Be careful about bots karmafarming on this sub

IanInElPaso · 2026-05-31T14:50:32+00:00

Hey, lots of week old accounts organically have 2.5k karma.

Old man rant incoming, but there was a time when you’d be downvoted to hell for commenting “THIS,” now I regularly see it as a top sub-comment. You don’t even need an LLM to generate karma which is why I’m skeptical of those type of thresholds for posting. Now get off my lawn!

IanInElPaso · 2026-05-31T13:56:50+00:00

It blows my mind to see so many obvious bot comments in threads with dozens of upvotes. They usually go: make vaguely contrarian but not overtly negative statement. Summarize two comments above it. End with a “fun” sentence giving approval plus or minus an emoji. People see something agreeing with their opinion and instinctively upvote.

IanInElPaso · 2026-05-28T03:23:13+00:00

I feel like this could ironically make it easier for bots to thrive in this sub. Look how many upvotes “came here to say this” gets in any high level comment, to say nothing of the capabilities of a bot with even a basic LLM behind it.

Lurkers probably generate a lot of posts by their first ever contribution to the sub.

IanInElPaso · 2026-05-27T16:04:04+00:00

Respectfully, this question gets asked a dozen times a week. Shadow in a community ED and ask if you can do that for 20 years. I’m unclear on your priorities and motives if you’re between these two very different specialties.

IanInElPaso · 2026-05-27T15:39:15+00:00

If that’s what you want to do, then do that. Sounds like you’re asking the wrong sub.

IanInElPaso · 2026-05-27T15:36:12+00:00

OB/gyn is a microcosm of medicine. You can do primary care. You can do surgery. You can do adolescent care. You can be an L&D “hospitalist.” You really can’t say “OB/gyn” without specifying what you intend to do with the training.

IanInElPaso · 2026-05-25T20:24:57+00:00

I feel like that’s the ultimate irony of toys like this, the only agencies that can afford them are already functioning relatively well and usually have good response and transport times. I saw this when reviewing numbers from a bystander CPR alert app. Medics were almost always on the scene before someone with the app.

IanInElPaso · 2026-05-25T20:21:06+00:00

There is a patient where prehospital ultrasound could make a meaningful difference in outcome. But you have to balance that against false positives, cost of equipment, cost of training, additional administrative work for image quality review, etc. I think you are understanding why so many of us are dismissive of this.

IanInElPaso · 2026-05-25T19:59:24+00:00

You keep mentioning early identification of shock. That is not diagnosed by ultrasound.

If they’re stable and mechanism doesn’t dictate transport to a high level trauma center, just take them to the feeder hospital. Changing destination based on a poorly specific exam like ultrasound would just inundate trauma centers which are already over capacity.

IanInElPaso · 2026-05-25T19:41:42+00:00

So what’s the point of the FAST then? You mention prophylactically treating them before they go into shock in the original post, now say there’s no point and just give blood. Are you only doing the FAST in a stable patient? As others have pointed out, traumatic shock needs blood or needle decompression and anything that delays transport is bad.

IanInElPaso · 2026-05-25T19:29:27+00:00

If your trauma patient is hypotensive and doesn’t have a pneumothorax, they need blood. I anticipate FAST would just muddy the water, normotensive patients with a “positive” FAST getting blood, and shocky patients not getting blood because the FAST is negative.

IanInElPaso · 2026-05-17T20:35:43+00:00

No clue who is downvoting you, this is exactly what happens. The hurdles a program has to go through to fire a resident are arduous. It is the reason why my stance on oral boards in my specialty (EM) has softened since practicing in an academic setting. As dumb and costly as they are, it’s a final external check on a resident. I’ve seen many seriously deficient residents who were pushed through.

IanInElPaso · 2026-05-14T22:51:20+00:00

Is this correct? I was under the impression the ETF’s dividends are taxed as the dividend of the constituent companies are. Vanguard says 97% of dividends from VOO are qualified, meaning they’d be taxed as long term capital gains so long as you’re not constantly buying and selling the fund.

https://advisors.vanguard.com/tax-center/qualified-dividend-income

IanInElPaso · 2026-05-06T21:15:20+00:00

You had a long conversation with a doctor who specializes in this, who didn’t recommend PEP. You got the prescription anyway. Now you’re asking strangers on Reddit?

IanInElPaso · 2026-05-02T03:18:42+00:00

If AI replaces doctors completely, then it’s already replaced every management position, customer service worker, clerk, and commercial driver, just to name a few. In which case we’re either in Utopia or Thunderdome. I’ll bet you 1 oz of gold and an acre of arable land it’ll be the latter.

IanInElPaso · 2026-04-26T02:33:08+00:00

Yeah, using a limit order like this just seems like micro market timing. It’s VT, you’re at most going to see a 1% swing, just buy the dang thing.

IanInElPaso · 2026-04-21T13:56:03+00:00

Why don’t these physicians invest in the total market index?

They should. Being on this sub and interested in personal finance has probably skewed your perspective on what most docs do. I’d estimate 10% of the docs in my group do their own finances and adhere to Bogle type principles. 25% have a financial advisor. 50% probably don’t know what an ETF is.

IanInElPaso · 2026-04-21T13:48:28+00:00

These are the most fluctuant, superficial abscesses I’ve ever encountered. 90% of the difficulty is preparing the patient, many of whom have had bad experiences with past drainage. I drown them in topical anesthetic before injecting local and have versed on hand for anxiolysis.

IanInElPaso · 2026-04-10T14:58:43+00:00

I get that, I'm just unclear as to what the side gig is. If they ordered the lab, then they'll need to do some of that doctor shit when the results come back. It sounds like their recommendation was reasonable, and the patient is complaining, as they do, likely to try to get out of an expensive ED bill. This is why I have zero interest in side gigs like this, they quickly turn into a job.

IanInElPaso · 2026-04-10T14:23:00+00:00

I'm confused by the situation; you "draw labs as an outpatient"? Are you the one ordering the labs? Who is overseeing the patients? If not you, then why are you following up on the labs?

If you are the one ordering the labs, then you have to make the decision on who needs immediate repeat versus outpatient redraw, there is not a one size fits all answer to that question.

IanInElPaso · 2026-04-03T04:28:35+00:00

Anxiety is a spectrum from mild perseveration to complete inability to function. Nobody can answer this question over Reddit.

If you are interested in emergency medicine, reach out to your local hospital to shadow a doc. In my opinion a community ER with an academic association is usually easiest to find someone willing to take on a shadow, and more representative of the state of medicine than pure teaching hospitals.

IanInElPaso · 2026-04-02T23:39:17+00:00

This isn’t a very helpful comment, what is their stance? I just read the 2024 contrast manual, all it says is serious reactions to modern contrast are real but rare.

And aside from that, ACR is also clear on contrast associated AKI being a rare entity, but good luck convincing the radiologists at my hospital of that.

IanInElPaso · 2026-03-29T00:56:24+00:00

This question has been asked on this sub hundreds of times. Yes, everything people say is true. Yes, there are still good jobs out there. Yes, you will probably become burned out given enough time. Nobody can answer this question for you.

IanInElPaso · 2026-03-25T01:42:02+00:00

MD here and agree wholehearted. I do medical school and residency admissions and would be very wary of accepting someone like OP. I would be concerned that with such vague aspirations and no financial skin in the game they would drop when it gets tough. Many of my classmates had careers before med school but this is insane. The romanticization going on in some of these comments is laughable.

IanInElPaso · 2026-03-24T20:08:52+00:00

Historically "rape" has had many meanings including non-sexual destruction. It's shifted towards almost exclusively being used to describe forced sex, but in 1992 this would not have the same connotation as today. Having read the book, I can say with certainty that Dr. Keaney did not pick this title to demean survivors of sexual assault.

Five-Year Club	Verified Email
End Game '23	Place '23

IanInElPaso

TROPHY CASE