ArnuMed Primary Care in Warren, PA

11/23/2025

https://www.darlingshomecare.com/

Fun fact: Despite being Asian and having gone to MIT, I suck at math.

Where 1+1 Becomes 3

I had submitted an order to initiate home care a few days prior. My patient expressed a preference for Darling’s. When I arrived at my patient’s home today, I discovered that a visiting nurse from Darling’s Home Care was already present.

While reconciling the patient’s medication list, she remarked that there were some that were… confusing. I gave a verbal order to stop several meds that would be redundant, even potentially unsafe.

The nurse stated the straight caths had been ordered but hadnt arrived yet. Not wanting our patient to go more than a full day of urinary retention, I had intended to go to the ER and get a straight cath kit. (🙏🙏🙏, Begging is not beneath me 😅, so long as it’s in a patient’s best interest.)

The nurse went out to her car and gathered some sterile medical supplies that would serve the intended purpose. We worked together to get our patient into his bed, in a comfortable position, and then swiftly emptied his bladder.

His wife remarked, “Done already? That was really quick.” When a task is well understood by all parties involved, the workflow can become remarkably synchronized—almost a hive-mind–like efficiency. It’s rare when this happens. This was one of those rare moments.

I yearn for the day when the medical community of Warren come together and act in unison to best serve our patients. Until then, I’ll take any bit of help I can get.

-Dr Le

11/21/2025

Man down, or rather, trapped. 🤦🏻‍♂️🤦🏻‍♂️🤦🏻‍♂️

I went to see a patient in at ICU at St V and ended up getting stuck in a parking lot because the only way to get out is to use a credit card. I have plenty of cash, but forgot my credit card at home.

I hit the “help” button and explained my situation.

“Sir, there’s nothing I can do. We dont have attendants on the weekend anymore”
“Maam, that would mean I am stuck here until an attendant comes.“
“I can understand your frustration but there’s nothing I can do. This has NEVER happened before.”
As she says this, a car trying to get out has the exact same problem and had to yell to the cars behind them to move back. And then 3 cars later, the same thing.

The shifting of blame was not helpful. Making a false statement was not helpful.

“You can try asking the person behind you to use their credit card and you give them cash.”
“If I was the stranger behind me, I wouldnt be comfortable doing that.”

That’s shifting their responsibility onto complete strangers, not a solution.

“What about getting a friend or family to come use their credit card?”
“I am not from here, I dont have friends and family to come get me.”

The wellbeing of my homebound patients is at stake over the weekend and I get the pleasure of hearing this condescending lady give me an endless list of non-viable solutions.
🤦🏻‍♂️🤦🏻‍♂️🤦🏻‍♂️

These are some solutions i could think of as safeguards against this.
-Requiring the scanning of a credit card to enter
-Place ONE machine near the exit that allows cash payment.
-Allowing to capture picture of driver license and punching in license plate
—>a bill (with fees) will arrive in the mail.
-HUGE signs saying “Do NOT park here if you do not have credit card.” (They dont accept all types of cards, so this is somewhat misleading).

11/20/2025

I was working at the Dept of Health the other day, the nurse screamed from another room, “Dr Le, can you come in here for a sec?”

I came in and assessed the situation: a difficult needle stick. I reassured the Filipina patient, “Dear, you’re in good hands. When I first learned how to draw blood, my mother was my volunteer.”I asked for a set of butterfly needle.

Got it on one try. I stabilized the needle as Kevin swapped out the tubes (geez, it was more tubes than I’d expected for ONE lab order).

I said, facetiously, “Kevin, we Asians are descended from, and have veins that are as sneaky as, ninjas. You have to FEEL, not look for it.”

Meanwhile, the patient tracks her eyes between me and Kevin with a baffled look. I imagine this is what we must sound like:

“Squirtle, squirtle, squirtle.”
“Pika? Pikachu!”
“Squirtle, squirtle!”

🤣😂😅

11/19/2025

About a dozen checks I still havent gotten around to deposit and what worries me the most is the status of a patient who had just had open heart surgery.

My web portal pinged me in real time about new labs coming in. I reviewed it extensively: some drop in his blood count, but otherwise everything else seems… reassuring.

I called his wife to get an update on how he appears. Told her I had a crazy busy day but that I would come visit in the morning.

“He would appreciate that. The ICU’s visiting hours are…”

“You’re funny. As his doctor, I come see my patient at a time he needs me most whenever I damn please.”

-Dr Le

11/17/2025

One thing I love about rural medicine is the feasibility of home visits, which allows me to help patients who need it the most. My patients live just minutes from my home or office, which means I can deliver care to people who might otherwise get little—or none. It also allows me to step in personally for procedures that are simple for me but incredibly difficult for the patient.

Gone are the inpatient days of writing orders like, “Bladder scan q8h; if >500 mL, page MD for straight cath,” only for a nurse to carry it out. God forbid Dr. Le ever perform his own orders. 🤣😂 Today I did exactly that—swung by a patient’s home and performed a straight cath (thanks to WGH ER for the quick supply). We drained 600 mL. That’s a lot! 😮

This patient is homebound and had a severe UTI months ago that left him delirious and hospitalized for an extended period. He had another UTI a month ago, and based on symptoms he described yesterday, I suspect he developed yet another. I immediately started antibiotics empirically (update: urinalysis results confirms he does have a UTI.)

Most men will never experience a UTI, but he’s losing bladder control and developing urinary retention—major risk factors. Normally, about 200 mL triggers the urge to urinate; he feels nothing even at 600 mL. With no ability to void voluntarily, his only “escape valve” is leaking into a diaper, waking up each morning soaked. Intermittent self-catheterization would be the standard solution, but it requires dexterity and confidence he simply doesn’t have.

Since taking over his care two weeks ago, I stopped his bumex—a powerful diuretic appropriate for heart failure but not helpful for venous insufficiency (thank you, Dr. Tahara, for the pearl). After emptying his bladder today, I brought his urine to the hospital lab for culture.

Rural medicine may not have all the bells and whistles, but it offers something just as valuable: the ability to show up, literally, for the people who need it most.

-Dr Le

11/16/2025

As a young doctor, I recognize the importance of continuous learning and welcome guidance from more experienced colleagues.

I err on the side of caution and seek expertise when necessary.

I am unafraid to acknowledge the limitations of my knowledge and admit when I do not have all the answers.

I am committed to providing patients with accurate and unbiased information, even if it may not align with their expectations.

The same mistake, regardless of the provider, will result in the same level of harm to the patient.
A bruised ego will be forgotten in days,
a preventable error will haunt me for life.

-Dr Le

11/14/2025

Another awesome day working with veterans🫡. 🇺🇸

One veteran happens to be a local so it was ironic we both had to travel to Bradford. I’m not sure VES has approved sites in Warren at the moment, as I havent been assigned there or near there. Other than my branch office in Bradford, other locations I’ve been tentatively sent to are Erie and Seneca.

My former office in Russell would easily be approved with VES, but my current office in Warren doesnt meet all of ADA compliance.

Any ideas on a suitable location in Warren (or even Warren county) that would give permission for veteran evaluations?

🫡🇺🇸
-Dr Le

Veterans Evaluation Services, a Maximus company, supports the U.S. Department of Veterans Affairs in its mission to provide Veterans and transitioning service members with the benefits they’ve earned through their service to our country.

11/12/2025

As a P*P, it is not uncommon for patients to defer a decision until they have discussed with me. Recently, I had the honor and privilege of a share decision-making in real time.

The other week, a patient and his wife asked me to be at a specialist appointment. The office being only a hop and skip away from mine, I agreed, if for no other reason than to provide moral support. During the visit, he was given several management options. Lost in thought, he turned over to me, “What do you think, doctor?” I remarked that the decision is entirely up to him. Considering it was *his* decision to ask me (not his wife, not the specialist, not any of his grown children) I spoke up in his advocacy, “If you were my dad, I would advise …. for reasons….” Thankfully, it aligned with what his decision would have been.

I can’t imagine being in the hot seat and asked to choose between the lesser of evils, catastrophizing what if they made the “wrong one.” I did not expect that when given choice A, B, or C, he shrewdly went with choice D, “Phone a doctor”.

To be trusted enough to chime in on a life altering decision reminded me how telling a patient that you’ll act in their best interest is very different than them knowing that you’ll always act in their best interest. It’s a privilege I work hard to earn, not demand as a default.

-Dr Le

11/10/2025

“People sacrifice their health to make money, then money to recover their health, while being too anxious about the future to enjoy the present, and ultimately ‘dies having never really lived’”

~Dalai Lama

11/06/2025

Had a peculiar and surprisingly fulfilling day today. I was informed that home health care was unable to draw blood from a wheelchair bound patient, one whom i did a home visit the night prior.

He has a truck, I have a driver license; figured what could possibly go wrong 🤷‍♂️. Drove to his house and got him ready for an adventure. Getting clothed was easy, considering I used to work as a personal care assistant (PCA). Initially I used momentum to get the wheelchair over bumps, but then realized I could use the backwheels as a fulcrum to lift a 240 lbs, 6’1” person over these bumps (yah, finally put my MIT degree to use). He was quite a trooper and got himself into the truck without much assistance from me. Apologies to all those affected by me operating a truck and DWA*.

Got the labs drawn, he got himself back in the truck, I drove him home, and got him settled in his house. I had the honor to get lunch out of the fridge for him, something he would have not been able to reach. As I left to head back to my office, he asked, “Are you taking me on as a patient?” I felt privileged at the thought of how a quick, simple choice by me makes a difference in someone else’s life. I replied, “You already are.”

I’ve been a PCA, and on a good day, I behave like a proper doctor. I could never imagine how gratifying it would be to simultaneously function as both for someone.

*driving while Asian

11/05/2025

Why I Chose to Build My Own Path

Some have asked why I didn’t simply join forces with an existing medical group. The truth is—I tried.

—————-

Did I consider joining WGH/WMG?

Yes. I interviewed at WGH in November 2023, around the time my position with UPMC Kane was ending. Within the first few minutes, the former CEO said, “WGH provides great care. How would I know this? Because I’m a patient here.”
I replied, half in disbelief, “Do you believe the average Warren resident receives the same level of care as the president of its hospital?”

That exchange made something clear to me: when healthcare disparities aren’t acknowledged, it’s impossible to close the gap. Unsurprisingly, I wasn’t offered a position—but it was an invaluable moment of clarity about the kind of medicine I wanted to practice.

—————-

Did I consider other local options?

Yes. After Dr. Stanton’s practice closed, I reached out to Dr. Horner, the last remaining private practice in town. We had a wonderful initial conversation—I admired his work and envisioned a partnership where we could share ideas and strengthen local care together.

However, a few days later, I was told the collaboration wouldn’t move forward due to internal concerns. It was disappointing, but in hindsight, I understand there were complex circumstances beyond our control.

Those experiences affirmed my decision to establish ArnuMed Primary Care—a place where thoughtful, patient-centered, and equitable care can thrive independently of corporate or political influence.

— Dr. Dien V. Le
ArnuMed Primary Care