iiinova — where your digital self keeps evolving

Leah B. Gilliam, MD @drgruralmd.bsky.social · 22h

What happens when you speak with a “clinician” in insurance appeals: “This medication is only FDA approved for children over the age of 6.” “She is 5 yrs, 11 mos, & 3 days. Do you think her metabolism will significantly change in that time?” “… I don’t know.” “Are you a physician?” “…………. No.”

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 05/10/2026

Carpal tunnel brace. Plantar fasciitis boot. This is 40. 😒

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 02/10/2026

Here’s the thing. These tech bro types keep saying that AI is going to change everything. But what is it going to do about the fact that patients can’t pay for the tests that AI says we should get or the meds that AI says they should take?

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 01/10/2026

There aren’t a whole lot of mountains in west TN to contend with and the nearest city for most specialties is only 30 minutes away, but it’s enough that my patients often forego necessary care.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 30/09/2026

AI doesn’t fix the fact that my patients don’t have a car that can make it far enough to get their colonoscopy. AI doesn’t fix that I have multiple adult patients who can’t read. AI doesn’t fix poverty or hold the check for a patient’s meds for a week until their paycheck gets deposited.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 29/09/2026

Same. But Medicare mostly. Otherwise they’re like $20 cash and cheaper not to use insurance.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 29/09/2026

They’re not mine, necessarily. We have a DME company that stocks my office with them and will bill the patient’s insurance. They bring the normal ones and fun shaped ones, ostensibly for kids. But my MA always offers adults the fun ones and they take them every time.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 28/09/2026

I’m ordering stickers right now. 😂

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 28/09/2026

I love that my adult patients get excited about getting a fish-shaped nebulizer. Everyone deserves to be happy.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 23/09/2026

If you love me, you’ll go vote in the Fat Bear Week polls and support 901. She’s a strong, independent woman and I love her.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 10/09/2026

Patient’s insurance requires them to use CVS Caremark. I see patient last week. BP elevated. I send rx to increase valsartan from 160 mg to 320 mg. CVS Caremark sends me a notice that they’re out of refills for the 160 mg dose and that this may affect their compliance. Yes. I suppose it will. 🫠

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 10/09/2026

It’s a recipe for significant polycythemia and the complications thereof.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 09/09/2026

I don’t know who needs to hear this (yes, I do) but please screen men for OSA before starting testosterone replacement. Untreated OSA is a contraindication to treatment. TYSVM for your attention to this matter.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 28/08/2026

If you’re going to take issue with the use of “y’all”, I’m going need to you stop using the word “don’t”. Both are contractures. It’s not “folksy”. It’s a legitimate word.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 28/08/2026

Also, language changes and contractions exist.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 28/08/2026

Notice from patient’s insurance: this patient is late to refill their Rybelsus. Yes. Because that medication is no longer produced. And the replacement prescription for Ozempic tablets was filled three weeks before this notice was sent. The insurer paid for them. Super helpful.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 26/08/2026

Agreed. My receptionist told me at lunch. We were devastated. He immediately changed the playlist on the office system to all Dolly for the rest of the afternoon.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 21/08/2026

My husband just asked me to cut his fishing line. For a second I panicked. Would it be too long? Too short? #medschooltrauma

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 21/08/2026

I love Montana, TBH. I dream of having a second home there one day.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 20/08/2026

I might send one patient to the ER per week. I sent two before 10 am today and I don’t like it.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 20/08/2026

It’s tough, but my husband is good at what he does. We’re not getting rich though.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 18/08/2026

Corona Radiata would make a lovely name.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 24/07/2026

I’ve never wanted to see it more.

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Reposted by Leah B. Gilliam, MD

Sandy Horne @sandyhorne.bsky.social · 21/07/2026

Happy Wrensday Wednesday! Here's one from my archives. A superb fairywren portrait. This is the common type of fairywren where I live. #wrensday

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 21/07/2026

She is ok. She says she “not ok” but she’s from a generation that was largely discouraged from having feelings, so being sad feels like failing. But it’s not. It’s very normal when it’s been a week since you lost your spouse.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 21/07/2026

My stepfather passed last week, so there is grieving to be done, but we’re ok.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 21/07/2026

My receptionist brought me back a T-shirt from Seattle Pride. Ignore my face. It’s been a rough couple of weeks.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 20/07/2026

Medical students love that nurse, don’t they?

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 13/07/2026

It’s real. Trying to plan dinner now because I won’t be able to tonight.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 13/07/2026

It should be illegal to ask me what I want for dinner after a day at work.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 05/07/2026

The time remaining on the front of my washing machine is a complete and utter fabrication.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 04/07/2026

I’ve seen several patients become hypertensive after drinking Gatorade for days on end.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 04/07/2026

Ok. The little pop-it things that pop loudly when you throw them on the ground… I’m the only one at this cookout who has ever snapped them with their fingers to make them pop. Tell me someone else here has done this.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 01/07/2026

According to them, fulfilling their life’s purpose. And maybe it is their purpose, but I’m gonna need them to learn a few things before they speak about things like this again.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 30/06/2026

I have words for the physician extender who I just heard say that hospice was for people who are “checked out” or “not feeling mentally strong”.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 30/06/2026

Mr. Bubbles bath color tabs are cheap and great fun. My child enjoys bathing in “swamp water”.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 30/06/2026

They don’t use it because they still can’t afford to because there’s an $8000 deductible.

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Leah B. Gilliam, MD @drgruralmd.bsky.social · 30/06/2026

But my youngest chickens managed to put themselves in the coop for bedtime two nights in a row without encouragement or assistance. So at least there’s that.

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