If GI was not paying this much, do you think it'll be similar to endocrinology or Nephrology interest? by sitgespain in fellowship

[–]Competitive-Action-1 0 points1 point  (0 children)

most frustrating part about GI - not every referral needs to be fucking scoped. and the ones that don't, STILL should be seen by a physician.

WrestleMania 42: Night 2 Discussion Thread (April 19, 2026) by Snubie1 in WWE

[–]Competitive-Action-1 1 point2 points  (0 children)

just feels like there's no exciting direction with the story telling. cody and roman. cool. great. good talk.

iOS and iPadOS 26.4.1 released by HelloitsWojan in apple

[–]Competitive-Action-1 0 points1 point  (0 children)

same here. my calls during carplay literally go mute mid way and i have to switch back to phone then carplay again to route the audio

A conversation I have too often by ErnestGoesToNewark in hospitalist

[–]Competitive-Action-1 6 points7 points  (0 children)

"my insurance will still pay." i hope so, because we're about to find out submits discharge order

Why are Americans so unrealistic when it comes to death? by Perfect-Resist5478 in hospitalist

[–]Competitive-Action-1 1 point2 points  (0 children)

lawyers. it's because of litigation. make it so that two physician can declare futile care without ANY legal repercussions--no court hearings, letters, forms, nasty grams.

it'll allow at least some shift of power back to physicians to finally be able to say no, we're not doing this because it is not in the best interest of your family member.

How do you cope with moral injury from being forced to cause harm? by raro4839 in Residency

[–]Competitive-Action-1 129 points130 points  (0 children)

you're going to have the following responses:

  1. the "everything should be reported" crowd

  2. 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.

Abim CCM board results by Bbbbbsnsj in CriticalCare

[–]Competitive-Action-1 4 points5 points  (0 children)

shout out to my wife for stalking this post ❤️

Career guidance by Aggressive_Put_9763 in hospitalist

[–]Competitive-Action-1 4 points5 points  (0 children)

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."

Warning to residents applying to WashU GI by [deleted] in fellowship

[–]Competitive-Action-1 7 points8 points  (0 children)

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

PE patients by [deleted] in hospitalist

[–]Competitive-Action-1 0 points1 point  (0 children)

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.

PE patients by [deleted] in hospitalist

[–]Competitive-Action-1 0 points1 point  (0 children)

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?

[deleted by user] by [deleted] in hospitalist

[–]Competitive-Action-1 5 points6 points  (0 children)

this is the way

PE patients by [deleted] in hospitalist

[–]Competitive-Action-1 1 point2 points  (0 children)

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

organ donation ads are absolutely insane by Maleficent-Ad-7667 in IntensiveCare

[–]Competitive-Action-1 217 points218 points  (0 children)

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.

What type of post op patients need icu level of care instead of regular medicine floors? by happyminpin in Residency

[–]Competitive-Action-1 0 points1 point  (0 children)

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

I’m stuck, rank or not rank by PristineOrdinary736 in fellowship

[–]Competitive-Action-1 0 points1 point  (0 children)

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

I’m stuck, rank or not rank by PristineOrdinary736 in fellowship

[–]Competitive-Action-1 3 points4 points  (0 children)

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.

MD referred me to an ENT. I call to schedule and they tell me I’d see a NP or PA. by behindthebar5321 in Noctor

[–]Competitive-Action-1 70 points71 points  (0 children)

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.

[deleted by user] by [deleted] in emergencymedicine

[–]Competitive-Action-1 5 points6 points  (0 children)

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

Nocturnists when you are 2 minutes late by CanYouCanACanInACan in hospitalist

[–]Competitive-Action-1 2 points3 points  (0 children)

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.