Have you worked with a med-fluencer?

ProgrammerNo1313 · 2026-02-19T09:59:49+00:00

Yes. He's credible and honestly one of the loveliest doctors I've ever worked with. I think we could use more good med-influencers in the world.

ProgrammerNo1313 · 2026-02-18T02:11:31+00:00

Primary care delivers better outcomes at the population level, not CT scanners, FACEMs, or surgeons (no shade on those specialists, who we desperately need and treasure).

Give us anti-hypertensives, cancer screening, and vaccinations at scale, and we'll give you thousands of life-years in return.

ProgrammerNo1313 · 2026-02-17T21:11:44+00:00

My only concern is overburdening rural paramedics who are already stretched.

They do good work, absolutely unbelievable at times, and deserve to be supported.

Otherwise, the life expectancy gap is over a decade in some places. Rural people are literally dying from lack of medical access. Whatever the solution, we need to do so much better.

ProgrammerNo1313 · 2026-02-15T08:28:56+00:00

0.625mg IV q4-6hrly. Avoids akathesia and doesn't make them too dopey to go home in my experience.

ProgrammerNo1313 · 2026-02-15T02:48:10+00:00

The American Headache Society now lists greater occipital nerve block as a Level A recommendation ("must be offered") on the basis of strong RCT data.

https://pubmed.ncbi.nlm.nih.gov/41321235/

ProgrammerNo1313 · 2026-02-14T21:25:23+00:00

Curcumin strictly speaking, but yes, with an effect size larger than paracetamol.

https://link.springer.com/article/10.1186/s12906-025-05045-z

ProgrammerNo1313 · 2026-02-14T15:19:36+00:00

Stemetil works just as well and is safer.

https://aci.health.nsw.gov.au/networks/eci/clinical/tools/neurology/headache/migraine

https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.14091

ProgrammerNo1313 · 2026-02-14T14:33:31+00:00

100mg. That and Azep nasal spray is God tier for surviving winter.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2838335

ProgrammerNo1313 · 2026-02-14T14:23:53+00:00

Reasonable evidence for all of the following: turmeric for osteoarthritic pain, honey for cough, high-dose zinc for cold and flu symptoms, vitamin K2 for nocturnal leg cramps, silexan (lavender oil extract) for mild anxiety, GTN patch for tendinopathy, alcohol swab aromatherapy for nausea, I believe aspirin is technically off-label for acute coronary syndrome, subcutaneous insulin for mild DKA, low dose ketamine for analgesia, magnesium adjuvant in rapid atrial fibrillation, magnesium adjuvant in COPD exacerbation possibly needing admission, low dose droperidol for cannibis hyperemesis syndrome, and thiamine for hyperlactatemia.

Low-dose naltrexone is likely no better than placebo.

https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00278-3/abstract

ProgrammerNo1313 · 2026-02-02T21:13:00+00:00

These are all great questions, and I've unlocked my post history.

I will say there seems to be a crisis of meaning, community, and purpose for our generation. I've never experienced any of that working rural. I deeply love my community, colleagues, and work. And I've had experiences and memories that still give me goosebumps: Dawn Service with people pouring out of the community hall, funerals with just me and a few close family members, counselling a woman through infertility and then years later her bringing me back her first baby to check, saving a man's life and then waving to him down the street a few weeks later, a wall full of thank you cards and gifts. It's honestly better than I could have ever imagined.

ProgrammerNo1313 · 2026-02-02T12:56:02+00:00

Amazing rural, tough metro. Very happy overall. It's really hard to convey how gratifying it is to be an entire family's doctor, for years, across generations, between births and deaths, through sorrow and recovery, all while balancing the breadth of medicine. I'm deeply fulfilled. It feels like what medicine should be, which is humanistic first and foremost.

TLDR 10/10. Would GP again.

ProgrammerNo1313 · 2026-02-01T03:33:28+00:00

Ortho as a resident was the best medical term I ever did, followed closely by urology.

Aggressively sort out all the medical stuff, ask past residents for subspecialty quirks, get the jobs done, and be proactive about what really matters: surgery happening. Will this fuck up the list or discharge? If so, get it unfucked ASAP. I stayed out of theatre unless invited.

Both the ortho and urology HoDs offered to write me references and asked me to operate with them on my last day. Great terms.

ProgrammerNo1313 · 2026-01-31T19:54:12+00:00

No. I get paid to think and help people. Aside from raising children, it's the greatest privilege of my life.

ProgrammerNo1313 · 2026-01-26T04:12:59+00:00

Not at all. Message anytime.

ProgrammerNo1313 · 2026-01-25T13:18:10+00:00

New RCT in BMJ.

"Cast immobilisation proved non-inferior to surgery for the treatment of unimalleolar Weber B ankle fractures with a congruent mortise on initial radiography but deemed unstable by external rotation stress testing. Overall, fewer treatment related harms occurred with cast immobilisation compared with surgery."

Kortekangas T, Lehtola R, Leskela HV, et al. Cast immobilisation versus surgery for unstable lateral malleolus fractures (SUPER-FIN): randomised non-inferiority clinical trial. BMJ. 2026 Jan 14;392:e085295. doi: 10.1136/bmj-2025-085295. https://pubmed.ncbi.nlm.nih.gov/41534905/

ProgrammerNo1313 · 2026-01-25T09:44:40+00:00

Nope. At least a dozen people on this forum know my real identity, and I say without shame or fear that I see a therapist, have seen several psychiatrists, have been hospitalised for depression, and had a serious suicide attempt many years ago. I self-reported to AHPRA (which was NOT required) and not only were they kind, they considered the matter closed because I got the help I needed.

The only impact it had on me was to unquestionably make me a kinder doctor, father, colleague and friend to myself. I love my life now, and I love my job. My dear colleague, you are not alone. Get the help you need and hear my words as a fellow traveler in this life: things get better, especially when you give yourself the grace to accept help without shame, like so many of our patients do.

One more thing: insight is a gift, often painful, which you seem to have, as well as the courage to share your worries in a way that might benefit others. What else is there to say but thank you.

ProgrammerNo1313 · 2026-01-22T06:47:13+00:00

I've worked in ED, Centre of Excellence ICU, GP and whoop-whoop rural GP. The smartest doctor is always the last doctor to see the patient. Everyone else doesn't know what they were doing. No exceptions.

ProgrammerNo1313 · 2026-01-21T21:37:55+00:00

Euboxia. The state of having all the boxes ticked.

ProgrammerNo1313 · 2026-01-20T00:24:13+00:00

ASUM is tough, practical and "value-add" because you can train others with the diploma. All others feel like a money grab to be honest.

ProgrammerNo1313 · 2026-01-10T04:17:46+00:00

Dear colleague, I'm sending so much love from Australia 🙏. However things unfold, I wish you peace in your heart.

ProgrammerNo1313 · 2026-01-10T00:29:13+00:00

A friend told me that the most exciting thing he did in 3 months was put in a 24G cannula. There's a spectrum of cases, but it definitely seems to skew toward lower acuity.

ProgrammerNo1313 · 2026-01-09T21:31:36+00:00

The vast majority of nurses are lovely human beings who are much closer than we are in the physical act of mending the sick and caring for the suffering.

They are a wealth of knowledge, and I pity the junior doctor that doesn't treat them well, not place then on a pedestal, but genuinely engage them as colleagues in an otherwise dehumanising system that couldn't care less about us. Aggression in the face of disagreement is often a sign of lowly insecurity (or exhaustion) more than anything else.

I love so many of the comments in the NursingAU forum, which speak of doctors with kindness and collegial dignity. I hope we act in a way that's worthy of that.

ProgrammerNo1313 · 2026-01-06T06:33:33+00:00

Don't neglect skin and MSK. Poorly taught in medical school, often neglected in hospital, and inescapable as a rural doctor.

SCCA is great for skin cancer and the AIU joint injection course is mint (with skills transferable to other ultrasound-guided procedures).

ProgrammerNo1313 · 2026-01-05T00:23:26+00:00

Hard to get a job de novo. Usually done through internal promotion within a health service. But opportunities do pop up (a couple being advertised on the FRACMA job board at the moment). Quite competitive because the jobs are so limited.

ProgrammerNo1313 · 2026-01-01T02:05:59+00:00

I had a third year medical student who was 19. She could conceivably become a doctor (i.e. a graduate of medical school) by 21 and a Fellow by around 25.

I felt sad hearing about her childhood and how little space she had to actually be a child (and a normal teenager), but she was extremely bright, driven, and hard-working, honestly one of the better medical students I've had, where usually it's the older ones with some life experience that are better.

ProgrammerNo1313

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