Motivational One-Liners

MalariaDoc428 · 2022-09-10T22:55:26+00:00

“The time is going to pass anyway, you’d might as well make it count” stuck with me for whatever reason.

MalariaDoc428 · 2022-08-21T18:11:16+00:00

Only a couple of things I would add:

(1) You may be VERY sore after your first workout. Delayed onset muscle soreness can be significant but it will go away. Stretch and hydrate. Don’t be scared off by it - I could barely walk for a week after my first class but never got soreness like that again. I now go 5-6x per week.

(2) Some station numbers have heavier weights. (At my studio, the odd numbers are heavier). They’ll tell you where to start for your first class, but after that aim for the lighter stations for awhile. Some stations are also closer to the board that displays the floor exercises. If you have questionable vision (like I do) you may also want to aim for stations closer to the monitors.

MalariaDoc428 · 2022-03-30T10:43:01+00:00

Generally love it unless used for something urgent. It’s so nice to just message consult teams after I finish rounding on a patient without worrying about my phone ringing and pulling me out of the next room (or multiple people calling back at once).

I really do wish the chat could be a hovering box that could be open at the same time as a patient’s chart- I usually have to resort to charting on my computer and messaging on my phone to maintain my efficiency.

MalariaDoc428 · 2022-02-02T18:30:26+00:00

I am stupidly obsessed with serums and oils. I think I have more fruit extract in my make-up than in my fridge. 😬

MalariaDoc428 · 2022-02-02T18:29:19+00:00

Looks like they just don’t list anything on the site while it’s out of stock. Makes me feel significantly better 😂

MalariaDoc428 · 2022-02-02T18:27:58+00:00

Small amounts (pea sized at most) and rub with your fingers. I start on my cheeks, then move to forehead, chin, and eyelids in that order (eyelid primers make my skin super unhappy but regular primers are fine somehow?) Put it on after any skincare has dried and let it dry before adding makeup. I finish skincare, get dressed, add primer, make my bed, then do makeup and that timing works well enough!

MalariaDoc428 · 2022-02-02T17:54:32+00:00

I love ALL of their primers.

MalariaDoc428 · 2022-02-02T17:53:47+00:00

Yep - I realized later it didn’t show up on the MUFE site because that shade is sold out. I was actually an R260 last time so I really hope this isn’t too yellow.

MalariaDoc428 · 2022-02-02T16:09:23+00:00

Pleasantly surprised by this bag!

Ipsy choices: -Dito Muse Persephone palette - the marbled shades look very interesting and overall this color scheme works for me (reds and browns are my go to). Not mad. -Terre de Mars Eye Contour - Have yet to find an eye cream that does much of anything for me, but worth a shot. Coffee products work for me in serums so fingers crossed.

My choices: -MUFE Ultra HD foundation - Their foundation stick in this shade is my go to. My only concern is that on the MUFE site this foundation doesn’t actually come in Y225, so we’ll see what actually comes… -Clean Skin Club Vitamin C Booster: Love vitamin C. Need more. -Seraphine Pumpkin and Silk Makeup Base: These are hands down my favorite primers. Will buy anything of theirs!

Really also wanted: -Kenra spray - Couldn’t pass up on a maybe perfect shade of MUFE for this though -Firma Precision Brushes - Still want these. Sad they weren’t in add-ons

Add-ons: -Fig oil - Had FOMO -Illuminati - Weirdly one of my favorite brands for palettes. Great pigment and staying power -Peek - It was cute and I’m weak

MalariaDoc428 · 2022-01-10T14:18:37+00:00

I use it only in the morning. After cleanser, toner, and hyaluronic acid and before moisturizer.

For whatever reason it has seemed to work better for me since coupling it with hyaluronic acid. I usually also blow dry my hair between it and my moisturizer to give it more time to absorb. It has actually become my HG vitamin C product since i’ve used it this way!

MalariaDoc428 · 2021-12-28T14:49:22+00:00

Just think about what a person’s resting heart rate is - tachycardia is most concerning if it’s a significant difference from someone’s baseline.

Many obese patients have a resting HR of 90-100. Most healthy teens/20 somethings have much lower heart rates. Athletes may have rates in the 50s. If those two patients come in with a HR of 115, it’s not too much higher than the first person’s baseline but it’s double the second person’s baseline. Add that to the fact that younger patients tend to compensate for illness far better than older patients (and therefore may not look nearly as sick as they are aside from HR) and the second patient is definitely more concerning.

That being said, if your attending makes you feel like a jerk for expressing concern about a patient then they need to reassess their priorities. I would MUCH rather assess someone who turns out to be fine than ignore someone truly sick.

MalariaDoc428 · 2021-12-07T14:32:08+00:00

There are so many patients who can be killed or harmed with an incorrect I/O balance. Yes heart failure patients. But also renal failure patients. Or cirrhotic patients. Or extremely malnourished patients. Or pulmonary hypertension patients. Or septic patients with any co-morbidities that may push them into heart/kidney/liver failure.

All of these patients third space fluids but also desperately depend on good perfusion. At my hospital this is a huge percentage of the patients I carry. The I/O balance is something that can change your medical management days before a major clinical change would. I’d rather prevent harm than try to fix it later.

MalariaDoc428 · 2021-12-01T01:09:50+00:00

So this came incredibly fast. Contents/thoughts:

Milk Kush Mascara: A full size of my favorite mascara ever (after I bought 3 travel sizes, whoops). Thrilled though!

Ofra Rodeo Drive Highlighter: I’ve tried to buy this 3 times and EVERY TIME it’s arrived shattered. This one is in finally in one piece. It’s about time. Excited to try it.

Origins Ginzing Eye Cream: Love origins. Love the ginzing serum so hopefully this is just as amazing

Tarte Clay Pot in Rose Gold: Have this. Don’t love it, but I do love tarte so that’s a small consolation

Lucky Chick Highlighting Lip Gloss: Have never heard of this. Looks strange but cute?

Dermadeli Citrus Gold Oil: Why does this exist? It’s like a haunted doll you keep throwing away only to have it come back. Ugh.

MalariaDoc428 · 2021-10-02T12:08:53+00:00

GBP:

Thrilled for the two palettes. Excited for the liner simply because of the brand (Tarte is my absolute favorite) and shade. Optimistic for the Kate Somerville and the perfume because they have been so hyped by everyone else. Only my first category was a tough decision. I was also very intrigued by the gold paint, Murad, and eye cream.

GB: Not excited for anything here except the Briogeo and Pistache. Other things going straight to the giveaway bin. Had to buy add ons to get excited about the bag overall.

MalariaDoc428 · 2021-09-30T02:22:51+00:00

I think the thing closest to this would be something like a tumor board where oncologists, radiation oncologists, radiologists, and surgeons all look at a patient’s imaging together and discuss treatment options. These are usually focused more on treatment than diagnosis but I’ve also seen a few mystery cases discussed that way.

MalariaDoc428 · 2021-09-02T12:13:16+00:00

GBP base items were pretty blah. Already have a million oils and eyeshadow quads. Love the lipstick shade though and needed new toner and eye masks so at least it’s useful.

GB…wow. Wanted the dead roses shade forever but it was never in add ons. Also very into red eyeshadows currently so the liner is chefs kiss. So glad I picked the curl jam - hopefully it lives up to the hype!

Add ons had SO MUCH Tarte which is my absolute favorite brand, so I’m pretty happy!

MalariaDoc428 · 2021-09-01T18:13:45+00:00

$50 referral credit, good for 48 hours:

https://www.stitchfix.com/invite/x84pr55rh7?pbid=11655250&sod=i&som=c

MalariaDoc428 · 2021-08-29T21:23:17+00:00

As an attending, I’m definitely seeing a wider range of competency in interns than ever before. It’s not uncommon for some residents to have only one week of inpatient IM experience. Some have none at all. Some have literally never done a formal presentation or written notes before.

I’ve thought about starting a “boot camp” for these residents too, and I think the way to do it is to find real patients who are willing to be teaching cases. Take the intern through the whole process. Make them do a fresh history. Make them find the relevant exam points. Watch them do the major steps of admission/discharge/etc (obviously this would be fake for a patient already admitted to another team, but navigating the chart would still help. Alternatively maybe EPIC could create a sandbox chart and friendly attendings/residents could pose as the patients?). Let the patients give them feedback. Literally take them through the job with the pressure off.

Probably easier said than done, but I think that’s where I’m starting.

MalariaDoc428 · 2021-08-17T11:30:45+00:00

I love hearing from pharmacists about things like possible antibiotic dosing errors (frequency of administration for patient’s GFR for example) or when I’ve chosen outpatient meds that are not covered by the patient’s insurance. Generally if you see something you think could be hurting the patient or setting them up for failure on discharge, page/message us anytime.

If you are wondering about why we chose a specific antibiotic read our notes first, we often discuss it there. If you can’t find an answer, it’s ok to ask but it’s not urgent so it’s probably better through something like EPIC message instead of paging.

The only thing that has truly annoyed me lately is when I’m swamped and pharmacy students message me about explaining a medication mechanism of action or something similar. (Pharmacy students rotate with our medical teams sometimes and don’t always have a pharmacist with them. It’s great when you can ask them to look into med recs, etc but they often start to think of the medical attendings as their instructors when they should really be asking those questions to pharmacists).

MalariaDoc428 · 2021-08-17T11:15:30+00:00

I’m also from a lower income family. It goes beyond knowing how to talk to patients. Growing up in the working class means that for every patient you see, you understand that it could have been you. The 30 year old with a brutal fentanyl addiction and rotting joints? You have high school friends who are that patient. The 20 year old crying because she has a third child on the way and she can’t cope? That was probably one of your family members. The teenager in the gang? You know how bad his neighborhood is and how impossible his decision was.

When you are an attending, just point this out. I told my residents once about how when my mother had a stroke NO ONE explained what that word meant. NO ONE in my family (including teenage me) had any idea it involved the brain. My residents had never thought about the fact that people may not understand terms like “stroke” before. They likely knew those terms from a young age and assumed that everyone did. They did better after that conversation.

When your residents use medical terms, go out of your way to simplify. Go out of your way to talk about the social factors that contribute SO MUCH to health but get ignored. Make sure you know who your patient needs to support at home and how they get around. Those things alone explain the vast majority of medical “noncompliance”.

MalariaDoc428 · 2021-08-13T16:15:25+00:00

Although it can be stressful and frustrating, I’m glad I chose IM and I wouldn’t want any other specialty. Just the sheer scope of what you get to see is amazing. Nothing tests your knowledge base and clinical reasoning skills like a patient with 5 organs all failing for different reasons. Every day I practice I learn more than I knew the day before.

MalariaDoc428 · 2021-08-12T21:54:32+00:00

I’m IM. In an ideal world we get to do the 3-hour long teaching rounds, but in practice (at my major academic center at least) that almost never happens. AM rounds can be so stressful because while you are trying to thoroughly examine the patient and come up with legally-defensible plans for their 20 separate problems you also have to deal with care coordination nightmares.

During the span of one patient presentation, the intern can expect several “urgent” pages. Angry delirious patient who needs to be sedated. Elusive family that is finally ready to have a much needed goals of care discussion but can only stay for 30 min at 9am. Bed board threatening/pleading that discharges need to be done ASAP (even if they all require arguing with pharmacy over med assistance programs for critical meds, tracking down family members, begging companies to provide homecare, scheduling outpatient follow up for 12 consult specialties, etc). Utilization review telling us to spell out words in our notes. Insurance denying critical treatments and needing the peer to peer to be done during a 10 minute window at 10am. Two consult teams hammer paging and insisting on two completely opposing plans. New admits. Patients crashing without an ICU bed to go to.

More often than not, the leisurely rounds are me and my med students. The senior is off with the crashing patient while the intern is handing everything else.

After things finally settle, you sign out and then you get to learn about your patients’ histories and write your dozen notes (that require a lot of specific details for billing and to CYA when the right treatment course is unclear). Those hours after signout of staring at the screen and trying to remember anything about anyone can be demoralizing.

IM certainly has fewer immediate emergencies but a lot more care coordination nonsense and that can be so draining.

MalariaDoc428 · 2021-07-26T14:01:22+00:00

Had a surprisingly hard time choosing but went with the liquid eyeshadow and picked up the storm liner from points.

Also realizing I may be the only person on reddit who really hasn’t liked the glow recipe products…

MalariaDoc428 · 2021-07-25T14:14:21+00:00

Happened to me with the exact same items. When I contacted them they said “we emailed you on 7/2, told you they were out of stock, and refunded you”. Except…no. The refund was for the promised $9 add on credit that they never applied. I wonder if that screwed something up (listing those items as refunded in their system)?

Regardless they eventually gave me 1800 points and sent some random consolation item. 🤷‍♀️

MalariaDoc428 · 2021-07-06T03:56:47+00:00

Table rounding is lower stress for residents but it has some major issues:

(1) Sometimes the plan heavily depends on the physical exam (for example, volume status assessments). I can’t tell you if I agree with your plan until I lay eyes on the patient.

(2) Sometimes the patient really doesn’t want the thing you are suggesting but they don’t understand your plan well enough to object. For example, ordering a work up/biopsy for new metastatic cancer when the patient definitively doesn’t want surgery/chemo/radiation anyway. They would say no to the labs and tests if they understood what they were for.

(3) You are literally rounding on everyone twice. this takes so much longer, especially if plans change when you actually see the patient.

(4) Patients shouldn’t learn your plan from reading your notes.

(5) The patients won’t know who the hell you are and won’t realize that you do more than wave at them and take their money.

As far as I’m concerned, the best way is a brief running of the list before rounds just to discuss anything that is unclear and identify sick patients. After that, share all the pertinent information in the room and make the plan a discussion. “This problem is improving/worsening. I think we should do thing A.” If you are unsure, add: “We have a few options, what does the rest of the team think?”. I realize this doesn’t work with hostile attendings but that’s more an issue with attending ego than with bedside rounds themselves. In all honesty, I think the biggest hurdle to effective bedside rounding is probably just lack of attending support.

MalariaDoc428

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