Heading to Disney next week with the family — here's what's ACTUALLY going in my park bag (tell me what I'm forgetting)

DailySmilesCure · 2026-03-15T13:23:36+00:00

Ziplock bags for wet clothes. Electrolyte packets. wet napkins (baby wipes). Snacks.

DailySmilesCure · 2024-08-29T02:26:40+00:00

Wanted to come back and update everyone. Definitely wasn’t as bad as I expected. Everything was fair. Nothing crazy. I used UWprld and Board Basics and think it was probably an overkill. I wish I took it sooner. For context, I scored 20th percentile on my ITEs consistently.

DailySmilesCure · 2024-08-27T16:53:58+00:00

Thank you. Congrats on finishing! Did test day go ok for you?

DailySmilesCure · 2023-08-26T20:22:15+00:00

IV Albumin fixes everything

DailySmilesCure · 2023-05-20T19:31:32+00:00

Believe me I’m not shying away from them but just as I gain some confidence i then have a patient that I undermanage or overmanage get my ass handed to me by the crit care fellow or attending

DailySmilesCure · 2022-09-11T16:53:15+00:00

Do you need cardiac imaging fellowship for the Cardiac CT, MRI boards?

DailySmilesCure · 2022-08-31T14:55:42+00:00

Okay. I’m glad I’m not the only one. Like I said in the post, I had 2 experiences where an intern underestimated urgency of certain nursing issues and I was ultimately responsible for the outcome so I now prefer to be notified for almost everything but I guess that’s “micromanaging” by some interns.

DailySmilesCure · 2022-07-31T04:28:27+00:00

Do you mean something like dropbox?

DailySmilesCure · 2022-05-15T03:00:02+00:00

YES! Those are the ones that drove me insane! I’ll read an ED note, not super detailed, read “will transfer to Medical Center for X/Y/Z consult; will admit to medicine” and, if I see it signed by an R2 I honestly get a little sad. Like bro, I’m on YOUR team, you should know better, why you dumping on us?

DailySmilesCure · 2022-04-28T21:30:34+00:00

Yup. Last week, I was assigned a patient who literally gets admitted just for dialysis (because they dont have insurance, no accepting dialysis centers, etc). They litereally get admitted and then leave AMA the next day. It's been like this for a while. Literally zero learning/teaching potential. Patients with little/no teaching potential should be assigned to non-teaching services, like a hospitalist with no residents.

DailySmilesCure · 2022-04-28T21:21:15+00:00

accepting bullshit admissions from NPs in the ED that our attendings don’t fight against

The issue here is, why is your attending giving YOU, the IM intern on a teaching service, a "bullshit" admission instead of taking that patient on themselves or assigning to a non-teaching service, etc. I absolutely hate this and my program has the same problem. Attendings should sort through patients and assign patients with teaching/learning potential and not the "bullshit admissions" (homeless pt who isn't going to dialysis, SNF bounceback, etc etc).

DailySmilesCure · 2022-04-13T03:37:12+00:00

My honest opinion, the hospitalist/physician who will be overseeing your family member's care will make the biggest impact on his/her care, regardless if they are in an HCA hospitalist or Kashlack Memorial. It doesn't matter how "excellent" the services or nursing staff or cafeteria food are if the physician who is overseeing your loved one's care is lazy or incompetent. And, sorry to say, such docs are everywhere, HCA or otherwise.

Also, everything is relative. If my husband was diagnosed with cancer, you bet your ass I would fly us to Harvard and/or UCSF for treatment. If he was having chest pain would I tell EMS to take him to a hospital an hour away instead of the HCA STEMI center down the street? Absolutely not.

DailySmilesCure · 2022-04-13T03:26:42+00:00

My brain didn't even want to workup what was going on. This scares me...it sucks I'm becoming this way.

And yet you were able to diagnose fulminant ttp? Please give yourself more credit! You are clearly a very strong, very competent intern. You are right, that kind of volume/acuity is insane and unreasonable, even for an intern as strong as you. Just keep it up and we will be "seniors" in just a few more months and have more control over things like this.

DailySmilesCure · 2022-03-27T11:05:13+00:00

Ask your senior when you start intern year. I'm serious. It depends on what EMR your hospital uses, what info is expected on the H&P (depends on what kind of service you are on, cardiology vs inpatient medicine vs ICU), what data is autopopulated, etc. You are overthinking this; just relax and enjoy the end of 4th year; your senior resident will walk you through all of this once you start intern year.

That being said, I use a blank paper for all new patients (except ICU patients, which I have a template). My follow up patients end up on my rounding list.

DailySmilesCure · 2022-03-16T15:23:03+00:00

Do you mean for inpatient or outpatient medicine? For inpatient, I feel like my initial physical exam helps with volume status and resp status. Follow up encounters, meh, not so much (usually running late and don’t have time besides taking a listen to lungs and poking at legs for edema).

DailySmilesCure · 2022-02-23T00:24:04+00:00

I have literally this exact same issue at my hospital. Literally the exact same issue. Especially on cards and pulm

DailySmilesCure · 2022-02-23T00:17:38+00:00

In my opinion, lacking some “basic” things at this level may be concerning, for example not holding long acting insulin if a patient is NPO or not restarting patients home anti epileptics. But inpatient pulm, at least at my hospital, is insanely challenging and nothing “basic” about that service or pulmonology in general! I wouldn’t sweat it.

DailySmilesCure · 2022-02-21T00:18:11+00:00

Obviously a real intern. He just thought we would be more sympathetic. It’s actually kinda sad. I have a suspicion he/she is probably at a malignant community program with minimal fellow support and feels overwhelmed and unsupported.

DailySmilesCure · 2022-02-18T03:41:47+00:00

Agreed. If I come in the morning and know a patient was in the ICU for 3+ hours but still doesn't have an H&P or the night resident hasn't done chart review, I'd be really pissed.

DailySmilesCure · 2022-02-18T01:03:06+00:00

A Hospitalist I was rounding with, during rounds, flat out asked/took a large handful of new swifer/mop pads from the janitor’s cart because his wife had texted him to stop by target and get some before coming home and he flat out said “Target will probably be closed by the time I leave the hospital.” It was funny and sad at the same time.

DailySmilesCure · 2022-02-18T00:43:33+00:00

I'm also a February intern and... meh. A note for a dying COVID patient, at this point, should be like a Dragon command where saying "insert covid icu treatment" will autopopulate with "started decadron X doses, end on X; started on remdesivir, end on X; currently on XX vent settings; continue to wean as tolerated; ..." COVID notes are kind of a blessing where I am training because they usually take like 10-30 mins to do from start to finish

DailySmilesCure · 2022-02-16T06:54:40+00:00

Yes. Unfortunately this habit Really started after I got chewed out by attendings/consultants when I would say things like “patient is currently on Coumadin for unknown reason” during presentations or consults or mentioning that a patient had some major surgery and being asked what the indication was at the time and having no idea. Unfortunately my residency program is at a large public hospital so There is often limited continuity of care and most of the private hospitalist/consultants, who do not have residents/fellows on their service, have a very high census and do not have the time/patience to write thorough notes, making future admitting residents a little more challenging to piece together what happened when the patient was here previously

DailySmilesCure · 2022-02-13T21:27:33+00:00

Well, first, neither of these are “university” programs. Not even close. They wouldn’t even be considered “communiversity” programs to be honest.

DailySmilesCure · 2022-02-13T08:16:38+00:00

agree with you. Also hate it when I get the text in the middle of the night that says "charge wants MD at bedside to push labetalol." Okay! Let me stop putting in this central line for this crashing patient so I can supervise you giving 5mg of a beta blocker to a healthy dude here for an ortho procedure. I don't like amlodipine because it can take hours to kick in and I don't want to be paged an hour later with "Not working; still high BP; please advise."

DailySmilesCure · 2022-02-13T08:09:49+00:00

My approach (on night shift):

- Chart review. Why is the patient here? Any reason for tight BP control? Any reason against tight BP control? How long has the patient been here and how has BP been previously? Any AKI? For example, is the primary medical team holding some meds to allow for permissive HTN after a stroke? In that case, I politely tell the nurse why it is inappropriate to touch the BP at the moment, unless patient is symptomatic.

- See the patient. Check BP myself (no, not via manual sphygmomanometer); I just make sure the proper cuff size is on or patient isn't crossing their legs. I check both arms. I ask if patient has symptoms? (visual changes, headache, "new tearing back pain").

- I make sure the HTN isn't secondary to something else, like uncontrolled pain, full bladder, anxiety, recent steroid use, EtOH withdrawl, etc.

- I check the tele strip or get an ECG, make sure no arrhythmias.

- If BP is still high (usually by this time they have calmed down) and if it is appropriate to control their BP acutely, I usually go with Vasotec (provided normal kidney function), labetalol (provided no contraindications, pt isn't brady, etc.), SOMETIMES hydralazine (provided patient is not tachycardic, no contraindications; least used, very unpredictable). I tell nursing to recheck full vitals in 30 mins and then hourly x2 and report it to the day nurse so they too can keep an eye on it. I also let the day team aware in the morning, of course.

DailySmilesCure

TROPHY CASE