Misc. Med Thread Vol. 2 redeux

[Radsguy]

This seems to be in reference to my comment. Being the "lowest" has nothing to do with being treated poorly. It has to do with the hierarchy of the system/team. Don't like it. Pick another line of work. I treat everyone with respect. But I still tell med students what to do. That is there job. To learn by being told what to do.

If you're respectful, then that's great, but you're in the minority, especially within surgical fields. I've met a lot of attendings that are pricks to medical students because they get off on the sense of authority that they probably lacked when they were losers in high school.

That hierarchical attitude is exactly what I hated about rotations. If you work at a teaching hospital, it's your job to teach and not complain about it. If you can't handle that while being a nice human being, work in private practice where you won't have students. This isn't necessarily directed at you personally as I'm speaking generally.

Pick another line of work? No thanks. I'll stick to a field of medicine at a program where the attendings enjoy talking to the junior residents and medical students. I'll keep doing my thing at a place where I can approach any attending with any question without fear of judgment, and because of that attitude, I'll make fewer mistakes for fear of not asking.

This is why medicine is a dying art.

So in order to be a good doctor, I have to make medicine my life.

Or I could just work my hardest when I'm there but still have a normal life. With all due respect, I feel that this attitude is archaic.

[Dr. Horse]

Or I could just work my hardest when I'm there but still have a normal life. With all due respect, I feel that this attitude is archaic.

Medicine is becoming full of shift workers and clock punchers. No sense of duty or responsibility to their patients. You can have a life outside of work, but in my opinion, being a physician means being dedicated to your patients. This requires sacrifices.

[Radsguy]

Medicine is becoming full of shift workers and clock punchers. No sense of duty or responsibility to their patients. You can have a life outside of work, but in my opinion, being a physician means being dedicated to your patients. This requires sacrifices.

100% agree with this. I don't endorse the shift working mentality. I have stayed late several times for the sole reason that I felt a sense of ownership of my patients and wanted to make sure things got done right. Gotta do right by the patient, and I'm willing to make sacrifices for that. I'm just not willing to make sacrifices to inflate an attending's ego or do meaningless work, which is commonplace in medical school and residency at times.

[MakeABanana]

Medicine is becoming full of shift workers and clock punchers. No sense of duty or responsibility to their patients. You can have a life outside of work, but in my opinion, being a physician means being dedicated to your patients. This requires sacrifices.

I agree with this.

It's the reason why I wouldn't be able to do outpatient medicine because I always want to try managing all of my patient's problems in that one visit even though my time is limited. Leaving loose ends always bugs me. I felt a lot more free to handle multiple problems during inpatient medicine.

[Austere]

Don't listen to Dr. Horseshyt.

I would suggest making use of your schools counseling services. Depression among med students and residents is common and underreported/undertreated. I don't know you, so I have no idea if you're actually experiencing anhedonia or if you're just burnt out. But it never hurts to talk to someone.

Lol yeah, I don't really listen to the horse person, I got enough haters as it is.

The thing is that when I was in college, I used to beast all the classes and stuff, and I sorta used to define myself through academic success. I don't really have much academic success here lol. Sometimes I struggle to get by. It makes me feel bad, and sometimes it makes me feel like I'll be a bad clinician, but then I tell myself that there's more to life than memorizing "ACE BATS Right-handed" and "Can't see / can't pee / can't climb a tree", and my struggles make me a stronger and more resilient man.

I use the school's counseling services. They have helped me, I probably would have flunked out of medical school without them.

Tbh, the reason I'm not really interested in surgery is because I don't really have a shot at getting into any competitive field. I know all the surgery brahs want peeps with 240+ and honors and stuff, and I'm a fairly poor student, so they're not interested in me. And I applaud that, you gotta get the best peeps you can get, and I'm not one of them. So be it.

But if the surgery brahs aren't interested in me, why should I be interested in them?

[HI_KKM]

Lol yeah, I don't really listen to the horse person, I got enough haters as it is.

The thing is that when I was in college, I used to beast all the classes and stuff, and I sorta used to define myself through academic success. I don't really have much academic success here lol. Sometimes I struggle to get by. It makes me feel bad, and sometimes it makes me feel like I'll be a bad clinician, but then I tell myself that there's more to life than memorizing "ACE BATS Right-handed" and "Can't see / can't pee / can't climb a tree", and my struggles make me a stronger and more resilient man.

I use the school's counseling services. They have helped me, I probably would have flunked out of medical school without them.

Tbh, the reason I'm not really interested in surgery is because I don't really have a shot at getting into any competitive field. I know all the surgery brahs want peeps with 240+ and honors and stuff, and I'm a fairly poor student, so they're not interested in me. And I applaud that, you gotta get the best peeps you can get, and I'm not one of them. So be it.

But if the surgery brahs aren't interested in me, why should I be interested in them?

ok this has to be a troll right?

lmao @ general surgery being competitive

[F23]

Medicine is becoming full of shift workers and clock punchers. No sense of duty or responsibility to their patients. You can have a life outside of work, but in my opinion, being a physician means being dedicated to your patients. This requires sacrifices.

You've been an attending for like, what, 1 or 2 years and now you're trying to hold up the standard for how things 'used to be'? Shift work is awesome. I don't want to have to deal with the needs of my patients outside my regular work ours.

The whole reason that physicians are shift workers and clock punchers these days is because they aren't in charge anymore. They're just another input to production like nurses, techs, facility, equipment, etc (unless, of course you're principal of a private group).

I agree with Radsguy that your attitude is archaic. I've seen a handful of attendings say that, and they're all 60yo+ hardasses who would never dream being seen in the hospital not wearing a buttoned whitecoat.

[Austere]

ok this has to be a troll right?

lmao @ general surgery being competitive

If it's not FM or Peds or some random IM program, then it's competitive.

[HI_KKM]

I agree with this.

It's the reason why I wouldn't be able to do outpatient medicine because I always want to try managing all of my patient's problems in that one visit even though my time is limited. Leaving loose ends always bugs me. I felt a lot more free to handle multiple problems during inpatient medicine.

that is the beauty of owning a private practice. you can do what you want.

my dad purposely schedules patients so he can take extra time to handle people with multiple complications. no fuks given.

[F23]

If it's not FM or Peds or some random IM program, then it's competitive.

AbrahamSimpsonwalkinwalkoutofbar.gif

[TheJoshuaa]

https://www.youtube.com/watch?v=LhNd...ature=youtu.be

Would this count as derm? (not the most pleasant video)

[Dr. Horse]

You've been an attending for like, what, 1 or 2 years and now you're trying to hold up the standard for how things 'used to be'?

Some years before I started internship, 80hr work wk was instituted. Lots of people grumbled about how can you learn all you need to learn about surgery in 5 yrs with limited hours. Many of my mentors did 120hrs a week. The year after I was an intern, the 80 hr wk was abolished for interns. Now it's 56h a week, no overnight call. I have seen a lack of stamina in the residents since that change. They've never had to power through a 30hr shift on their feet all day. So when they have a rough call night, in the OR all night, the are pissing and moaning about how tired they are the next day, instead of getting chit done like a boss. They just haven't learned how to push themselves, because they haven't had to do it as much.

Shift work is awesome. I don't want to have to deal with the needs of my patients outside my regular work ours.

Good for you. That is just a difference between certain specialties. Surgeons operate on patients and then they own us day and night until the statute of limitations is up. If my patient has a complication, I am not going to pawn it off on one of my colleagues.

The whole reason that physicians are shift workers and clock punchers these days is because they aren't in charge anymore. They're just another input to production like nurses, techs, facility, equipment, etc (unless, of course you're principal of a private group).

I may not be in charge of the hospital or "my" staff, but I am still in control of how I take care of my patients.

I agree with Radsguy that your attitude is archaic. I've seen a handful of attendings say that, and they're all 60yo+ hardasses who would never dream being seen in the hospital not wearing a buttoned whitecoat.

u mad I wear a buttoned up white coat in clinic?

[Radsguy]

You've been an attending for like, what, 1 or 2 years and now you're trying to hold up the standard for how things 'used to be'? Shift work is awesome. I don't want to have to deal with the needs of my patients outside my regular work ours.

The whole reason that physicians are shift workers and clock punchers these days is because they aren't in charge anymore. They're just another input to production like nurses, techs, facility, equipment, etc (unless, of course you're principal of a private group).

I agree with Radsguy that your attitude is archaic. I've seen a handful of attendings say that, and they're all 60yo+ hardasses who would never dream being seen in the hospital not wearing a buttoned whitecoat.

You must spread some Reputation around before giving it to F23 again.

[Dr. Horse]

A perspective from someone in internal medicine:
\
http://thehappyhospitalist.blogspot....tions-for.html

[ViktorFrankl]

A perspective from someone in internal medicine:
\
http://thehappyhospitalist.blogspot....tions-for.html

Just below that, they mention compliance with the duty hours. I'm sure it exists at some programs. Sure as chit doesn't exist at our gen surg program (1st hand knowledge) and doesn't at 3/4 of the medicine programs I'm looking at (2nd hand knowledge). I think there's something to be said for volume and repetition, but I think there's also something to be said for having time to actually read

[incomingbrOMS]

Wanting to work shifts and being uninvested in patients are not mutually exclusive.

[Dr. Horse]

Wanting to work shifts and being uninvested in patients are not mutually exclusive.

In some specialties it is. Brb knee deep in a motherfukker of a case, but my shift is up- will hand off to relief surgeon.



edit: just realized u probably did a unntentional double negative. So technically I agree with your statement, I guess.

[Radsguy]

A perspective from someone in internal medicine:
\
http://thehappyhospitalist.blogspot....tions-for.html

Yeah I'm sure admitting 100 people with AKI on CKD instead of 50 will make a hospitalist incapable of managing it. There's no good objective data to support the notion that the new duty hours have compromised patient care. This is all just a bunch of butthurt doctors mad because "It's not how it used to be". Maybe we should go back to the days of the surgical intern scrubbing in after 48 hours straight of no sleep because that's safe. While we're at it, we'll bring bloodletting back.

[veggie530]

I obviously appreciate what nurses do, but they sure know how to rustle your jimmies.

http://www.slate.com/articles/health....html#comments

I'm pretty sure your average student/resident gets bulled by nurses way more often than nurses get bullied.

I just happened to stroll in at the right time so I'll comment.

Nursing is a female profession, through and through. I'm one of the 7% male nurses that make up the profession and it's my personal viewpoint that most nurses poison their own profession.

They whine, bitch and moan at every available opportunity -- stab each other in the back and refuse to settle things "like men," i.e., face to face and professionally. If a doctor "bullied" me I would be in his grill about it (my job is not worth my dignity), and I think I portray that attitude all the time -- never had anything but positive interactions with all physicians, even the godly neurosurgeons and cardiothoracic surgeons.

I am not surprised at all that nurses would pen such a piece as the one you linked. Instead of having a spine and standing up to a physician like a human being they allow themselves to be treated like children and then complain like them, too.

Thanks for rustling my jimmies before a 3x12 weekend on nights.

[Berkush]

Advice on med school applications as they open today and advice on schools to apply?

Credentials:
Mcat - 33
GPA: 3.904 Biomedical Engineering
Clinical: 100 hrs volunteer, 50 hours shadow, personal care attendant (job)
Research: 1 year experience, 3 posters, 1 published journal paper
Leadership/Volunteer: Have a lot (founder, internal relations chair, service chair)

[Hardlifter9]

Some years before I started internship, 80hr work wk was instituted. Lots of people grumbled about how can you learn all you need to learn about surgery in 5 yrs with limited hours. Many of my mentors did 120hrs a week. The year after I was an intern, the 80 hr wk was abolished for interns. Now it's 56h a week, no overnight call. I have seen a lack of stamina in the residents since that change. They've never had to power through a 30hr shift on their feet all day. So when they have a rough call night, in the OR all night, the are pissing and moaning about how tired they are the next day, instead of getting chit done like a boss. They just haven't learned how to push themselves, because they haven't had to do it as much.



Good for you. That is just a difference between certain specialties. Surgeons operate on patients and then they own us day and night until the statute of limitations is up. If my patient has a complication, I am not going to pawn it off on one of my colleagues.

I may not be in charge of the hospital or "my" staff, but I am still in control of how I take care of my patients.



u mad I wear a buttoned up white coat in clinic?

So essentially being tortured by abnormally long hours during your prime time living is good because it "hardens" you up?

[SurgeonBrah]

So essentially being tortured by abnormally long hours during your prime time living is good because it "hardens" you up?

Really there are a bunch of slack-jawed *******s around here. I swear it is a generational thing, with everything being at the touch of a button, click of a mouse, wave of a credit card life is easy...

Well let me tell you something, life, as a doctor, isn't ****ing easy.

It is hard work. It is long hours. It is staying well after you have stopped being paid to make sure bloods have been checked, corrected and ordered for the following day.
It is getting up at 530 every day to be at work by 630 to make sure lists are updated, sick patients are checked and theatres are properly booked.

It is pushing through 50 patient clinics before lunch without a break for food because you only have this afternoon operating slot in the next two weeks to do the radical neck dissection on the old 76 farmer with metastatic SCC of his scalp. It doesn't matter that he smoked like a chimney, or spent all his time in the sun, on a tractor, not wearing sun protection. You do it because if you dont, he will die a horrible slow painful death. Suffering.

It is accepting that their will be a significant portion of your life that will be dictated by the needs of others (namely your patients) rather than yourself... ( As I typed this I have had two calls from the hospital regarding patient orders...)

If this doesn't sound like something you can handle, my best advice is get out now. Medicine is not a job you can blow through, hating coming to work but doing it for the money, prestige etc etc... Too many medics will take their own lives because of the stress that the job causes, starting out on the wrong foot must surely turn those odds even more against you...

If you can handle the pressure, the long hours, the sacrifice you will be rewarded beyond your wildest dreams.
To see the faces of patients who were for all intents and purposes dead, alive and well, thanking you is such a great feeling you cannot comprehend it until you have it for yourself.

To laugh and joke and have the camaraderie of colleagues that have gone through the same rigorous training as you is to form friendships that last generations.

To be able to travel the world, and use the skills that you have earned through such hard training to help those that would otherwise never stand a chance.

To sit back at the end of each day and realise that you have actually made a difference to someone else, that is worth working hard for.
That is why we do medicine.

[Geoloop]

^^ tl;dr and my shift is almost over so see you *******s on monday.

[incomingbrOMS]

In some specialties it is. Brb knee deep in a motherfukker of a case, but my shift is up- will hand off to relief surgeon.



edit: just realized u probably did a unntentional double negative. So technically I agree with your statement, I guess.

I wasn't intentionally trying to be annoying, I just am. And I don't see shift work as having a place in surgical fields. Because in the scenario you presented, a good surgeon might spend 4-5 hours finishing up that one case while being 'off the clock'. That doesn't make sense.

I don't see shift work having a huge place beyond hospitalists/ER/rads maybe. And if/(hopefully when) I am a hospitalist would I personally stay an extra hour or two past my shift (without pay) to tie up loose ends and provide better care to the people on my floor? 100% yes.

[Dr. Horse]

So essentially being tortured by abnormally long hours during your prime time living is good because it "hardens" you up?

Was typing out a long response, but then realized surgeonbrah already said what I was saying so...

Really there are a bunch of slack-jawed *******s around here. I swear it is a generational thing, with everything being at the touch of a button, click of a mouse, wave of a credit card life is easy...

Well let me tell you something, life, as a doctor, isn't ****ing easy.

It is hard work. It is long hours. It is staying well after you have stopped being paid to make sure bloods have been checked, corrected and ordered for the following day.
It is getting up at 530 every day to be at work by 630 to make sure lists are updated, sick patients are checked and theatres are properly booked.

It is pushing through 50 patient clinics before lunch without a break for food because you only have this afternoon operating slot in the next two weeks to do the radical neck dissection on the old 76 farmer with metastatic SCC of his scalp. It doesn't matter that he smoked like a chimney, or spent all his time in the sun, on a tractor, not wearing sun protection. You do it because if you dont, he will die a horrible slow painful death. Suffering.

It is accepting that their will be a significant portion of your life that will be dictated by the needs of others (namely your patients) rather than yourself... ( As I typed this I have had two calls from the hospital regarding patient orders...)

If this doesn't sound like something you can handle, my best advice is get out now. Medicine is not a job you can blow through, hating coming to work but doing it for the money, prestige etc etc... Too many medics will take their own lives because of the stress that the job causes, starting out on the wrong foot must surely turn those odds even more against you...

If you can handle the pressure, the long hours, the sacrifice you will be rewarded beyond your wildest dreams.
To see the faces of patients who were for all intents and purposes dead, alive and well, thanking you is such a great feeling you cannot comprehend it until you have it for yourself.

To laugh and joke and have the camaraderie of colleagues that have gone through the same rigorous training as you is to form friendships that last generations.

To be able to travel the world, and use the skills that you have earned through such hard training to help those that would otherwise never stand a chance.

To sit back at the end of each day and realise that you have actually made a difference to someone else, that is worth working hard for.
That is why we do medicine.

...this.

"hardening" up the interns isn't about hazing them. It's not like O-chem as a "weeder" course. It is preparing them for real life. Being a surgeon (yes even a nose-picking one) is hard work. Now that I'm out of training, the "big" salary doesn't seem that big anymore. It is difficult and stressful and we are not overpaid in the slightest. The stresses of medical school and residency are laughable by comparison. Am I generally less sleep-deprived now? Yes. Was it still WAAAAAAY easier then? Yes.

[anonymous]

Some solid discussion going on here atm. Would definitely like to hear insight from the attendings on the medical side of things (swim, getz, etc.).

That being said, I want to pose an unrelated question: What electives do you brahs think are "mandatory", or close to being so?

I think Rads and ER are up there, but would appreciate insight on others as I piece together my elective year. I definitely want to refine/solidify my fund of knowledge in 4th year but also explore the electives that I'm interested in pursuing via residency/fellowship.

[Radsguy]

Really there are a bunch of slack-jawed *******s around here. I swear it is a generational thing, with everything being at the touch of a button, click of a mouse, wave of a credit card life is easy...

Well let me tell you something, life, as a doctor, isn't ****ing easy...

lol

Wanting to sleep 8 hours a night, work 8-5 at a job where I'm doing something meaningful, have time to go to the gym every evening and hang out with friends and family, and make a good living while doing so makes me a slack-jawed *******.

You're just mad that people in fields like radiology, dermatology, radiation oncology, and others will make more than you while having done 50% of the work. And before you go on with the whole "saving lives" plug, IR guys save lives by embolizing bleeds, dermatologists save people from dying from cancer, ophthalmologists prevent people from going blind, and radiation oncologists often cure cancer, so don't try to act like you gotta be a surgeon to make a difference. Sorry bro, it was your choice to become a surgeon.

[HI_KKM]

Yeah I'm sure admitting 100 people with AKI on CKD instead of 50 will make a hospitalist incapable of managing it. There's no good objective data to support the notion that the new duty hours have compromised patient care. This is all just a bunch of butthurt doctors mad because "It's not how it used to be". Maybe we should go back to the days of the surgical intern scrubbing in after 48 hours straight of no sleep because that's safe. While we're at it, we'll bring bloodletting back.

don't EU *******s work 40 hrs a week with tea time?

how do they do it?

BrocepCurls GTFIH

i guess their system lets them work a lot longer before they get good

[zonee2k]

Ok wrote a huge ass post, accidently went back a page. FML.

I will just leave this here; so many rustled jimmies on this page. Now me included.

[BrocepCurls]

don't EU *******s work 40 hrs a week with tea time?

how do they do it?

BrocepCurls GTFIH

i guess their system lets them work a lot longer before they get good

48 hours max working week set by EWTD, you can opt out if you want to work more and I'm assuming many in surgical specialities do that (or are pressured by seniors to do so, discretely). So officially it's 48 but in reality a lot of docs esp in the difficult specialities will do more one way or another. There are concerns about the loss of working hours/amount of training still and i think there may be some new proposals to extend it somehow but not sure of the specifics, Im just a dentist who tightens braces 3 days a week to pay for my maserati