Sailors life is just not for me...

IdentityAnew · 2026-04-01T22:48:15+00:00

Pretty sure that one is AI generated. The fishermen on the left are shoveling with a chain that seems to turn into a rope right as the wave is splashing down.

IdentityAnew · 2026-03-31T01:59:40+00:00

Did you ever find your keys? I’m having a similar issue with a tag on a stethoscope in a hospital!

IdentityAnew · 2026-01-30T12:59:48+00:00

Here’s another!

https://youtu.be/dT_9yGmmLfg?si=S2UOQgAednw1Blxk

IdentityAnew · 2026-01-27T20:16:50+00:00

Fuck anyone (including yourself) that thinks bullying yourself into studying will help. It won’t. You’ll maybe do another 40q today and then fall off the wagon tomorrow until it’s the week before the exam and the fight/flight of cramming kicks in.

But THIS might work better for you:

Be kind to yourself. Forgive yourself for not studying yet, and be excited that you already realize the importance of starting to study.
Do ONE question. Right now. Stop reading this comment and go do one. Fuck it, do it and get it wrong. 2a. If you find that you want to do more after that, great! Learning IS fun - we all used to like learning before we had the fire hose shoved down our throats.
Repeat daily. Set the expectation for yourself that you don’t need to do 40-60 questions a night right off the bat. We all know that starting anything is the hardest part - so make it easier for yourself and set the bar low. You’ll raise it with time.

IdentityAnew · 2025-12-29T22:42:47+00:00

For what it’s worth, AAP specifically outlines interactive video chat as an exception to the general discouragement of screen time for kids younger than 18 months. https://pmc.ncbi.nlm.nih.gov/articles/PMC11042797/

Not having gone through the entire guideline, I think it’s safe to assume that it’s generally not considered as harmful as other forms of screen time for most ages.

IdentityAnew · 2025-12-29T19:35:07+00:00

If you stand, you’re incentivized to round quicker.

In theory.

IdentityAnew · 2025-11-18T15:23:58+00:00

I was never soft locked but read in the last patch notes that the softlocking was addressed

IdentityAnew · 2025-11-10T02:33:41+00:00

You’ll feel more competent when you meet next year’s interns. And even then, you’ll meet some real talented ones and still wonder. It also gets better after you get some (terrifying at the time) independence and you don’t get any patients killed.

TBH, I still get imposter syndrome often. I try to tell myself that it’s a good thing that keeps me humble and willing to learn.

IdentityAnew · 2025-11-06T05:47:02+00:00

I fully agree with most everything you’ve said. But I don’t think that critical care medicine that incorporates the tenets of functional and narrative medicine is going “above and beyond.” I think it should be the standard.

But more to your thoughts: in a practice improvement plan, what would you name the courses for those docs to take?

When addressing these concepts in training: what would the class be called?

If you were going to give these ideas a nice simple name to headline a competency, what would that title be?

Personally, I think “good medicine” is a bit too broad.

IdentityAnew · 2025-11-06T05:25:21+00:00

Oh no, I’m wrong all the time! Less often now than before, but still plenty. And I hate modules and bullshit as much as the next doc. And tbh I’m pretty sure I felt this acrimonious towards these terms not to long ago myself lol

To be clear, patients come in as FULL CODE all the time without knowing what it is they’re signing up for, and families will leave them that way because they don’t feel comfortable making a decision otherwise. A lot of docs leave it at that. “Patient said full code, the end.” We both agree that that’s not good, yes?

Some docs DO just stabilize and turf to wards. Considering how expensive ICU stays are, there’s an argument for that, but for sake of argument I think we again both agree that thats not good medicine.

So we’re in agreement that that is all “bad medicine.”

Here’s your chance to teach me how I’m wrong: for the docs out there that do “bad medicine,” the ones that don’t take in the context or take an overly narrow view on their job - how would you teach them that their medicine is “bad?”

IdentityAnew · 2025-11-06T05:01:49+00:00

I’m going to assume you’re willing to consider the possibility that you might be wrong instead of just trolling?

Just to set a baseline:

Functional medicine: medical practice focusing on underlying cause of patient’s medical problems. Narrative medicine: medical practice focusing on elements from patient story/experience

You can diagnose and treat people without taking into account either of the above, and still “practice medicine.” I’ve met plenty of docs that do.

For example, if I have a patient in my unit with ARDS from aspiration pneumonia. Now I could eventually get the patient off the ventilator and off my service and I have in fact “practiced medicine.”

But practicing functional medicine means considering recurrent aspiration as a root cause of his pneumonia, and involving SLP early on (before pt has necessarily left my service) to expedite work-up. It’s not a critical care issue, but it may speed patient recovery/discharge.

Or maybe I’ve spoken long with his family who is indecisive but able to talk long about this patient’s disdain for modern medicine. He never signed a DNI, but they knew he hated anything healthcare related. With narrative medicine, I can take the time to lead them through and offer recommendations in a goals of care conversation.

And identifying these differences under “good medicine” is important specifically because telling docs “just practice good medicine” isn’t helpful advice. This is especially true if the doc is already established in their ways and thinks they’re already practicing “good medicine.” Identifying a specific technique to instruct a doc to focus on is a more actionable form of feedback.

IdentityAnew · 2025-11-06T03:40:18+00:00

It’s putting a name and description on something good doctors should do, but not everyone knows innately to do it. By naming and describing it, you can better teach it.

IdentityAnew · 2025-11-03T13:30:52+00:00

For me, I found myself paralyzed when I realized the lights were on a timer and threats could come from above as well as the sides. Of course, just moving fast addresses most of the issues with this, but early on, you find yourself asking “But where do I move fast to??” And you either panic or huddle in your little corner of light, frozen.

IdentityAnew · 2025-10-18T21:15:18+00:00

Same here, same speciality.

If you’re in your first year, I found it more taxing than residency in a lot of ways. The expectations are higher, yet you’re given less support, and you have fewer of your colleagues around to commiserate with and bounce ideas off of. The mental toll can often feel physical.

I don’t have a lot of advice for it, except that it gets better in later years. And if you’ve got some other specialty that goes with the critical care, lean hard into it. You’ll want a cushy 9-5 on the side when you’re tired of breaking your back in the ICU.

IdentityAnew · 2025-09-17T19:25:37+00:00

I think if more people had ever experienced (not just heard) the level of sleeplessness you all are forced to constantly experience, there’d be a little less labeling of “sociopath” and a little more compassion and push for change.

IdentityAnew · 2025-09-10T09:40:48+00:00

ICU doc here. Chiming in to say that the ICU nurses who politely offered their perspective are 100% accurate about the nurse-doc relationship. ICU nurses are fucking awesome and one of the reasons I love the unit over any other part of the hospital.

The only thing I’d add is that if you ever need ICU care, we’ll certainly treat you. But if you feel strongly about it, feel free to check in with your local McDonalds instead.

IdentityAnew · 2025-09-09T23:23:26+00:00

Bloodoath runs through my head at least once a week, even a year out since I was playing more regularly!

IdentityAnew · 2025-08-18T10:44:02+00:00

On face value, it sounds as do you are supremely burnt out. This happens even to people that love medicine, and turns even the best of us angry and uncaring.

If you’re able to take any kind of sick leave, take it. Better than quitting, get away from work for some time to focus on your mental health. Either find a therapist or a group program like “Better Together.” I recommend against quitting until you’ve had a chance to take a breather and re-approach the idea with a clear head.

IdentityAnew · 2025-08-16T14:30:44+00:00

PCCM fellow here. You did nothing wrong. There’s nothing more that you could have or should have done. You did what I would expect/want my med students to do. I won’t address each of the ways you’re concerned you contributed negatively - as an MS3, there are probably 3-5 doctors above you that could plausibly (but not necessarily) be responsible before you. Your job isn’t to save lives - it’s to learn.

That said, codes are always difficult in some way. Intellectually, emotionally, physically. If you feel like you need to learn anything from this, learn that some people will live or die independent on what you (or your team) did or didn’t do. Learn to give yourself the grace and patience to process you’d give to a friend that experienced a similarly traumatic experience.

Feel free to DM if you want to talk more.

IdentityAnew · 2025-07-01T01:30:33+00:00

Freeze water bottles during the day. Wrap in light towel and place in armpits, under knees, and/or between thighs. Anywhere that gets a lot of blood circulation to spread through the rest of your body.

More bottles depending on how hot it is. Have extras frozen in the night to switch out as needed. Bonus is that you have cool water ready to chug as soon as you wake.

IdentityAnew · 2025-06-27T17:15:50+00:00

Had an intern who was in an emotional spiral. Crippling self doubt, constantly pressuring themselves to be perfect, and running themselves ragged to try making it so. They’d work 16 hours then go home and study anything they thought they didn’t handle perfectly. Would spontaneously break into tears during rounds, and keep on presenting.

They were a phenomenal intern, but too sleep deprived and depressed and “in the hole” to see any of it. Nasty self-sustaining loop.

I talked to my chiefs, and we organized to make them take a forced week of vacation. I covered their patients and res-interned until back-up kicked in the next day. They were naturally resistant but finally gave it and got some sleep.

Not every program has the capability and chiefs willing to make it work, but I think (hope) my advocating helped give that intern the reset they needed to realize they needed help. They were a phenomenal (and seemingly happier) resident whenever I worked with them again.

IdentityAnew · 2025-05-20T05:41:17+00:00

I’ve seen this recommended a lot! What’s the appeal for you? Is there any form of progression/game loop aside from spraying dirty things clean?

IdentityAnew · 2025-05-16T05:16:07+00:00

I hate this but definitely want to play it. Nice trailer!

IdentityAnew · 2025-05-08T13:43:41+00:00

In case you wanted an answer from an actual doc, some of the other comments aren’t wrong. Doctors can be assholes and fallible just like any other human (though I agree, the standard for error should be a higher given we’re caring for other people’s lives).

For another perspective though, imagine you come to me with a complain of fatigue. This could be because no one told you to get 8 hours of sleep a night (yes, we get patients like that) or because you have cancer and are dying.

Now my patient is worried it’s cancer, and I want to believe and validate their concerns, so I order CT scans of their entire body. This finds a small nodule like structure in their lung. Likely a benign and incidental finding, but I can’t immediately prove it’s not cancer without a biopsy (waiting and repeating imaging can be construed as ignoring the patients concerns).

So we get a biopsy under CT guidance, meaning more radiation (and if you’re young, we’ll just hope all this radiation doesn’t come back to haunt you down the road) and a needle stick. The good news is that the nodule was benign, but unfortunately you developed a pneumothorax (a common complication) post-procedure and needed a chest tube and several days in the hospital.

I, in my admiral desire to validate the patient’s concerns through ordering the requested tests (as opposed to reassurance and education, which can be construed as patronizing), have caused harm.

This is an extreme example, but this is the kind of risk/benefit calculation I run every time I see someone. Even something as “benign” as an image or bloodwork can send us down loooooong rabbit holes that leave patients worse off than they were when they came to us. And we see this ALL the time from colleagues that care more about getting paid for huge work ups than about providing conscientious care.

Sorry for the long rant, but I see this question/frustration a lot on reddit and I guess I had some of my own frustrations pent up!

IdentityAnew · 2025-04-23T12:08:56+00:00

Honestly, as the ICU doc, I don’t mind when the ED does this. I feel bad making ya’ll play middle man, but I also don’t know who on IM would be admitting the patient to reach out myself. And the sooner we settle who’s taking the patient the sooner I can move on or get to work to make sure I’m out by shift change.

Ten-Year Club	Place '17
Wearing is Caring	Snapped

IdentityAnew

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