Misc. Med Thread Vol. 3: caribbean diabetus strikes back

[ViktorFrankl]

In my simple brain it seems like CT > all for initial dx and you should pretty much get one every time.

When should you NOT order a CT? (aside from obvious bone injuries)

You should do EM

[WeekndOrNah]

You should do EM

no thx jeff

[ViktorFrankl]

Anyone here feel any sort of way about the Vitamin C 1500 mg IV q6hrs , thiamine, and 50 mg hydrocortisone IVP Q6hrs used for "septic" patients? I've heard individual stories of it doing work and patients recover well without significant organ damage that seemed likely. I've also heard a lot of respected PharmDs and MDs say not to get on board without further evidence. Curious if any of you have seen much of it.

Marik goes on about highly motivated investigators doing single center trials and getting implausibly positive results, then he goes and does that for his pet topic sepsis. He's a cheeky **** that's for sure. I'm skeptical but w/e there's a multicenter underway so find out soon enough

[MakeABanana]

This is interesting. Can you tell me other pet peeves your radiologists have. What if I order a routine chest X-ray "dry cough x2 months" with no other info. Does that make you brahs irate?

Or how about a routine knee xr "knee pain x 2 months. Atraumatic" but I don't include a r/o so and so?

Hit me with more pet peeves so I can order imagining better.

Those are good, better than what a lot of physicians do. We need symptoms, signs, abnormal tests results, etc., for clinical indications to bill. In addition, you can add your clinical question such as "r/o pneumonia" or whatever but only as long as you include the clinical information that makes you suspect pneumonia in the first place.

[santal0l]

For those applying EM - why?

Old EM docs seem like they always want to kill themselves. IRL they have to see a certain # of pts/shift in order to hit their targets to get a bonus so they're basically slammed their entire shift and have to stay 1-2 hrs afterwards to tie up loose ends, hand off pts or call admits. And theyre always fighting each other for easy pts they can discharge quickly.

The younger guys seem to like ED for the trauma but when **** gets heavy most of the time you end up calling the surgeon anyways so whats the point? ATLS and chest tubes all day?

As for surgery, have fun working all dem hours and making less than the other doctor in the OR. For those applying gas - you'll have about 5 yrs to pay off your loans after residency before the hospital replaces you with a cheaper CRNA lmfao


IM or bust phuckers. If all else fails and I dont get the fellowship I want I'm doing hospitalist with per diem work mixed in for a steady ~$300k anywhere in the country
.

Yeah being a babysitter and having every nursing home on speed dial must be so rewarding.

[DoctorGetSwole]

really hoping I don't fail step 2 cs...

took the other day and in retrospect felt awkward with a few sp's and a couple seemed standoffish in the elevator

rip me

[echoareone]

Just lol at IM; social admits, babysitting other services patients, nursing home placements, fruitless and expensive work ups, ungrateful patients, academic circle jerk medicine, zero hands on skills, just lmao.

Y'all are making me posthumously reconsider my specialty choice.

[WeekndOrNah]

really hoping I don't fail step 2 cs...

took the other day and in retrospect felt awkward with a few sp's and a couple seemed standoffish in the elevator

rip me

I have a graded session with 2 SPs coming up this month. Mind still full of fuk as to how I'm supposed to get H&P done in 15 min + SOAP note in 10 min.

[hyoogmyron]

You didn't counter any of the points I made...Everyone knows IM has a lot of bullchit that goes along with it but every single one of those pts will be seen by an EM doc first along with all the bs coughs and colds and every hobo off the street. Pts will literally come in for toothaches on the weekend

So why EM?

[Glutamine1]

I have a graded session with 2 SPs coming up this month. Mind still full of fuk as to how I'm supposed to get H&P done in 15 min + SOAP note in 10 min.

you'll know the main dx within the first 20 seconds. you'll have a second and third differential within the same time frame. from there it's just asking questions to either rule in/out what you think it is. once you practice you'll see how quickly you do things. ran out of time on my last two patients and still passed.

copy/paste is your friend for the note.

[DoctorGetSwole]

why do you think people fail step 2 cs? still feeling like I failed

[JCTWP46]

why do you think people fail step 2 cs? still feeling like I failed

Cause they have trouble speaking english, or their school put no effort into preparing them for the test.

[DoctorGetSwole]

Cause they have trouble speaking english, or their school put no effort into preparing them for the test.

well this is what I think I screwed up:
felt like at a number of times I wasn't making enough eye contact
thought the interaction was awkward with 2-3 patients
didn't finish exam in one station
ended mid closure twice
inevitably didn't ask all questions
for sure didn't do all exam manuevers and not once did fundoscopy even though it was likely indicated a few times
one note didn't document physical exam well (did last and ran out of time)
3rd diagnosis was weak sometimes
ran out of HPI space so couldn't always write all pertinent negatives
asked some questions several times to reclarify

took the elevator with a couple sp's and they seemed standoffish

[RobParks2M]

well this is what I think I screwed up:
felt like at a number of times I wasn't making enough eye contact
thought the interaction was awkward with 2-3 patients
didn't finish exam in one station
ended mid closure twice
inevitably didn't ask all questions
for sure didn't do all exam manuevers and not once did fundoscopy even though it was likely indicated a few times
one note didn't document physical exam well (did last and ran out of time)
3rd diagnosis was weak sometimes
ran out of HPI space so couldn't always write all pertinent negatives
asked some questions several times to reclarify

took the elevator with a couple sp's and they seemed standoffish

Did you tip them though?

[kovalchuk71]

Residency brahs, how much information from your medical school years do you actually remember once residency begins? I'm only an M1, but I feel like so much of the information I have to learn is just getting dumped out of my brain after the exam. Is this normal?


We also started systems at the beginning of the month. Do you all think it would be a good idea to start hitting Zanki/Bros and just occluding the cards that we haven't gone over yet? Or should I just wait?

[WeekndOrNah]

can someone get me some viagra srs

We also started systems at the beginning of the month. Do you all think it would be a good idea to start hitting Zanki/Bros and just occluding the cards that we haven't gone over yet? Or should I just wait?

I'm a Zanki brah and I would recommend doing the relevant Zanki system to your system. Divide total cards in Zanki system by # of days you have of the course. Just do the cards regardless if you've learned it or not in class.

[kovalchuk71]

can someone get me some viagra srs



I'm a Zanki brah and I would recommend doing the relevant Zanki system to your system. Divide total cards in Zanki system by # of days you have of the course. Just do the cards regardless if you've learned it or not in class.

Thanks brah. It’ll still be worth it even if we haven’t touched the material yet? Wouldn’t you want to have an idea of the concepts before you do the cards?

[WeekndOrNah]

Thanks brah. It’ll still be worth it even if we haven’t touched the material yet? Wouldn’t you want to have an idea of the concepts before you do the cards?

YMMV but it doesn't bother me. It's nice for me bc my classmates will complain about whatever new concept we learned in class but it'll be something that I already learned via Anki.

[echoareone]

dumped out of my brain

Pretty much that.



It's not something worth stressing over. I used to mentally quiz myself intermittently (like when I was trying to sleep, perfect time for it), and see how much random stuff I could remember from basic sciences. Don't be that person.

[JCTWP46]

well this is what I think I screwed up:
felt like at a number of times I wasn't making enough eye contact
thought the interaction was awkward with 2-3 patients
didn't finish exam in one station
ended mid closure twice
inevitably didn't ask all questions
for sure didn't do all exam manuevers and not once did fundoscopy even though it was likely indicated a few times
one note didn't document physical exam well (did last and ran out of time)
3rd diagnosis was weak sometimes
ran out of HPI space so couldn't always write all pertinent negatives
asked some questions several times to reclarify

took the elevator with a couple sp's and they seemed standoffish

Calm down. All you need to do is pass. I didn't feel as if I did perfectly either. Don't stress about it until you get your results.

[MakeABanana]

Residency brahs, how much information from your medical school years do you actually remember once residency begins? I'm only an M1, but I feel like so much of the information I have to learn is just getting dumped out of my brain after the exam. Is this normal?


We also started systems at the beginning of the month. Do you all think it would be a good idea to start hitting Zanki/Bros and just occluding the cards that we haven't gone over yet? Or should I just wait?

To be honest, I've forgotten a lot of it mostly because I don't use that information on a regular basis.

[MakeABanana]

That's good to know. Didn't know you guys like lab results etc. I kinda just assumed you guys glance at the patient's chart if there is any question.

How throughly do you guys actually review cases before the study is done to make sure the correct imaging is ordered assuming its outpatient setting & routine? By default when we order imaging we check "radiologist may change at their discretion". Sometimes i'm on the border if contrast is needed or not so i hope the radiologist changes it if indicated (Assuming recent creatinine is available and we include what we are looking for)

We usually won't heavily dig through a chart especially if it's a straightforward case. For example, if someone has a diabetic foot ulcer and the clinician orders a foot radiograph, I know they're primarily looking for evidence of osteomyelitis so I'll focus on looking for cortical erosion, periosteal reaction, subcutaneous gas, etc.

To be honest, I haven't done rotations in an outpatient imaging center yet so I don't know how the protoco-ling (da fuq is with the censoring in the Misc?) process works. I assume it's likely the way you describe it, at the radiologist's discretion.

[kovalchuk71]

Today sucked. I had a 190 question integrated exam (Histology, Biochem, Physio, Clincial Skills) today and ran out of time. I only got through 183 questions. I’m such a dumbass and am so fuking upset with myself right now. Fukkkkkkk

Sorry, needed to vent.

M1 is hell.

[stevesteve12]

any reason why radiologists dont read ECHOs?

[WeekndOrNah]

Today sucked. I had a 190 question integrated exam (Histology, Biochem, Physio, Clincial Skills) today and ran out of time. I only got through 183 questions. I’m such a dumbass and am so fuking upset with myself right now. Fukkkkkkk

Sorry, needed to vent.

M1 is hell.

pretty sure half my class failed our first Cardio quiz last week. I and a few of my friends BARELY passed (like we scored 71-75%)

lol

[kovalchuk71]

pretty sure half my class failed our first Cardio quiz last week. I and a few of my friends BARELY passed (like we scored 71-75%)

lol

But that’s a quiz.

We talking quizzes. QUIZZES. Not a Test, not a test, but QUIZZES.


Iverson.jpg

[WeekndOrNah]

But that’s a quiz.

We talking quizzes. QUIZZES. Not a Test, not a test, but QUIZZES.


Iverson.jpg

10% of our final grade tho

EDIT: lol i see ur post on reddit. join the r/medicalschool Discord and troll with me

[kovalchuk71]

10% of our final grade tho

EDIT: lol i see ur post on reddit. join the r/medicalschool Discord and troll with me

Shhhhhhhh

[WeekndOrNah]

holy fukking cringe

https://www.instagram.com/_twolittlebears/
she fukkin goes to Ross. apparently got rejected by them the first time around too. been posting pics since pre-med

https://www.instagram.com/premedmotivation/

[kovalchuk71]

holy fukking cringe

https://www.instagram.com/_twolittlebears/
she fukkin goes to Ross. apparently got rejected by them the first time around too. been posting pics since pre-med

https://www.instagram.com/premedmotivation/

Tempted to neg for this. I don’t think I can cringe any harder than I just did.

“Minimalism”....as she posts pictures of different watches/juices/snacks everyday and sips on her hipster coffee. Fuking lol.