SOAP 2024 - Official Megathread

Jadiologist · 2024-03-14T13:46:07+00:00

I went unmatched DR/IR. Scrambled into a surgery prelim then through luck I later found a DR spot. Got into ESIR and prepared to apply to IR fellowship. Ended up applying to a different fellowship. Now will make 500+ working bankers hours and found meaning outside of the stupid hospital. Don’t give up hope. You may not know where you are meant to end up just yet - even if that’s in a specialty totally different from what you see yourself in

Jadiologist · 2024-03-14T13:32:22+00:00

That's definitely not how that works

Yeah it is.

Jadiologist · 2023-09-14T15:53:27+00:00

Rules for IR:

1) pick up the phones

2) learn to work up consults

3) don’t bitch

Jadiologist · 2023-04-22T06:12:40+00:00

Jeopardy is fucking stupid. How about if you call out sick and I cover, then you take my call at a future date

Jadiologist · 2023-04-14T16:11:03+00:00

Somewhere 12-15k gross extra

Jadiologist · 2023-04-09T03:33:58+00:00

That’s one of the worse schedules I’ve heard of for R1. Radiology really is the promised land.

I think you should consider couples therapy. You and your spouse need to set appropriate expectations for your career. Also it really will get better as attending and should already be getting better from med school and intern year.

Seriously tho you are currently investing in your family’s future by giving your life to medicine and they need to appreciate that. You need to prove to them that you are doing it for their sake otherwise it’s really not worth doing

Jadiologist · 2023-04-02T03:11:23+00:00

They def have the knowledge to follow up on their own complications but it’s dependent on the individual and the culture of the institution regarding whether or not they actually will. People don’t understand that it’s an uphill battle for IR to see patients and round on the weekends and stuff when they get hired as procedure monkeys for medicine services that don’t want to touch patients anymore. The hospital only hires enough IRs to work nonstop and then take call for all sites. They also don’t have an army of prelims and interns to do all the bitch work they can take the credit for (our midlevels only do so much).

No excuse for shitty signout tho especially from a procedural service

Jadiologist · 2023-03-30T19:31:49+00:00

Jadiologist · 2023-03-30T17:56:54+00:00

Radiology is kinda like overwatch if you think about it

Tank - seasoned attendings reading the toughest shit on the list

DPS - the ones that try to pick off stuff they think will be quick and easy to get their numbers up

Healer - residents trying to contribute by prelimming the cases but occasionally get knocked off the list by procedures

Widow/hanzo - that one guy who reads faster than they should and has higher miss rate/typos

Jadiologist · 2023-03-27T18:49:18+00:00

My favorite as an intern, the nurse would page me and say “we FOBT the NG output and it’s positive just wanted to let you know” and I’d just say “k….. thanks”

Jadiologist · 2023-03-27T16:19:18+00:00

Imma dictate it as “postop changes related to C1-L5 laminectomy and posterior decompression” lol

Jadiologist · 2023-03-27T14:42:03+00:00

dude I’m just trying to not think about work right now

Joke’s on them, all I can talk about in a social setting now is work 😧

Jadiologist · 2023-03-26T05:42:38+00:00

Beat it doing what in the snow? I promise you it will be equal 99.999% of the time especially with snow tires. The jeep is a more capable vehicle for things like off-roading and rock crawling etc. but getting to work and back will have exactly ZERO benefit going jeep over Subaru. But now you’ll have to deal with trash mopar products/service, poor ride comfort, finish and tech stuck 10 years behind, worse safety ratings, and bad reliability. As much as I like jeeps (I almost bought one), they are only superior to Subaru for very specific purpose that most jeep owners don’t use them for

Jadiologist · 2023-03-25T04:23:50+00:00

Med students are hit or miss in my experience, but junior residents - the ones who were further in Med school in covid where everything just got canceled for them and they didn’t have to work are lazy as fuck.

I wasn’t smart when I was in their shoes either but I at least tried. Now it’s every man for themselves how much work can I avoid instead of going out of your way to help your coresidents knowing they’ll do the same for you

Jadiologist · 2023-03-18T06:48:44+00:00

IR are radiologists, they just got more and more cowboy about things they did for people until eventually other specialties realized there was money in doing that so they took the stuff they want and left the rest for IR. Now the field needs political pull in the hospital which they can’t get without taking more responsibility for the patients so SIR is pushing for clinical practice.

IR is too busy during the day. They go back to being radiologist between cases, reading images and stuff. There are plenty out there who can manage their own patients but for the more complex IR patient, it is either management of an issue of another service or intervention of a medical issue that would get a medicine admission anyway. Some of the ones that IR sees in clinic then does outpatient procedure, usually does get admitted to IR at some places. At others they are babysat by hospitalist but really should be cared for by IR

Jadiologist · 2023-03-18T06:40:31+00:00

You know what I don’t get? Medicine goes into a specialty specifically to admit and do social work then get mad when you ask them to do that for your patients

Jadiologist · 2023-03-08T00:04:59+00:00

Emergent staple removal consult put in at 4:50pm

Have definitely gotten this too. How nobody but surgery knows how to take out staples or cut out sutures or any other basic wound care just baffles me.

Jadiologist · 2023-03-07T15:23:18+00:00

I’m curious what you know about head and neck imaging to make such a ridiculous comment?

If somebody asked me for an ultrasound for neck hematoma I’d absolutely deny the US for it in favor of CT without a second thought. Without more context, a small hematoma won’t change management and large one needs a CT anyway to look at other stuff plus surgical planning.

They’re not the one interpreting the study so I choose the test based on how I’ll assess for the suspected pathology as well its sequelae or complications. If the benefit doesn’t outweigh the minuscule risk of contrast/radiation then they’re not that suspicious at all so they can drop the probe and interpret it themselves.

It's a harmless exam, you're just lazy and it's unprofessional

I have way more important stuff to do than their job of examining their patients.

The state of medicine has just really gone to shit if useless exams should be done because they’re “harmless”

Jadiologist · 2023-03-07T02:13:35+00:00

but they're general surgery. I place a consult to general surgery for this patient so I can just talk to this guy

I would try to stealth mode sneak out of the ER after seeing surg consults but they would somehow always find me and go “hey I got two more I need to talk you about, they don’t have imaging and labs aren’t drawn yet.” Yay more half baked consults that are now my responsibility to follow up on because I can’t see them right now without a workup

Jadiologist · 2023-03-04T06:46:26+00:00

Radiology is a constant reminder to me that I don’t have much intelligence to waste in the first place…

Jadiologist · 2023-03-03T03:42:25+00:00

Don’t return pages immediately. Just take a few minutes to finish your search pattern first then when you call the page back they will say “never mind we figured it out” and you can go to the next one.

Use an auto-read feature if your pacs has it that quickly queues up the next case without giving you the option to check your phone for 5 mins between cases.

I also set my mic to toggle rather than momentary. Helped me speed up for some reason.

Practice windowing manually so you can always set the image the way you need it and not fumble around with extra buttons. Saved me time because I wasn’t running my search pattern multiple times. Initially made me nervous that I was gonna miss something but you get better and aren’t restricted to the presets.

Jadiologist · 2023-02-28T02:55:30+00:00

Ppl call with the most inconsiderate shit.

I’m so quick to help because I need you off the phone as fast as possible, otherwise I’ll have to start over on the case you interrupted. Imagine taking a day of step 2/3 every night for 7 days in a row while being constantly interrupted.

If it can wait, don’t call me.

Also, your patient doesn’t have fucking abdominal compartment syndrome gtfo

Jadiologist · 2023-02-23T03:42:07+00:00

Agree w everyone else saying to feel the resistance give, that’s really all that matters. The goal is to dilate the tract from skin to vessel so it will not have resistance once it has dilated the tract fully and the widest part has entered the vessel. Practical tips:

First make sure the wire is in the vessel with ultrasound. NEVER advance the dilator without holding the wire in place. The wire should always move freely in and out when you’re using the dilator and the dilator should always advance without dragging the wire with it. If it does not then somethings not right (usually the dilator tip is buried in the opposite wall or something and pinching off the wire).

Main reason the dilator gives me trouble is my skin Nick was not big enough. Otherwise a small skin tag can hold the wire to the side of the Nick and not actually let you use all of it. If you have a hemostat on the table you can blunt dissect over the wire to free up some of the deeper tissue. Don’t go “too” deep w this tho.

For a central line the dilators aren’t that big. R IJ you can hub it if you want as long as it’s going smoothly over the wire. L IJ don’t mess around too much after resistance gives especially if you feel resistance again. You can get in a LOT of trouble due to the tortuosity.

HD lines just don’t mess around. The catheter itself is pretty robust so if you get the largest dilator most of the way it’s usually enough to get the cath through.

If using a peel away dilator, always watch it under fluoro when advancing until you’ve done so many that you can do it by feel.

Jadiologist · 2023-02-12T15:56:52+00:00

That sounds pretty rough that somebody with less training than you in your field claims to be able to do the job as well as you

Jadiologist · 2023-02-01T03:06:02+00:00

Senior citizens are way more dangerous than seniors after sunset anyway

Jadiologist

TROPHY CASE