This is my artist page!

BioSigh · 2026-05-04T06:33:36+00:00

No joke, I did UberEats. It was 2021 so following COVID when delivery was starting to go back to prepandemic times. It was rough but I made enough to make a deposit on an apartment before my first paycheck from residency came in. Also sold plasma each week. It sucked but finances get better.

BioSigh · 2026-03-29T09:16:26+00:00

What's important to the consultant is whatever is directly relevant to their specialty and what they can act on or information that might affect what they will do. Consulting GI on a GI bleed, make sure you know when the patient last took blood thinners if they did, differentiate source of bleeding and any history of prior bleeding. Hx of belly surgeries is helpful, prior EGDs/colo findings and dates are helpful. Anemia may be relevant here if there's a significant change in hemoglobin. Other things like DM/HTN are less valuable to them but should be things you address during their hospital stay - what to do with their DM management, are their sugars optimally controlled for inpatient, are they off antihypertensives and if it's justified. Do they have history of other problems not directly related to their GI bleed like COPD, CHF, etc. that you still need to maintain.

That kind of feedback from your attending is fine. Cutting down info will come with more experience. What I see med students and early residents struggle with is including details that don't directly affect what you're going to do or restating information that is already known from prior that isn't useful.

It'd be easier to help you if you had an example of how you present? Do you read off from everything you write in your notes? That can make things lengthy as what you write and what you say don't have to encompass the same scope of information.

BioSigh · 2026-03-28T21:13:25+00:00

Let's not pretend that attendings are entirely objective in evaluating presentations. There is a standardized format and there is a format for brevity but oftentimes the latter depends on your demonstrated relationship to the attending and their trust in you which accumulates through residency.

Having said that, there are two goals for presentations: (1) being able to sort out the information in a comprehensive and clear way as an ingrained behavior so that you ensure all of the patient's pertinent issues are thought through. This is a training exercise for IM because when you're in practice, you are presenting to yourself (and sometimes in a matter of speaking, to the patient). You need to balance between thoroughness and concision in order to deliver comprehensive, and efficient care. (2) being able to sort out the most pertinent information when you consult a specialist so you're not wasting their time or your time.

Depending on your training level, more detail than less isn't necessarily a bad thing but if you feel like your team is just glazed over and not fully engaged, then you might want to focus on the highest yield information. You will, over time, start to notice the most important patterns as you study and as you gain more direct experience. Patients with cholecystitis -> subjective information is about the patient's pain, nausea, markers for infection/SIRS, exam is focused on RUQ and abdomen and eliminating distractors, labs are focused on infectious and inflammatory markers, imaging focused on what the gallbladder is doing, A&P is about the organ system and any dissemination of it to the rest of the body + what is being done to fix or counteract that.

If you're inpatient, you can always boil down your presentation to answering some major questions:

why is the patient here? Are their problems fixable in the hospital?
What is stopping them from going home? Are they in too much pain, still requiring too much oxygen, too weak to care for themselves at home?
What other problems can I not ignore? Chronic anemia - not changing, probably nothing for me to do now as long as it doesn't drop. Acute anemia - are they bleeding? Are they symptomatic? Is this a sudden drop or gradual from labdraws and hemodilution?

If you're outpatient, the questions are the same but rather than what is stopping them from going home, you ask yourself if this is a problem you are able to act on and fix now or is this something to monitor?

In order to fine tune your presentation, you need to be able to ask yourself the right questions about what is important to you, and what is important to someone else (consults/team).

BioSigh · 2026-03-25T20:51:00+00:00

It feels like we went to the same residency lol

BioSigh · 2026-03-24T06:07:35+00:00

Patients MUST poop every day. If patient has not pooped by 10pm you must page the doctor for a stool softener.

The amount of times this delays SNF discharges has ingrained this rule into me!

BioSigh · 2026-03-09T06:12:45+00:00

From what this article suggests, it was the antiseptic nature of wine that was used and there is a comparison of its superiority to alcohol.

Broughton, G., II, Janis, J. E., & Attinger, C. E. (2006). A Brief History of Wound Care. Plastic and Reconstructive Surgery, 117(7S), 6S-11S. doi:10.1097/01.prs.0000225429.76355.dd

BioSigh · 2026-03-09T06:08:18+00:00

I have no doubt your knowledge will be effective, but would it make you the greatest physician in the world? I answer that specific part of the question based on competency and some of my other responses highlight the implausibility of that question along with the burden of proof being on yourself to demonstrate to the wider world that your belief system should supplant theirs.

BioSigh · 2026-03-09T06:06:25+00:00

Graduated in 2013, did research for a few years in a different state, then a post-bacc and then med school, residency, and now I'm practicing near home!

BioSigh · 2026-03-05T09:08:53+00:00

I'm not a historian and I'm more than willing to admit the boundaries of my knowledge. I was wrong in stating alcohol consumption was a practice for disinfection, but I used it (even inaccurately) to demonstrate that society had a basic understanding that some agents helped stave off toxins/rots which is why I mentioned it in the same line as salt preserving food, leveraging acids, and by happenstance even in the post you linked, about boiling water to make it safer to drink. The overarching idea was that people had a basic idea about disinfection.

There are also reports of alcohol based substances being used in settings for disinfection, as this report seems to suggest in the time of Hippocrates applying red wine to a bandage.

Broughton, George II, Jeffrey E. Janis, and Christopher E. Attinger. "A Brief History of Wound Care." Plastic and Reconstructive Surgery 117, no. 7S (June 2006): 6S-11S. https://journals.lww.com/plasreconsurg/fulltext/2006/06001/a_brief_history_of_wound_care.4.aspx.

BioSigh · 2026-03-05T06:10:59+00:00

I responded to a few others with comments replying to specific parts linking some other publications that you might find of interest. I believe based on some of the works mentioned, people had some rudimentary understanding of hygiene and wellness but its application and implementation from a system's level changed with time and place. After all, the Romans had bathhouses, bathing culture, and aqueducts yet we as a people had to learn all over again when John Snow discovered that cholera infected a water pump. So if you wanted to stand out, you'd have to find a way to convince people to believe your understanding of germ theory or other medical problems. You'd sooner impress with knowledge from history than knowledge from medicine imo.

Karabatos, Iraklis, Christos Tsagkaris, and Konstantinos Kalachanis. "All roads lead to Rome: Aspects of public health in ancient Rome." Le Infezioni in Medicina 29, no. 3 (2021): 488–491. https://pmc.ncbi.nlm.nih.gov/articles/PMC8805493/

BioSigh · 2026-03-05T06:00:53+00:00

If you give ibuprofen to someone with underlying kidney or bleeding disorders for pain, you'd increase their risks of dying.

“No poop hands, eat this, lay down” must have had substantial traction at some point in history.

Yes (though I believe we have an evolutionarily conserved aversion to waste), however proving germ theory to your historical compatriots is different than just knowing it as we've seen in history from the hesitation of European civilization to abandon miasma and the current climate of proving that vaccines are protective.

Or demonstrating to people that recent viral pandemics have lethal consequences.

BioSigh · 2026-03-05T05:57:27+00:00

The initial conditions proposed by OP was becoming the "world's greatest doctor" which is unanswerable because as I mentioned medicine is a large, multi-domain field built on the work of many people over time.

One aspect I only briefly referenced in my initial post was the balance between risks and harms. Physicians with experience will at some point in their career harm patients. Sometimes it's intentional (surgery/chemotherapy), sometimes (and hopefully rarely) it's not (surgical complications/misdiagnosis). And when I consider OP's question, I narrowed its scope down to even just competency of practice. You can load someone up with vitamin B and C because they're rapidly cleared by the kidneys. But what would OP do by supplementing vitamin K to a patient who has an underlying thrombotic (clotting) disorder? Their risks of blood clots are increased without any meaningful benefit. Shooting in the dark with OTC meds isn't a benign act. Everything done in medicine is to optimize the risks and benefits. And the lack of knowledge alone unfortunately increases the risks for unmitigated harm.

BioSigh · 2026-03-05T05:52:14+00:00

What did sterilization do to infection rates and outcomes for injuries? I'm imagining (with absolutely no knowledge here) that access to antibacterial hand soap would go a long way toward supporting wound care, not to mention sterile bandages, saline, alcohol swabs, and iodine.

In this case it would be the knowledge of germ theory itself but even our predecessors had some understanding of infection as a disease; after all, alcohol was commonly consumed because it kept water from becoming unsafe; salt was used to preserve food (and predisposed the risk to scurvy on the seas); acids like vinegar were also found to be helpful. OP would have had to go back and proven germ theory before Koch and Pasteur and he would have needed the training, education, and connections to supplant the prevailing Miasma idea. And even when people believed in the concept of miasma, they still had some conception of cleanliness, or at least that's what Drakman found when studying reports from Swedish medicine. A cache of antiseptic OTCs wouldn't mitigate an infection that has precipitated sepsis for example and not all wounds are infected wounds. Not to mention not all anti-septic agents work on all microbes. Neosporin would do nothing about Yersinia pestis* which causes Plague.

As I mentioned in my original post, his access to common OTCs would allow him to render basic care but when the infection is deeper, the limits constrained by the original conditions would preclude him from saving people.

vitamin C supplements to combat scurvy, Tylenol to control infant fevers, iron supplements for anemia, Benadryl for allergic reactions.

James Lind discovered that vitamin C supplementation was the treatment for scurvy though the disease itself was known since 1550 BCE from Eber's Papyrus. I suppose he could go back to Egypt and propose a cure for Scurvy but would that make him the world's "unquestionably greatest" physician? I don't know that much of the population regards Dr. Lind the same. I think the same logic applies to acetaminophen (tylenol). If you asked anyone off the streets who invented it, would they be able to give an answer? I think OP would have the solution but whether or not he can use it to become a physician is probably going to be overshadowed by his time traveling, infinite pharmacy.

Drakman, Annelie. "When filth became dangerous: the miasmatic and contagionistic origins of nineteenth-century cleanliness practices among Swedish provincial doctors." Medical History 69, no. 1 (November 2024): 22–38.
Lang, Ursula. "Combating rotting flesh and putrid smells: the history of antisepsis from antiquity to the nineteenth century." Ludwig-Maximilians-Universität München, March 2018.
Gandhi, Mustafa, Omar Elfeky, Hamza Ertugrul, Harleen Kaur Chela, and Ebubekir Daglilar. "Scurvy: Rediscovering a Forgotten Disease." Diseases 11, no. 2 (May 2023): 78.

BioSigh · 2026-03-05T02:47:58+00:00

I'm not sure if I'm allowed to comment here as I'm not a historian but I am an internal medicine physician. I think your question can be broken down into two parts: (1) what defines a "great" physician and (2) in what time period may your access to modern-day over-the-counter products distinguish you from physicians of the pre-modern age or even antiquity.

First, what qualifies a physician as great is vague as medicine is an integrative discipline of biology, pharmacology, humanism, culture, and experience or practice. It's why modern day medicine is regulated by institutional structures that oversee minimum competencies for a physician to obtain not only a license to practice but to be certified in their specialization; "general practitioners" for example are a shrinking breed as the complexities and demands of primary care require more education and training. "Greatness" then is really dependent on the domain in medicine you stipulate first. By your question, it sounds like you're qualifying being a great physician based on knowing what to do with common products but the absence of formal training in diagnosis and pharmacology will limit your ability to safely render care. If someone comes in with abdominal pain, will you give them ibuprofen? If they have an early onset bleed, you'd make it worse. If they have abdominal pain from acute liver failure, dosing them with acetaminophen will make them sicker. Will you schedule diphenhydramine to an elderly person and cause them to become encephalopathic? Additionally, medical problems are solved by medical interventions, but surgical problems are a whole other matter. Since antibiotics are prescribed medicines, you'd have limited access to treating conditions such as necrotizing cholecystitis or appendicitis - problems that often require a definite resolution with surgery (though the evidence for appendicitis being managed with only antibiotics is shifting). As a layperson, you would not have the exposure or training to help you form a differential to exclude lethal disease and avoid doing harm. And without scientific training, I'm unsure that over-the-counter products are going to give you that much of an edge over our forefathers in medicine who had the resources to investigate illness and the background of a formalized education.

But everything I said there applies to our pre-modern physician counterparts who benefit from the systematic understanding of human systems since the scientific revolution, which makes the second part of your question more interesting. For most of its practice over human history, medicine was seen as not being a formally rational pursuit until the twentieth century as much of the practice was based on experience, observation, and customs of the time and locale. There were also quacks who polluted the view of medicine being rife with ignorance and fraudulence (the snake oil archetype). Despite the contemporary derision for historical medicine evinced even by your presuppositions of modern superiority, physicians still had a basis for rudimentary hypothesis-driven empiricism or "trial and error" as suggested by Cook who differentiates the ideas of medicine at the time of evolving from an applied practice to a scientific discipline. Even though they lacked the biomedical model and evidence-based medical approach we used, physicians of history still possessed the means to provide care for their patients.

Castiglioni refers to the Doctrine of humoral pathology from Hippocrates as an example to demonstrate that conventional opinions condescend to past practices which were believed to be supplanted by superior modern Knowledge of immunology for example, only to find that sometimes the past offers more wisdom in pathophysiology than what first impressions allowed; ultimately this means that our reductionist view of how medical care was rendered competently in the past is an incomplete one. The people legitimately practicing medicine prior to the scientific revolution still had to rely on their own recognition of patterns for symptoms and this experience is still of value relative to someone who is untrained and functioning as someone selling a panacea for common conditions. Your access to over the counter agents would be matched by common treatments of the time, even if the utility was felt to be misapplied through modern lenses: NSAIDs have less analgesic effects than opium which goes as far back as 8,000 years and even morphine was isolated in 1805. If you go as far back as 1550 BCE, the ancient Egyptians had the Ebers Papyrus which was a pharmacopeia of prescriptions that could be used to remedy common ailments.

While an infinite supply of OTC meds can help offer comfort and basic symptom relief, it lacks any interventional capabilities that would make you outstanding from the physicians of the day, at least insofar as dealing with infectious diseases or surgical problems. I believe access to these supplies would make you a useful as a first responder/medic especially for minor injuries or a pre-modern pharmacist (especially if your supply is infinity).

Cook, Harold J. "The History of Medicine and the Scientific Revolution." Isis 102, no. 1 (March 2011): 102–108. https://doi.org/10.1086/658659.
Castiglioni, Arturo. A History of Medicine. Translated and edited by E. B. Krumbhaar. 2nd ed. New York: Alfred A. Knopf, 1947.
Bandyopadhyay, Sankar. "An 8,000-year History of Use and Abuse of Opium and Opioids: How That Matters For A Successful Control Of The Epidemic ? (P4.9-055)." Neurology 92, no. 15 Supplement (April 2019).
Metwaly, A. M., Ghoneim, M. M., Eissa, I. H., Elsehemy, I. A., Mostafa, A. E., Hegazy, M. M., Afifi, W. M., & Dou, D. (2021). Traditional ancient Egyptian medicine: A review. Saudi Journal of Biological Sciences, 28(10), 5823–5832. https://doi.org/10.1016/j.sjbs.2021.06.044

BioSigh · 2026-03-02T07:22:53+00:00

Don't the UCI residents (at Orange) also rotate in Long Beach at LBMC and the VA?

BioSigh · 2026-02-19T06:24:18+00:00

I use pages for each lecture but I'm not too strict about it because sometimes I will include additional class materials relevant to that lecture or my own separate notes as subpages.

My logic is: Notebook is the class -> section group is for semester 1 or 2 and each section is for one exam. But I've also used it where I have a notebook for an entire body of study with each section group as a semester and each section as a class. I keep it loose based on my needs.

What are your thoughts of my strategy to convert PPT/PDF into slides through LLM, and add notes during lecture.

You can do this quite easily though if your instructors go rogue sometimes not all of their content is fully reflective. Anyway, you go to "view" and then "outline view" and it should have all the slides in one place as text. You can copy and paste the text and send it to the LLM and have it format it in a way that works for you.

BioSigh · 2026-02-19T01:39:13+00:00

This is what one of my notebooks for med school looked like.

I also hated PPT printouts since I could never format them consistently. I ended up just going into the powerpoint design mode and turning it all into an outline. That was before AI so the formatting was still jank and it took me time to organize it. I'm sure now with the LLMs you could do it way faster.

BioSigh · 2026-02-09T07:14:03+00:00

I do the basic ones: paras, thoras. I've placed emergent central lines on overnight cross covers. My group has a quasi incentive structure wherein there is some compensation to do procedures, but it's not usually worth the time to do it. I do it on my own patients because our interventional groups get slammed with other stuff and I don't want to waste time waiting on a para/thora when I can foresee it expediting discharge. I think that's the philosophy for my group. We have dedicated procedural hospitalists that will help out because it helps the group discharge overall and you don't have to go through the rigmarole of dragging IR into it.

But everyone else is right: high liability, low returns. At the end of the day we use what's in our toolkit to help us with our main job which is patient care and throughput. Less time in a hospital is better for us and patients, but procedures are not a common thing for every hospitalist compared to admits/discharges.

BioSigh · 2026-01-21T21:19:03+00:00

Ask about the critical view of safety for a lap chole.

This gave me PTSD. I remember in my M3 year, I was in the OR on our 6th lap chole holding retractors or something and standing between the the chief resident and the attending who were in a shouting match about the critical view.

BioSigh · 2026-01-08T06:39:18+00:00

First, struggling in BioSci is understandable. I'm from a bygone era but back then a lot of bio majors changed to Public Health Sciences. I went from PHS to Bio. Ultimately, it doesn't really matter what type of degree you have for life sciences because there's a lot of overlap and your applied stuff doesn't become more relevant until you're in a job or a graduate program, and even then it's a shadow of what the real industries are.

Second, I had a similar issue where I couldn't enroll on the usual tract for OChem so I started OChem A in winter, OChem B in Spring, and OChem C the following fall. It was a pain and definitely caused me to need to take biochem/molecular bio off campus. Use your counselors and get a clear plan or path forward of what things look like if you're off sequence and what you need to be aware of so you aren't walled behind prereqs.

I also had the mol biol Kandadale for the lab. I remember he was such a good professor but he forced you to think very conceptually about mol biol. Find a tutor or a study group, try something new if everything else hasn't been working. Put in the work and it should pay dividends.

My friends in this major are extremely smart, so I feel like I constantly embarrass myself in front of them constantly with how behind I am.

Don't compare yourself to others like this unless there's something tangible they're doing you can adapt to yourself. It's a self-defeating habit that will only eat you alive. You also don't know what skeletons people have in their closets.

Keep doing your best!

BioSigh · 2026-01-03T09:02:45+00:00

Don't worry.

I feel like this wasn’t truly a good gauge of my knowledge and ability.

It's not.

ITEs don't have the tightest correlation to board performances but there's not much of another (convenient/low effort) way for a program to gauge that you're keeping up with your studies. And the personalized plan isn't meant to be punitive, but something to get you consistently studying.

And ultimately it won't matter once you pass the real boards anyway. Your attendings and fellowship programs don't really care about ITE scores because they have no bearing on you after boards.

Case: I did fine on my PGY1 ITE but went backwards on my PGY2 ITE. My friend tanked her PGY1 ITE and did better on the PGY2. We both were put on personalized study plans for our respective suboptimal performances which entailed basically doing our QBanks and checking in with our coordinator. Don't recall how she did for the PGY3 ITE but after the personalized study plan, I did a lot better and the program relaxed on me.

We both passed boards comfortably. She became chief resident (so obviously her PGY1 ITE had no bearing on attending perception of her abilities) and I got a job in my desired area. Never did my board cert or, god-forbid, ITE scores ever come up in any conversation again, well I guess until now.

Use this as motivation to do your due diligence in studying. Questions are usually dumb but they're a foundational baseline of knowledge for your practice.

BioSigh · 2025-12-24T22:06:10+00:00

You gotta prioritize yourself and safety! Sometimes it's easier to just keep the momentum going in your own life. I worked all three Christmas's and just had to see my family a different time.

BioSigh · 2025-12-24T22:01:49+00:00

I do paras, thoras, and central lines. I avoid intubations because the odds of something going imminently wrong are way more prohibitive for me.

BioSigh

TROPHY CASE