binders only have compression in the chest area (Even their full length tank ones) which is good because full-length compression is uncomfortable like wearing Spanx or shapewear to flatten your stomach because it covers that area too. Some Underworks binders have full-length compression, so make sure you avoid those.

Binding does NOT cause:

  • Breast cancer
  • Lung cancer
  • Any cancer at all
  • Mastitis

Normal side-effects:

  • Getting winded after walking quickly/upstairs with binder on, but able to catch breath
  • Chafing in the underarm areas 
    • putting on lotion can help, or getting a bigger binder
  • Soreness during or after binder in arms, shoulders, or back 
  • Increased acne on chest or back 
    • washing your binder regularly should help, and over the counter acne cream from the pharmacy is good
    • Here’s a post on washing a binder. Binders should be washed about as often as you would wash a bra. Some people say every 3 days, and some people say once a week. It depends on how much you sweat and whether your skin is irritated easily.
  • Mild anxiety about tightness
  • Chest sagging 
    • This is a cosmetic change and not a medical concern. It’s similar to the natural sagging you get with age, but a bit accelerated.

After binding:

  • Take some deep breaths
  • Force a few coughs to rattle around any mucosal buildup in your lungs/chest
  • Stretch your back/shoulders to release any tension.
  • Additional exercises: simple trunk twists, arm circles, pulling each arm across the body, and tip your head side to side to stretch your neck. 

What are the general safety rules of binding?

  • No sleeping or exercising while binding
  • Don’t bind for more than 12 hours maximum, 8 hours to be safer
  • Take breaks if possible
  • Break in a binder - don’t go straight to 8 hours of use. Instead, wear it for a few hours more each day,
  • Never bind too small, use the right size (if between sizes, go up)
  • Never use ACE bandages or tape
  • Don’t wear more than one binder
  • Don’t wear any compression garment under, like a compression sports bra. 
    • You can wear this type of bra or a soft undershirt if you want something under your binder, although most people wear their binder directly on their skin
  • Take it off if you’re experiencing pain

Can I bind while doing x?


  • On a plane
  • At school
  • Doing normal routine stuff that won’t raise your heart rate
  • While smoking or vaping
  • While taking a walk or light bike ride


  • While playing an instrument that requires breath
  • While singing (singing in the car is okay, choral singing or any singing where you need good breath control is not)
  • While exercising
  • While moshing/screaming/dancing at a concert
  • While sleeping
  • While swimming (unless you have a specific swimming binder)
    • There are swim binders available from underworks, and all gc2b binders are safe to swim in (but it’s good to get one a size up from your every-day one for swimming)
    • However, if you swim competitively, lifeguard, or do any type of “exercise” swimming, use a sports bra and rash guard instead.
  • On roller coasters/thrill rides
  • When you’re sick (coughing particularly)
  • During marching band
  • During gym class
  • When you’re visiting somewhere that is much hotter than temperatures that you are used to (vacations)
  • When you have a chest/torso injury, etc.

How do I know if it’s the right size?

  • Can you fit your fist between your binder and the centre of your chest? then it’s big enough!

What do I do if it’s not the right size?


General info:

Practicing with pronouns:

  • Pronoun practice app
  • Pronoun dressing room (read about someone with a certain set of pronouns)
  • Using their preferred pronouns in conversation or writing it down can be very helpful! Practice makes perfect, and the more you use their pronouns the sooner you’ll get used to it. 
  • It took my parents about a year to be able to consistently call me by my pronouns because they were so used to calling me “She” because that’s what they’d done all my life until I was outed
  • Using a trans person’s name and pronouns is something that can really validate them and make them feel better! Trans people often suffer from depression, and being misgendered (that means being referred to with your old pronouns) can really hurt their mental health.

Trans info if you don’t know much about what being trans means:

Pap smears!

Because I got a few questions about it after I posted..

Pap smears are v important for people with vaginas. You should start getting them when you turn 21 (or earlier if sexually active, so I started getting them when 17). The ACS recommends from 21-29 getting them every 3 years. This screens for cervical cancer.

You go to an OB-GYN, you’re naked under a robe. You scoot down until your butt is at the very edge of the bed and your legs go in stirrups. I don’t know the terms, please Google them, but the put a metal thing up your hooch that pushes against your cervix. They will put an instrument through that to scrape a sample from your cervix. That is tested and you will be called with the results. If it is normal, all good, if it’s abnormal…that may not mean something is wrong, you just need further testing. (If you’re on your period, this may skew the results too…but you can still do a pap on your period.)

As for what it feels like. Umm, for me? A long, hard cold dildo lol, but honestly it’s just like, a lot of pressure? And when they do the scraping/swiping it can feel a little pinchy? You’ll have another female assistant in the room with you (especially if you have a male OB-GYN) that will be there to support you if you feel uncomfortable.

There are places that will do this exam for you for free if you’re uninsured or low income (Planned Parenthood, health fairs, health dept, etc), Google your options!! this has been a small PSA. If you have a vagina, go get your tune-up!

i hate when people unfollow me when i say the bode meme wasn’t funny like

are you really out here trying to defend the Comedy of animal abuse and getting mad about it… i know it seems like it’s not that deep but so much animal abuse happens because of internet popularity

please think of macgyver the lizard, the endless memes and ‘cute’ videos of fat animals being unable to function, of people terrorizing and scaring and stressing out their animals for views. you need to stop anthropomorphizing and stop acting like real life fat animals are fine and okay to consume content of as jokes without criticism because there are going to be people, there already are people out there, making a market out of abusing their pets because people find it cute and it makes them money and they see things like that and they get more incentive to keep it going

fat positivity has no place in a non-human space and you can’t act like your animals are little people you have to spoil and overfeed and throw out the basic care guidelines you should know as a responsible pet owner, you can’t act like it’s a positive thing that you have control over every aspect of these animals lives and you’re using it to generate internet fame instead of caring for them properly 

anonymous asked:

Soka, I am not trying to intimidate you but there are bloggers who have left this week because they were harassed for having different opinions from the majority of those who matter in fandom. Just a word of caution to you.

“My silences had not protected me. Your silences will not protect you…. What are the words you do not yet have? What are the tyrannies you swallow day by day and attempt to make your own, until you will sicken and die of them, still in silence? We have been socialized to respect fear more than our own need for language” - Audre Lorde

Threats don’t intimidate me. Silence is deadlier than an empty threat. 

The notion that you think there are people who matter and there are those who don’t is baffling to me. We all matter. This is a fandom. People do this for fun (for the most part). Everyone matters. Why the incessant need to rank who matters? Where is this mysterious guideline? Care to list the “designer bloggers” you are imagining? 

Hello Everyone!

I’ve ended up with an extra copy of Harry Styles’ self-titled album. Brand new! Still in shiny plastic wrap! Oooh. Ahhhh.
Since I do not need two copies of the same thing, I figure I’d give this one away to someone from the tumblr universe. Get it for yourself! Get it for your mom! Get it for your mailman! I don’t care. Just enjoy it.

- ONE winner will be picked by random number generator on August 19th, 12:00 pm EST.

-You must be following my tumblr to enter
- Likes do not count as entries 
-Reblogs DO count as entries. Reblog as many times as you’d like, just don’t spam people with it, ok? Be responsible and kind about it. 
-No ‘giveaway only’ tumblrs
-I will contact the winner through Tumblr message. They will have 24 hours to claim their prize. If they do not claim it within 24 hours, another person will be chosen. 
-You must be willing to provide me with a shipping address so i can send you your prize. (You would think this would be obvious, but- apparently it’s not)

Have fun guys. Don’t spam people. Don’t enter if you’re never gonna use the CD, Don’t enter if you’re a mean jerk who secretly hates Harry Styles.

Thanks and good luck!

testanxiety  asked:

Any advice for an m3 starting family medicine clerkship?

Here’s a brief little post I wrote about what to read and what to study for the shelf. 

But wait, there’s more!

Family medicine is a hard rotation, especially to have at the beginning of the year, because it covers SO much material.

  • Hi Yield stuff to know
  • Think systematically. Use mnemonics to help you expand your differential diagnosis. Keep patient demographics and co-morbid conditions in mind as you make your differential.
  • Even if you have no interest in family medicine, you will learn something relevant to your specialty of choice on your family med rotation. Depending on your attendings, you may be able to tailor your rotation a bit toward what you are interested in (more kids! Pregnant ladies! women’s health! sports medicine for you ortho folks! office procedures for the surgeonly types! more psych for you little Freuds!).
  • Embrace the variety. Don’t let it overwhelm you. You will see something new every day. Write it down and read about it when you go home. Write down the medications or diagnoses that are unfamiliar to you and read on them too.
  • The AAFP is your friend. They have tips for doing well on your rotation too. You can make a student account and access lots of practice questions for your shelf exam. Use the online board exam prep questions.
  • If you have the opportunity to do your family medicine rotation in a community or rural practice rather than an academic medical center, take it. Family medicine was designed to be a community based practice, not academic, so you will find the specialty looks very different in those two settings.
Watch on

Sharing is Caring (some guidelines for sharing these goodies!) with Anjali Bhimani (VA of Symmetra)

“Learned a new lesson about sharing this week, and wanted to make sure to keep all you beauties safe as you share content from this channel on your own (although always feel free to share the links from here anywhere!)…”

Sand Boa Care

This is going to be long, so be prepared. Be advised, this is what I do and these things work for me and my snakes. Others will tell you differently, and that is okay. Sand Boas are very tolerant snakes.

I WISH someone had recommended a sand boa for my first snake. I started with a corn: A little ghost girl, named Jake, bred by Reptiles by Mack. I love her to death, but my sand boas are my pride and joy.

Morphs and Genetics

Kenyan sand boas are not very popular in the hobby.  Some people see them as boring, uninteresting, and ugly. Most are the beautiful orange and black/brown color, but more and more morphs are being produced: Albino, anery, albino paradox, nuclear meltdown, hypo, snow, etc. The Rufescens sand boa is being used to diversify the genetic population. Because of this, and the general disinterest from huge, big box Reptile breeders, most sand boas are genetically sound. I have yet to see a sand boa affected by a dangerous genetic anomaly. There are no known fatal morphs or morph breedings (like with BPs and corns)  to my knowledge, and it appears that, in sand boas, paradox spots are genetic and reproducible, instead of random, like with most other snakes. Which I think is pretty cool.

Getting Your Snake

When choosing a sand boa, you should look for bright eyes, strong body (they are STRONG snakes), a tongue that extends all the way from the mouth, curious demeanor (sniffing things, trying to burrow, eyes following movement of your hands), a clean vent, and white ventral scales (yellowing can be a sign of dehydration and pinkness can be an indication of either an impending shed or a burn, so be careful). Check the spine for kinks by gently pressing along the entire spine of the snake. If there is a kink, you will know it. The spine will suddenly feel different or jut out. It’s fairly obvious. Additionally, ask if your new sand boa is eating live food or frozen/thawed food. Try to get a baby that is at least a month old and is eating f/t day pinkies. Sand boas under a month can have some issues with thriving, and they are TINY, so feeding them that young can be scary. When you get your snake home, make a vet appointment and look daily for stool you can bring with. A fecal exam is very important!


For an adult female, a 29 gallon or 20 long aquarium or comparable tub is a good size. They will utilize the space! Bigger is better. Sausage has been in a 40 gallon breeder before and loved it.

For an adult male, 20 gallons is usually good sine they stay so small. A 20 long would be good as well for larger males. I wouldn’t do anything bigger, though, since my males are a bit nervous and tend to go off feed.

For babies: A 10 gallon aquarium or comparable tub is good for the first year to year and a half of their life. After that time has elapsed, they can go in their adult enclosures.

As for tank set up, see my Sand Boa Enrichment post! It details substrate, depths, cage furniture, etc.

Note: Whatever enclosure you choose, USE LID LOCKS/CLIPS/BINDER CLIPS. These snakes WILL try to escape and they are S T R O N G and heavy bodied.

Temperature and Humidity

This is where advice will vary significantly. I keep my sand boas with a 95 degree F hotspot and they thrive. I have seen keepers with their snakes at 110 degrees F successfully. The range I have heard is 90 (minimum) to about 105 (maximum) for the hotspot temp, but your snakes will tell you what temperatures they prefer. My adult female prefers temps around 93, where Bacon prefers them much higher (closer to 100!) so adjust according to the behavior of your snake. If they are avoiding the hotspot, laying around but not on it, or huddled in the center of the UTH, you know you need to adjust.

Keep your hotspot temperatures up with an Under Tank Heater. I prefer Ultratherm, but ZooMed is okay. CHEs and heat lamps just don’t cut it for these guys since they stay burrowed so much. Make SURE you control the temperature carefully with a thermostat, or at the very least, with a dimmer and probe thermometer you check religiously.

These snakes spend about 90% of their time burrowed, so ambient temperatures are less important than with other snakes. If the temperatures in your reptile room fall below about 68, you should use a ceramic heat emitter (NOT a heat lamp) to bring temperatures up in the enclosure. You should do this in winter regardless, unless you are brumating your snake and have followed brumation procedure.

These snakes do best with LOW humidity. Most pet stores recommend at least 40-60%, but humidity that high is a great way to give your snake a respiratory infection. If you live in a place where the humidity in your reptile room is especially high, use a CHE to warm up the enclosure and zap any excess humidity. During shed, however, you MUST moisten the substrate daily with a spray bottle. Fluff it up, too, so the humidity exists where they exist: Underground. You can also moisten some moss and bury it. They will use it like a humid hide. You could also bury a humid hide in the substrate.

A fairly large dish of fresh water should be available at all times.

Feeding Schedule

As with most snakes, you should feed an appropriate sized prey item (rodents) once a week to once every two weeks. If you have a baby snake, start with pinkies and progress from there. I’ll give you some examples:

Sausage: 425 gram female: 1 large mouse every other week. Small rats occasionally.  Two medium mice every other week occasionally.

Bacon: At 26 grams, 1 medium/large pinky mouse every 5 days. At 67 grams, 2 fuzzy mice every week.

Egg: At 86 grams, 2 hopper mice weekly. At 125 grams, 1 small adult mouse every week.

Hamburger: At 15 grams, 1 pinky mouse every 5 days.

These snakes do not typically refuse food unless something is wrong with their husbandry or they are headed into shed. If your snake refuses food, be on the lookout for signs of shedding!


Sand boas, as babies, will shed every 4-6 weeks.  Classic signs include dull colors, a greyish tint to their body, and milky ”blue” eyes. When you suddenly notice one or more of the above, it’s time to up the humidity! Your snake should shed 4-7 days after their eyes return to normal.

Egg, at 125 grams, sheds about every 8-10 weeks. Sausage, at 425, sheds about every 3 months or so.

When to Head to the Vet

First off, keep detailed feeding and growth records. Record on a desk calendar or in a notebook the day you attempt to feed, the time you attempt to feed, the weight of your snake (you should try and weigh them the day of feeding, before they eat, or the day before), the size and weight of the prey item, and any oddities: Thunderstorms, screaming baby, dropped the snake on the floor, mouse was a different color than normal, mouse comes from a new supplier, etc.

These records will help you keep track of patterns and will offer you peace of mind when something weird does happen, because thunderstorms and screaming babies CAN stop your snake from eating.

When your snake regurgitates a meal, refuses food 3, 4, or more times, has more than one runny, watery stool, passes undigested food in their stool, has saggy skin when the snake is not in shed, visible ribs, blistering or brown colored ventral scales, off or crusty looking scales anywhere on the body, exhibits “odd” behavior like twitching, wheezing, blowing bubbles from the nose or mouth, coughs more than once, has missing patches of scales, seems weak or lethargic, seems disoriented…. It’s time to see a vet. I won’t speculate on the causes of these symptoms, but get to the vet fast!

Other things to watch for: Midbody swelling, lumps, misaligned jaw, retained eye caps, bloody stools… If anything seems “off” to you, it’s best to get to the vet and ask questions later.


Reptiles in the BEST of circumstances have parasite loads and can harbor hidden illnesses. DO NOT move items from enclosure to enclosure without sanitizing them properly. CLEAN YOUR WATER BOWLS: Use blue Dawn and hot water and a LONG long rinse. I know lots of people will tell you not to do this, but a microscopic amount of soap residue from an animal safe soap is better than a huge bacteria bloom. If you are uncomfortable with the Dawn, use a veterinary disinfectant and allow bowls to air dry completely.

Do a complete substrate change every month or two. Spot clean feces the day you see it, and you should be checking every 2-3 days. When you do total substrate changes, do a deep clean of the enclosure. Hides, branches, and bowls should all be disinfected frequently. Deep clean the enclosure itself by scrubbing it down with a veterinary disinfectant or bleach soak. Make sure you have a clean, ventilated tub your snake can go into while you clean!

@kaylee-tam I hope this is helpful!!!


I probably forgot lots of stuff, but this is my general care guidelines. Let me know if you think of anything I forgot to cover.

EXO reaction to finding their girlfriend passed out outside in the rain/snow

I don’t know how this is going to turn but just a little warning if you don’t like sad/serious reactions. Xo, Admin A~

/I don’t own any of the gifs used, unless stated otherwise/


*Runs to you when he sees you* “Jagi! Wake up!! You can’t be here… I’ll take you back inside… it’s warm there” *His internal flame starts to warm you a little while he takes you back*


*Your angel arrives fast* “Don’t worry baobei… I’ll take you home in no time. You won’t be cold ever again…” *Flies back home with you in his arms*


*Looks for you nonstop* “Jaaaaagi!! Answer me! A storm is coming… where.. jagi!!!” *Feels like having a heart attack until he finds you*


“Good thing I grabbed this coat… you said it wouldn’t be useful” *Covers you with it and does everything he can to keep you safe*


*Quickly transports you to a warm place* “Come on jagi.. wake up, you need to.. What were you doing sleeping out there? Snow isn’t.. a blanket.. come on jagi!” *desperate* 


*Tries not to panic and keep you warm and awake* “We are almost there… don’t give up jagi, we are almost there”


*Doesn’t leave your side for a second* “I already changer her clothes… tug her in bed… Why isn’t she waking up?” 


“I thought I was going to lose you baobei… Please don’t go alone next time, I don’t want it to happen again” *Almost in tears while holding you tightly*


*Waiting for you to come back* “I wonder where… Is she safe… maybe I should check on her… *Arrives just in time*


*No matter how strong the storm is he will always find you* “Jagi… please be safe… we have to move before… I’ll keep you warm.. please wake up” *kisses you before carrying you and taking you home*


“Hey babe… you woke up, are you okay? I bought you home as soon as I found you. I was scared something could happen to you” *Feels better now that you are awake and safe in his arms*


*Gives you his dry clothes to keep you warm while he takes you back home and to take care of you*

[Masterlist] [Guideline]

anonymous asked:

I can't even begin to state how you have turned my perception of Petco around. I work for an independent pet store, and the Petco branch we have in town is terrible. They don't care for half their snakes if they aren't eating, give incorrect advice, and when I got a bearded dragon from them they gave me NO information on how to care for him. I am so happy to know that it's only the one in my town and not the company as a whole, keep up the good work!

Yeah– even though I work for them I STILL say that EVERY PET STORE IS DIFFERENT.  I had a super great Petland near my apt in Brooklyn that took great care of their animals and fish and housed everyone appropriately.

Head up the road about 20-ish blocks and the Petland there had everyone on sand, their fish all had fin rot and were kept with incompatible tankmates, the bird cages were dirty (it was mid day so if cleaning was being done it would have been done by then) etc.

PETCO’s animal care policies (the company standard and care guide) are actually REALLY GREAT, but the employees at each store (including managers) have to CARE.  We get monthly inspections but I know that some stores just buckle down for inspection day and don’t give two hoots any other time because they are putting more focus on other parts of the store.

That’s why I like being the animal care manager at my location– I get to make the calls in terms of what we get in (to an extent), I enforce cleaning standards and I educate everyone I work with on the proper care/setups for all of our animals.  I also dictate when animals should go to the vet and I’m on great terms with out exotic vet in the area.

I think I’m the only PETCO in our area that keeps ALL their beardies/leopard geckos on carpet (the care guide says that carpet or sand can be used, but I educate employees as to why we shouldn’t use sand).  :\

I think what’s hardest is that even with a company that cares about animals is that they still sometimes use outdated information (bettas being in bowls, the impaction debate on reptile sand, etc) and it can be hard to work around the company’s opinion while still staying within the care guidelines/policies I HAVE to follow.

I do my darndest though!  I make sure that I do a TON of research before ordering anything new to the store so that I can coach everyone on it!

anonymous asked:

Hello! What apps would you recommend to get more up to date with medical literature/news that's happening? Thank you!

I use:

  • UpToDate (which is not free… quite pricey but if your hospital provides it you can get app access)
  • Medscape
  • ePocrates (you can get the full version free sometimes as a student)
  • Pap guide (easy flow chart to tell you what to do with abnormal paps)
  • GoodRx
  • AHRQ ePSS - not a catchy name, but you put in a patient’s age, sex, and a little more info, and it will tell you all sorts of preventive care guidelines that apply to that person, and what the quality of the recommendation is
  • Prescriber’s Letter - also not free, but it’s not terribly expensive for a 1 year e-subscription, and lots of med schools get it for students anyway. It’s basically like 5 pages a month with little blurbs about all sorts of different drugs and what the evidence on them boils down to - whether you should use them or not, big side effects to remember, drug interactions, etc
  • FP Notebook - not always completely up to date, but if you like outlines, it will give you good basic history/physical/diagnosis/treatment info on commonly seen issues in family practice
  • AFP Journal - Not free - Has great articles that are practical, useful, and not as boring as JAMA and NEJM.
  •  Youtube - I use it more for patient education than my education, but there are some great videos demonstrating home exercises or explaining complex medical conditions. I will occasionally use them to review my musculoskeletal exam skills because I hate ortho and have a hard time remembering which test means what sometimes.
  • Don’t forget podcasts! The only medical ones I listen to are the American Family Physician podcast (even more condensed “high yield” info from the journal, only about 20 minutes) and Sawbones, which is more funny than educational, but it focuses on history of medicine and crazy things that we’ve used as medicine in the past.

anonymous asked:

What forms of asset protection are there to protect your personal assets in the case of a malpractice lawsuit? What ways are there to prevent a malpractice lawsuit? How do you deal with the stress of knowing that there is a high likelihood of facing a malpractice suit, even if no malpractice was committed?

Asset protection is something you should discuss with a malpractice insurance carrier or a financial advisor or accountant, not me, because I have no assets and I know nothing of such things. 

Ways for preventing malpractice lawsuits:

  • Don’t be a doctor. Seriously. 75% of physicians in low risk specialties will be sued at least once in their careers, and it goes up to 99% for those in high risk specialties. If you don’t want to ever be sued, don’t practice medicine. 
  • Be nice. Patients are less likely to sue doctors that they like, even if something goes wrong.
  • Be a good doctor. Stay up to date on standards of care and current guidelines. 
  • Be a good communicator. Many perceived wrongs or errors could be avoided with good communication between doctor and staff or doctor and patient. Make sure your patients understand your instructions, their conditions, their procedures, and their drugs. 
  • Document, document, document. All documentation should be thorough. It may save your butt or a patient’s life one day. If you talked about risks and benefits of XYZ, document it. If a patient refuses a screening test or medication, talk to them about the consequences and document it. Your documentation will remember things that you won’t be able to remember a year from now.
  • Don’t drop the ball. Don’t forget to follow up on that abnormal lab or get the report on that stat chest x-ray. In a busy practice, it’s easy to forget. Make sure your practice has a system in place for making sure things don’t slip through the cracks. 
  • Know your patient. Review their med lists and charts to make sure you’re not causing their problems with the meds you prescribe. Know their allergies before starting something new. Know major interactions and side effects they’ve had. Know their conditions and how they will interact with each other. 
  • Be compassionate. Show your patient that you care about what happens to them. Often they will forgive adverse outcomes if they know you had their best interests in mind.
  • Acknowledge your mistakes and don’t repeat them. Most states have laws that allow doctors to apologize for adverse outcomes and not let their statements be held against them in malpractice suits. But in many cases, all a patient wants to hear is “I’m sorry. I made a mistake. We didn’t mean for XYZ to happen.”

How to deal with worrying about being sued:

I never worried about being sued until I got sued. Then I worried about it all the time for a while. Now I’m back to not worrying about it much, but it has definitely changed the way I practice.

Avoid the temptation to practice defensive medicine. Doctors get sued whether they did the useless CT scan or not. So don’t waste resources doing unnecessary tests.

Work on documenting well. I can’t stress this enough. My documentation and that of the nurses who worked with me is what proved that we followed standard of care and national guidelines to a T in my case. It gave me peace of mind because I was able to look back and know that I did exactly what I was supposed to do in the situation and that there was nothing I could have done to anticipate or prevent the outcome that happened.

Constantly push yourself to be a better doctor. Read more. Learn from past mistakes and don’t repeat them. Strive to deliver high quality care to your patients. 

Accept it when it comes. This is why we have malpractice insurance. I’m not going to lie: being sued SUCKS. Big time. It’s miserable. It makes you feel like total garbage, even if you did absolutely nothing wrong. You kick yourself for not being able to prevent a bad outcome, or you feel guilty for actually screwing something up if you did mess up. But there’s really no avoiding it sometimes. You hope for the best and move on when it’s over. 

Advice to New Interns: Family Medicine Edition

Since you’re a seasoned veteran, do you have any advice for a new FM intern? I feel like the second half of fourth year of med school has made me really stupid…-hostileshrubbery

Welcome to the wonderful world of RESIDENCY! You have inspired a new series, my friend! But first, things specific to Family medicine residency. 

  1. You will have to take ACLS, PALS, and possibly ALSO. It sucks. Bring snacks and an iPad to class. 
  2. You will be required to get a certain number of “continuity” OB deliveries. If your program doesn’t have a system in place for this, then on your first OB month, claim everyone you see in clinic who is halfway sane as your continuity and get those bad boys knocked out. 
  3. You will get tons of time to see patients when you’re first starting out in clinic. Take advantage of that time. Really get to know your complex patients and scour through their history with them. It will benefit you greatly as you transition from seeing 6 to 12 patients in a half day and have much less time.
  4. If you’re in an opposed program (too bad), don’t let residents from other specialties treat you like a med student. Be extra good at your job so they have no excuse to belittle you. 

  5. Get a preventive care guidelines app (AHRQ ePSS is good) and run your patients through it at their first visits with you. Make a Preventive Care section in your Past Medical History section on your EMR if there isn’t a separate place for that stuff so you can keep track of it on every patient. Your attendings will love it when you check out a diabetes follow up and add “oh yeah, and he’s due for a Pneumovax.” Attendings love Pneumovax. 
  6. Set time limits for yourself in everything you do. I’m going to get my notes done by X, or I’m going to have my H&P done in XYZ minutes, or whatever. Keep challenging yourself to be more efficient.
  7. Don’t let your CME days go to waste. They’re like extra vacation days if you pick the right conference. 
  8. Learn those $4 drugs. Better yet, get the GoodRx app so you can know how much all the drugs are costing your patients (and tell them where they can get stuff cheapest!)

More Advice to New Interns Coming Soon!

anonymous asked:

ooo i have a fic idea! Malia makes fun of Lydia or says something offensive to Lfydia for something serious (be it money problems, the fact that she doesn't know how to use her banshee powers or the fact that Meredith just died) and Stiles hears it and is all defensive and then they break up and stydia is canon

Aww poor Lydia :( 

Anti-Malia/Stalia up ahead, so keep scrolling if that’s not your thing! 

Here’s your fic, hope you like it.

Keep reading

Routine Antenatal Care

According to Antenatal Care Guidelines developed by the National Institute for Health and care Excellence, here are the minimum set of tests for routine antenatal care:

First contact with health professional

  • Give specific information on folic acid supplements, food hygiene, healthy lifestyle, and all antenatal screening
  • offer information about screening for sickle cell diseases and thalassaemias.
  • Give information about the anomaly scan and let them know that this gives them a chance to terminate pregnancy, prepare for treatment or care of disability, manage the birth in a specialist center, and have intrauterine therapy. Inform them of the limitations of ultrasound screening and that the detection rates vary by the type of anomaly, pregnant person’s BMI, and the position of the fetus at the time of the scan.

At booking

  • Explain the development of pregnancy, nutrition and diet (including vitamin D supplements), exercising (including pelvic floor exercises)
  • start planning the place of birth
  • information about breastfeeding and workshops in the area
  • information on participant-led classes
  • information on maternity benefits.
  • Identify people who may need additional care and plan pattern of care for the pregnancy.
  • Measure blood pressure and test urine for proteinuria (pre-eclampsia)
  • Inform those under 25 of the high prevalence of chlamydia in their age group and give details about STI screening.
  • Offer early ultrasound scan for gestational age assessment and structural anomalies.
  • Ask about mental health, ask about mood to identify possible depression.
  • Ask about occupation to identify potential risks.
  • Haemoglobinopathies screen
  • Blood group and rhesus D status
  • Hepatitis B virus screen
  • HIV screen
  • Rubella susceptibility
  • Syphilis screen
  • MSU for asymptomatic bacteriuria
  • risk of venous thromboembolism evaluated (previous VTE, thrombophilia, medical comorbidities, surgical procedures such as appendicectomy, age about 35, BMI above 30kg/m, 3 or more children, smoker, varicose veins, systemic infection, immobility, pre-eclampsia, dehydration, etc.)
  • test for gestational diabetes if there is an identified risk (height, weight, family history, ethnic group, previous pregnancies, etc)
  • measure Height, weight, and body mass index and give health advice.

After 10 weeks 0 days

  • Before 13 weeks 6 days: ultrasound scan to determine gestational age
  • Before 14 weeks 1 day: Combined test for Down Syndrome

16 weeks

  • Review, discuss, and record the results of any screenings.
  • Measure blood pressure and test urine for proteinuria (pre-eclampsia)
  • investigate if haemoglobin level is below 11g/100ml and consider iron supplements.
  • Give information on the routine anomaly scan to take place at 18 weeks.
  • offer those with significantly atypical red-cell alloantibodies a referral to a specialist.

After 14 weeks 2 days

  • Before 20 weeks 0 days: Serum quadruple test for Down Syndrome

All appointments

  • blood pressure
  • urine test for proteinuria

At booking and 28 weeks

  • Haemoglobin
  • Red-cell alloantibodies

18 weeks

Before 20 weeks 6 days: ultrasound screen for structural anomalies including

  • fetal echocardiography of fetal heart
  • detection of neural tube defects

25 weeks

only needed if you’ve never been pregnant before to measure blood pressure/test urine and measure and plot symphysis-fundal height

28 weeks

  • measure blood pressure/test urine
  • offer a second screening for anaemia and atypical red-cell alloantibodies.
  • investigate a haemoglobin level below 10.5g/100ml and consider iron supplements
  • offer anti-D prophylaxis to people who are rhesus D-negative
  • measure and plot symphysis-fundal height.

31 weeks

Only needed if you’ve never been pregnant; review, discuss, and record the results of screening taken at 28 weeks, measure blood pressure/test urine, measure and plot symphysis-fundal height

34 weeks

  • Review, discuss, and record results of screening taken at 28 weeks
  • measure blood pressure/test urine
  • offer second dose of anti-D prophylaxis to those who are D-negative
  • measure and plot symphysis-fundal height
  • give specific information on preparation for labor and birth including the birth plan, recognizing labor, and coping with pain.
  • Give information about cesarean section including indications of a need for c-section, what the procedure involves, risks and benefits, and implications for future pregnancies after c-section.

36 weeks

Fetus is approximately full term.

38 weeks

  • measure blood pressure/test urine
  • measure and plot symphysis-fundal height
  • give options for management of prolonged pregnancy.

40 weeks

only necessary if this is your first pregnancy; measure blood pressure/test urine, measure and plot symphysis-fundal height, and further discussion of management of prolonged pregnancy.

41 weeks

  • offer membrane sweep
  • offer induction of labor
  • measure blood pressure/test urine
  • measure and plot symphysis-fundal height

42 weeks

  • from this point on offer those who decline induction of labor increased monitoring (at least twice-weekly)

People should be able to make an informed choice about whether to accept or decline each tests, and notes should include a record of any tests offered and declined as well as the results of tests accepted

Dear Tumblr staff,

I am having an actual problem with harrassment and stalking and your Abuse@Tumblr email is “teaching me how to block and ignore users” as if I’m five years old and don’t know how. I have a problem with another user, who I have told to stop contacting me, who I have blocked both their account and their Anon IP, and who I have already turned off my Anon feature to avoid, who has now made another account to circumvent my attempts in order to continue contacting me. 

This is a blatant attempt at breaking your rules, and you’re telling me to “block her and ignore her because you left Anon on so it’s basically your fault.”

Yes, that’s why I turned Anon off when this problem occurred. I thought it was solved, but apparently not. I now have a second account to block and ignore twice, and I can forsee it happening again and again if something is not done.

I don’t know what I want you to do about this, but what I don’t want is for someone to act condescending in teaching me how to use your basic functions when someone is trying to guilt trip me into talking to them again by threatening suicide. I take suicide very seriously and I don’t appreciate that it’s being used as a guilt tactic to keep me around.

hey uh. if y'all neopagans could stop dismissing orthodoxy/religious guidelines/careful intent as being useless or unimportant that would be gr8. not everyone’s religion is solely about connecting with the spirit of the universe. not everyone feels that their deities will be chill even if they mess stuff up or disregard all tradition. for some of us, orthodoxy and ritual are comforting, reassuring, and important to feel that we’re doing the right thing by our Gods. sometimes it’s important to worship in certain ways because the Gods demand the best we can give Them, and that doesn’t always mean something nebulous with a lot of crystals.