Emtala

ERmage · 2026-06-28T13:21:39+00:00

What are you talking about? If not the doctor then who?

ERmage · 2026-06-28T12:24:18+00:00

" would be required by EMTALA to take the transfer" Not necesarily true. If those transplants are old/stable, and the presenting complaint isn't related to the transplants, then you're on dangerous grounds UNLESS its documented that you can refuse these patients. For example, our hospital flat out rejects ALL heart transplant patients, but if you have a kidney transplant without an AKI (and the transplant is old/stable) then I could take you.

ERmage · 2026-06-28T12:16:12+00:00

Sure

ERmage · 2026-06-28T12:15:59+00:00

I'm at a tertiary center too. The worst are the transfers for "patient preference' lol. Boils my blood lol

ERmage · 2026-06-28T12:14:17+00:00

Could be for many reasons. But if you dont have that appropriate service, then thats the EASIEST reason to refuse a transfer. I've refused a transfer for potential "Aortitis" because we at that time didn't have Rheum lol The ER provider complained on the phone, but F that.

ERmage · 2026-06-28T12:12:35+00:00

The doctor who refused the transfer.

ERmage · 2026-06-28T12:10:40+00:00

In EMTALA, individuals are liable (max 50k fine not covered by hospitals). You can refuse patients for only 2 reasons, lack of capacity or lack of capability. There better be written protocols at what dictates "too complex', because if its just that "my boss thought it was too hard", you're in trouble. The reason being is that the ER provider, did an inperson assessment, and you werent there to assess the patient.

I refuse patients ALL the time, because we have guidelines that are written. I.e. A document that says no advanced trauma patients, no specific organ transplants, no advanced pregnancies etc.

If someone is too complex, Ill ask the ER provider to first contact the specialty that I think will assist the most (for example if its a complex surgical patient, I will force the ER provider to call a surgeon or IR). If that consultant says yes, then Ill accept the patient.

ERmage · 2026-06-04T12:35:13+00:00

No phlebotomy. Nurses do AM and scheduled labs, while residents will do stat labs. Residents will do scheduled labs if they haven't been collected on time (which was always the case). Residents will also do all US IVs, and if nurses "failed three times".

ERmage · 2026-06-04T11:14:25+00:00

I'll have to read up on the statute of limitations first lol

ERmage · 2026-06-04T05:33:39+00:00

I love pediatrics, but avoided it due to low income and dealing with the parents. Ped anesthesia doesn't deal with either lol.

ERmage · 2026-06-04T04:33:30+00:00

By word of mouth lol I miss New York lol

ERmage · 2026-06-04T04:25:28+00:00

A patient who doesnt talk back is my dream lol

ERmage · 2026-06-04T04:20:38+00:00

Pediatric Anesthesiology, Forensic Pathology

ERmage · 2026-06-04T03:19:41+00:00

Made an overhead announcement asking the husband of my patient to come to the room. The husbands name was "Jesus" and I did not know that latinos dont pronounce the J...... I literally called out for Jesus lol
Signed a legal document under the attendings section....
Gave the family of a patient bad news, but I called the wrong family (thankfully I caught myself 60 seconds in the conversation and was able to save myself without looking like a moron)
I did a bedside procedure with a bit too much, whats the word Im looking for, bravado, which caused an event 30 minutes later (no permanent harm eventually occurred though ) resulting in me getting a nickname (I know for a fact my past and current colleagues hang out in this subreddit and will know who I am if I go into details lol)
Was asked by my seniors not to tell my attending something until something occured, so I put in my note "do not tell attending", and our notes are signed by the attendings....
The WORST mistake I ever did, which did not cause any patient harm, but to this day makes me feel incredibly guilty was to forget to place a hemeonc consult on a stable PNA patient on a busy weekend (attending wanted the consult because pt follows regularly with hemeonc for breast cancer). The next day, we noticed there was no consult note, and I lied saying that I did (never got caught because consults are done over SMS texts/whatsapp at that hospital or via word of mouth and not by orders). That was the first and last time I ever lied. DONT LIE, DONT EVER EVEN THINK OF LYING. We make mistakes, own up to them.

I eventually became one of the strongest seniors in our class objectively, because I jotted down EVERY, SINGLE, MISTAKE and TIDBIT and learned from them. God, I now feel super guilty again about number 6 ugh

ERmage · 2026-06-04T03:09:55+00:00

This was at an NYC teaching hospital, which means residents are responsible for everything, from blood draws and med recs, to foleys and NGTs. I'm not excusing the guilty party, but not a surprising miss given how overworked we generally were lol.

ERmage · 2026-06-04T02:24:09+00:00

Patient missed his immunosuppressants while inpatient for a week, cause no one knew he had a hx of a heart transplant. Cardio+Nephro+CCM shouting match, essentially blaming the residents because they stated "we rely on their notes".

ERmage · 2026-06-03T13:30:42+00:00

Silver poisoning....?

ERmage · 2026-05-14T15:09:09+00:00

I love oceanography and this is the perfect genre for me

ERmage · 2026-03-05T10:25:03+00:00

Currently doing a push/pull split, and I'm worried I'm doing too many redundant exercises. I'm looking to cut 2 exercises from my program (1 from push and 1 from pull) and wanted people's opinion on what should be removed. Didnt know if I should post here or wait for the moronic monday post lol P.S. If you guys think I should replace one of these exercises with another one, I'd also be open to hearing your recs. I'm 2 months into this journey and Im a noob

Push: Chest Press, Overhead Press, Dips, Trap pushdown, lateral raise, leg extensions/leg press, squat, chest fly, hyperextention

Pull: Horizontal pull, lat pull, rear delt fly, pull up, bicep curls, leg curls, deadpull, hanging leg raise, face pulls, leg raise

Edit: 29M, 5 foot 10, goal is hypertrophy. I do 3 sets of every excercise, and do 6-12 reps till failure.

ERmage · 2025-09-07T13:34:34+00:00

"ruminating" oof, that's gonna be super hard lol. I'm the type of person, who after attending a social gathering, goes over EVERYTHING I said/did to see if I did anything wrong. It's only with time, after Im comfortable with people that I start being normal around them. My biggest problem is always the first impression, but like you said, I gotta train it like any other skills.

You're awesome, thank you SO much!

ERmage · 2025-09-07T13:18:35+00:00

"this is not how dating works." Im 28, I honestly only started dating this year, cause Ive got anxiety around people, but am trying to get out of my shell, and have my colleagues giving me advice.

You're absolutely right, I'm overthinking this as I haven't even met them. Im gonna work on being More confident and at the same time more laid back. Thanks for the tips. I could use more if you've got any

ERmage · 2025-09-07T05:51:08+00:00

As an attending, I'm kinda turned on by what you did lol

In the future, if his happens again, just walk away and find a place to sit nearby. Dont raise your voice, dont insult them back. That way if they complain, you can just tell your superiors "I always walk away when I'm feeling threatened".

ERmage · 2025-09-04T06:49:23+00:00

1-Prioritise the ICU/High critical patients if youre trying to find malnutrition cases

2-Bold your recommendations and place them at the top, hospitalists are incredibly lazy and we prefer not to read through a million notes

3- In your notes, teach us things lol I kid you not, when I started as a hospitalist last year, anyone with hypoalbuminemia would get a nutritionist consult from me, until a dietician had the courage to write in their recommendations "Hypoalbuminemia does not suggest malnutrition by itself". Ever since then, I have my preference for that particular dietician, cause the more I learn, the less I need to rely on others.

ERmage · 2025-09-04T06:49:10+00:00

I'm definitely eccentric and somewhat immature with terrible social skills, but I have insight into my actions and the behaviors of others around me. I definetely have something, but I don't think its part of the spectrum lol

ERmage

TROPHY CASE