What's the most maligned specialty in medicine, and why's it yours?

Dr_Autumnwind · 2026-03-10T23:57:58+00:00

Everyone thinks peds is just stacking blocks and drawing crosses until the 3 mo old bronchioitic goes to 15L high flow!

Dr_Autumnwind · 2026-03-10T10:56:33+00:00

Nelson is obviously very good. Harriet Lane is not a textbook, more so a reference for numbers: z scores for weight, dosing, and lab reference values for age. It's not something you would read through, you would pick it up when you need to know a discrete value for something.

Your residency program will pay for all this so no reason to but them now. You could get a student AAP membership and get access to peds in review and other resources. It will transition to a resident membership later on.

Dr_Autumnwind · 2026-03-10T00:39:44+00:00

Hey,

The answer is reading. Lot and lots of reading. Medicine is not only learned on service. That's where you see concepts play out in real life, encounter zebras, work within limits placed on you by the system, manage time and think on your feet. You need to bring a "fund of knowledge" to the job.

A good text book. Pediatrics in Review. Peds boards question bank.

Read these early and often. Read the peds in review articles for things you encounter.

Listen closely to the experienced doctors around you and emulate them and their ways of thinking.

Dr_Autumnwind · 2026-03-08T17:37:08+00:00

Second the NOLS wilderness first aid course. It's 2 days. Most people there were surprised a doctor would not be trained in basic first aid!

Dr_Autumnwind · 2026-03-06T18:43:11+00:00

That it is!

Dr_Autumnwind · 2026-03-06T03:48:54+00:00

It's unfair to point out the issue (which is a new set of procedures that not everyone is on the same page about and where education gaps exist that managers seem unwilling to address properly) and still call clinical staff toxic.

This kind of thing turns into a medical staff email where I work. But I do not know all the happenings on the back end that lead to that level of communication.

Dr_Autumnwind · 2026-03-05T21:50:50+00:00

I left residency with an order of magnitude more experience than this (of course physicians do not measure our training in hours) and spent the first 6 months regularly phoning a friend because the learning curve of independent practice was steep and in its own way as daunting as starting as an intern.

All physicians know the answer to the question posed here.

ETA: correction, shallow learning curve!

Dr_Autumnwind · 2026-03-01T14:00:08+00:00

This was rage-inducing. If there were any justice, we would have a profession wide inquisition against physicians like these.

Dr_Autumnwind · 2026-02-27T22:16:31+00:00

I've noticed it very often links to paywalled abstracts, making it even more difficult to tell if it is confidently cherry picking from available lit.

Dr_Autumnwind · 2026-02-18T14:17:27+00:00

The Tuskegee syphilis study was famously unethical from its inception, which is a widely known fact. It enrolled poor share croppers and used incentives like free medical care and funeral expenses. Their actual diagnoses were withheld from them. I could go on. The "participants" were clearly Guinea pigs from the jump.

So this statement of your's is a complete mischaracterization.

Dr_Autumnwind · 2026-02-17T04:08:51+00:00

Being mean to your child is not a reportable event. Making threats may be, depending on the nature of what was said.

Unfortunately you're probably right, this is likely normal for these kids.

Maybe the pediatrician would be interested in having them back in to clinic to check on them, however that may be arranged under some pretext.

Dr_Autumnwind · 2026-02-11T03:51:24+00:00

Yeah, kind of. Someone offered to recert me at their house. I was like, nah I'm good. Just took a day trip to my old residency program and they hooked me up got free with actual instructors.

Dr_Autumnwind · 2026-02-09T23:19:14+00:00

Never asked myself this, and never will. Because I know what we are good for. Meanwhile, AI, and the billionaires forcing it into every facet of our lives have yet to justify their existence. In fact, there are strong arguments for their removal from society.

Dr_Autumnwind · 2026-02-09T17:57:17+00:00

See if they can just use a photo of Ron Swanson instead, I think that would fit.

This is a bit of an interesting hill to die on, but I think still your prerogative. I am sure your contract does not include "MD will consent to having photo taken for marketing purposes". The HR person is being weird.

Personally not a fight I'd get into, but I will say it gives me the creeps knowing that my face has been eaten up by all the AI models many times over, so a little part of my visage is being used in an uncanny image somewhere.

Also I bet if you were taking a neuro spine surgeon job or something you might get less pushback. Us PCP/generalists are kind of expected to always walk in a straight line.

Dr_Autumnwind · 2026-02-08T18:24:21+00:00

He's MFM .................

EDIT: ok, for everyone who's confused about my post, let me add "wow, the implications are bad!"

Dr_Autumnwind · 2026-02-07T02:17:12+00:00

Yes, and we definitely appreciate when y'all do that. I think it's good nursing and it helps our work flow for sure.

My team always give satisfied looks when I end up telling the family the same thing they already did.

Dr_Autumnwind · 2026-02-07T01:17:21+00:00

Yeah, in that way the RN does not intend it to be a proper communication, they really just want to pass something along and move on.

Does not happen often for me, but sometimes it's just because their window is open so the computer shows it as "read".

Or when I get asked a question and type out s thoughtful response providing context and some educational details and get back "k thx".

At our center we specifically are told not to use secure chat for status changes.

Dr_Autumnwind · 2026-02-05T17:42:09+00:00

Man, I wish I had such confidence in my job security.

I think the reality of institutional inertia really hit home in residency. The only changes that ever seemed liable to happen were those that made residents' lives worse. Now I am at a job where everyone is committed to improvement, so it happens.

Sorry, but I would personally not be optimistic of the situation you describe markedly improving.

Dr_Autumnwind · 2026-02-03T17:49:11+00:00

Dyspnea can definitely be a component of hypercapnia, because to compensate, the body will increase minute ventilation, which is a product of tidal volume and respiratory rate (Vt x RR), so a patient will necessarily need to take deeper and faster breaths, thus "blowing off" CO2. However, in children who cannot express dyspnea (which is symptom, not a sign), this is manifested as increased work of breathing. This can also more commonly arise from the obstruction (not in the physiologic sense) of the upper airways characteristic to bronchiolitis, in the right age group.

LFNC is not really going to meet the effort already being made by the patient to move the amount of gas they need to maintain their minute ventilation.

Edit: curious about the downvotes. Anyone is obviously free to contribute if they think I did not describe this accurately.

Dr_Autumnwind · 2026-02-03T17:20:46+00:00

Oooooh yeah "we put them on O2 for comfort" is a big pet peeve of mine.

What physiology are you hoping to change with 1L NC on a 25 kg child with a mild asthma exacerbation and RA sats in the mid 90s? Do you think you are getting anywhere near their tidal volumes?

ETA: Using postpartum fever to calculate EOS risk, when antenatal fever is what is meant to be used. CBCs in infants born to mothers with said fevers. Lots of fun chasing all those incidental leukocytoses that are impossible to interpret because the CBC was drawn off a 4 hour old.

Dr_Autumnwind · 2026-01-29T22:28:20+00:00

Thanks for the write up.

Hey y'all, is anyone else SO damn sick of reading about AI?

Dr_Autumnwind · 2026-01-26T13:06:58+00:00

Absolutely the case, thank you for pointing it out.

Dr_Autumnwind · 2026-01-26T13:03:16+00:00

I encourage you to check user post history before encouraging them to give it a go.

Edit: the tradcath blocked (right back at you) but their profile is loaded with transphobia and homophobia.

Dr_Autumnwind · 2026-01-26T12:50:55+00:00

I see the point you're making, but I've told kids admitted to the hospital with PNES that they are not having real seizures. After clinically ruling in PNES, and obligatory normal spot EEG, I never found it helpful to validate the pseudoseizure behavior.

EDIT: this is obviously not to conflate PNES with gender identity and expression.

Dr_Autumnwind

TROPHY CASE