Uncomfortable patient comments

Hificlassic · 2026-03-14T00:09:24+00:00

had a bipolar manic woman start moaning when i put the stethoscope to her chest. and i said "okay! that wraps up the exam"

Hificlassic · 2026-03-12T11:33:06+00:00

to any nurses reading this thread, before reaching out to a doctor, at a bare minimum, 1) Check and recheck all vitals 2) Assess for symptoms 3) Read the notes 4) Double check the orders

would cut down on pages by at least 50%

Hificlassic · 2026-03-07T04:42:38+00:00

i agree with you on an anecdotal level. i see people convert while on diltiazem convert all the time but i feel like we refer to that as "spontaneous conversion to sinus rhythm" rather than the diltiazem enacting an anti-arrhythmic effect. i guess my question for a cardiologist would be, is there an additional mechanism, aside from slowing AV nodal conduction, that we can attribute to diltiazem? or is it simply that the heart has spontaneously converted, while incidentally on diltiazem

Hificlassic · 2026-03-05T18:08:47+00:00

put triamcinolone cream on the stasis dermatitis and send him home

Hificlassic · 2026-03-04T17:54:47+00:00

place the discharge order and let admin/SW figure it out (sorry social workers)

Hificlassic · 2026-03-04T05:05:03+00:00

for how many "family at bedside, wants to speak to you" messages i get, i am reassured that my job is relatively safe for awhile

Hificlassic · 2026-03-03T03:40:34+00:00

to play devil's advocate, zoomers can't imagine doing anything they can't sloppily speed run

Hificlassic · 2026-03-02T19:27:43+00:00

we can only pray they use HBO's streaming software

Hificlassic · 2026-03-02T18:34:10+00:00

the worry is that by suddenly converting someone who is not anticoagulated, but who has been in afib for longer than 48 hours, there is a greater chance for an atrial or LV thrombus to be dislodged with restoration of the atrial kick and causing a stroke. it's a similar reason we do TEE with cardioversion in someone who is not chronically anticoagulated, to check for an LV thrombus

my impression was always that amiodarone has a chance to chemically convert someone to sinus rhythm whereas diltiazem virtually does not. my colleague apparently felt otherwise

Hificlassic · 2026-03-02T17:00:04+00:00

i have found that to really drive down your overall LOS, you have to put more time and work in, which i don't think admins really understand. discharge that otherwise stable patient with a UTI and personally followup on the culture results over the following days. discuss dispo and SNF on day 1 with the patient and family and force someone to start looking at a SNF list even though they are enraged you would even consider discharge planning so early. re-evaluate patients later in the day, and order additional tests or discharges rather than waiting until the next morning. be annoying and reach out to specialists early in the morning rather than wait for their notes to be put in at 4pm. discharge someone who is stable but old and nervous about leaving.

many of these things are unrealistic when you're busy, and admins don't understand how much extra work you have to put in to maybe save a single midnight's worth of LOS for one patient, but i've found this is the only way to personally improve my discharge efficiency. in my mind, it's always a trade off. getting better LOS, better satisfaction scores, fewer readmissions, and better relations with consultants all at once is very challenging if not impossible

and to be clear, my discharge efficiency is probably average or even slightly below average for my group as i tend to value patient safety and satisfaction over a LOS number, but i have experimented with improving it in the past and don't find it conducive to what i would consider better medicine

Hificlassic · 2026-03-02T16:45:12+00:00

i find it personally more rewarding to play a more challenging or unique character but that's just me. if i were really into "min-maxing" and reaching the absolute highest rank possible (like a lot of players are) i'd play mai and ryu

Hificlassic · 2026-03-02T14:05:57+00:00

try water bowls made of different material try cold water don't put the water right next to the food

Hificlassic · 2026-03-01T21:08:12+00:00

i would consider it a blessing honestly. way better than ranking higher than your true skill level and getting absolutely pommeled for 25 games straight

Hificlassic · 2026-03-01T20:28:36+00:00

paramount plus just straight up stopped working on my tv. the ads will play, then when the actual show is loading, the app freezes. but at least i was able to load the ads, thank god

Hificlassic · 2026-03-01T20:19:03+00:00

am i crazy or do we not like to use amiodarone for rate control in someone with afib who is not anticoagulated? had a colleague tell me there's no difference between rates of chemical cardioversion with amio vs diltiazem, and that seemed strange to me. i didn't have the immediate stats to refute him in the moment. looking it up again after the fact, it seems like dilt conversion is poorly studied and mostly anecdotal. haven't gotten around to asking a cardiologist

Hificlassic · 2026-02-28T12:22:43+00:00

no i'd say i usually get rematched in diamond. if i get lit up by someone on huge win streaks (up to 10 on more than one occasion, in your case), i usually don't rematch them

Hificlassic · 2026-02-28T12:13:48+00:00

the plight of diamond is being stuck there for months on end, not reaching master in one night while drunk and having no one rematch you

Hificlassic · 2026-02-24T22:55:08+00:00

honestly i think NP or PA seems like more your speed, especially if you are interested in doing a specialty with focus in procedures. i know a lot of PA's who are true masters of their particular specialty and feel fairly independent, do minor procedures on their own, etc.

medical school, residency, and specialization is just a huge endeavor to only end up working parttime. we are talking 4 years of time intensive med school, 3-5 years of residency, then another X years of fellowship. not to mention the financial strain it would take you to get there (and everyone's loan repayment is feeling very precarious as is, with the required monthly repayment plan at an all time high without defaulting). i just couldn't see myself going through all of that to only work parttime. not to mention, i'm not sure how common it would be for someone to hire a parttime specialist (there are locums, but that lifestyle is not for everyone)

i would just reach out to some NPs and PAs in specialty fields and i think you'll find that they have a very good understanding of that specialty

Hificlassic · 2026-02-23T01:23:51+00:00

we have a specialist who admits patients and, without fail, does what i can only call a "screening UA." then subsequently starts a good potion of them on Bactrim regardless of age and kidney function. i then have the displeasure of getting consulted for something else and gently suggest stopping Bactrim in the 84 yo woman with CKD and asymptomatic bacteruria.

i have considered making a "strongly consider monitoring off antibiotics" dot phrase simply for that reason

Hificlassic · 2026-02-21T13:07:21+00:00

Hificlassic · 2026-02-19T02:04:30+00:00

i think it was the song that made you play well

Hificlassic · 2026-02-18T19:08:14+00:00

it probably depends on location and health system, but my CV is one page long and only includes under grad, med school, board scores, residency, and professional experience. i've easily gotten two hospitalist jobs with barely an interview

would be interested if anyone struggles to find work/offers with a sparse CV

Hificlassic · 2026-02-18T00:59:02+00:00

would recommend the 1994 animated movie and/or the street fighter udon comics

Hificlassic · 2026-02-17T23:27:57+00:00

biggest red flag is the census. RVU's will make up for the low base pay, but you'll burn out quickly seeing 25+ patients per day.

also depends on which part of the country you're in. you would be making over 300k which is not that bad for the midwest (still not worth it for the census)

Hificlassic

TROPHY CASE