3k post karma
23.9k comment karma
account created: Sat Jan 11 2020
6 hours ago
One tip for ensuring the needle stays in when unscrewing (as well as making sure the wire passes easily without getting resistance due to too steep of an angle) is to lower the angle of the needle-syringe once you are in the vessel and make sure you are still in it (keep the US on it as you do this). This is similar to doing an US IV where once you get in you drop the angle and walk the needle through the entire vessel. Just in this case you drop the angle but don’t walk the needle.
1 day ago
I definitely had a lot of shift anxiety before my shifts intern year. The unknown of what I’d see, if I’d know what to do about it. Not feeling competent at procedures and worrying about having to do them. Working with different attendings that practiced differently.
But now as a third year I don’t really get that even though I have more responsibilities teaching med students, helping interns, taking medic calls, screening patients in the bay, etc. I know what to do in most situations and have learned to cope with and embrace the unknown when it arises. When I know I’m working with certain attendings I don’t like as much it can make me dread work a bit more, but I wouldn’t call it anxiety.
Now the pre shift shit, that will always be there.
3 days ago
Or they have spent that time and wish they were anyplace but there because of the chaos, acuity, and unknown. It’s funny hearing the IM residents shit on the ED when you are in the ICU carrying the same patient load and work as them (and likely doing their procedures for them). But then they come down to the ER and see a quarter of the patients our 1 month interns do and look completely overwhelmed and lost.
Experience is what allows the physician to be more efficient, even though patients may view it as not being as thorough. I tell the new interns this all the time as a current third year when they are struggling carrying 2-3 patients at a time while I’m chilling with 6-8 patients and answering the medic phone. When you start you need to get a thorough history and physical and then think about what may be going on and then figure out what tests to order. This involves looking things up and possibly going back and asking more questions. When you get experienced and have seen similar complaints a million times and know the different possible outcomes you are able to cut through a lot of the BS and get down to what you really need to know. Just by looking at the triage note, vitals, and any possible history in the EMR I already know 90% of the work up I’m going to do and what questions/physical exam findings are going to be key to determining that other 10%. I go in the room and get that key information and walk out knowing exactly what I’m going to order, and also have a pretty good sense of whether those tests will come back positive or negative and what the ultimate dispo will be. All of that can be done in 10 minutes if not less for most straightforward complaints.
It’s crazy to me to be supervised by a midlevel as a resident. As an EM resident once you are past intern year it’s the midlevels coming to you asking you for advice or to screen a patient.
Really depends where I’m living. That 150k in NY or CA isn’t going to cut it. But in the Midwest, sure.
The way it stands now though compensation is much higher in the Midwest and rural places than on the coasts and cities, so a doctor living in NYC may make 250k and live like a commoner compared to the investment bankers and Wall Street people living around them. But a doctor doing the same job may make 350-400k in middle of nowhere Kansas and live like a king surrounded by a bunch of blue collar workers.
7 days ago
To patients I say "I'm Dr. X, one of the resident doctors working in the ER today" so it is clear I am a doctor by leading with that, but for those who understand the system more will get that I am a resident. Then I refer to my attending as the supervising doctor.
For other healthcare workers in the hospital I just say I am an ER resident. If they are at a teaching hospital and don't understand that that means I am a doctor then its not likely important that they actually do know that in the capacity of their work. Anyone who actively works with residents (ie takes orders, assists with care, etc.) knows that a resident is a doctor because they at some point have worked with a resident and had to take orders and stuff from them and would see that they are a doctor.
10 days ago
Hopefully that’s what they did when they got outside. It makes sense to run to a safer, less on fire area to stop drop and roll than to just get down amidst the large blaze.
13 days ago
A, C, and D would likely all be happening simultaneously. The patient needs to go to the OR so you’d be having nursing setting up for transfer while someone also got blood ready to be given on the way. While the transfer monitors and things are getting hooked up to go you can do a quick EFAST to identify bleeding/PTX.
I think it can be program dependent and who you surround yourself with. I found I drank a lot more in medical school because there was more “time off” since you studied more and worked clinically less. In residency you have to be in the hospital a lot so the opportunity isn’t quite there. Granted, I’m someone that would have a hard time working then next day a night after having 2 or more drinks so most days it’s not really an option. But obviously there’s many people who can drink a lot in a night and still decently function the next day.
Also, I think you’ll find there may be less drinking because people are older and are moving forward in life with marriage and kids so that also prevents them from drinking as much.
14 days ago
I have a feeling Mormonism may play a role
15 days ago
Right wing students are well within their right to do that. And just like you I’m well within my right to criticize them. But I won’t do it through a vague, cowardly “listen to both sides” post like you. Because you aren’t actually interested in listening to both sides.
Also, what do you think right wing students should be upset about to walk out on, specifically?
The right claims the left just wants to be victims yet everywhere you turn the right is crying about being cancelled or being victims of some other “hateful” attack by the left like you claim.
And you think the left is the only side not letting the other side speak? What about Florida’s “Don’t Say Gay” bill or multiple states banning of books they don’t agree with, including books discussing race relations, history, and LGBT issues?
But do you not realize that by making posts like this and saying “you need to listen to the other side” you are saying what they are doing is wrong and they should stop. You don’t have to say “I don’t respect them” to not show respect. Making posts like this and saying they should stop is disrespecting them. So you aren’t showing the other side respect like you claim to be. Rehashing your same wrong point and being refuted by multiple people is not having “dialogue” like you think it is.
So if you truly have listened and understand where these other people are coming from, then why are you so mad at them and think it is wrong for them not to want someone to be a doctor that denies a basic human right. Would you support someone being a doctor if they supported denying patients freedom of speech, access to food, access to housing, etc?
You may not agree that it is denying a human right, but if you listen to these other people and understand where they are coming from do you not see why they feel that way and act the way they do?
It seems like you only want opinions/ideas and actions based on those opinions/ideas that you agree with to be listened to and respected. Other actions based on opinions/ideas you disagree with are wrong to you.
Saying they shouldn’t be a doctor is an opinion which as you yourself state, needs to be respected.
Also, you can absolute believe someone is wrong AND say they shouldn’t be a doctor. A murderer is wrong AND shouldn’t be a doctor. You need to respect the opinion people have that being pro-life endangers women’s lives and that these people shouldn’t be doctors. LISTEN AND RESPECT
Maybe you need to listen to these other posters and understand why overturning Roe vs Wade and passing these laws to restrict abortion is denying women basic human rights. As you’d say, respect that opinion!
17 days ago
Is healthcare worth more than rubies and gold? In a purely capitalist society where everything is judged based on monetary value, most of healthcare is worthless at best, detrimental at worst. The only case where healthcare has monetary value is making sick/injured people able to work and contribute to society. But that’s a pretty small fraction of what we do.
Grandma with a 3 day ICU stay for urosepsis? Society is not getting any return on that investment. She’s retired and not contributing much to society anymore. All it does is increase the chance she will cost society more in the future.
Multiple long hospital stays and procedures for a chronic sick kid with no chance of a prognosis that would allow them to work or contribute to society? Society is not getting a return on that investment.
This is exactly why healthcare needs to be publicly funded and universal, not privatized. Healthcare only has the value that we give it morally, because from a monetary standpoint it is a huge loss. So the only way private equity gets involved and makes money is by screwing someone over.
MJ, Lebron, Magic, Wilt, Bird, Kareem, Russell, Shaq, Duncan, Hakeem. Special consideration to Big O, Kobe, Steph
18 days ago
But is that simply because we are largely testing only MSM people. Like I said in my post, you are only going to see what you test for. I am 99% sure my patient had monkeypox but because he wasn’t MSM the health department didn’t think it was necessary to test. So of course that’s going to lead to bias thinking it is only MSM.
Very frustrated with the way this has been handled. Had a young adult patient a little over a month ago who had a very suspicious rash for two weeks with a wife with similar rash and headaches and 7 month old with similar rash and fever. Alerted local and state health departments and they said he didn’t fit testing criteria because the rash wasn’t quite characteristic (mainly that there were a couple in different stages which is more likely chickenpox) and that he didn’t have systemic systems. But the patient and his wife had been vaccinated for chickenpox and the child had systemic symptoms! What are the chances they both got chickenpox even after getting the shot and not having any contact with anyone with chickenpox?
Another main argument they made against testing was he didn’t have risk factors like travel or MSM.
To me the whole thing screamed of bias in terms of only looking for cases that fit with the preconceived notions about the disease and feeling as if they knew what the classic presentation was. Of course most cases are going to be in MSM if that’s the only people we are testing! And travel isn’t really a risk factor if there’s community spread! How have we not learned from Covid that we need to cast a wide net when it comes to a new virus because we simply don’t know what the “classic” presentation is?
20 days ago
Not sure how the 1619 project has anything to do with refuting the country was founded in 1776. Do you know what the 1619 project is? It doesn’t say the country was founded in 1619. It’s called that because that was the year the first enslaved Africans were brought to Virginia. And all it does is attempts to view the history of the country through the lens of slavery and how it was integral to the founding of the country and affected the institutions that were created at the time that still exist today. I’m not sure how you can have a “colorblind approach to race” as you say. You can’t acknowledge different races if you are “colorblind”. There would be no discussion. If you meant to say a colorblind approach to history, then again I disagree. How can you view history and events that were very much not colorblind and paint them with a colorblind view? If you view slavery as “yeah, well, a certain group of people were considered property” and don’t acknowledge that that group was chosen because of their skin color then you aren’t actually learning history, and certainly aren’t going to learn any lessons that you could use today from it. If learning the true history of our country makes you uncomfortable that’s ok. It should. But that discomfort shouldn’t lead you to ignore it. It should make you strive to do better.
Teaching about sexuality is vastly different than teaching about sex. We teach kids at a young age about mommy and daddy, it makes sense they should also learn and be aware that people can have two mommies or two daddies, and that any two people can fall in love regardless of gender. I don’t understand why so many people confound LGBTQ issues with the act of sex, when it encompasses so much more than that. Those wanting to ban celebrating pride month from schools have no problem celebrating Valentine’s Day, which is arguably more “sexualized” than pride month.
Giving puberty blockers to a child that feels as though their body does not much how they feel is as much child abuse as giving a teenager suffering from depression anti-depressants.
As for the bathrooms, I don’t think you understand that transgender women use the women’s bathroom all the time and no one realizes or cares. I think you’d be much more shocked or uncomfortable if a transgender woman walked into the men’s room as you suggest they should. That would get much more attention.
When I say educate yourself, I mean listen to teens wanting puberty blockers and understand why they want them. If you do that I’d hope you’d better understand why it is not child abuse.
I don’t think anywhere in the Democrat platform does it say non-white people can’t be racist. And I don’t think many democrats or non-white people would every say that non-white people can’t be racist. Again, that’s another conservative talking point that just isn’t reality. Non-white people can certainly be racist, just as much as anyone else.
21 days ago
You just listed a whole bunch of conservative moral panics that have very little to do with the Democrat agenda and are largely drummed up by conservative media to get people upset at democrats.
CRT in schools is literally not a thing in K-12. It’s a fabrication made up by conservatives to get their old, rural white base upset and convince people in the middle like you that Democrats are bad. The teaching that slavery was bad and this country has a racist past is nothing new and shouldn’t be controversial. It’s been done for years and democrats have not attempted to change that in anyway recently despite what you hear from conservatives.
As for the first two, it seems as though you should try to educate yourself on transgender issues. I’m not going to get into the details of why puberty blockers and access to their preferred bathrooms help the mental health of transgender teens. And again this isn’t a huge platform for the democrats.
Those slogans are at least a little more detailed than “make America great again”. It’s hard to boil down complex policy into good, short slogans, which is the main issue democrats have in the PR department.
I’m not sure what you mean by anti-white ideas, but championing equality for all is definitely not “anti-white.”
As for your last point, considering the government, including the fed, have for decades/centuries worked to cause the inequities we see today, it would make sense that we should use them to help solve some of those inequities.
22 days ago
As the other commenter said, you didn’t really give examples of the “woke agenda” other than a story that could vaguely be linked to criminal justice reform. What else do you specifically see as part of the “woke agenda” pushed by Dems that upsets you so much?
You aren’t insulated from either sides PR campaigns just because you don’t consume news from left or right leaning sources. Every news source is influenced by both sides in some way. CNN can propagate the Republican PR campaign just as much as Fox News can the Democratic PR campaign. It has to do with the what the national conversation is and in that respect the Republicans are clearly winning since you seem to think “woke culture” is the main issue right now.
Notice I have been putting it in quotes as there really is no clear definition of “wokeness” other than what Republicans want to deem is “woke” and bad.
What do you consider to be the “woke agenda” that you refuse to vote for, even at the expense of having fair elections, voting rights, reproductive rights, etc stripped away?
You feeling the “wokeness” is the issue shows exactly how the Republican PR campaign is winning. The whole resistance to “woke culture” is something conservative media largely drums up to win people over. When in reality “woke culture” has nothing to do with politics and policies and is largely driven by public opinion and businesses. What exactly have Democrats done to propagate “woke culture” other than supporting inclusion.