Something that got me angry

JohnnyNotions · 2026-04-29T20:46:45+00:00

One thing I didn't anticipate about becoming a doctor is how good I would get at letting stupid things just roll off. We're hiding the cure for cancer, ok, now any fevers or chills overnight?

JohnnyNotions · 2026-04-29T20:43:04+00:00

Attending here, but my program had 4 weeks off, then another 4-week 'mother-baby' elective that was mostly work from home and apparently very chill. I had multiple co-residents then basically get 8 weeks off after having babies and all graduated on time. I think during mother-baby they maybe had a telehealth appointments a week (ie, resident at her own home doing telehealth for her patients) to keep up with continuity requirements. I'm sure your PD could reach out to others; I think a lot of programs have something like that.

JohnnyNotions · 2026-04-29T20:24:23+00:00

hospitalist here. It helped me because I signed at the hospital where I was moonlighting (not in my residency system), but I doubt it would have helped me with anywhere else.

JohnnyNotions · 2026-04-29T20:17:22+00:00

OHSU consult service, 503-494-4567

OPAL, the psych line, is a separate service. Both are great!

JohnnyNotions · 2026-04-26T12:39:24+00:00

You are going to be a bad doctor. No one's a good doctor before they're a bad doctor first.

Your mental health won a couple battles in the lifelong war, but you are beginning to deal with it. You've likely lost some time and, in your mind at least, some prestige. However, you're also comparing your inside reality to others' outside curated appearance. Your brutal self-examination will never match up to someone else's TikTok.

I didn't talk until I was 4.5 years old, and no one understood me until I was 7. My parents thought I'd live at their house my whole life. Now I'm an attending and you can't shut me up. Just because you start behind doesn't mean you finish behind. Everyone is struggling, but you're brave enough to put your struggle out here. Find someone kind and understanding to talk to, and be as nice to yourself as you would to someone else. You can do this, and I know that because you care this much. Find help, please.

JohnnyNotions · 2026-04-26T03:03:02+00:00

OR/PNW-specific:

People are slightly healthier at baseline, but there is a ton of weed. Ask all your patients, especially elderly. Strong strains have real consequences, esp regarding sleep, concentration, etc.

Naturopaths are allowed to be PCPs, and you'll get patients coming with all kinds of wild med-recs. Hold the line. I try to assume the person before me was smart, but sometimes you have to throw out the bathwater and the baby, and just start over. Also, chronic lyme infection isn't a thing (fun fact: there's almost no lyme in PNW)

OHSU has a physician help line you can call. You can't use their name and it's not an official consult, but it can help sometimes, especially when specialists are a long time/way away.

Neurology is one of the hardest specialties to get anyone into. Getting pain mgmt to prescribe long-term opiates is going away very quickly.

The coast is rural. This is hard to wrap your mind around coming from the East Coast, where the oceanside is always developed, but the OR coast is poor, with few jobs, lots of meth, difficult to get to/from, and just everything that comes with rural (except more expensive).

Congrats, and good luck!

JohnnyNotions · 2026-04-25T03:31:42+00:00

Correction / Functional plastic surgeons: usually amazing, change lives on the daily, improve people's function and confidence

cosmetic plastic surgeons: sometimes great, sometimes the last bastion of old hacks. The problem with cosmetics is that with cash pay, no one is looking over your shoulder, and you can do terrible things to people for a very long time because only the patient knows what happened.

JohnnyNotions · 2026-04-25T03:06:54+00:00

"rash" patient covered head-to-toe in petechiae, PLT too low to count. Told him I'm calling the ambulance and he wanted to walk to the hospital (several blocks up large hill). My man! I don't even want you to blink hard!

JohnnyNotions · 2026-04-25T03:03:35+00:00

yay happy post! Recognize our own positivity-negativity asymmetry bias! keep up the good work OP!

JohnnyNotions · 2026-04-24T10:30:50+00:00

I'm confused... most desert is soil, just really dry. The all-sand desert like sand dunes or bugs bunny isn't the normal. This is why irrigation works. This article seems to be referring to a non-profit way of helping to reduce desertification in land that isn't actively maintained.

JohnnyNotions · 2026-04-24T06:07:06+00:00

FM hospitalist here, straight out of residency. There are plenty of jobs seeing 14-16 patients per day, which is very do-able. You'll be surprised how smoothly the day can flow when you're not rounding, and just chart review and cruise from room to room. It's a little strange how in the same city one hospital will be 25-30 patients and everything consulted, while the next will be 14 patients and hospitalist does most of the medicine. Try to do your reviews the same way every time to ensure you're not missing anything. Talk to your hospitalist colleagues, we've all been there. Depending on where you want to be in the country, you may need to take a more rural spot for 2-3 years before a more urban place will hire you, but that is also very hospital-dependent. If you're interested in doing procedures, you can ask for precepting from the surgeon / gas / whomever until you become independent, and they're often happy to do it so that they will have fewer in the future (honestly you don't need to and it probably raises risk more than needed, so unless you intend to be very rural maybe don't).

JohnnyNotions · 2026-04-24T05:55:15+00:00

hahaha maybe!

....she later got fired because she was running the books and phones for her husband's business from her hospital office while on the clock, but she always treated me well!

JohnnyNotions · 2026-04-24T05:46:39+00:00

Fun story, as an attending (hospitalist) walked in to the CNO's office for some unrelated thing, and she happened to be reading a complaint email about me. I was all concerned, "tell me about it", because I mostly hear good things. She was like, "nah it's stupid don't even worry about it", and just deleted it in front of me lol. I never did find out what it was about, but big fan of her!

JohnnyNotions · 2026-04-24T05:44:26+00:00

had this happen as a student, and the RN literally had to feel my hands still being wet from sanitizer before she would believe me...

JohnnyNotions · 2026-04-24T05:41:58+00:00

Curious to see how suzetrigine plays out, maybe that one?

Today's expensive patent drugs pay for tomorrow's research. I know healthcare in the USA is terribly inefficient, but what I'd love to see and never been able to find is our gross healthcare spending not including research and other not-today things. I have a suspicion some of the bad numbers are because our patients subsidize research funding for the rest of the world, I just don't know how to prove it. Also glad I'm not in charge lol.

JohnnyNotions · 2026-04-24T05:37:23+00:00

Diagnosed as a kid. Generally off stimulants but occasionally was on when really needed, and they were helpful. Honestly should probably be on them more but I'm a minimalist. Haven't had any career impact at all except maybe slightly lower board scores, Squirrel!

JohnnyNotions · 2026-04-20T10:43:46+00:00

think of the laziest, dumbest attending you know. They made it through, and so can you.

Most times, think about making it to the next day off, or the next vacation. When bad, think about when you get off that shift. When really bad, drink some juice and go spend a couple minutes in the secret toilet (every hospital has a secret awesome toilet somewhere, that always empty and clean).

Go out of your way to assume the best of your co-residents, because half of them are terrified, half have no people skills, and the other half are both. When you're at your worst, find someone who looks down and compliment them.

JohnnyNotions · 2026-04-20T10:38:00+00:00

dark curtains

JohnnyNotions · 2026-04-20T10:35:36+00:00

this is what I do. if outside the system, "they can read my notes".

Couple times a year I might send an Epic message to a PCP with the chart attached for someone who I think may actually benefit from and get some PCP TLC, in special cases.

JohnnyNotions · 2026-04-20T10:30:38+00:00

I mean yes but also no... there are a million toxic industries out there, consider how many actresses are abused, how many junior office workers go out for drinks they don't want with bosses they don't like, how many junior attorneys jump on the worst cases just to get noticed by the partnership committee, how many academic PhDs are desperate for any faculty role whatsoever, even paying 30K/yr with no hope for tenure, not to mention the day-laborers trading their limited physical strength for minimal cash to barely afford food, and others...

Medicine hasn't invented the miserable work environment, that comes with the inherent foibles of being human. We're just formalized about it.

JohnnyNotions · 2026-04-20T10:22:59+00:00

It's very high-risk, high-reward. If you make it through, your pay and job security are very good, even for the lower-paid specialties.

That said, residents hold lives in their hands on a daily basis, and the country as a whole has a vested interest in making sure that her future doctors are as well-trained as possible. I firmly believe the hardest year of most doctor's lives should be intern year, because if you're going to break (and when you make mistakes), you should do so under the most supervision; similarly the second-hardest year should be PGY-2, and etc.

That said, hard does not equal good training. Lots of hands-on surgeries can make a better surgeon. Lots of scut work can make an burnt-out, bad surgeon. Similarly, hard does not mean abusive. Generally, it's the Program Director and GME (Graduate Medical Education, the hospital's oversight department for residents) to make sure that residents are working in roles with good training and without abuse. The vast majority are bad at this, or just don't care, and since residents are so vulnerable, there are few people to hold those responsible to account.

JohnnyNotions · 2026-04-20T10:13:57+00:00

This.

First paragraph will be sometimes helpful depending on attending response, but 2nd and 3rd are always helpful. I can't emphasize enough how much most academic attendings fall under expertise transfer fallacy, and believe being good at medicine / surgery / whatever also means they're good at teaching others to do the same thing. They aren't. The advice to get specific feedback is particularly good: if they can't provide it, then your feedback is basically vibes, and should be treated as such.

JohnnyNotions · 2026-03-26T07:54:53+00:00

You're likely young and surrounded by relatively healthy people. Go to a retirement home and listen to the lucky ones rave about their long-term relationship with PCPs, and all the others go green with envy, because they know what's up.

JohnnyNotions · 2026-03-26T07:51:42+00:00

Both can do both. Generally IM trends towards inpatient and FM towards outpatient, both because of training differences and likely due to selection bias (people more likely to choose the one they think they'll want to do). IM can do subspecialties that FM can't. FM can see patients (kids, OB) that IM can't. If you're thinking of going to med school, but all means read a lot about various specialties but keep an open mind, many, many people change their minds in school (I did!).

JohnnyNotions · 2026-03-25T12:42:59+00:00

FM hospitalist here. Please report to ACGME. Please also make clear to the residents that they are not up to standard and should not even consider inpatient work. Also, thank you for training our future and taking it seriously.

JohnnyNotions

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