1. Excuse me? I’m sorry for calling out unprofessional behavior on a professional forum.

  2. Dang, I glossed right over that one. The yes, all is in order. Grandma is gonna live forever

  3. I often admit the sweetest little old grannies and watch them become feral around hour 4 like bilbo when he saw the ring at Rivendell.

  4. I just hate back pain. And to be honest: practicing in a country with a functional social system, there's a certain population where you just know that nothing you will do as a doctor will cure or even alleviate the back pain. Some people are just tired of working their menial jobs and want to get written sick for life and live off their handicap-pension. Can't really blame them. Some jobs are really hard once you're in your mid-fifties.

  5. Yeah I was lucky enough to get a butterfly in PGY2, mostly self taught though. I do wish more internists were willing to pick up a probe, such a great tool at the bedside. In the last year I've done everything from optic nerve sheath diameter for ICP to DVT studies, and tons of echos.

  6. You seem super reasonable, I understand that particular user bugs you, but when you argue with their points you honestly sound super anti-ED. chatting with you more clarifies that doesn’t seem to be the case. You seem nice and like you get that we’re all on the same team.

  7. That's fair, honestly I feel like the hostility really escalated when they tried to brush me off because "internists are scared and insecure around complex patients and that makes them mad" so I can't very well then be upset at a little tribalism coming from the other direction, now can I? But yeah, that, and basically claiming they were just as good at specialty knowledge and decision making was what put me off in the first place.

  8. No worries man! It’s all good. Mad respect for anyone carrying around a butterfly iq especially on a busy shift!

  9. This is aside from your main point but I think it maybe bears pointing out - this isn't an "additional billing procedure." You're essentially taking something that radiology was billing for and billing for it yourself, or having surgery bill for it instead. It's not new, it's just moved to a different department/provider.

  10. Oh yeah for sure but I’d think Gen surg groups would like to increase their own groups billing

  11. Maybe they would. I just wonder if it's the best way to do that. Particularly considering the time to learn how to do the exam well enough to have the confidence to go to surgery on it, then the time to do these actual exams, and the required QA/QI process to be able to bill for it as well. A POCUS GB bills for about $29. It's an extra $29 per GB patient, but a not insignificant amount of time and effort to get it.

  12. That’s why you should get ahold of the general anesthesia team

  13. I thought people came to meddit bc they had an empty life and no friends?

  14. I think it is if you omit the most experienced male providers and compare the remainder, it makes the outcomes more similar (though not the same). I think the implication is that if you are so old you are reluctant to prescribe new-fangled medications like warfarin, your outcomes may not be as good

  15. Agreed I see this as a potential confounder. I haven’t really had time to parse through this but Were the physicians who were older and um more experienced predominately male?

  16. Nights like this are tough. You did everything right. I remember it like this: if they’re sick resuscitate them if they’re not discharge them asap.

  17. I think this is a symptom of over demand for psychiatrists. Too few psych MDs and too much need for them.

  18. Can you elaborate about why this is so bad for patients?

  19. I just think physicians and pharmacists should work in conjunction to come up with diagnosis and treatment plans. You’re the expert at meds and drug drug interactions we are experts and piecing together a cohesive diagnosis and treatment plan. Teamwork my friend

  20. Is this for home or office use?

  21. You should also take a nap during your shift it time allows.

  22. Agree with what others have said, absolute must on the 2hr preshift nap. Only thing I have to add is I go for an evening run before my shift. Even just 20 mins. I find it wakes me up pretty well, along with the shower. I bolus 200mg caffeine on the way in, redose around 2-3AM.

  23. Love the on shift exercising, I used to run the stairs when not busy to stay awake

  24. EM attending here, not colorblind but cannot imagine any situation in which it would be critical to be able to differentiate purple vs gray haha.

  25. So difficult dealing with this situation. Please make sure you’re taking care of yourself. Residency is so tough as it is.

  26. I'm so so sorry you're going through this. My only thoughts are right now seek mental healthcare. See a therapist. Take a breath and see a professional before making any decisions

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