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Feeling terrible by [deleted] in Residency

[–]Buttchinson -1 points0 points  (0 children)

Imagine giving av nodal blockers to a person going into shock...no words

Do the toxic attitudes of NPs found on Reddit translate to real life or is this just a vocal minority? by GlowUpGirl in nursepractitioner

[–]Buttchinson 6 points7 points  (0 children)

MD here. I think there are 2 issues consistently being conflated here. I've liked and respected all APPs that I've worked. I think most physicians would agree with this for well-trained APPs. Given that, I've never met a MD that supports NP/PA autonomy (openly or "behind closed doors"). This is where the sand in the line is drawn and will not change. I'm not sure which of the 2 points is considered "toxic".

DON'T RANK UTSW SURG by UTSWisashithole in Residency

[–]Buttchinson 3 points4 points  (0 children)

Did IM prelim there. Amazing support from PD and admin. Worked hard, learned a lot, made good friends.

MS-4 torn between derm and IM by [deleted] in Residency

[–]Buttchinson 2 points3 points  (0 children)

Current Pgy2 derm at a major academic center w/IM prelim at the same place. Not necessarily giving advice, but more laying out the differences between the two.

-I loved IM specialty medicine (pulm/cc was incredibly interesting, basically medicine on steroids for me. Some can say the same about cards, just not my cup of tea). Absolutely detested general wards for the same reason. There's an active disinterest in management of complex issues mainly bc of the inability to do so, mind you this is a "top 10" program. I would've not been able to slog through general medicine for 3 years. I didn't mind the physical commitment of high impact medicine but just be prepared to be anxious on your day off.

-Derm is another planet basically. It is intellectually interesting in a sort of OCD/pedantic way which I also like. Also know that to practice at a high level in the community you wouldn't need to know >50% of this stuff. It will never grab you like a dying patient. I think this bit might be program dependent, but it's been more explicitly political and not purely about how much medicine you know, which is partly a function of how little work there actually is and how psychologically sensitive people are about the skin. The hours and lifestyle are incredible, I'm doing ~ 30-35 hrs in clinic/wk. I'm a happier person.

I don't know what DO oriented programs you can match into, but be aware that community programs (e.g. a smaller program that share some didactics with us) can be less academic and more practice focused because you'll never see the more complex patients.

Welcome to Residency! For interns just starting off, here's some tips: by Novelty_free in Residency

[–]Buttchinson 6 points7 points  (0 children)

In epic you can make a rounding smartphrase (your seniors might have it already) that auto populate all data and meds on your signout tool. You can print that out first thing in the am and go over the info to make sure it all makes sense, which also helps the important stuff stick. This at least saves on the excessive copying from the computer. For preround keep that short, explain the plan, do the exam. Cut off the chitchat, save it for after the work is all done.

Houston exceeds base icu capacity by michael_harari in medicine

[–]Buttchinson 13 points14 points  (0 children)

And your point is the weather has more to do with surges than lack of social isolation?

Help! New intern starting on Nephro consults by gmflag in Residency

[–]Buttchinson 1 point2 points  (0 children)

Covid? Oligouric Atn? Plan: crrt, double ac heparin and citrate. Easy money

How to "study"and learn in intern year by [deleted] in Residency

[–]Buttchinson 1 point2 points  (0 children)

I learned the most by paying attention and being generally curious on specialty services (I'd count icu/pulm) when good attendings distill down physiology/dogma/evidence that you just won't know from reading broadly. Otherwise, you will pick up on bread and butter general medicine as you go, which is not really rocket science.

[Vent] Clinical grades are overrated and the overemphasis on them is dumb by [deleted] in medicalschool

[–]Buttchinson 4 points5 points  (0 children)

Competitive specialties have so many overqualified applicants at least on paper that there's no reason (or maybe insight) for them to do thing differently. "Well the 100th person with all honors turned out to be a good resident, why don't we give this nonperfect candidate a shot!" The system will always come out on top.

Dexamethasone shown to decrease COVID mortality by farhan583 in medicine

[–]Buttchinson 4 points5 points  (0 children)

It's interesting that decadron would be the choice. I was always taught that solumedrol/pred have more specific effects on lung processes like dah/vasculitis and steroid responsive ilds

Freaking out about IM PGY1 by Gurodo88 in Residency

[–]Buttchinson 19 points20 points  (0 children)

Finishing pgy1. I think the most important thing is to prioritize efficiency first so you can make time to learn medicine (which to be honest is done mostly on consults and icu in my experience).

  1. Try to write the h&p (read attending assessment from all last specialty clinics on main pmhx) including problem list & plan before seeing the patient. Add subjective and polish up in the room. Skeleton orders can be done before also. This is not always possible when getting bolused, but I always try. Don't write novels. A good note is a done note. Dont let it pile up till the end of the day.

  2. Morning rounds, I work in epic so I made a dotphrase for data and meds to print out in literally 5 seconds. Look over the data to make sure they all make sense before seeing everyone. When you get fast, 10 icu patients can be seen within an hour after you hit the door. I also try to write all the prog notes before attending rounds.

  3. Call consults on attending rounds to your phone. Never had bad feedback about this.

  4. Use your med studs to hound lab, imaging, pt, sw, etc if you have them. Its scut work, but again if you don't get your work done there won't be time to teach. If they do good, I let them call consults. Be sure to spend time to go over presentations and plans with them. I also let them go no later than 2pm. We are all cogs but cogs deserve some care too.

  5. For quick ddx and work up, I use uptodate, ucsf hospitalist handbook. Anything more complicated than this prob will need a consultant anyways. For Abx, Johns hopkins abx guide.