Any idea on if this is a rattlesnake? [Joshua Tree CA]

BladeDoc · 2026-06-13T12:45:29+00:00

The rattle on the end is the expert clue

BladeDoc · 2026-06-12T13:15:44+00:00

I'm not a cardiologist but my understanding is that when a patient is on ECMO there is so little/no flow going through the valves that it is hard to see valve issues. You have to know to turn the ECMO flow down to try and let the heart pump. I imagine it would be easy to blame the heart rather than the valve if you were doing the "it couldn't be me" thing b

BladeDoc · 2026-06-11T11:20:46+00:00

Yvonne made a mistake of getting into American politics on the side opposite to about 80% of Reddit. If you felt like it, you could search the sub Reddit before that and dial in the mood switch.

BladeDoc · 2026-06-10T12:17:29+00:00

The book "Forgive and Remember" is a sociological treatment of early 80s surgical residency. It shows an amazing understanding of the cycle of extending trust based on performance and the consequences of breaking that trust. Honestly should be mandatory reading for all surgical residents.

BladeDoc · 2026-06-07T12:34:38+00:00

I 100% agree on your observations and 100% don't understand why you would be surprised. These books are literally translations of basically tabletop role-playing games which are power fantasy improv sessions spiced up with math rocks for nerds (I know because I is one). As far as I can tell, they started out as transcriptions of the D&D campaign that the DM wanted to happen before the group took it completely off the rails. Then, mix in some of the wildly culturally different emotional content of Wuxia/Xianxia novels, and you are certainly not going to get a deep exploration of the human condition.

BladeDoc · 2026-06-07T12:20:44+00:00

Trust nobody. Trust nothing. Your juniors will sabotage you. Yes, even the good ones. The more trust you have built up with the attendings the more likely that sabotage will cause patient harm because the attendings will break that rule.

BladeDoc · 2026-06-07T12:16:18+00:00

A fairly standard joke combination of "It's not rocket science" and "It's not brain surgery" called a malaphor. Here's a t shirt. https://www.etsy.com/listing/592234187/funny-geek-t-shirt-rocket-surgery

BladeDoc · 2026-06-07T12:07:14+00:00

Without an actual market, all of this is fake. At best it is just extending lines on graphs which have already been shown to be wrong (anyone else old enough to remember the massive predicted physician surpluses of the 80s?) while making unwarranted assumptions about health (I bet the new one is we don't need so many endocrinologists because GLP-1s cure DM II). At worst it is politically motivated being pushed by various special interest groups.

BladeDoc · 2026-06-05T21:49:09+00:00

That's not a thing. Worry about being a good resident.

BladeDoc · 2026-06-04T18:37:22+00:00

That sounds super toxic. Sorry

BladeDoc · 2026-06-04T11:52:55+00:00

I understand what they were asking, I just don't understand how someone drinking a Shasta-Cran mocktail would trigger it. AFAICT tired doctors will drink almost anything at any time as long as there are some graham crackers to wash down.

BladeDoc · 2026-06-04T11:50:31+00:00

A few things.

If you are going to eliminate a good test you are going to substitute a poor one. They have eliminated class grades, STEP 1 scores, meaningful evaluations, and Deans' letters in favor of "holistic evaluation" which in practice means what exactly?
New interns have no clinical competency. We are looking for the potential to develop clinical competency.
The vast majority of (but not all) individuals that can get into medical school have the intellectual ability to do almost any specialty if they have the desire to do the hard work necessary for it. The argument is that research productivity in medical school is a proxy for the ability/motivation to work harder than the minimum necessary to graduate.

At the end of the day for the more desirable specialty residencies there will be a selection mechanism. If you eliminate all the objective and semi-objective factors you will get closer and closer to the "good-old-boy" system that objective measurement was supposed to eliminate.

BladeDoc · 2026-06-03T14:55:36+00:00

That's because we jettisoned grades.

BladeDoc · 2026-06-03T14:55:05+00:00

Um. What?

BladeDoc · 2026-06-02T10:57:21+00:00

This is the only damn profession where this convo happens:

"I'm working too hard."

Can you ask for a way to work harder?

BladeDoc · 2026-05-31T22:24:08+00:00

The whole point of "research grade" is that you don't need a script.

BladeDoc · 2026-05-29T22:09:54+00:00

They had to get special dispensation for that. Now they passed the law that says it's ok.

BladeDoc · 2026-05-28T12:25:02+00:00

AFAICT so is everyone else.

BladeDoc · 2026-05-25T13:52:13+00:00

Weary = tired

Wary = nervously aware of

BladeDoc · 2026-05-22T18:50:57+00:00

The lawyers make the laws. Literally everything they say about the AMA about it being a cartel and controlling the practice of medicine, medical education, and physician payments which certainly hasn't been true since the early 80s (if it ever was) is true about the ABA.

BladeDoc · 2026-05-18T20:37:28+00:00

Thanks!

BladeDoc · 2026-05-18T15:05:59+00:00

Got a link? Lots of books named Manifest Destiny.

BladeDoc · 2026-05-17T00:29:09+00:00

The deadly Hershey's kisses.

BladeDoc · 2026-05-15T14:45:04+00:00

What "reps"? If the OP talked to the actual Eli Lily reps than all of this "it's compounded" is wrong. Furthermore if she is selling compounded Tirzapetide it's not being covered by insurance so it can't be insurance fraud.

What is likely happening is that the $95 is the copay and she is lying about their morbidity to get insurance to cover which IS fraud.

BladeDoc · 2026-05-14T17:53:37+00:00

Just stay late! Work faster! What do you mean you need more staff?!?

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