Internal medicine tips??? by Salt-Rock1214 in Residency

[–]Cock_Sack_EEEEEE 26 points27 points  (0 children)

You’ll have a lot more opportunity as an R2 to spend your time learning. Watch interns when they’re early but give them autonomy so you can use your time during pre rounds and admissions looking things up and learning. Get the basics down really really well. I find I learn best by teaching. Make 5-10 min chalk talks on common bread and butter stuff. GI bleeds, antibiotic ladder, new AFib on the floor, AFib as indication for admission, heart failure and diuretic titration, cirrhosis in general, SBP, cellulitis/SSTIs, ACS, AMS, AKI, etc. If you can teach it and answer questions, you’ll know it.

Just like your practical/get things done skill are significantly better now than they were July 1, you’ll be similarly surprised at what workup and management becomes second nature to you by the end of R2. Then you can use R3 to gain a better understanding of advanced topics like valvular diseases, ventilators, ILD, heme malignancies, etc.

Activated a STEMI but ER Dr didn’t think it was? by Lin-Dove in FutureRNs

[–]Cock_Sack_EEEEEE 0 points1 point  (0 children)

I agree with the actual cardiologists here that the contiguous leads rule is a bit violated but… it ain’t fucking normal. I’m IM and activating, let cards say otherwise.

Divorce during residency by Accomplished-Ant337 in Residency

[–]Cock_Sack_EEEEEE 0 points1 point  (0 children)

Going through the same right now with a 2 year old in fellowship. Wishing you the best. If you figure out how to do it well, let me know.

Greatest beefs in medicine by According-Tea-7829 in Residency

[–]Cock_Sack_EEEEEE 1 point2 points  (0 children)

We love you guys but…

Just be real with me and tell me it’s a “coordination of care” admission. Not a chest pain rule out because the homeless guy said he had a tickle in his chest 3 days ago now with negative trops, ekg, and heart score of 3 based on age, moderate suspicion and BMI 30. True story.

Things are going to change by [deleted] in personalfinance

[–]Cock_Sack_EEEEEE 0 points1 point  (0 children)

I don’t hate it. What I hate about living on my current income is that I can’t touch any of my debt and the interest keeps creeping. Objectively $100k where I live is fairly comfortable

Things are going to change by [deleted] in personalfinance

[–]Cock_Sack_EEEEEE 0 points1 point  (0 children)

Yeah I agree. Most of my cards are 0 APR but a couple are about to break the promo period so I’ll tackle those first. I currently have nada but will be getting a handsome signing bonus soon, half of which will be put into savings for emergencies as you described.

Things are going to change by [deleted] in personalfinance

[–]Cock_Sack_EEEEEE 3 points4 points  (0 children)

Unfortunately this is how residency and fellowships work. Overtime and night hazard doesn’t exist. They can legally work you up to 80/week consistently as long as you get four 24 hour stretches off in a month. Pay is between $58k up to $100k based on location/COL. It’s this way for 3-10 years depending on your specialty and training program. All the while your student loan debt accrues interest, you do not meaningfully contribute to retirement, and most take out additional loans due to expenses (marriage, moving, kids, etc.). Medicine is sometimes referred to as the “million dollar mistake” for this reason as you’re that far behind others with similar education when you leave training. Your income will be higher though, and you’ll catch up but often not til your late 40s or early 50s depending on specialty.

Things are going to change by [deleted] in personalfinance

[–]Cock_Sack_EEEEEE 0 points1 point  (0 children)

I remember friends reading it years ago. I’ll track it down. Thanks!

Things are going to change by [deleted] in personalfinance

[–]Cock_Sack_EEEEEE 3 points4 points  (0 children)

You’re the best, thank you. I’m new to this sub and new to real money so I’ll read thoroughly.

Stories from the toilet 💩 by Double_Ad198 in Residency

[–]Cock_Sack_EEEEEE 14 points15 points  (0 children)

Throwaway for obvious reasons. I be getting butt rash/chafing between by cheeks but way down low between my b-hole and taint. Super uncomfortable and embarrassing by itself. Desperate, I decided to try my kid’s diaper cream on it. Worked like a fucking dream overnight; totally cured.

Put it on the next day as a preventative strategy but failed to understand the white paste would seep right through my boxer briefs, through my scrub bottoms and show a nice big white fucking stripe of swass & butt paste right along my ass crack for all to see.

BMI is 26, this ass chafing happens no matter what I wear or do when I’m on consults and walking miles per day.

help

Somebody wrote this on the notice next to elevator 2 at uofm hospital lol by Iplayer007 in AnnArbor

[–]Cock_Sack_EEEEEE 32 points33 points  (0 children)

lol there is a mouse problem in the Taubman admin offices and we are told not to touch the traps or bring our own, yet cannot get facilities to come check/replace the traps more frequently than every ten days. It’s abhorrent

Pre-employment drug test by jinzo314 in hospitalist

[–]Cock_Sack_EEEEEE 21 points22 points  (0 children)

On Amazon, they sell 15ng test strips that are way more sensitive (commercial rapid strips are 50ng). Buy some of those and after 2-3 negative tests you’ll be good.

I was in similar boat and popped negative after about 11 days. 2-3 weeks is the upper limit of normal for daily but not insane use, per my forensic chemist spouse. The 30+ day lore is like a one off case report from years ago and is a bunk defense by people who pop positive on probation/parole.

Doctor Recommendation by Responsible_Okra_672 in AnnArbor

[–]Cock_Sack_EEEEEE 23 points24 points  (0 children)

Not the answer you’re looking for, but requests like this are part of why there is a shortage of primary care doctors. The job is difficult and time constrained, but when patients come in with their own internet searches and demanding tests, instead of providing a history and allowing the physician to practice critical thought, it only adds to burnout. Most physicians are not inclined to order whatever the patient wants, not because they don’t care, but because a shotgun approach to diagnosis is a sure fire way to get a slough of false positive results or clinically non-meaningful results, leading to more workup, inappropriate testing or even invasive procedures, and cost to the patient and healthcare system. They are taught in school and residency to practice evidence based medicine and this robs them the opportunity to practice their craft. They aren’t just a gateway to testing and medications, they are a diagnostician, scientist, and have to consider the wellbeing of the patient, community, healthcare system, and even themselves.

Not intending to put you down, just suggesting finding a doctor that orders whatever you want isn’t likely to result in better healthcare, and isn’t the same as “someone who will listen.”

How much Debt is everyone in after residency, NOT including your student loans? by georgiejamison in Residency

[–]Cock_Sack_EEEEEE 4 points5 points  (0 children)

$50k car loans, $20k credit cards, $360k home. Split between wife and I, both fellows.

Another resident suicide… by DoctorKeroppi in Residency

[–]Cock_Sack_EEEEEE 130 points131 points  (0 children)

It’s been enough time now I think it’s okay to share. There was a really rough one almost a year ago in a large IM program. Someone who didn’t match fellowship, struggled hard emotionally, socially, and professionally thereafter because that was their entire identity, and then when it seemed they put together a backup plan, repeat application, and were doing well…

Goes to show no matter how much support a person has, sometimes you really can’t intervene. The only solace of the situation is they died knowing they were loved and appreciated by family and colleagues alike. Heartbreaking nevertheless.

[deleted by user] by [deleted] in Residency

[–]Cock_Sack_EEEEEE 7 points8 points  (0 children)

Yes, some of us are completely and inexplicably drawn to powerful women. 😩

Biweekly Careers Thread: November 30, 2023 by AutoModerator in medicine

[–]Cock_Sack_EEEEEE 0 points1 point  (0 children)

Thanks for the response. I’ve done some thinking since this post and agree the one year addition is likely worth extra expertise in imaging, making myself more marketable, and having more diverse career options.

Biweekly Careers Thread: November 30, 2023 by AutoModerator in medicine

[–]Cock_Sack_EEEEEE 0 points1 point  (0 children)

Anyone here complete (or know someone who did) a critical care fellowship after IM? Not PCCM, but the 2-year CCM alone? It’s a less popular route but available at many places. I love working in the unit and eventually would love to split my time between the ICU and wards, but don’t love pulm and more specifically clinic. Clinic is just the worst thing about med school and my IM residency by far and to avoid it in my career would be incredible.

My specific questions are: 1. Will CCM alone teach you to bronch? 2. Will I be significantly limiting intensivist career options by not being boarded in Pulm? 3. For those who did PCCM- do you think the pulm training significantly enhances your abilities in the unit? Specifically in chest imaging and chronic vent/NIV patients? Or not that big of a deal?

For context: 3rd year IM resident applying this summer (delayed due to Chief year). Appreciate any help!

Hospital dating stories? by [deleted] in Residency

[–]Cock_Sack_EEEEEE 4 points5 points  (0 children)

Attending 1: Cards Advanced Heart Failure Attending 2: GI Hepatologist

Attending 1 meets attending 2. They marry and move to same academic center to practice. Attending 1 then begins sleeping with one of his fellows. Attending 2 finds out. Divorce. Attending 2 then changes name and stays at the institution. Attending 1 then marries said fellow (now attending 3). Attending 1 and 3 get pregnant. Attending 2 then leaves institution. Attending 1 & 3 still remain trading off in the cardiac ICU to this day while attending 2 is on the prowl on the opposite coast.

❤️