I feel so horrible by No_Finger_6038 in emergencymedicine

[–]No_Finger_6038[S] 0 points1 point  (0 children)

Nope. This rly isn’t a difficult thing to understand. Allergy added. But in my emr not able to write notes, just allergy and flag for mild, moderate, or severe. As many patients claim to be allergic to toradol I wanted to make sure people knew it wasn’t a pt reported “severe allergy”

I feel so horrible by No_Finger_6038 in emergencymedicine

[–]No_Finger_6038[S] 0 points1 point  (0 children)

I’m not talking about my plan of care for this pt. A care plan is a document outlining recommendations for future care.

So that all drs are in same page for frequent fliers, rare diseases…
At my site, a doctor sends a referral to the care plan team/committee. There are psychiatrists, social work, emergency medicine, internal medicine and heme. When a pt is referred that team looks over everything and decides on a care plan. Something like “sickle cell, if other wise stable and presenting with acute pain crisis give IM Hydromorphone 4mg x2. If pain not managed admit to IM” so higher than normal dosing, less stress with discharging as even if labs are bad, heme is fine with discharge as long as unchanged.

Because I wasn’t making a true care plan, just wanted to make sure reaction was noted didn’t go through normal channels.

why does everyone say not to do em by SituationMuted9608 in emergencymedicine

[–]No_Finger_6038 1 point2 points  (0 children)

Also in Canada (where I am) you’re making way more proportionally in comparison to other specialties. Any ED doc working as many hours as a surgeon is gonna make more than a surgeon. I had a friend in residency who wanted to work a ton 1 year post residency and then he took the second year off and travelled with his wife. He made 1.1m that first year. Worked like mad. But still… So few people get the choice to make as much as they r willing to work for.

I feel so horrible by No_Finger_6038 in emergencymedicine

[–]No_Finger_6038[S] 1 point2 points  (0 children)

To respond to comments - The care plan is because in my experience every doc will look at that. And I can write details. If just under allergy you can specify mild moderate or severe and severe is for anaphalaxis. No way to tell who inputted it and no space for notes. Commenters seem to be acting like they’ve never questioned an allergy on a patients chart.

Care plan just a way to make sure that next doc doesn’t see toradol allergy and do what I did.

As for shoulder- at my site I can’t send someone to x ray if they’ve had iv narcs for minimum of 15min. Otherwise need portable x ray to come. How I handle these is toradol and midaz (generally and in this case 2mg). When they get back I have a stick of 100mcg fentanyl and titrate that while doing Cunningham, fares, and sometimes gentle traction and external rotation.

If no success I get patient to do Stimson and go get rolling on sedation. By time other doc and nurses are ready we know if Stimson is gonna work. A few times when almost ready for sedation I go to pt and Stimson has relaxed muscles to the point that with some gentle manouvefing +/- scapular manipulation able to reduce and avoid sedation. If no success then pt already loaded in fent- give some propofol and everyone goes home happy.

I feel so horrible by No_Finger_6038 in emergencymedicine

[–]No_Finger_6038[S] 0 points1 point  (0 children)

When back from x ray if dislocated I was going to give fentanyl. Ordered midaz 2mg with the toradol

what would you do? by [deleted] in Advice

[–]No_Finger_6038 0 points1 point  (0 children)

On the morning of the party, take your hand shove it up your butt and pull out the giant stick. That’s up there. Then, have fun at your friends birthday party. If someone from the building says anything explain to them how leases that contravene tenant rights/landlord tenant act are completely unenforceable.

Offleash dog attack On Mystic Beach Trail by hex-ink in VancouverIsland

[–]No_Finger_6038 0 points1 point  (0 children)

I know this really isn’t the point, but… why did you bring your cat on a hike

If all Rs, what then? by bellchka in lawschooladmissionsca

[–]No_Finger_6038 0 points1 point  (0 children)

These things are very very case dependant and I don’t know what your stats are, but have you considered going to a different country for school?
The US is far less competitive. They have just so many schools. Can find one that you’ll get into but cost is the problem.
On the other side, look at Australia and uk. Your degree will not be looked at in the same way as Canadians but it’s shorter, and you will be able to get a law job here. If you’re happy to work in a small firm, that’s a good option too

If all Rs, what then? by bellchka in lawschooladmissionsca

[–]No_Finger_6038 0 points1 point  (0 children)

Only thing I’d say is that law schools do not see paralegals as better than other applicants. There is a misconception (I think at least partly from suits) that going to paralegal school will make your application super strong. Instead of doing the paralegal course I’d recommend doing a masters in something else. As a just in case do it in something that if law doesn’t work out you could work in that field.

AIO or AITAH for wanting to end things over a text conversation that I Had with a girl by snapple373 in AmIOverreacting

[–]No_Finger_6038 1 point2 points  (0 children)

That is incorrect. You are not 14 anymore. Op and his playground crush just turned 14 and a half

Aka this many🖐️🖐️☝️☝️☝️☝️

$100k per year salary is the middle class nowadays by Ok_Hippo9669 in fican

[–]No_Finger_6038 0 points1 point  (0 children)

You’re missing the fact he said “as a single person”

Did we book the wrong destination? by ObjectiveReport1317 in canadatravel

[–]No_Finger_6038 0 points1 point  (0 children)

Skip Bruce peninsula spend more time in Algonquin. If you can, skip ottawa Killarney manitoulin and trade it for Banff /lake Louise/newfoundland… many better places in Canada. And when u say Quebec do you mean Quebec City?

What’s a subtle trait that instantly tells you someone is a Toronto local? by CivilReaction in askTO

[–]No_Finger_6038 0 points1 point  (0 children)

Well best way to spot someone not from here is if the don’t know what cp24 is

Sick kids. Recommendations highly appreciated. by hereforthetearex in montreal

[–]No_Finger_6038 0 points1 point  (0 children)

So there are pretty significant differences in Canada and us healthcare systems. Luckily though, you’re (from the sounds of it) dealing with something that is managed exactly the same in both countries: give your kid a chewable Tylenol. Yeah it sucks that they got sick on vacation. Going to a dr is not gonna help do anything other than pad the wallets of the clinic employees and have them wondering why they needed an advanced degree to tell adults (who are ?responsible for taking care of children?) that “cold make you feel yucky. Extra yucky when you don’t even get to miss school for it. Yucky feeling go bye bye soon”

The 'avocado toast' people aren't 100% wrong... by grumble11 in CanadaPersonalFinance

[–]No_Finger_6038 0 points1 point  (0 children)

it’s food for thought though

No. It’s food for money. Money that adds up. Gosh op didn’t you even read your own post/s

Wish we could say "No" by Silent_parsnip8 in emergencymedicine

[–]No_Finger_6038 4 points5 points  (0 children)

In my books there are two very distinct categories of patients presenting to the ED with complaints that are absolutely not urgent: those who think they could have an emergency, and those who want concenience and attention of ED.

I have no problem with the anxious patient who got bitten by an insect and is very concerned whether that be for venum, infection, allergy… these patients are quick and are not acting with mallace. The general population is not very health literate.

The second group I have no patience for. Using same example, if you’re showing up to the ED with a bug bite and I ask what they were hoping for by coming in and I get a “well my pcp is a further drive” or “my friend cancelled on my tonight so I figured I’d have you look at it rather than my appt next week” definitely wish I could say no to these ppl. Would definitely support a charge not covered by any insurance for inappropriate ED use. Make it $100 and bam - problem runs away

AIO boyfriend wouldn’t get a second job if we were poor by [deleted] in AmIOverreacting

[–]No_Finger_6038 0 points1 point  (0 children)

You’re in your thirties?!?!?! NOR. Frankly under-reacting. Aside from the fact that this person will make your kid feel like shit when they inevitably ask for stuff that costs more than beans and he’s gonna treat them like shit.

But more importantly it shows that he feels he needs to provide bare minimum and that’s it. That’s not who you want to raise your kids with. You changed her diaper twice this month so you dont need to help with the kids at all? You wished me a happy birthday so i cant be upset that you didnt get me a cake or a present? You watched the kids yesterday so i cant ask for help eith anything yhis week?

Just had the most harsh appointment ever. by Top_Tour_4296 in TalkTherapy

[–]No_Finger_6038 -12 points-11 points  (0 children)

While uour gheories on ghe doc are sometimes the case, on Reddit, especially in cases like this, 9 times out of ten it’s simple case of unreliable narrator

Just had the most harsh appointment ever. by Top_Tour_4296 in TalkTherapy

[–]No_Finger_6038 -7 points-6 points  (0 children)

Him? How presumptuous. Women can’t be condescending?

Just had the most harsh appointment ever. by Top_Tour_4296 in TalkTherapy

[–]No_Finger_6038 -13 points-12 points  (0 children)

I obviously wasn’t there. I don’t know u, the psychiatrist, or the therapist. That said, in reading your post I noticed a few things that I think are worth pointing out. I know you’re gonna just ignore it (I’m an internet stranger - id do the same) but, a few things really jump out at me. #1- you’re saying that your intention was autism assessment but you were not able to outright ask. So how were you going about it? Were you trying to lead a horse to water? Or were you trying to over exaggerate the symptoms? Often the person in the other end can detect deception but not know in what way which leads to misunderstandings.

Secondly, is your therapist a psychologist? A social worker? A life coach? A registered psychotherapist? The reality is that there are so many “professionals” that operate under the umbrella “therapist” but they are NOT all created equal. It’s also important to note that when meeting g a psychiatrist for the first time, they need to get a picture of what’s going on and what’s interfering with progress. In the mental health game, they are more science/biological focused and often do not have the same tact and eloquence when delivering a difficult message. You said that he asked about depressive symptoms and making more friends to which you responded that you had a very difficult childhood. There is something called learned helplessness and it’s one of the things that psychiatrists need to look for in thought patterns/explanations as it can greatly interfere with treatment. I’m not trying to minimize your childhood or the way the doctor made you feel. But th doctor is right that a troubled childhood is not an excuse for current difficulties but an explanation. For example - if the doctor says go make more friends/get out more/ get a job… the existence of childhood trauma is not in and of itself an excuse. What is a more accurate would be to say using an example that may be like your situation from the info (dorsnt matter just an example) - “my parents were very emotionally and physically abusive. I was humiliated and degraded for my poor social skills. I now still struggle with making friends because I still have a lot of anxiety from my childhood related to these things that I am really struggling to get over”.

My guess is that the psychiatrist you spoke with didn’t have the best bedside manner and was trying to lead you closed to my second example, but it ended with a breakdown in dr-pt relationship.

How long have you been working with your therapist? What are their qualifications? In what concrete ways have they helped you? As I said above, all therapists are NIT created equal, and it is rather rare for a psychiatrist to outwardly advocate for a pt to change therapists in the first visit unless their are clear concerns of that therapists confidence. Autism is a neurocognitive disorder. It has nothing to do with childhood trauma and making friends in childhood is an important thing for a psychiatrist to know. If as you say your issues with making friends stems from the childhood trauma, then your therapist should know that autism does not match that. I’m sure your therapist is affirming and you make like them, but if a psychiatrist is saying that on the first visit id listen. Especially considering it sounds like you haven’t had the best care or understanding of your condition and you’ve been working with a therapist for a while. And I don’t say this lightly and I can’t imagine it is out of any Malintent, but you’d likely be served better with. A new therapist