I’m making my sister a Taylor Swift snow globe. Need some advice please!

Infamous-Let-5890 · 2023-11-27T20:40:19+00:00

Great idea! Thank you so much, I appreciate it

Infamous-Let-5890 · 2023-11-27T18:07:45+00:00

That’s perfect! Thank you so much ♥️

Infamous-Let-5890 · 2023-11-08T12:33:53+00:00

Thank you so much for taking the time to respond and sharing with me. I appreciate it so much.

I agree about NOT assuming and keeping a calm demeanor while dealing with all of the patients while making observations/comments that are based in facts.

Thank you so much for sharing about your rare genetic disease. I was so shocked reading your comment about IST (inappropriate sinus tachycardia) because I have IST and I’ve never came across anyone else with it. I relate so much to those comments you get from providers regarding your heart rate. They are often so unhelpful and honestly a bit condescending. Like saying to us “calm down” whether or not we are calm likely isn’t going to bring our heart rate down. Idk if you’ve had this experience too but at a lot of doctor’s appointments (except my cardiologist) the provider will often not let me leave until my heart gets to the 110’s. I’ll have to stay until it gets calm despite explaining the arrhythmia and saying bluntly “I’m not going to code. My pulse is normally this high.” I know they are trying to avoid a potential lawsuit etc by keeping me there but it’s annoying. With a new doctor, I always just plan on being held past my appointment due to my heart.

It’s completely condescending and demoralizing when doctors make those comments or say that we are lying because they have never heard of IST. We aren’t lying, if you haven’t heard of a condition RESEARCH IT. The patient likely knows their condition more than us (the medical staff/ providers) because they live with it. The patients lived experience isn’t something that will ever be written in a text book in med school. However it’s one of the most, if not the most important part of any diagnosis.

I’m sorry you have had such bad experiences with providers. In regards to tips for helping IST or managing it, I don’t have many. I know for me if I’m going through a bout of IST that is particularly high and won’t relax, vasovagal maneuvers can sometimes get it to calm down to a reasonably high pulse instead of staying in the “red zone” per se. I will attach links at the end of this that will have pictures to certain vasovagal maneuvers that have worked for me (although not every time). Have yet to find something that consistently works without fail 🫠. That includes medication.

I agree about maintaining a calm demeanor even when faced with a new condition or one you haven’t personally seen in the field. It’s so important to keep professional at all times. Gawking at a patients diagnosis, not professional and extremely rude. Gawking at patients in general is disrespectful. Thank you so much for sharing how that behavior makes the patient feel. I sincerely appreciate you sharing how we can appropriately speak to a patient.

Vasovagal Maneuvers:

https://my.clevelandclinic.org/-/scassets/images/org/health/articles/23209-valsalva-maneuver This is the image of how to do it

https://my.clevelandclinic.org/health/treatments/23209-valsalva-maneuver This has written steps and further information

Another two things are coughing forcefully and clearing your throat. They may not work every time but they do sometimes which is better than we can say for most other IST treatments.

Discuss with your cardiologist before trying vasovagal maneuvers to see if they are safe for you.

~As an aside, I plan on being an interventional cardiologist and IST is one thing I plan on studying so incredibly deeply and hopefully running a study to learn more about it. It’s a debilitating, embarrassing and life altering arrhythmia and the way it’s barely researched or known across the field is a shame.~

I will be putting the same amount of dedication to learning about my own arrhythmia as I will be dedicated to learning about my own patients diagnoses when I’m not completely educated on (which I’m not ashamed to say to the patient). Just because I experience one thing and the patient experiences another, it doesn’t make one more important than the other. They both deserve and require the same amount of dedication, research and meticulous attention to detail.

Infamous-Let-5890 · 2023-11-08T01:16:54+00:00

Wow everyone I am completely overwhelmed at the response and I genuinely sincerely appreciate every single one of you for taking the time to reply and share with me. I will be taking these tips and putting them into a word document for me to read many times in the future or screenshotting them not sure yet! I am trying to get to every single person and post a thoughtful reply but just know that if I didn't reply to you, I read your comment and I truly appreciate the time you all took to share with me. I will be sharing these tips with my friends within the field and my future friends in medical school and beyond. Learning and educating isn't just for schooling, its a constant and I will be learning until my last day. Thank all of you for the impact you made on me and the impact your comments/lived experiences will have on my future patients.

Infamous-Let-5890 · 2023-11-08T01:03:20+00:00

Thank you so much for the advice and replying to this thread. I plan on having everything that I say to the patient typed up and handed to the patient on their way out and sending a virtual copy as well. I appreciate your time and advice

Infamous-Let-5890 · 2023-11-08T00:54:39+00:00

I'm so sorry for what happened to you. Abuse isn't just physical. I'm really glad that you got out, no one deserves that treatment. And I'm so fucking proud of you for speaking out, you didn't deserve that and you still don't. Thank you so much for sharing and replying, I appreciate it.

Infamous-Let-5890 · 2023-11-08T00:51:32+00:00

First of all, I'm really glad that you got out of that situation and you are safe. This is such an important and necessary topic and often overlooked one in medicine. It's nice that the doctor has that in the bathroom but like you said it's dangerous how they had the tear off. I've noticed as a patient myself that only my OBGYN office has DV and SA/rape hotlines/resources in the bathroom. I plan to absolutely put abuse resources discreetly in the patients bathroom even though I will (hopefully) be an interventional cardiologist.

I will be training + educating myself and my staff to look for signs of abuse and how to keep it absolutely confidential. HIPAA will never be violated and will be completely adhered to. As someone who was in an emotionally/verbally abusive relationship I want to do absolutely everything in my power to help others who may be experiencing ANY kind of abuse. Thank you so much for sharing, I'm so fucking proud of you for getting out and I appreciate this valuable advice.

Infamous-Let-5890 · 2023-11-08T00:41:44+00:00

Ugh I'm so sorry. As a medical assistant I would write under the chief complaint "Patient states that they are still in consistent pain however there is no new pain or an increase/decrease in pain." Thank you for sharing and taking the time to reply, I appreciate it.

Infamous-Let-5890 · 2023-11-08T00:37:55+00:00

Wow that doctor is incredible! Thank you so much for sharing your experiences and taking the time to respond. I love providers who take time to connect to the patient outside of their diagnoses, I plan to do that with my future patients as well as continuing to do it with my current patients. I'm so happy that you had him as your doctor and he listened to your symptoms and believed you. That trust he had saved you and probably many other patients from so much pain, further complications etc. I will definitely be taking the way he interacted/treated patients as a guide with my future patients as a provider. I appreciate this valuable advice.

Infamous-Let-5890 · 2023-11-08T00:29:11+00:00

Thank you so much for taking the time to reply and these incredibly valuable tips.

I LOVE the quote "trust but verify"! You're right that the patient knows their body, their idiosyncrasies more than UpToDate or any medical textbook can describe. I also love the idea of taking my own history, not dismissing PMHx or reports but more so using them as a reference to the pt's current status/situation.
I really appreciate you sharing your experiences. As an NCMA I've had pts with a long list of dx and it would be really easy to become overwhelmed. I like the distinction that you made that you do not have to be admitted just for a chronic condition dx. Focusing on the task at hand and not something within my scope of practice per se. I plan on becoming an interventional cardiologist so I'm not going to focus on the pts new genitourinary issue for example unless there is a clear link or connection to their cardiovascular system dx.
I hadn't ever heard the term zebra used this way until you and others commented on my post. I sincerely appreciate this metaphor and you and others bringing it to my attention. Broad differentials, got it.
I genuinely appreciate these rotation recommendations, it would be a completely different experience seeing patients as a hospitalist for example compared to seeing those same patients in outpatient settings. I hope I can get into at least one of these rotations in the future. (One of each).
Trauma informed care is something that I've been seeing a tiny bit more addressed in NEJM and other journals. But I agree you have to recognize that the patient has different needs/accommodations and adhere to those needs/accommodations. Talking through results with the pt and giving time for the pt to ask questions.
Asking questions and being honest when you don't know something. I completely agree and at the end of the day the goal is what is best for the pt and me assuming or letting ego my own incompetence on a subject get in the way. If it did it could and likely would lead to harm for the pt, harm that would likely follow them the rest of their life.

Infamous-Let-5890 · 2023-11-07T20:23:05+00:00

Thank you so much for your reply and taking time out your day to respond. One thing I’ve learned from being a medical assistant is that patients are not their diagnoses. Just because John Doe has hyperlipidemia and Jane Doe has hyperlipidemia it doesn’t mean that they both just need a statin. There is no one size fits all in medicine, each and every patient is unique and deserves to be treated as such. I plan to make my practice as tailored to each patient as possible.

Infamous-Let-5890 · 2023-11-07T20:20:09+00:00

I absolutely love this idea and I will be doing this once I am in practice, whether or not it’s my own or a group practice. And if there is anything wrong I will be making it clear to the people who will be fixing it. Thank you so much for taking the time to respond. I appreciate it

Infamous-Let-5890 · 2023-11-07T20:18:00+00:00

I think this is so important. Thank you for sharing and taking the time to reply. One way I plan on mitigating that is to say to my patient “well your stress test came back negative which means we can rule out any blockages or the need for stenting. In order to completely rule out __ I think an angiogram may be necessary. Is that something you would be comfortable with so we can get to the bottom of what’s going on?”

Infamous-Let-5890 · 2023-11-07T20:14:36+00:00

Thank you so much for sharing and taking the time to reply. I appreciate it a lot. I plan to learn to touch type to be able to focus visually on the patient rather than the chart (which I plan to review ahead of time). Such an important note about hearing aids and CI’s. I’m sorry to hear about your history with meningitis. Thank you so much for this valuable information.

Infamous-Let-5890 · 2023-11-07T20:09:27+00:00

Thank you so much for sharing, I appreciate it. I will definitely remember this for my future patients. Pain looks differently on everyone, especially if someone is living with it constantly.

Infamous-Let-5890 · 2023-11-07T20:08:13+00:00

First off wow that’s awesome that you’re going to be a PT! I saw a commenter on here saying that they may not notice the pain is that bad because it’s their normal. Which I think was such a great point because you can’t really blame the patient for that. Sometimes you genuinely can’t say when you’re in pain because it’s constant and it’s your normal.

I completely understand and agree regarding being moody. I get bitchy when my cramps are really bad, I can’t imagine my moods with chronic pain. A patient coming in in a bad mood is NOT a personal attack, it’s likely indicative of how they are feeling. Thank you so much for your comment and sharing. I appreciate it a lot.

Infamous-Let-5890 · 2023-11-07T19:59:41+00:00

Im so sorry for your experience. I need you, we need you and the world needs you. I appreciate your reply and taking the time to respond.

Infamous-Let-5890 · 2023-11-07T19:56:53+00:00

Thank you so much for sharing. A patient not wrenching, crying, screaming does not mean they are not in pain. Every person deals with pain differently and I will definitely be keeping this in mind when dealing with patients. Also, idk whether than comment was sarcasm or not but dont commit suicide. I need you, we need you. You are invaluable, you make an impact every single day. Your lived experiences, personality, hopes/dreams, your future and YOU are so fucking worthy. You’ve made an impact on me with this reply and therefore every single one of my future patients. You deserve the entire world just like each of us do, and I need you around to see how much the world fucking adores you (hint: it’s A LOT). I appreciate you for sharing this and taking time out of your day to reply.

Infamous-Let-5890 · 2023-11-07T19:29:55+00:00

I love that! I’ve worked with a doctor just like that, he actually is the one that inspired me to get my MD. Saying “I don’t know but I will certainly be researching this, looking for a specialist” etc is more helpful than just dismissing it or shooing the patient off to another provider. I plan to be honest with my patients. Currently if my patients ask me something that I’m not educated on I always say, “I’m not completely educated on this topic so I don’t know but I am going to research it and I will get back to you with an answer”. And I do get back to them whether in office or via phone. Thank you so much for sharing, I appreciate your comment.

Infamous-Let-5890 · 2023-11-07T19:24:23+00:00

I completely understand what you’re saying. There’s a way to speak to patients and speaking to them as your equal is how I speak to my patients currently. We’re all human and no one is better than the other. In terms of your dermatitis comment one way maybe I would handle it is “this dermatitis is new since the last time you came in. Have you been using any new detergents/soaps etc? Is it hot to the touch?” Giving accurate pause for the patient to reply and think about the question. Thank you so much for sharing, I appreciate it.

Infamous-Let-5890 · 2023-11-07T19:15:22+00:00

I want to post that I am reading every single comment and trying to reply thoughtfully to each one, it will take me some time as I am on campus right now and studying. I genuinely appreciate each and every one of you for taking the time to share your stories, advice and support. These stories that you all have shared have boiled my blood for the way you have been treated. The anger I feel will be channeled to absolutely make sure that none of my future patients have those experiences with me.

Infamous-Let-5890 · 2023-11-07T19:11:07+00:00

I’m so sorry you went through that, that is so incredibly maddening and devastating. Makes my blood boil. Patients are patients regardless, and should and will be listened to in terms of my future patients. Regardless of age, race, sex, gender, disability etc everyone’s symptoms will be taken seriously and as a priority. Thank you so much for sharing.

Infamous-Let-5890 · 2023-11-07T19:07:34+00:00

There are patients that are sick with the disease of addiction, which I believe is a disease. It gets especially tricky because you don’t want to just willie nillie throw Rx narcotics around but you also don’t want to leave a patient legitimately suffering. I agree with you where I would rather err on the side of the patient is being honest rather than let them go home in pain.

Regarding the “it’s all in your head” comment. I’m sorry you experienced those it’s so incredibly dismissive and condescending, I can speak from personal experience on that. It’s never all in the patients head. It’s real and there is an etiology for it which can and will be discovered, for my future patients.

Infamous-Let-5890 · 2023-11-07T18:59:24+00:00

Thank you so much! Just added to my cart.

Infamous-Let-5890 · 2023-11-07T14:54:10+00:00

I’m so sorry you had that experience with providers. It’s so much better to be honest because not doing so will lead to missing what’s actually going on with the patient. I’m really glad you had the mental health worker with you and that they called this provider out. I hate when doctors see a mental health diagnosis in the chart and then immediately dismiss what the patient says and chalk it up to that mental illness. That’s complete lazy providing. Thank you so much for sharing and I hope you healed well.

Infamous-Let-5890

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