I don't agree with most the thing he says, but I can get behind this. I've even seen cancer drugs like wtf ???? You want the patient to ask the DOCTOR if a certain med other then what they said is the right one to save there life cause they saw it on tv..... They do say even a broken clock is right twice a day 🤷🏽‍♂️

Does anyone else feel like internal medicine is just glorified secretary work? You’re essentially the case manager of medicine

Please upvote this post and help me lobby the mods to possibly pin this.

In the meantime, the folder link is in my profile description. If you can’t find it, lmk. Getting a metric buttload of DMs!

Pass it along -- thank you!

The folder includes the newest White Book, and:

• PDF on POCUS
• 2022 cardiology housestaff manual
• Heme/Onc manual

What prevents them from hiring the same type of staff that an efficient private clinic has?

Watching the college football bowl games lately (one of the few times I’m exposed to a significant amount of cable TV commercials), I can’t help but feel a bit daunted by the quantity of disease modifying therapies for specific conditions in the form of -mabs that are rolling out. As a newish attending, there’s already a bit of a learning curve catching up on the fancy drugs that people who go to resident clinic and safety net hospitals generally can’t readily access. But it seems like every day there’s a new, brand-name drug out there with a unique MoA and side effect profile. I feel that as a doctor, I should know at least something about the medications my patients show up taking. Keeping up within my own specialty is a task, but it seems like things have gotten out of hand with the sheer volume of new drugs being marketed to people over stock footage of smiling, active people engaged in wholesome, fulfilling activities as a list of concerning side effects are read off.

I know these things can be looked up, but that can significantly hinder timely decision making in a busy ED or clinic vs common meds that are widely known. I hate the feeling when a patient mentions the brand name of their infusion I’ve never even heard of.

Another peril of direct-to-patient advertising, I know. But what are y’all’s thoughts on this? How do you navigate the surge of new niche meds?

Help me lobby the mods to approve my auto-removed post. How incredibly annoying

Test: https://www.dropbox.com/scl/fi/ciuhqvzs1b6olb4xnizfy/MGH-Housestaff-Manual-2024-2025.pdf?rlkey=hazf90wlhl9ygjlhw29ajmd6l&e=1&st=przhdhdv&dl=0

Your patient comes up to the floor from the ED? Are we supposed to be sending a message saying “hey doc., patient has made it to the floor.” Is that just annoying and redundant?

I just want to go deep into understanding the real basis of autonomy. Just want to get my moral axioms stronger.

I took step 3 today and day 2 was baddd. Only 2 of the CCS cases ended early 2 had negative updates until the end the others no update/good update but none ended early. I feel like I failed

pgy2 here (peds if it matters)

I’ve seniored 2 weeks and will be doing more soon. Overall I liked my interns, and when we all debriefed we all thought we worked well together. My first block senioring was nights which does include a lot of cross cover. At my program interns are first call for nearly everything from nurses and consultants.

One thing I found hard was figuring out how much I needed to ask/know.

Overall I felt like my interns and my nurses had decent instincts when to involve me along with the interns. But there were a handful of times they signed something out in the morning and I was like oh I wish I knew that, and I would have advised quite differently/ been more worried about certain pages.

I did tell them at the beginning to let me know about certain kids who were watchers, major changes in plan or status and anything they got paged on more than once because clearly someone was worried. Short of that what are some concrete ways to do better with this?

Besides the obvious dignity, autonomy, sleep, and self respect:

My favorite travel coffee mug (>10yrs use) - maybe somewhere in MRI

Nintendo switch charger

Stethoscope - although I found a suspiciously similar one and decided it was mine.

What have you lost that still bothers you?

I'm casually starting to look into what programs I might want to apply to for fellowship. Whereas residency pages often had so much information about the program, the benefits, etc, and I usually could find comments online about the program from people who've rotated there or been employed there, that information seems harder to come by for fellowship. Where have you/are you guys looking? Anybody know of any programs in particular that are good or bad in some way for pediatric cardiology?

I have had a few patients die over the years with no contactable next of kin. I have sat by their bedside so they wouldn’t have to take that last breath alone. But sometimes the night turns to day and I have to go to my next shift. I want to utilize a service like no one dies alone, but I am unsure of the ethics of asking a stranger to sit with my patient as they pass. I understood these services to be primarily for families to call. I’m not sure it’s appropriate for me to call since I don’t actually know this person. Any advice?

My buddy has a patient who is done with chemo in remission, but says they are in constant pain in the hip there bone Mets where. It was pretty big he told me I didn't see any patient identifying information ofc he just told me what i just told y'all lol.

Hello folks! Here is a link to the newest edition of the MGH White Book.

My only ask is that you share freely with your colleagues or whoever else may benefit from it.

Thank you for all you do as talented physicians.

I’ve gotten the feedback a few times about being more thorough with my patients in terms of both asking them HPI questions and their chart.

Sometimes I feel weird asking them questions I should know (it’s already in their chart somewhere) and sometimes I just don’t know what to ask because I don’t know what’s relevant.

I also have a hard time digging through their charts. It’s often times overwhelming and too much information, so I don’t bother.

Any ideas on how to slow down?

Just submitted my call shifts for reimbursement last month, and I calculated that the average pay I had while on call was $6.80CAD/hr, which has been illegal in my province since October 1, 1995. That’s before I was born.

I don’t claim to be some kind of hero but I do think I deserve to be paid the same for being up all night trying to stop patients from dying, as the coffee shop barista who was up all night preventing me from dying.

Hello, I am currently a PGY-4 fellow at a university program in Ohio. Due to family reasons and personal ties to Michigan, I am seeking someone interested in swapping positions with me who is currently training at a program in Michigan. Please DM me if interested.

Currently rotating through a children’s hospital and some of you guys are the most pushiest, demanding people I have ever met. I’ve never met a group of more annoying residents than in this field. I’ve never had this much push back from the adult side. You’d expect that people who would be working with kids would be nicer but no they’re awful.

For me, I think that I would be a writer.

Even now I feel like I want to accomplish it.

I always expected that residency would be when I finally set aside childish things and grow up, but I doubled down instead. It’s got to be a coping mechanism. The tougher the days the longer I stare at the screen mashing buttons later. It’s not the healthiest stress reaction. I wish I became a gym rat instead to blow off steam. My professional life is not spiraling out of control, either. The work is getting easier. Zeroing in on a well-paying job. The stars are starting to line up. And yet I’m grinding WoW like my life depended on it. I just think it’s kind of amusing and bizarre.

Anybody else experiencing this?

Hey humans of Reddit.

I’m applying this cycle to FM residency, a very strong candidate for my region in which I’m applying. My story is complicated in that I don’t have family help/assistance, and I’m a single mom to a 5 year old. Custody is split 50/50, but kiddo’s dad’s girlfriend is having a baby some time in the spring, so shits probably gonna hit the fan over there, and I anticipate probably having him more often through the summer and fall.

Where I’m located and applied, I have really two options- hospitals close by (15 mins) with all their rotations in house, but bigger systems, more nights, more inpatient, arguably much better training. Secondarily- hospitals about 40 minutes away, lots of traveling to other training sites, smaller systems/probably less comprehensive training, but minimal nights and minimal call.

I obviously don’t want up in a situation where I’m not meeting the requirements of my residency program. I also want to be able to adequately support my son and know he’s well taken care of. I know I won’t be able to be at everything, but I’m struggling with navigating the nuances of a very unknown season.

Would love any advice for prioritization you did or did not do, or recommendations in hindsight that you have.

Probably a major factor in bad inpatient outcomes as we continue to automate and systematize things within the EMR. At some point we gotta turn away from objective but incomplete data noise and just return to intuition

My girlfriend will be sitting for IM boards in August and just curious if anyone has good study tips/ resources that they used to prepare! She is very much an overachiever and overthinker so any test scenario brings on a lot of “what if I fail and all of this was for nothing” 😬! TIA!

I've been asked to revise the hospital Regulatory Education for our new residents. Topics include allegations, safety event reporting, legal document review, ect. Here's my question: how do you prefer for that Education to be delivered? Live? Video? Podcast? Webinar? Paper forms? Something else entirely? Any feedback is potentially helpful! Thanks!