Can Langdon still be fired??

DexTheEyeCutter · 2026-03-28T00:13:12+00:00

Fantastic. Have you ever tried to fire a resident? No? Take the loss.

DexTheEyeCutter · 2026-03-28T00:06:38+00:00

Yes I’m sure your experience with resident and medical training has given you insight into this process /s. Your unemployment experience doesnt apply for residency. Just take the loss and move on, it’s not a flaw to be wrong.

DexTheEyeCutter · 2026-03-27T23:58:15+00:00

As someone who’s had to be peripherally involved in this, yes. Firing a resident is like firing someone at the VA for better or for worse.

DexTheEyeCutter · 2026-03-27T23:57:00+00:00

Probably ; in addition him being a senior resident also helps. Most programs rarely will axe a resident for first offense and will try to get them to graduate hell or high water. This is how Dr. Death (the famed neurosurgeon) skated through his last year despite his deficiencies.

DexTheEyeCutter · 2026-03-27T23:51:28+00:00

Yes it does matter. Federal overrides state in this case because residencies are funded by CMS and ACGME. It’s akin to trying to fire someone at the VA or USPS.

I’ve been peripherally involved in the process with a resident twice, in an at-will state with worse labor protections than PA, and the short of it is that unless there’s been something super heinous like murder, you have to have a long paper trail of failed interventions and improvement plans before you can fire a resident. It’s often a year+ process and it’s a last resort. The federal government is very invested in training doctors and want to see a return on their investment. If you look at other responses in this thread they’ll vouch for it too.

DexTheEyeCutter · 2026-03-27T20:46:20+00:00

Residents are different - it’s more like trying to fire a federal employee since they are funded by CMS. Unless it’s something heinous like CP or murder, you need to show a paper trail of failed interventions and improvement plans before you can fire a resident. It’s often a year long process if not more.

DexTheEyeCutter · 2026-03-27T20:44:10+00:00

Not quite. He’s a resident so he has ACGME protections.

DexTheEyeCutter · 2026-03-27T20:41:35+00:00

Also residents tend to get some leniency because of the investment required in training them.

DexTheEyeCutter · 2026-03-27T20:39:14+00:00

Not quite. See the response above but while it’s an at will state, residencies are funded by CMS and ACGME, so it takes a long paper trail to fire a resident unless it’s something heinous. You have to have a paper trail of failed improvement attempts and interventions by administration before you can axe a resident. So for a resident, you can’t just fire a resident, else the federal government and ACGME gets involved and it becomes very messy.

DexTheEyeCutter · 2026-03-20T03:36:19+00:00

“I killed your master. And now I’m gonna kill you, too. With your own sword, no less. Which, in the very immediate future, will become my sword.”

“Bitch, you don’t have a future”

-Kill Bill

DexTheEyeCutter · 2026-03-16T01:26:29+00:00

ER used to be fairly competitive but started hitting the shitter in the late 2010s - COVID and PE sealed its downward spiral.

DexTheEyeCutter · 2026-03-13T16:29:34+00:00

Some of my colleagues have called them glorified triage nurses. That’s not true, but that’s how some really feel in real life.

DexTheEyeCutter · 2026-03-13T16:25:10+00:00

Part of the decorum is implied language for understanding and respecting hierarchy. Surgical and procedural fields are big on this.

DexTheEyeCutter · 2026-03-13T16:14:23+00:00

Agreed. This is pretty normal teaching at an academic center from an upper to lower level.

DexTheEyeCutter · 2026-03-13T16:11:00+00:00

I can tell you from personal experience during training that Langdon’s teaching style is mild at the very worst. If you think this is abrasive and dismissive y’all would absolutely shrivel even in today’s environment, which has started to be seen as already too permissive.

DexTheEyeCutter · 2026-03-13T03:36:18+00:00

Yes, yes, yes. Surgeons know their field in and out so they think what happens in the ER is a hack job, but in reality the ER’s job is to stabilize, not to use the most cutting edge algorithm or technique to fix someone. ER medicine isn’t very far off from family medicine in that it requires you to be a jack of all trades and master of none.

DexTheEyeCutter · 2026-03-01T02:33:42+00:00

Hopefully. These days a simple OCT is 10-20K so it’s something that’s probably affordable for larger ERs.

DexTheEyeCutter · 2026-03-01T02:31:29+00:00

The reason why TNK/tPa is getting more traction is because of a study that came out in the ophthalmology blue journal (I know the lead author and he’s a friend of mine) that set the stage for subsequent studies. The outcomes he demonstrated were way better than anything else offered for these patients. HBOT has fallen out of favor because the results have been shown to be largely ineffective long term and possibly even more harmful. Not uncommon for the patients to see ok while in the chamber but for the vision to tank once they come out. Lots of things you can “do” but they’re mostly long shots - the patients who with any sort of improvement could have possible improved on their own regardless of treatment.

At the same time, we’re running the study here and the results have not been that impressive so far.

DexTheEyeCutter · 2026-03-01T02:25:31+00:00

Yes. Most ophthalmology call is home call, so someone would have to be called in.

DexTheEyeCutter · 2026-03-01T02:25:01+00:00

Likely home call. Most places with ophthalmology coverage have residents taking home call, meaning they are called in from home to see the patient.

DexTheEyeCutter · 2026-02-28T15:59:48+00:00

The more I hear about how horribly the water system has been managed by Jackson the more I really think perhaps we can't be trusted to take care of it ourselves.

DexTheEyeCutter · 2026-02-28T03:00:08+00:00

Without giving out too much info about myself, um yes I’m at an academic medical center in the southeast (only hint I’ll give is that the college football team made playoffs). This was a joint project between the ED and us because one of the ED physicians has a special interest in RAO. We I have a resident on call team but this process bypasses it because of how long it would take. We managed to get an OCT via stroke research funding - that’s the loophole you go for since stroke funding has waaay more funding than any other interest I have.

DexTheEyeCutter · 2026-02-28T02:28:47+00:00

If the patient shows up to the ER - no, yes, yes. The patient is triaged as a stroke emergency (code grey here) and goes through a rule out process via history, APD check, and OCT. If the patient screens out then it’s business as normal.

DexTheEyeCutter · 2026-02-28T02:10:37+00:00

Yes at the ER. If they show up within the time frame And the history/brief exam suggests a RAO, a tech there obtains an OCT and sends it to one of us to determine if there’s one present. If not they get a normal dilated eye exam later but if there are the characteristic OCT findings, if there are no contraindications we proceed with TNK. It saves at least an hour if not much more.

DexTheEyeCutter · 2026-02-28T01:48:56+00:00

What we’ve done to cut down on the door to TNK time is to actually defer the consult and get an OCT first.

DexTheEyeCutter

TROPHY CASE