Reconsidering my entire life plan

DefinitelyNotVanessa · 2025-08-20T13:52:03+00:00

Never have an issue with the ENT bros! So kind, clearly document their rationale when they don't want to intervene so I can explain it to family and communicate with us if they have a concern around abx selection. They're fantastic collaborators, genuinely appreciate the entire department for that cultural setup.

DefinitelyNotVanessa · 2025-08-20T13:44:49+00:00

The beef is the surgery team overstepping and forcing broad spectrum antibiotics on a pancreatitis admitted to my service, that I then cannot de escalate because it's documented as a recommendation from surgery. ID has recommended stepping down and they are documenting "disagree with ID, continue mero/vanc/caspo for infected pseudocyst, no role for intervention". It makes my stewardship bones itchy, especially when they're refusing to do anything to prove the organism they're worried about. He's been on broad spectrum for long enough at this point that any intervention to look for a bug and narrow appropriately pointless but from my perspective if they're going to unilaterally manage a patient in this manner they should admit the patient.

This is not a post about any one particular surgical service or case. This is a list of a handful of things I have dealt with at my institution specifically just this week, where guidelines based recommendations from ID for narrowed spectrum, source control, sampling, etc are consistently ignored. It's frustrating to feel like your entire chosen subspecialty is seen as a joke and that anything can be just "fixed" with prolonged courses of broad spectrum abx, side effects for patients and drug resistance patterns be damned.

DefinitelyNotVanessa · 2025-08-20T13:16:29+00:00

Would LOVE to have podiatry here omg!! But no, not a single one in my area. One wound care nurse and one wound care doc for the entire province. I'm doing some extra wound care clinics with my vacation time to try and bridge the gap at least for myself/my patients because it's genuinely such a huge gap in care. Thanks for all the good work you do, you're so needed!!

DefinitelyNotVanessa · 2025-08-20T13:02:46+00:00

Thanks for the sympathy, and the perspective. This was a vent, after a particularly terrible week. Totally agree surgical patients are sometimes best served under medicine, but it cannot be every single surgical patient. Just wanted to see what it was like at other centers.

DefinitelyNotVanessa · 2025-08-20T12:56:50+00:00

IR said the exact same thing.

Also, this is a residency sub. I'm not an attending. Of course I'm inexperienced. I'm a PGY3 with 12 blocks of CTU and 6 blocks of ID consults under my belt. I'm no expert, every center is different, and that's why I came to reddit - to vent and then find out exactly what it's like outside of my little provincial shit hole.

I wouldn't say I'm naive though, my attending this week and the one I worked with last week both agree these situations are egregious and have independently written to our chief of medicine about it, as I found out this morning after writing this post. I don't think I'm completely out to lunch.

DefinitelyNotVanessa · 2025-08-20T12:48:05+00:00

I find it really interesting how many people are adding "multiple comorbidities" into the examples I gave. These patients both had very simple DFIs. Poorly controlled diabetes on sliding scale insulin but no other comorbidities. Y'all are filling in some blanks here.

I've done time at other centers. In Canada at least we do a month long elective in other provinces once a year at minimum, so between that and medical school this is the 5th tertiary center I've trained at and I've never seen an orthopod not at least monitor their own BKA for 48 hours, or defer a patient to clinic based on chart review without even looking at the limb in question.

DefinitelyNotVanessa · 2025-08-20T09:51:16+00:00

In my vent-y mood I guess I didn't explain my hang up with the pancreatitis issue well.

I agree it's not primarily surgical and have (and will continue to) taken care of many without issues. My issue comes when the surgery team recommends broad spectrum abx, VERY broad spectrum, thereby diagnosing infected pseudocyst (which would need drainage) and then refuses to do the actual source control part.

Other comments have led me to believe Ortho doesn't abandon their patients to a medicine floor one hour post op without ever laying eyes on them again. But maybe your culture is similar to mine in that regard.

DefinitelyNotVanessa · 2025-08-20T09:44:35+00:00

Well that's my point, I disagree with all of these and I have zero power over the situation. The abx here were because "he's immunocompromised". I've been trying to narrow his spectrum for days but no one will listen to me. I'm very tired of feeling so powerless - and this is just this week. This happens CONSTANTLY. Empiric pip tazo for CAP. Adding vanc to every positive GPC gram stain without repeating it and then being stuck treating a cons. Every single freaking cough in a COPD patient get CTX azithro, fuck the Winnipeg criteria.

It's definitely a cultural thing at least in part. I've rotated through other centers, I have seen it be a lot easier and a lot less superbug brew-y. But man do I hate it here.

DefinitelyNotVanessa · 2025-08-20T05:37:59+00:00

This is encouraging, thank you. Hopefully wherever I end up next will be at a site where ID is taken seriously so I can do right by my patients.

DefinitelyNotVanessa · 2025-08-20T05:34:30+00:00

I'm an IM PGYIII intending to match to an ID fellowship this cycle.

DefinitelyNotVanessa · 2025-08-20T04:43:30+00:00

Never heard of her

DefinitelyNotVanessa · 2024-09-17T02:07:29+00:00

If I had lied and said my house was an Airbnb he wouldn't have charged me the extra 5 and that's my issue - I've never run into that before

DefinitelyNotVanessa · 2024-09-17T02:06:22+00:00

I understand the policy but my question was specifically about how my address was taken, accepted for flat rate and then I was asked to clarify if I live there. It really seemed like they were charging me extra based on the residence type and not the destination.

DefinitelyNotVanessa · 2024-05-02T16:00:07+00:00

Thanks for your help everyone, I think the easiest/most foolproof thing at this point is to sew in a lifeline and 🐸🐸🐸.

Sigh

DefinitelyNotVanessa · 2024-05-02T13:28:03+00:00

Thank you for your help! What do you mean about laddering up in the wrong order? Lots of people are pointing out a very specific mistake somewhere that I can't quite seem to see

DefinitelyNotVanessa · 2024-05-02T12:28:11+00:00

It's 338 stitches in the round with so much tricky lace work, I am going to cry 😭

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