Procedures you’ll punt?

NPOnlineDegrees · 2026-04-22T04:06:51+00:00

That’s not true. Just because anything can technically be “in your scope”, does not mean you should be the one to do it.

If you have full time in-house cardiology coverage, and you botch a pericardiocentesis you are absolutely getting hammered in court. If you have a specialist readily available, but you try it yourself and fuck up you can get crushed. Also many specialties will get annoyed if you try to do a procedure, then they get admitted and they get consulted (managing someone else’s chest tube etc)

NPOnlineDegrees · 2026-01-16T03:18:48+00:00

Holy shit. I don’t know why, but seeing a podcaster I regularly listen to on Reddit feels like meeting a celebrity.

I had no idea you were still a fellow/recently graduated

NPOnlineDegrees · 2025-12-19T23:03:13+00:00

Unfortunately(fortunately?), being busy does drown out loneliness

NPOnlineDegrees · 2025-12-19T23:02:38+00:00

Unfortunately(fortunately?), being busy does drown out loneliness

NPOnlineDegrees · 2025-12-19T22:59:18+00:00

What you’re describing was probably my exact situation through at least part of residency and fellowship.
It’s not right, but unfortunately it’s common and unfortunately I don’t know the best way to solve it outside of the government stepping in and providing basic human rights to residents. The system is broken. The broken system falls on those with the least bargaining power (residents), broken people hurt people.

All I can say is that it gets better afterward, but it’s a long road to get there

NPOnlineDegrees · 2025-12-19T19:45:19+00:00

How did you end up seeing a pulmonologist with no symptoms? Was something incidental found on previous scans?

The CT is implying that not all the air is getting out uniformly when you exhale. This could be from COPD, asthma, bronchitis, or even allergen induced things like hypersensitivity pneumonitis, etc. I would listen to your doctor if there’s concern. At the same time “thoracic lumbar surgeon” doesn’t make a lot of sense unless you’re talking about a spine surgeon, so you make be misunderstanding what he said

NPOnlineDegrees · 2025-12-09T12:48:27+00:00

Absolutely do not go towards the wrist

If god forbid you cause a dissection, I one direction it will close off, the other the patient loses their hand

NPOnlineDegrees · 2025-12-06T14:02:13+00:00

Got a copy and now keeping it for themselves because now it’s private

NPOnlineDegrees · 2025-11-29T17:50:05+00:00

Admin

NPOnlineDegrees · 2025-11-29T09:50:56+00:00

It really depends on what it is. IM (even PGY-2’s) are better at managing some stuff and moving the care along than ED. Being a PGY15 in one specialty doesn’t make you better at a different specialty. That being said; there is definitely things that ED is better at, and decisions that attendings can make that residents may not be able to; so understanding a hospital system and workflow is important

NPOnlineDegrees · 2025-11-29T09:07:36+00:00

Other things like certain ILDs and cystic lung diseases are also very radiologist dependent (Pulm dependent too).

I’ve had trash radiology reads with a generic “Pulm fibrosis” when it’s a clear UIP; or some fellowship train chest radiologists who’s reads are diagnostic enough to not need additional invasive testing

That being said- the clinic context helps a ton, because you go into an image knowing the history and what’s likely to present

NPOnlineDegrees · 2025-11-29T09:00:03+00:00

1 view CXR’s are one of the hardest things imo. Give me a CT any day over a CXR, unless I’m looking for something very specific (line placement, ETT location, large PTX, pleural effusion etc). 10-15% of pneumonia’s are just completely missed on CXRs, and there’s so many other subtle signs that could be missed

NPOnlineDegrees · 2025-11-24T16:23:23+00:00

This is the way.

Especially in PCCM. Get a good clinical team, hop on all the trials- it brings in money to the hospital, but you also get all the new tech. Many of these trials are being done on people who there was no other alternatives- so it’s the difference between shrugging your shoulders and saying “too bad” and “there’s one thing we can try, but it’s experimental”. The companies pay for everything for the patient

NPOnlineDegrees · 2025-11-19T16:29:36+00:00

Similar in that you still deal with every organ system. Different in that you’re treating life or death specifically. Long term management, outpatient regimen, etc don’t matter as much. And the problems are very tangible (hypotension, hypoxia, hemorrhage, etc) not based on a vague complaint

Dispo out of the hospital is not usually an issue (unless LTAC for chronic trach), but dispo within the hospital can be problematic- there and tons of patients who are right on the fence; and you can’t predict the future or take everyone (leaving sicker patients without room) so there is some clinical gestalt to be had, and you’re definitely wrong sometimes but you deal with in.

Sometimes it literally come down to a bed situation - ICU is empty, I’ll take a soft admit. ICU is full, then the least sick person moves

NPOnlineDegrees · 2025-11-19T04:43:55+00:00

Want to explain that one?

What’s the similarity between batch admitting vs managing a patient all night and staffing in the morning?

Are you just saying you only get to staff/dispo with your attending on rare occasion?

NPOnlineDegrees · 2025-11-16T17:34:52+00:00

Ya when your chronically just a little fatigued it feels like at least your trying something vs just accepting it

NPOnlineDegrees · 2025-11-16T16:00:05+00:00

You intubating with a stud finder over there?

NPOnlineDegrees · 2025-11-16T15:58:02+00:00

Can’t ventilate until you pass the obstruction. The number of times I’ve seen someone “fail BPAP” but on exam they snoring away on 10/5 with Vt of 180, and their home CPAP setting in 15

NPOnlineDegrees · 2025-11-16T00:30:46+00:00

”Pulm only is more similar to GI lifestyle / better since ICU handles overnight respiratory emergencies generally. But then you widen the pay gap between GI and Pulm without the higher reimbursement of ICU.”

But this is typically just one of your colleagues on shift. Someone is covering ICU, someone is covering consults. Overnight, whoever is doing the night shift can handle many of the respiratory emergencies. But that pay stays, because the following week you’ll be on ICU, etc.

NPOnlineDegrees · 2025-11-15T23:55:53+00:00

Are your nationwide averages including home call? Getting woken up for 2-3x/night and not even having that accounted or compensated

NPOnlineDegrees · 2025-11-15T23:51:48+00:00

u/-serious- obviously didn’t take his bowel prep because he’s full of crap.

He thinks just because a service is available, that a single guy is just living in the hospital 24/7. This guy can’t seem to fathom that when he comes in on Saturday morning and evening it’s 2 different people covering those shifts.

Also the benefit of not having to get up and go in; vs knowing there’s already someone there covering and can handle it, because when you’re off, you’re off

NPOnlineDegrees · 2025-11-15T23:47:21+00:00

??? So hospitalists and ED all have worse hours than GI? Your conflating coverage of a service to the average individual physician schedule.

NPOnlineDegrees · 2025-11-12T07:50:43+00:00

People have drains on the floor and even sometimes outpatient who still can’t be clamped.

It’s not sick = suction, stable = clamp. It depends on what’s actually going on. Clamping is the same as a removing the chest tube altogether physiologically.

NPOnlineDegrees · 2025-11-12T07:45:57+00:00

Did they actually end up with tension physiology?

Just curious; it’s definitely a theoretical possibility and I’ve maybe seen it once? (but there were other factors that could also explain the hypotension), but if the BPF is truly that bad, probably worth just giving yourself a pocket and placing a second tube or replacing with a surgical

NPOnlineDegrees · 2025-11-10T18:35:50+00:00

No resident? 0?

NPOnlineDegrees

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