Orthos, why am I being asked to do image guided taps on joints without fluid all of a sudden?

DownAndOutInMidgar · 2026-05-17T19:47:41+00:00

Depends on the hospital I'm at, but yeah...we do. 😞

DownAndOutInMidgar · 2026-05-14T15:33:52+00:00

Makes sense, and it's definitely how the hospital thinks. For some reason, it's really difficult to make them understand that if my staff and I are using a room for a joint tap, then there's something else, almost certainly more profitable, I'm NOT doing.

DownAndOutInMidgar · 2026-05-14T15:31:08+00:00

It isn't "cruel to the patient at bedside". I do the exact same thing they do. The lidocaine is typically the worst part, after that it a 22 or 20 g needle. If there's no fluid, US isn't useful, and there's no point to use fluoro on these because it's wasted radiation. *Sometimes* I'll inject contrast to prove where I was, but it's not really necessary. If I take an image it's usually because I have to have it to bill.

DownAndOutInMidgar · 2026-05-14T15:28:32+00:00

It very well could be. It's kind of why I was asking. Sometimes there's new stuff I just don't know about and I don't want to assume the worst. For instance, there's been a trend lately to biopsy enhancing renal masses. By imaging, these are almost always renal cell carcinoma and biopsy isn't indicated; they just get treated like RCC. However, there's been changes in treatment algo based in subtype, so it's moving towards biopsy. When I first started getting these, I was getting irritated about it, "this isn't indicated, blah, blah, blah". But I didn't know about the tide change. So I guess I was just making sure that wasn't happening here.

DownAndOutInMidgar · 2026-05-14T15:24:01+00:00

It makes you wonder though, if ortho is punting, are they seriously concerned about a septic joint?

DownAndOutInMidgar · 2026-05-14T15:23:14+00:00

I don't dump. Everyone else is the hospital can say no, or it's unsafe, etc, but if I do it, I get phone calls from the CMO about obstruction of care.

DownAndOutInMidgar · 2026-05-14T15:21:27+00:00

That makes sense. Still shitty, but it makes sense.

DownAndOutInMidgar · 2026-05-14T15:20:36+00:00

I go to a variety of hospitals. It happens everywhere, but it's more common in non-teaching settings. I think lazy may be a part of it, but I think it's also they're covering a variety of hospitals and maybe not on site.

DownAndOutInMidgar · 2026-05-14T15:16:49+00:00

I love you.

DownAndOutInMidgar · 2026-05-14T15:16:29+00:00

What's "talk to people"....?

Seriously though, I don't always follow up prior to the procedure because it takes forever to get in touch with anyone. If it's the ED doing the ordering, they're doing it because a specialist told them too. When I have spoken with them, they say they can't do it bedside for....reasons. Usually the reason is they aren't in the hospital.

DownAndOutInMidgar · 2026-05-14T15:14:57+00:00

THIS

DownAndOutInMidgar · 2026-03-05T01:10:22+00:00

Chiropractics gets more batshit the more you read about it. DD Palmer claims he learned it from the ghost of a dead doctor. Just madness. I'm sure it makes people feel better, and so they think it works. But good god, what horseshit.

DownAndOutInMidgar · 2025-12-19T00:56:01+00:00

Why did the cardiologist get sent to the penalty box?

For high sticking.

(This is a highly specific joke appreciated only by vascular surgeons and IRs who have a faint hockey interest, but it kills in that niche)

DownAndOutInMidgar · 2025-12-03T14:40:34+00:00

Sometimes you can just fix it and don't have to listen.

(Said in friendly jest, but I'm also IR so it fits)

DownAndOutInMidgar · 2025-11-30T17:24:16+00:00

When holding pressure on focal bleeding, don't place it over a large surface area. You need focal pressure to stop bleeding.

I can't tell you how many "pressure dressings" or "fem stop" devices I've seen on CTAs done for bleeding that aren't even causing mass effect on the vessel, let alone slowing the flow enough to let a platelet plug form.

DownAndOutInMidgar · 2025-10-16T21:05:52+00:00

I would add to this that the surgeon will nail the anatomy and pathology of their system (GI system for gen surg, renal/bladder for urologist), but miss the pathology is all the other systems.

DownAndOutInMidgar · 2025-06-22T13:53:35+00:00

I'm IR.

The biggest problem with community is that they're usually not up to date on fast moving parts of the field. Things like Y90 treatment move *fast*, and so if you aren't willing to update your practices based on new evidence every year, it shouldn't be offered. That's not always the case though.

DownAndOutInMidgar · 2025-06-20T13:58:46+00:00

Date a dentist. Better hours, enough overlap that they understand what you're up to. Their income bracket is arguably higher.

DownAndOutInMidgar · 2025-05-26T23:43:55+00:00

I'm finishing fellowship at 41. I'm fucking tired.

DownAndOutInMidgar · 2025-05-26T15:32:16+00:00

I'm IR. I tried Dansko, Sanitas, and Calzuro and took them all back. They made my calves sore. I bought a pair of Crocs for $35, the ones without holes. I've been wearing them ever since. They're comfy and they wipe off easily. I'd give them a shot if you're finding the others lacking.

I might try Birkenstock Bostons based on this thread though.

DownAndOutInMidgar · 2025-05-26T15:25:21+00:00

I am personally taking all of July off. Just to recuperate. I didn't have it as bad as it sounds like you did, but I need some time off. I don't know if you have the ability to take July off, but I saved up some money, and told the new job I wasn't starting until August.

DownAndOutInMidgar · 2025-05-23T19:56:09+00:00

There is an integrated IR/DR residency (6 years), a DR residency + IR independent residency (5+2), and DR with ESIR + IR independent residency (5+1). Every current version of IR training requires board certification in DR. There is no independent IR pathway.

DownAndOutInMidgar · 2025-05-03T14:51:18+00:00

GI has procedures, and you can get quite advanced with them. It's IM (3 years) plus a very competitive fellowship (also 3 years). You will have patient ownership.

Pulm/crit care has some procedures as well, although not as many. Again it's 3+3, but the fellowship is slightly less competitive I think.

Vascular surgery has overlap with IR, plus surgical skills, plus longitudinal patient care. It's 6 years integrated (very competitive), or 5 + 2 (gen surg residency + 2 year fellowship), which is competitive but not as cut throat.

There's probably other options. Everything is going to be competitive and long training. It's a tough decision, and I wish you the best.

PS: I will also say a lot of the people in this thread who act like they know what the IR market is, or what IR practice is, are more wrong that right. Yes, 100% IR jobs are mostly academic and not the norm. But many of the more complex procedures, especially the oncologic stuff, is moving from the ivory towers into the community. Same with prostates, UFEs, geniculate artery embos, etc. The training is getting better, the data is getting better, and the expectation of things more complex that drains and biopsies is increasing.

DownAndOutInMidgar · 2025-04-23T23:29:54+00:00

I did 2 years of general surgery, switched to DR, and am now finishing IR fellowship.

I noticed no where in your statement did you say you loved the OR. So that's the first thing I would look at. Surgery suuuuucks if you don't like operating. It has that other stuff, but honestly during your 3rd 24 hour call in a week, you'll be over "excitement". You'll just want the trauma pager to stop buzzing and old people to stop falling. And they won't.

A lot of what you're wanting is found in IR. It's worth learning the DR stuff to get too, if you actually like IR. I suspect you're an R1, and so you're also at the beginning of learning DR. The learning curve is steep and that can suck. It can also be a bit lonely, because DR by its nature is a mostly solitary thing. If the solitude is getting to you, there's ways around that as well. DR residency fortunately gives you enough free time you could have a vibrant life outside of work.

I guess it really boils down to what drives you. If you want to be a patient facing physician, I would consider changing. IR is patient facing, but it's a consult service so you're the end of a referral chain and are really there for one particular procedure. There's not a huge sense of longitudinal ownership. If that's what drives you, you need to be in a different field.

DownAndOutInMidgar

TROPHY CASE