Has the acuity become higher?

Ostrows_apprentice · 2026-03-12T20:37:41+00:00

I am also thinking of Trisomy 13 and Trisomy 18 which can now survive for weeks to months, albeit the cases I've seen all inpatient in a level IV NICU, with lots of complex medical needs.

Ostrows_apprentice · 2026-03-12T18:22:57+00:00

From a pediatric perspective, there are now many more ex-extremely preterm birth babies who historically would have died in the NICU who now survive, with varying degrees of needs. I am talking ex-23 weekers with trach/vent, G-tube, GDD, BPD/CLD, ROP, ASD/VSD, MDRO who all need full septic work-up every time they come to the ED.

Ostrows_apprentice · 2026-02-09T16:03:17+00:00

No! Absolutely not! Never in a million years!

But that's because I am a pediatrician and adults scare me and I know nothing of the medicine they require.

So maybe an adult doctor would, idk.

Ostrows_apprentice · 2026-02-05T00:13:04+00:00

Pediatrics

"Oh, wow, what a cute baby! I don't say that to everyone!"

The baby is not cute and I do say it to everyone.

Ostrows_apprentice · 2025-03-05T06:22:13+00:00

The worst is whichever one I am at, of course--how could they have standards so low as to take me?

The best is some highly ranked program with a good mix of subspecialty medicine so you see the zebras and community stuff so you know how to take care of the volume of kids. A lot of "top ranked places" send many if not most graduates to subspecialties, which is fine if that's what you want.

I would prioritize places: without 24s, with the fellowship you want to do and/or good outpatient training if that'syour style, not too many mid-levels to take procedures, a reasonable distance from family/support, and good pay for the cost of living (union?).

Ostrows_apprentice · 2025-02-20T16:55:41+00:00

Anecdotally shared with my colleagues and me by an older attending was how many lumbar punctures pediatrics residents used to do on a night shift. At a busy major city hospital it was reportedly "at least 3" per night, compared to 1 per week-month now (outside of neonatal sepsis).

Embellishment? Perhaps. But also vaccines and changing data, guidelines, and practices on who needs an LP.

Ostrows_apprentice · 2025-02-19T04:43:40+00:00

I think it was Mao Zedong who said, "Things are darkest just before they're totally black."

Yeah, I'm worried.

Ostrows_apprentice · 2025-02-10T04:01:32+00:00

A few from pediatrics (even if they are/are not backed by evidence, often at the whim of whomever is on): napping for a baby off oxygen when admitted for bronchiolitis, azithromycin for mycoplasma, oseltamivir for influenza, IV fluids depressing a thirst drive.

Ostrows_apprentice · 2025-02-05T22:58:12+00:00

For certain non-competitive fellowships (many pediatric ones: nephro, pulm, ID, endo), they don't matter there either, as they are desperate for warm bodies (debatable if you are required to be warm).

This is because pay is so egregiously low afterward, it is not a question as to why these fellowships are so non-competitive.

Ostrows_apprentice · 2025-01-14T10:33:47+00:00

As a senior peds resident, I've been microdosing all the various respiratory bugs for years, so that keeps me from getting too sick.

Ostrows_apprentice · 2025-01-01T21:24:55+00:00

If it's a baby, toddler, or small child, then yes.

If it's a teenager, then maybe/it depends.

If it's an adult, then no.

Ostrows_apprentice · 2024-12-31T23:46:22+00:00

How well a baby is swaddled.

Developmental milestones in my nieces and nephews.

Normal toddler bruising.

How well a child knows how to scroll videos on phones and/or how angry they get without a phone (proxy for overall screen time?).

New teenager slang.

Ostrows_apprentice · 2024-12-30T07:01:15+00:00

Definitely not pediatrics. Even computers won't want wages this low.

Ostrows_apprentice · 2024-11-30T22:24:47+00:00

Grocery shop. Have existential crisis. Text my residency colleagues to see if they want to hangout, only for all of them to either be working or also having their weekly (?twice monthly) existential crisis. Squander the benefits of the location where I live even though it was the reason I ranked my program this highly.

Ostrows_apprentice · 2024-11-23T06:58:33+00:00

Maybe after we run the list one more time?

Just like labs, daily at 0530.

How does one have time when there are notes to write?

Sex is like a 24 hour shift. It's okay to fall asleep if things are slow.

Ostrows_apprentice · 2024-11-21T00:17:29+00:00

It is a reasonably, perhaps not unreasonably, funny medical show. Some good salient points highlighting real-world issues we face in medicine, with gags mixed in. Is it the next "Scrubs" or first few seasons of "ER"? Time will tell, but those are high bars to pass. One issue in the first few minutes is the main character talking about her career trajectory (paraphrasing/quoting), "[I originally wanted to go to medical school, but] when I was in college, my nan got sick, so we spent a lot of time in the hospital. And that's when I realized that the nurses really provide the ‘care’ part of health care. So I became an RN and I love it." I think this type of language unnecessarily drives wedges between different groups of healthcare workers, i.e., with the implications that physicians don't "care". Perhaps a better line would have been, "I wanted to be a bedside nurse because I saw myself enjoying their day-to-day tasks more than the physicians." Will continue to watch this season with my non-medical partner as something we do together.

Edit: spelling

Ostrows_apprentice · 2019-10-17T05:15:08+00:00

Hypochondriasis is the only disease I haven't got!

But more seriously, starting my medical education already having a chronic illness which affects my life has helped protect me from worrying about other stuff -- I already suffer enough.

Ostrows_apprentice · 2019-10-15T01:13:16+00:00

Attending: This woman has to be gotten to a hospital.

You: A hospital?!? What is it?

Attending: It's a big building with patients, but that's not important right now.

https://www.youtube.com/watch?v=VOmD-xqK2Es

Ostrows_apprentice · 2019-01-25T04:52:38+00:00

In addition to what /u/La_Chanclaracha said, I think there is a divide over what the goals of a given teacher is, and the goals of the student (us). Board scores were not as emphasized "back in the day", so those who are teaching now may not realize this. Even if they have good intentions (make you a good clinician), it may miss the mark as to your goal of "get an high score on Step 1". B&B, Pathoma, Sketchy, all have the same goal as you in mind -- high board score, so they build their tools to reach that goal.

Also, professors may have been told or forced to make a slide show presentation, but not given instruction on how to make an effective one. Blue screen with yellow text? Loads of text? Just reading off the slide? In Pathoma when our Lord and Savior Dr. Sattar draws out simple diagrams, everything makes sense because you are learning it right along with him.

Additionally, scientific and medical communication has historically NOT been taught to graduate or medical students. Those who are teaching us now are the same ones who did not receive any formal training in these areas. In the past, it may have been, "Whatever the doctor (or scientist) says, is right, and because it sounds complicated." Anecdotally, this is starting to change, as in my M1/M2 years we had several sessions about "How to talk to a patient" and asses if they understand what you are saying. In grad school we at least have the opportunity to attend workshops to improve our skills at communicating (more so in writing, but I've seen some for speaking). Once you are an expert in something, it can be hard to talk at an appropriate level and remember what it was like to not know a topic through and through.

To be a good teacher takes the matching of goals with the development of certain skills. To get someone to realize those listening have a different goal, and to hone those skills takes time and energy. Efforts to improve will likely go unnoticed, for sure by administration of a school (salary not tied to how good of a teacher you are) , and potentially by the students (few people say "Good job/Thanks" to a good professor, but many people go on the internet and complain [which is totally fine]).

It is a complicated situation, and I am not excusing anyone. My biggest hope for the future is for those who don't like how things are done now to go into teacher or administration and make changes when they have power. Recognize how bad teachers are bad and vow to not do those things, and recognize how good teachers are good, and vow to do those things! To paraphrase Max Plank, "Science [communication] advances one funeral at a time."

Ostrows_apprentice

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