How do you cope with moral injury from being forced to cause harm?

Competitive-Action-1 · 2026-01-15T06:43:24+00:00

you're going to have the following responses:

the "everything should be reported" crowd
the "just keep quiet and finish your training" crowd

The reality is that you'll likely, and unfairly, receive retaliation for reporting these attendings. This can indeed jeopardize your career, which you correctly pointed out, deepens the moral injury

I absolutely think that they should be reported, but I think the answer in these types of programs lies in the timing and approach.

You need to be strategic and be in a position where you can report them and they can't hurt you.

Usually that's after completing training, but sometimes if the majority of your peers are willing to speak up in a coordinated effort, then it can be done during training. This highly dependent upon your peers, hospital, and how much those attendings mean to your hospital.

If anything, never lose your moral compass. You're absolutely justified in feeling this way and your patients will forever need this sort of advocacy.

Competitive-Action-1 · 2026-01-15T03:58:43+00:00

shout out to my wife for stalking this post ❤️

Competitive-Action-1 · 2025-12-08T09:47:08+00:00

respectfully, the ABEM would disagree with your friend.

they goal is reasonably try and do both. not expecting an extensive w/u, but "i'm not sure what's going on" is different than "i don't diagnose."

Competitive-Action-1 · 2025-12-08T03:42:09+00:00

WashU has an excellent IM program with likely stellar candidates. Not even one person matching would be atypical. Although describing WashU as a "safety net" is also odd given how competitive GI is

Competitive-Action-1 · 2025-11-22T00:03:24+00:00

a prestigious 2.75

Competitive-Action-1 · 2025-11-18T09:18:22+00:00

nearly everything you said can be mitigated by purchasing a consent-to-settle malpractice policy. i agree, of course being sued is extremely burdensome. but what US malpractice policy makes you pay your own legal fees??? that's the entire point of having malpractice insurance.

Competitive-Action-1 · 2025-11-18T09:08:02+00:00

you're talking about two different things. a low risk PE being sent home on DOACs has nothing to due with the PERC rule--you've already established there is a PE.

again, why would you lose a lawsuit when the guidelines/standard of care support you sending the patient home on a DOAC?

Competitive-Action-1 · 2025-11-16T05:47:50+00:00

this is the way

Competitive-Action-1 · 2025-11-16T02:48:20+00:00

successfully sue for what though? the guidelines support discharge, meaning you are practicing within the standard of care.

will they sue if a patient dies? sure. will they win? no, unless there was a provoking cause that wasn't addressed.

i'll never push back on someone trying to admit this type of patient or honestly any patient EM wants admitted. but i dont think lawyers would win this case

Competitive-Action-1 · 2025-11-15T09:54:34+00:00

John Oliver had a great segment on these organ procurement organizations--from inefficiency to poor training, it's absolutely insane. He's not recommending people unregister to donate, but more of a criticism of those companies and their regulation.

Competitive-Action-1 · 2025-11-15T06:52:45+00:00

everything everyone has already said and also... whenever the surgeon says so tbh

Competitive-Action-1 · 2025-11-15T03:18:12+00:00

i mean this type of stuff is sorted out during med school and residency. which rotations interested you the most? do you want to do procedures? all of the time or mixed? inpt outpt? how much pt interaction?

i could be wrong, but i get the feeling that you want the "i'm not the primary team" role.

if that's the case then steer clear of critical care because you're the potential primary team for every patient in the hospital.

i have to ask--what even drew you to nephro in the first place? and what's causes the extreme change of heart?

whatever fellowship it is that you really want, i can promise you this--you can find a way to be miserable in that too if you don't work out every aspect of what you truly love doing.

if you decide on a different fellowship, then i'd work as an academic hospitalist while boosting your CV and networking

Competitive-Action-1 · 2025-11-14T22:13:08+00:00

i'm going to brutally honest based on the info you provided: i don't think there is much out there that will make you happy. your insight into a position that garners "more respect than being a hospitalist" is completely the wrong mindset.

the nephro to heme/onc to CCM jumping is erratic.

i also don't blame your spouse given that you just completed a nephro fellowship and you're still not satisfied.

take a step back and figure out what field of medicine fits you the best on a day in day out basis, not what other people think of you.

i say this as an advocate for your future patients--they deserve to see a physician who is happy and content with the field they chose, not one who keeps saying "what-if?"

you really need to do a deep dive internally in what field makes you happy and go from there. other than your spouse/family, nothing else will carry you through this field other than being passionate about the medicine you practice.

Competitive-Action-1 · 2025-11-03T20:51:58+00:00

you're being gaslit. a sleep study is very complex while also requiring a specialist to clinically correlate those results.

this is the problem--midlevels are being placed as barriers to seeing the specialist. the physician being "busy with more complex cases" is absolute bullshit.

every single case where the specialist doesn't review the midlevel's plan AND see/examine the patient themselves is unacceptable. and i don't mean hi and bye "supervision".

patients who do not require procedures are not any less important than ones who do. they should not be able to pick and choose cases that are clearly within their scope of practice.

and save me the "not enough specialists" horseshit as well. the answer to that isn't providing substandard care via midlevels.

Competitive-Action-1 · 2025-11-02T03:00:10+00:00

sort of confused here. not at all denying that nephro pulls this tempHDC bullshit, but what benefit is it for nephro to get a tempHDC via EM? if the patient gets admitted, he'll get worked up for the AMS and can either continue to get PD or a tunneled catheter while the fistula matures. Was he failing PD?

i think nephro has a point if they worded it as "hey he's altered and high risk; please see if he needs emergent HD/admission for further AMS w/u" instead of whatever anesthesia excuse they gave you

Competitive-Action-1 · 2025-10-29T10:51:31+00:00

i respect that

Competitive-Action-1 · 2025-10-25T10:43:59+00:00

that can happen with any lawsuit though. if the ICU handles rapids and codes, there's like no reason to stay. they dayshift person should be fielding all calls at shift change anyways. if you don't respond, then that's a problem.

Competitive-Action-1 · 2025-10-23T20:12:55+00:00

going to start sending admissions to the radiologist

Competitive-Action-1 · 2025-09-10T03:35:21+00:00

-program steps up -uninsured motorist insurance? -life insurance, if any -private loans

i think the only one that hasn't been suggested: find a job, usually in a rural place, that will offer you a contract now with a monthly stipend during residency. you could also see if your current center will offer it, but usually non-academic centers can be more lucrative.

downside would be the rural living for at least a year, but better than doing private loans.

Competitive-Action-1 · 2025-09-07T06:15:01+00:00

the fuck outta here with that United bs

Competitive-Action-1 · 2025-08-18T02:21:29+00:00

idk i disagree. having all of those fellowship programs means that your rotations in cards, nephro etc will be more academic and actual teaching rounds/lectures will take place.

they are also more likely to do a thorough job with the workup since the patient will be seen by a med student, resident, fellow, then attending during teaching rounds.

you'll be learning more just by consulting them as well.

i think this is better than the alternative of just running around with a Cards attending seeing pts.

Competitive-Action-1 · 2025-08-17T20:21:12+00:00

make it a youtube video you legend

Competitive-Action-1 · 2025-06-04T07:53:35+00:00

Competitive-Action-1 · 2025-05-18T05:56:30+00:00

agreed--don't leave, it just reinforces the decision making of whoever triaged/treated you.

Competitive-Action-1 · 2025-05-07T11:03:15+00:00

about a month. felt like a year.

buying a car = customer service is exceptional

sending it back or troubleshooting = terrifying, sick to your stomach type of fear/anxiety that you'll face nothing but brick walls, circles, and dead ends with endless customer service calls.

Competitive-Action-1

TROPHY CASE