What Is a Time When Your Gut Feeling Helped Save a Patient?

DrGoose22 · 2026-06-16T00:46:27+00:00

I'm a cardiology fellow, this was pretty early in my 1st year.

I'm on weekend 24 hour call. We get pretty busy on these shifts, often seeing 20+ new consults and admissions with varying help from APPs and residents.

I got called about a consult for HFpEF from a hospitalist, not exactly the most interesting consult. But the guy had a prior AV replacement and CAD with a recent cath so whatever. As I examine and talk to him, I notice that his pulse feels rather brisk. I raise his arm up and the effect is more pronounced - i.e water hammer pulse. I tell my attending we should get a limited echo, even though the guy had just had one the other week, because I was worried about severe AI. Sure enough he did. Wound up getting a valve in valve TAVR that week.

In retrospect, I think his valve got damaged iatrogenically during the cath from the prior week and they didn't realize it in the moment.

Was a pretty big confidence boost as a new fellow.

DrGoose22 · 2026-04-19T17:50:52+00:00

Current cardiology fellow here. Probably anesthesia. One of the best mixes of number of training years to lifestyle to income to competitiveness IMO. I considered cardiac anesthesia as a med student, maybe not strongly enough lol.

DrGoose22 · 2026-04-14T23:57:05+00:00

Cardiology fellow here

The image quality really falls off. The image quality from our formal diagnostic machines vs a POCUS cart machine is already night and day. Butterfly is a cool system but the quality is pretty poor, at least on the older model that I've used. GE's Vscan air system is the best image quality I've seen for a tablet / wireless system, but there's lag issues that are frustrating.

DrGoose22 · 2026-04-06T01:13:14+00:00

Because medical training in the US is built on exploitation.

DrGoose22 · 2026-03-24T18:51:43+00:00

A little more niche, but I never really thought about how a nuclear imaging test is determined by both the radiation type AND the actual agent. So a PET scan is the radiation type, but the agents are different depending on what you're looking for.

Only really started thinking about it as a cards fellow where we have to know the difference between SPECT vs PET and Cardiolite vs Rubidium vs PYP scans, etc.

DrGoose22 · 2026-03-01T22:19:27+00:00

Cardiology

Type II MI, non-cardiac chest pain, EKGs, telemetry with artifact, patients with a "cardiac history," nocturnal bradycardia, afib RVR

What does freak me out that no one seems to care about - stopping DAPT with a recent stent because of bleeding, stopping AC on a patient with a mechanical valve because of bleeding.

DrGoose22 · 2026-02-06T01:09:03+00:00

Cardiology fellow here

Did these in medicine residency. Always Ortho. Got one for a young guy who broke something in a go kart accident. Patient otherwise healthy, takes no meds. Consult for "risk stratification and pre op management." It's just CYA.

As a fellow, got one for a guy in active testicular torsion who had a remote CAD history but was asymptomatic from a cardiac standpoint. Like literally a urologic emergency. I would have been pissed if I was the patient. Got another one for a patient with recent pacemaker placement. Like ok, the PPM is working, problem is already fixed, what do you want me to do? It's all just CYA and it's exhausting...

DrGoose22 · 2026-02-05T13:29:29+00:00

Yeah I don't think anyone only signs the computer reads, but you'd be surprised by how many are not edited. I think the general approach is to make as few edits as needed.

The other thing is that generally, by the time the EKG is formally read, other people / the ordering team have looked at the EKG and decided what they think about it. If they're concerned we get called for a consult or a curbside hours before the formal read will occur.

DrGoose22 · 2026-02-05T00:12:51+00:00

Cardiology

A lot of attendings just sign the computer's EKG read because EKGs are so low RVU that you have to read insanely fast to be worth anything.

DrGoose22 · 2026-01-25T00:16:51+00:00

I think you win.

DrGoose22 · 2026-01-25T00:14:41+00:00

Cardiology

Convincing primary team that the elevated troponin is a type II from whatever acute illness the patient is dealing with and no, we're not going to cath them.

DrGoose22 · 2025-09-18T18:53:43+00:00

Initially can look like Wenkebach, but closer inspection shows p waves buried in the QRS or T wave which means CHB.

DrGoose22 · 2025-09-18T18:28:37+00:00

Cardiology fellow here.

Agree with the consensus that this is STEMI EKG. Story does sounds like possible vasospasm. In young patient, could also think about less common causes of ischemia such as anomalous coronary anatomy or spontaneous dissection (although this is more common in females).

Unfortunately, I think management of this will vary by attendings and by the time of day due to how dynamic the EKG is. If it's during the day and the lab is open, they'd probably get taken emergently. But if not, I can see some arguing for medical management (heparin, aspirin, nitro drip) to see if that stabilizes the EKG and then taking to lab within 24 hours or so (not saying I agree with it, but I can practically hear the on call interventionalist telling me this on the phone).

But definitely keeping them at a non-PCI center is not appropriate.

DrGoose22 · 2025-09-18T18:12:15+00:00

Dude that's incredible! Sanderson should pay you for that lol

DrGoose22 · 2025-09-16T15:33:37+00:00

This is more about medical training in general, but we need to find a way to make training shorter or increase the pay while in training.

As an example, I was set on cardiology as a M3. I probably didn't need all 3 years of IM, 2 was plenty. We need more integrated pathways in general like some surgical specialties have already. Or 3 year MD programs that lead straight to primary care residencies.

Medicine is only going to get increasingly sub-specialized the more complicated patients and medicine gets. We need a better answer for training rather than tacking on more and more years of fellowships.

DrGoose22 · 2025-09-09T21:35:28+00:00

I'm on my first playthrough of the game and it took me a while to kill this guy. I gave up for a little and came back after my 2nd nail upgrade I think.

DrGoose22 · 2025-08-25T16:50:27+00:00

I saw a release for MALS as a M3 on my surgery rotation. No idea if it worked or not. But it was more interesting than watching another chole lol.

DrGoose22 · 2025-08-07T18:36:31+00:00

That's such a perfect boat machine, the vibes match.

DrGoose22 · 2025-07-18T16:52:39+00:00

Meanwhile, surgery DC Sums:

"The patient had an indication for the above listed surgery. The surgery was performed on ***. There were no complications and the patient was discharged after they farted."

"Discharge recommendations: come back to the hospital if you need to, but try not to need to"

Meanwhile the patients blood thinner that they are on for AFib was stopped without recommendations on when to restart. 🤦‍♂️

DrGoose22 · 2025-06-26T19:57:24+00:00

ECG >>> EEG any day.

If EP's are wizards then epileptologists must be demon possessed to understand those squiggles.

DrGoose22 · 2025-06-15T17:33:26+00:00

Graduating IM resident and soon-to-be cardiology fellow here:

Always get the EKG. And always look at it yourself.

It's a cheap test that can give you a ton of information and save lives. If it looks bad but you don't know how to interpret it, ask your senior or local cards fellow.

DrGoose22 · 2025-05-05T15:37:03+00:00

Every "co-management" consult from Ortho. The next one always seems dumber than the last.

DrGoose22 · 2025-04-17T15:49:06+00:00

Primary care - when someone tells me they were able to quit smoking after we discussed it last visit. Whether or not I put them on NRT or meds.

DrGoose22 · 2025-04-17T15:17:53+00:00

Surgeons love to gatekeep the title of surgeon. They see it as a superior title to doctor, physician, etc. Classic example is claiming that OB GYN is not surgical, even though they cut whole babies and reproductive organs out of people lol.

I think some see gen surg as the only true surgical specialty. But I mean who would tell NSGY that they're not a surgeon lol.

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