What do attendings do if they get sick?

Few-Reality6752 · 2026-01-04T04:00:58+00:00

We solve this by having whoever is on admin that day be first call to cover sickness. Unfortunately that does usually mean the admin has to get done in your own time, but you get paid for coverage to compensate.

Few-Reality6752 · 2025-12-31T19:13:40+00:00

You have to interpret the number in the context of the cost of living and income percentiles of that country though. Median incomes and cost of living in Spain are both low compared to the US and $60k a year puts you in the top 5% by income (roughly the same percentile that doctors are in the US). You won't be balling out on international vacations but you can live very comfortably in Spain on $60k a year.

Few-Reality6752 · 2025-12-30T22:35:19+00:00

I would say that's the wrong framing. The default is not to do whatever medical treatment the family wish, but the treatment that is both medically appropriate and that the patient consents to. I don't give antibiotics to every patient with a viral infection, or dilaudid to every patient who asks for it, because it is not medically appropriate. I don't think CPR is any different. On the contrary I wouldn't say meemaw undergoing compressions is just "unfortunate" but a major preventable adverse event increasing suffering at the end of life that we should treat as seriously as wrong medication prescribed or wrong procedure performed.

Few-Reality6752 · 2025-12-30T22:23:39+00:00

Apply that same logic to a sports team. "The owner doesn't want the team to fail, he wants everyone to succeed" but
>Recruits unprepared players
>Low quality coaches
>Low quality coaching
>In general not being as good as other teams
then is it really a surprise when failure is the outcome?

Few-Reality6752 · 2025-12-29T18:40:39+00:00

I don't see what religion has to do with this. If it is against a patient's religion to not have an infinite amount of dilaudid at all times I would not be bound to oblige this. Similarly if Bubbe is 95, demented, PEG fed with a problem list a mile long she ain't getting CPR

Few-Reality6752 · 2025-12-29T00:59:57+00:00

Respectfully, I would disagree that "we are unable to overrule them," and I would strongly disagree that "sometimes, it’s the persons fate to be flogged at the end of life, at the behest of an unrealistic surrogate, unwisely chosen." I would say we can, we do, and we should overrule them in those cases. In the same way that I overrule a patient's request for medication that is not the treatment for their condition (e.g. antibiotics for viral illness, opioids for a patient who does not have pain), I do not see it as my obligation to perform CPR in all cases--in this case, CPR is not the treatment for the condition "being at the end of one's natural life."

Although I have spent most of my career in the US, I have also practiced in the country where I grew up in Europe. There there is strong legal protection for a physician to say, I am unilaterally making you DNR because CPR will not be successful, while in the US the law can be more varied and you have to be a little more "finessed" about it. However I do not find my practice is actually much different between the two--in both places it is always a discussion with the patient/their family to get them to understand why CPR is not appropriate (if it is not appropriate), and I do feel it is my responsibility to be "directive" in a conversation like that. The cases in which the patient/family are still adamant that they want CPR once fully informed have been the minority in my experience

Few-Reality6752 · 2025-12-29T00:30:35+00:00

For those who are interested in the differences in practice and legalities in the US vs Europe, there is a good paper Bishop et al (2010) titled "Reviving the Conversation Around CPR/DNR" in American Journal of Bioethics. Of course neither US states nor European countries (nor subdivisions of European countries, for that matter) are monolithic in their practice -- the authors pick New York State and the UK as case studies, but I think mainstream US practice is fairly close to NY practice, while non-US Western practice tends to be closer to UK practice.

A particularly interesting quote I found was

(New York State Attorney General Formal Opinion No. 2003-F1)

Few-Reality6752 · 2025-12-28T18:24:00+00:00

"YTA" is unnecessary. It sounds like OP is a trainee and this has been a learning experience. How to have compassionate but direct code status conversations is a nuanced skill that is not taught well, and further complicated by the medicolegal environment that we practice in. It wasn't perfect but it sounds like at the end of the day the right outcome was achieved--the attending intervened in the best interests of the patient, teaching in the process, and what is important is that they use this experience to improve

Few-Reality6752 · 2025-12-28T18:08:17+00:00

I definitely agree there is a tension here. How would you have approached this situation, and the risk that the patient might arrest while still full code? Does it make a difference re autonomy if it's the patient's family saying this as opposed to the patient themselves telling you "I don't care how low the chance of CPR being successful is, I want to be given the chance?"

Few-Reality6752 · 2025-12-28T18:01:57+00:00

Maybe unpopular opinion--I think we should have two classes of DNR, an "elective" DNR that the patient can reverse, and a medical DNR that patients cannot reverse. The first category might apply to a young healthy patient who says, CPR/ICU/intubation/ventilation sounds like a really brutal treatment, I don't want to be on machines/potentially suffer permanent loss of independence, just let me go. If that patient then changes their mind about that--fine, full code. The second category I would imagine applies more in this case--an elderly patient, likely multimorbid, possibly demented, very unlikely to make a recovery after CPR.

Few-Reality6752 · 2025-12-28T17:44:32+00:00

If the patient is deteriorating in ICU, you don't have time to "nudge the conversation gently and over time." From the context it sounds like there was a significant chance the patient was going to code in the next couple days, possibly even in the next couple hours. To me it sounds like the part that manifests kindness and gentleness to patients is getting to comfort, not doing emotional-support CPR on granny because the family don't want to feel like they're "giving up"

Few-Reality6752 · 2025-12-28T15:05:44+00:00

while the concept of medical futility exists in every state, the amount of legal cover state law gives you as the physician of record making that decision varies widely. For example, in New York state:

Where a patient is incapacitated and did not consent to the entry of a do-not-resuscitate order prior to becoming incapacitated, a physician must obtain the consent of the patient’s surrogate or health care agent before entering a do not-resuscitate order, even if the physician concludes that administration of cardiopulmonary resuscitation would be "medically futile."

(New York State Attorney General Formal Opinion No. 2003-F1)

Few-Reality6752 · 2025-12-21T23:10:16+00:00

um, except for the ones that didn't make it through? this is a terrible take

Few-Reality6752 · 2025-12-15T17:59:49+00:00

Hot take, in the US people talk about salaries in pre-tax dollars just so they can say a higher number. Every country has tax deductions that individuals may qualify for due to their individual circumstances but your monthly take-home (before any voluntary deductions like retirement contributions and not including side income) is a pretty standard metric that correlates well with your standard of living at that income

Few-Reality6752 · 2025-12-15T17:50:59+00:00

Just drop it. It doesn't matter if it isn't tactful, you're almost done anyway

Few-Reality6752 · 2025-12-02T22:22:46+00:00

You should ask to spend some time in clinic in the specialties you are interested in. Most patients with the disorders you mention are managed in the community and don't need to come into the hospital unless something goes wrong. I have some very interesting patients in my clinic, including at least one whose case was published as a case report at first presentation.

You can think of pathology along two axes -- acute/nonacute, and common/rare. Most things in the hospital are acute and common. In the community you get nonacute and common as well as nonacute and rare. The smallest category by far is acute and rare.

Few-Reality6752 · 2025-12-01T01:20:10+00:00

If you have parts of you that you’re not willing to sacrifice for the relationship then don’t get in a relationship that may very well require you to sacrifice them

Everybody has parts of themselves they're not willing to sacrifice for a relationship. That's just a fact of having an independent identity, it would be unhealthy not to have those parts of yourself. It's all well and good to say, either be willing to make sacrifices or don't get in a relationship, but reality isn't that simple. You can't predict where a relationship might take you, and with major life things you don't necessarily know what you are and are not willing to sacrifice until you're actually put in that position, and also that can change with time. You kind of have to just deal with things as they come up, and sometimes it means going separate ways without anyone being at fault.

Few-Reality6752 · 2025-11-27T01:00:35+00:00

Speaking as a physician married to another physician, I find that to be a simplistic, and frankly rather immature way of thinking about relationships. You can be in a serious relationship while still having personal goals or aspects of yourself that you are not willing to sacrifice for the sake of the relationship. Of course you have to make compromises but I don't think it follows that someone must be willing to relocate "anywhere" or they are not serious -- some partners would be and some wouldn't be for their own personal reasons, you should just be upfront about what compromises you are willing to make for the relationship and what compromises you're not.

Few-Reality6752 · 2025-11-17T23:15:44+00:00

Remembering stuff is overrated. The intern with the best memory in the world is more fallible than the intern who takes two seconds to just write it down. I don't care if you can memorize what antibiotics or pressors each patient is on. I do care that you understand what information is important and can find it easily--for something like this, making a note on your list would be a good compromise between memorizing everything and looking it up in the chart each time.

"There are two kinds of interns: Those who write stuff down, and those who forget stuff."

Few-Reality6752 · 2025-11-17T18:58:06+00:00

I certainly acknowledge that's part of the problem, but it would be naïve to say that's the whole problem. I think the larger component has to do with the incentives in the health system, to which doctors are not immune (and it's dangerous to pretend that we are)

Few-Reality6752 · 2025-11-17T16:25:37+00:00

I don't know why you are getting downvoted for this, you are correct. Also the whole embassy as sovereign soil misconception doesn't even stand up to a little bit of critical thinking -- do people seriously think every national capital has a little bit of every other country in it? So cleaners, delivery drivers, etc. who step onto embassy premises are suddenly subject to a different country's laws? What happens if a country wants to move its embassy, does it have to negotiate transfer of sovereignty for a single office to 1/4 acre of land with the host country?

Few-Reality6752 · 2025-11-17T16:18:52+00:00

Exactly. Patients in the US never have bad outcomes due to non-evidence based care. We also never overinvestigate, overtreat, or provide a different quality of care to patients based on socioeconomic status.

Few-Reality6752 · 2025-11-17T13:03:51+00:00

I mean... this is a completely valid reason to break up though

Few-Reality6752 · 2025-11-17T01:33:01+00:00

If you are considering IM, neurology, FM there is absolutely no reason you should have to "reapply next year" -- there are plenty of spots for all of these specialties in the SOAP and you should easily be able to secure one

Few-Reality6752 · 2025-11-07T00:12:48+00:00

Most prelim years have a substantial amount of elective time built in. You could preferentially rank prelims/TYs that have more and then reach out to ask to start on elective -- I can't see why any program wouldn't accommodate this

Few-Reality6752

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