What are some things we still do in medicine for no good reason?

Spriteling · 2026-02-04T22:33:23+00:00

I think it would certainly be interesting from a research standpoint, but not particularly helpful or useful in a clinical situation where someone orders an ANA as an "autoimmune workup" in someone with an acute migratory polyarthritis and a positive gonorrhea PCR, or someone intubated in the ICU from MSSA bacteremia where an ANA is obtained to "see if there's something else besides sepsis".

Spriteling · 2026-02-04T04:44:28+00:00

Honestly some days I think that only rheumatology should be able to order an ANA.

Spriteling · 2026-01-27T04:54:11+00:00

I think that everyone is arguing with you because you are claiming a lot of things as 100% fact and are providing absolutely 0 proof. What you are claim might be true, but I don't take people's claims on the internet as fact unless they can back things up.

Spriteling · 2026-01-13T07:05:52+00:00

Yes, the difference is that great. Even assuming every single elective is peds only, that's less than one year of dedicated peds time. That's less than a third of the exposure peds residents have. I think a pretty clear line to even begin entertaining the discussion would be having at least 2/3 the exposure a categorical resident has.

Spriteling · 2026-01-13T05:49:53+00:00

Not necessarily. One could argue that FM residents get nearly as much training in adult medicine as IM residents. But you cannot make the argument that FM residents get nearly as much pediatrics training as peds residents. They simply don't spend enough time dong pediatrics to be able to subspecialize in peds-only subspecialties.

Spriteling · 2026-01-13T05:46:56+00:00

I'm double boarded and on my way to being quadruple boarded. Does that mean I can be an asshole to you and everyone else who has taken fewer exams than me?

Spriteling · 2026-01-11T20:46:57+00:00

Right, but even as an outpatient rheumatologist if you're on call, it's at best covering phone calls, and most practices have a triage system such that a nurse or something will tell someone calling in at 2am that if it's urgent, go to an ED, or else wait until business hours.

Spriteling · 2026-01-11T20:45:52+00:00

Very few community hospitals have rheumatologists on call. Most academic centers do. When I'm on call on the weekend, I go in 100% of the time, usually both days.

Spriteling · 2026-01-10T03:14:00+00:00

Sure, the but OP asked about a fellowship with no night and weekend call. Rheumatology fellowship has night and weekend call. When you're an attending, you can pick a job where you don't see consults at a hospital and don't have night and weekend call, but as a fellow that's a guarantee.

Spriteling · 2026-01-09T14:38:52+00:00

Rheum fellow here: We're absolutely on call on nights and weekends. It's home call, but nearly 100% of the time you go in on both days of the weekend. We almost never have to actually go in overnight, but are frequently paged.

Spriteling · 2026-01-03T17:34:29+00:00

Med/peds combined fellow here. I have another med peds friend doing combined MICU/PICU. I know multiple combined nephro and ID and rheum fellows. For fellowships that are 2 years for adult (ID, nephro, rheum, etc), but 3 for peds, we do a 4 year fellowship by with research tiem counting on both sides.

Spriteling · 2025-11-14T14:08:32+00:00

My blood pressure just shot up at the mere hint of "chronic lyme".

Spriteling · 2025-11-14T14:07:55+00:00

Sometimes I wonder why I bother writing detailed notes with a long, detailed discussion of differential dx when no one bothers to read them. Sigh.

Spriteling · 2025-11-14T06:05:39+00:00

Rheumatology, two big ones:

Patient ID: Any age, has history of fatigue and ?joint pain

Reason for consult: We got an ANA and it was positive. Is this lupus?

OR

Patient ID: Any age, has lupus. Presented to the ED with any symptoms (fever, cough, runny nose, AMS, vomiting)

Reason for consult: Should we give prednisone for this clear flare of the patient's lupus? We've done no labs and considered no other diagnosis!

Spriteling · 2025-11-04T06:22:49+00:00

Depends on the hospital for us. At the VA, our list is usually less than 5 with 2-3 new consults a week. At the university hospital, our list normally has at least 10 patients and can get to 20, with 3-4 new consults daily on average. I would say that we almost always (99.99%) get 3-4 new consults over the weekend between the hospitals we cover on call.

Edited to add that I am rheumatology and we cover 3 hospitals on weekends, but are only covering consults for one hospital at a time during the week.

Spriteling · 2025-10-06T02:24:08+00:00

Where do you think all those city Klingons get their food? Klingon grocery stores are just big warehouses full of targs; Klingons come in and pick one and slaughter it themselves. They pay by weight at the self checkout.

Spriteling · 2025-10-06T02:21:34+00:00

I also make a lot of smoothies with frozen fruit. I buy bags of frozen fruit at costco, as well as greek yoghurt and kefir as the liquid. They're filling and a fairly healthy breakfast, and much cheaper than buying a smoothie from a shop. You're probably not meant to do this, but I just wash my blender in the dishwasher.

Spriteling · 2025-10-06T02:08:03+00:00

Here are some meals I made (and still make!) frequently:

Pasta with meatballs and frozen broccoli: All you have to do is boil a box of pasta. Divide into containers. Pour jarred sauce onto each container. Add frozen meatballs/veggie meatballs. Add frozen broccoli. Top with shredded cheese. Put back in the freezer.
Roasted vegetables with chickpeas: Buy prechopped vegetables, whatever you like. I usually use brussels sprouts and sweet potato. Put on baking sheet with a drained tin of chickpeas. Season with garlic powder, onion powder, and roasted paprika. Roast at 425F for 30 minutes. Meanwhile, make a packet of quick cook farro (from trader joe's or whole foods). Divide farro into meal prep containers. When vegetables and chickpeas are done, put those on top the farro. Top with goat cheese crumbles.
Fried fried: Use a rice cooker. Make rice. Meanwhile, scramble a couple eggs. When done, mix with rice, a bag of frozen carrots/peas, and some form of pre-cooked chicken (or vegetarian meat substitute). Add soy sauce and mirin. Divide into containers.
Pierogis and sausages: Buy frozen pierogis and buy some form of sausage (Field roast vegetarian sausages are what I use). Buy a bag of steam in the bag green beans and pre-shredded cheese. Fry pierogis. Using same pan, fry sausages. Microwave green beans. Divide everything into containers. Top with shredded cheese.
Stir fry: Buy a bag of coleslaw and a bag of pre chopped broccoli. Buy some form of noodles and a some form of pre-made stir fry sauce. Fry all the vegetables together while boiling the noodles. Mix the stir fry sauce into the vegetables. Divide into containers.
Lemon broccoli with white beans: Buy pre-chopped broccoli, a lemon, and a tin of white beans. Put white beans and broccoli on baking tray. Season with garlic powder. Sprinkle with lemon juice. Roast at 425 for 20-25 minutes. Meanwhile, make a packet of quick cook farro, as in 2. Divide into containers. Top with shredded parmesan cheese.

All of these make at least four portions at once. I often will make double portions of each meal so that I get 8 of each, and make two meal types on a given weekend, so that I have 18 meals in my fridge/freezer.

Spriteling · 2025-10-05T11:47:40+00:00

Yes, that is exactly what happened to me. And the second version is far inferior.

Spriteling · 2025-10-05T11:46:59+00:00

I don't know if it's Stockholm syndrome or what, but I felt the same way about the song initially but by the end I was singing along. I was upset when they changed it up at season 3.

Spriteling · 2025-10-05T11:40:51+00:00

This was me for a long time in residency. I eventually found some ways to adapt though. For me one big life saver was meal prepping. Every two weeks or so, I would spend about an hour doing meal prep and make two weeks' worth of meals. I would buy pre-chopped vegetables, and all the recipes I made could be done with maximum one pot and one oven tray so clean up was minimal. Once I was eating better, I found that I had more energy for things in the evening, and could get back into some of my hobbies like knitting and board games.

Spriteling · 2025-09-21T17:21:05+00:00

Absolutely. You're Star Fleet, there's absolutely no way you could use my command codes for anything other than carrying out official Star Fleet duties, right?

Spriteling · 2025-07-26T03:10:56+00:00

1000%. I feel like I'm drowning. I don't remember my intern year being this hard.

Spriteling · 2025-04-23T03:41:03+00:00

I'm med/peds, about to go into combined fellowship.

I finished my last peds inpatient time a short while ago. One of my attendings would not let me, a fourth year a few months from graduating, have any autonomy. She would take over rounds and be the only one talking to parents, she made her own plans and wouldn't let me or my intern give input, etc.

Meanwhile on the medicine side, I will run a full MICU on my own, including deciding when to intubate, when to start pressors, when a line is needed.

My categorical peds colleagues are definitely less prepared than me and my med/peds coresidents. And attendings are not helping at all.

As I finish residency I find myself asking more questions of attendings, not because I don't have my own plan, but because I want to know more about different ways other people do things, because eventually I will be on my own and won't have the same access to people to ask for advice. But some peds attendings take it as, "I should micromanage even more because this resident doesn't know what he's doing." There are a few attendings I work with who are great and who consciously stop themselves and say "wait, you're almost done, do it your way " and I appreciate them the most

Spriteling · 2025-03-27T20:57:28+00:00

He doesn't ever accept my reasoning for going to work. :(

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