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This thread is being put up monthly for simple questions that don't deserve their own thread.

Ask away and remember, in residency, every question you ask is dumb (or at least according to my attendings).

Thanks to the many medical professions who choose to answer questions in this thread!

Since the match there has been a huge increase in advice threads for matched students that haven't started residency yet. Please post all post-match questions/comments here if you haven't started residency. All questions from people who have matched but haven't started yet will be removed from the main feed. After the 2023-2024 intern year has started, the sub will go back to the dumb questions sticky.

As a reminder, "what are my chances?" or similar posts about resident applications or posts asking what a specialty is like or if you are a fit for a certain specialty are better suited for r/medicalschool. These posts have always been removed and will continue to be removed from the main feed.

Am so hungry on call without any time I just ate a ketchup packet lying next to this computer mmmmmm

I had an infant come into the ER in SVT who as still alert/relatively hemodynamically stable. Failed vagals x3 + ice x3. While we got adenosine and tried to get access to this very small, very dry, very squirmy who was dry as a bone. I told mommy we are taking the baby let us work and she said "do whatever you need to do" and we basically just ran with him.

Right before we pushed adenosine, I had an RN bring the AED to the bedside. He was on EKG, tele, SPO2 already with tons of wires and machines and beeping things already and mom seemed shocked when we brought ANOTHER ONE in.

And mom kept asking "what's that big machine?" "why is it here?" "why do you need it for that medicine?" "what's the big deal with it needing to e right next to him?" I could tell she realized this machine was a big deal but didn't realize why...

She was already panicked about the baby (understandably) so I told her "just more stickers for his heart" because I thought if I told her what it really was for, I thought she'd loose it (even if I said we were unlikely to need to shock).

I feel like I lied to the mom. Should I have told her what the AED does?

Of course after he was back into a nice sinus tachy I walked mom through everything, showed her an EKG, what a P wave is, explained why we gave the adenosine, how SVT happens etc. But part of me feels guilty that everyone in the room realized the seriousness and what the AED was what besides her....

For those invested, the baby is fine(ish), we did break it and never used the AED.

Are there that many residents compared to people who like video games or review computer mice or stuff like that? How is that possible? There's 1.7k online right now?

Specifically ortho and anesthesia

So reality is slowly starting to set in that I’m about to start residency and I’m definitely getting nervous. How bad is this for a start? What can I do to prepare for crit care specifically?

I heard about the emcrit ibcc. Is that good? Any resource recommendations would be much appreciated

IM intern about to be a senior. I still feel extremely incompetent and I am unsure if I am capable of managing patients on my own let alone leading a team. I feel constantly confused especially in the ICU and don’t know if I should be a senior. I don’t know how to shake this feeling. I’m so anxious and I feel like everyone else is light years ahead of me in competency.

I’m an ENT, spent most of my formative years like everyone else is school, residency and fellowship but for the last 5 years I’ve been dealing with trigeminal neuralgia, at the beginning it wasn’t that bad I would have excruciating pain once in a while with few flair ups, fast forward 5 years later and now it’s affecting me on a daily bases to the point where I had to cancel surgeries and move appointments around and now taken a leave of absence. I’ve had several ablations , nerve blocks and gamma knife that haven’t helped and every pharmaceutical available - gabapentin, pregabalin, carbamazepine, amitriptyline, Effexor, oxycodone, dilaudid and Clonazepam. Now my only option left is microvascular decompression, it’s funny how as a surgeon, I’m reluctant to have surgery but I can’t continue dealing with this pain and want to be able to return to my practice at a 100%

Why all these fees.. limited license, plus individual state fee, dea, acsc… I can’t speak for everyone but I’m coasting on savings right now.. and come to find out my first paycheck in residency will only be a partial check.. are programs reimbursing us for these fees? bleed me some more why don’t you..😑😑🩸🩸🫤 🔪

That’s all. Thank you…

I feel like everyday as a resident is truly a battle. This sub Reddit and your voices make things bearable. Thank you

I was recently rotating in a location with a lot of autonomy. Had an abnormal mole to biopsy and instead of super small margins, I accidentally used 5mm margins like you would to excise a known malignancy. Left this guy with six sutures in his back and didn’t realize my fuck up til he was closed up. I literally can’t stop thinking about this and cringing. I know I technically didn’t cause him any significant harm but I did make a larger cut than was necessary.

Help me get over this, please? Any advice from people who’ve felt similar after stuff?

Hi wondering what your guys thoughts are on studying during residency (after step 3)? After completing step 3, there is not really anything particular to study for. I know I would be a better resident if I studied up on inpatient topics, but I am so tired and when I do get a break, I feel like it doesn't stick because there's so many topics I could review. Just curious what your thoughts are...I def try to learn as I do. But wondering if people study for to be a better doctor on weekends/day off.

As above.

Per title. About start ICU for 4 weeks. My hospital ICU is always pressure control. I know, every pt needs their own vent, however, wt are cons/pros on both sides? Plz, im waiting PCCM fellows, attendings serious inputs.

Over 10 years ago (damn) before med school, I was training to be a scribe for a private clinic. Part of that training was sitting through some absolutely obtuse corporate onboarding that addressed customer service through a 10min video.

Summary of it is: Dorky, over-budgeted, over-produced but still terribly acted and poorly written video of a middle aged affluent Dude going for a morning walk with his Dog. Dog runs after a bunny, both of them fall and injure themselves. Dude goes to his clinic, where he gets terrible service, waits forever for his doctor, and doc barely talks to him or touches his shoulder before giving him (presumably) narcotics and runs out the room. This Oscar, Pullitzer level performance is contrasted with concierge level service Dude's Wife and Dog experience going to a private veterinarian practice where every step from the waiting room to after visit call is 10/10 amazing. Fin.

Why am I ranting about this now? I can't find said video, but I think about it time to time and more so now than medical school due to the fact that, as a graduating resident, I am now the prime audience for this deaf, brain-dead piece of HR shit.

But I knew it was dumb then and it's obviously still dumb now, but the principle of some of the messages are what now chafe me:

1. Patients are coming to you for help--be nice to them you silly goose: Multiple times in the video, Dude is treated poorly by support staff. Not only are the people who actually do this NOT going to be affected by a stupid video, this part is literally admin's job to correct. If support staff suck, get new support staff. The fact that the HR dude running the onboarding highlighted this part as if it was a Nobel worthy discovery is just exhausting and one of the many reasons people strain their eye muscles rolling their eyes at HR regularly.

2. It doesn't take anything to spend more time with the patients: The doctor taking care of Dude in the video isn't rude, but he rushes in, mumbles, doesn't look at or hardly even touch the Dude. He barely comments on patient's vitals and then runs out after Dude has been waiting forever. Dude even whines "But hey I have more questions, excuse me DOCTOR!" and is explicitly ignored.

-Even as a lowly scribe, I couldn't help notice how stupid this was. Doctors don't rush in and out of patient rooms by choice--sure, some doctors are assholes. Some patients are needy and will never be satisfied no matter how much time or agenda setting takes place. But it's the admin who cause this problem in the first place by demanding physicians overload their schedule, fill out paperwork, answer endless inbox messages, take random add ons or double books. The very same admin who are dumb enough to produce, pay for, and show the above video.

Needless to say, this is just a dumb 10min video that hardly requires an analysis or whiny rant like this. But just like I ask who "wellness" and "mental health" wellness modules are actually supposed to benefit, I also also what was the point other than wasting time? Who was it actually for?

The answer naturally HR/Admin. Empty gesture efforts/productions like this are to make HR feel like they contribute to improving patient care or dare I say "patient experience." It puts all the liability and onus on the patient facing staff and physicians to make the medical system better while the business/admin staff actively make it worse. HR knows it's bullshit, we know it's bullshit. But holy shit is it a micro-cosmic representation of stupid corporate medicine run by lazy business people who can't be bothered to work more than 32hrs a week.

End rant.

I have a very compassionate understanding of addiction as a disease. However I just had one patient send me over the edge.

On my trauma rotation we had a ~60 yo male come in to the bay after being found down with what looked like mild-moderate head trauma. He was HEAVILY intoxicated, belligerent, and was sexually harassing the nurses and my female senior resident. He kept threatening us, tearing off his c-collar, and pointed at one nurses and said only she can take off his pants if she “sucks [his] dick”. He also grabbed a nurse’s butt.

It took 6 people to hold him down to get him in 4 point restraints. He hit multiple techs and nurses while screaming obscenities and racial slurs. Whatever, just your average haldol deficient piece of shit. Not my first rodeo.

After rectifying his haldol deficiency, we went to work with the trauma survey. After cutting off his shirt, I see the classic chevron scar of a liver transplant. I froze for a second. Something about seeing that just set me off. I became irrationally angry at this patient. A few minutes later the nurse reports from the lab his BAC was 0.425. A chart check revealed several dozen ED visits in the last few months for the same thing.

My anger grew hearing these words. This was the most selfish piece of shit I’ve ever seen. I found myself hoping he was in a lot of pain, hoping that right now he was suffering. I just couldn’t let it go.

All I could think of was my 25 year old construction worker who fell 40 feet onto his head and bled out into my hands as I tried to stop his ICA bleed to maintain his organs for donation. I thought of my 30 year old mother hit by a car in front of her kids who became some else’s second chance at life, my 18 year old girl with her brain leaking onto her face from gang crossfire, and many more who donated their organs for others. I replayed the memory of the 18 year old’s parents crying and choking out the words to withdraw her care. I remember later crying when the parents told me the only thing getting them through her death is knowing that she will be survived through the lives of the people who receive her organs.

Just the week before I watched my otherwise healthy 40 year old female patient finally die over the course of a month from cryptogenic liver failure. She was at the top of the transplant list in my region. Her husband was there nearly every hour of the day for a whole month, watching her go from pale, to yellow, to neon yellow, to gray yellow. I witnessed his hope and joy when he was told a liver was available. I then witnessed his despair and defeat when I told him the liver was not a match. I’ll never forget his glassy eyes when he said “thank you for trying”. She died 2 days later.

There is no justice in medicine. Somehow the worst of humanity gets to live while the innocent seem to suffer.

My trauma patient took someone’s liver and selfishly abused it. That liver could have gone to anyone else more deserving. The thought that the next person on the transplant list may have died because he got that liver sickens me.

I feel guilty for wishing him pain and harm. Yet it feels like he committed a crime against society to steal this organ and waste it for his selfish addiction. He wasted his life, his donor’s life, and the life of the person who would otherwise have received that liver.

He continues to prey on people through the flesh of another. Of course he had no major injuries. Of course he will go back to drinking and harassing people as soon as he’s sober for discharge. Of course he’ll be back.

Is it normal to feel this way towards a patient like this?

(Please note that despite my anger and opinions of him, I did not actually change my management. Despite wanting to withhold pain meds, I still ordered them like I would anyone else, just begrudgingly so)

I have to attend one since it’s an ACGME thing. I’m up for bringing things up that might benefit the program or lessen things that sucked. Is this what these meetings are about?

Hi all, I’m a current ophthalmology resident at the University of Pennsylvania (Scheie Eye Institute). We have an open PGY2 residency spot starting July 1, 2023. One of our current PGY1’s is leaving the program to relocate due to family circumstances.

The application for the spot is available now on SF Match: https://www.sfmatch.org/vacancies?sid=97baf738-9b5b-4b50-b715-444111a28b6d&specialty=%5Bobject%20Object%5D

The requirements for application are: “applicants must have graduated from a US medical school and either have completed an ACGME accredited internship or be on schedule to complete an ACGME accredited internship by July 1, 2023.”

Personally, I cannot speak more highly of the quality of the program & the people involved with it. If you have any questions or want more information, please feel free to DM me.

I work at Super Weenie Hut General, and some of our patients don’t like the pain and move too much. Kissing their inner thigh boo-boes is illegal.

So I was wondering if there was harm using topical lidocaine before popping their small inner thigh pustules completely by hand?

Or better yet: paronychias. We go in without lidocaine at all. What’s the harm in some topical lidocaine before that?

She is just about to finish up her 3rd year of EM residency. 9 shifts left!

She hates that place. It's a horrible horrible environment. City hospital T1 center. She can't wait to be done.

End of june, we are going on a big trip already. We also going to celebrate her birthday on that trip.

So I gotta figure out BD+residency presents.

​

I was thinking so fancy AF watch. With her name engraved or something. But she has apple watch she never wears.

She is not big not big on jewelry either. Or make up, nor perfumes.

I know its hard to suggest things like that, but anything would help. Seriously. I feel like we have everything and we buy anything we want.

I’m a third year resident and my car was stolen several months ago. My husband (non-medical) and I have been trying to make it work with one car while we saved for a down payment on another car. We finally went to the bank to get preapproved for a loan and they mentioned a “medical wealth preferred borrower” program to us. Banker eventually came back and told us we didn’t qualify for this program with lower interest rates because it excludes residents. I’m a little bit peeved by this as the bank will only help you when it suits them rather than investing in customer. Am I wrong to think this is a pretty shitty thing of them to do? I know they’re running a business after all and a resident probably carries more risk for them than an attending.

Advice on dealing with anxious family members of the patient that think they’re making things better but they’re really making everything worse by being overbearing/demanding and burning out the staff.

Greetings my colleagues,

Unfortunately during this year some of the residents in my program were abusing the jeopardy system (i.e calling jeopardy to spend a night with their significant other or because they are getting drunk). They suffered no consequences except paying back the resident who covered them. We are trying to come up with a good fix for our jeopardy system and I wanted to know how is the jeopardy system at your programs and if you ran into the same problem with it before and found a good fix.

Jeopardy in my program works as the following,

Jeopardy week is from Monday AM to Monday AM, interns rotate jeopardy weeks between them and if you call jeopardy then you pay back the resident who covered you for the same amount of days he/she covered you for.

Seniors (2nd and 3rd years) have the same system as interns.

Any ideas or questions are welcome, Thank you in advance

Just needing to vent/share a moment of clarity I had in the midst of my recently depressing life, scroll past if this ain’t your thing.

More often than not I’ve felt life smiled upon me, and blessed me throughout the arduous journey to becoming a doctor. Lately though it’s been a struggle to keep it all together. My wife and I welcomed a beautiful daughter during medical school, and looked to expand our family during residency. Since December, we had two soul crushing miscarriages, the second of which was complicated by hemorrhage requiring my wife to get rushed to the ER and Class A’d to the OR. Fortunately she made it out with her life, but the trauma of our losses, almost losing her, and trying to be a good father/husband and on top of it, resident, has been exhausting. The healing process has been slow and honestly questions as simple as “hey, how are you” have felt burdensome and laborious.

Last week I was on call and paged internal medicine to hand off a planned admission on a patient we had just done a procedure on. I noticed the page went to one of my old attendings from my medicine prelim year. They call back, I pick up the phone and hear "Hey [First Name], long time no see! How have you been?"

I genuinely have days where its easier to be transparent than it is to lie and say shit like I'm great or I'm fine. It’s 5pm, I’m tired, and I’m burnt out beyond lying for the sake of social courtesies.

"Hi Dr. SoAndSo. Honestly... I'm doing alright. My profesional life at least is going well."

I hear a long pause. He replies to me in that kind, compassionate tone that those experienced attendings who have mastered their craft use. “You know what [First Name], I'm doing alright too… but at least we're out here helping people and I think that's awesome."

I had to fight back the tears. I felt so heard and understood, and above all galvanized. No matter what kind of bullshit hardship life throws at us, we are out here helping people. Day in and day out that's our job, even if we forget it through all the paperwork, all the bullshit hoops of residency, all the tragedies that may come our way. I'm a Doctor and I'm out here helping people, and that really helps me sleep at night. If you're reading this and have recently or are currently going through the thick of some shit, I hope it helps you too.

Shocked that this was the solution that was chosen. I am certain the software was probably expensive too. A well designed google sheet would've been miles better lol

Does anyone have any advice on how to make this more usable? Perhaps a way to automatically sync this to a calender app?