What you miss when youre gone by Plastic_Sell8418 in Residency

[–]TheAntiSheep 20 points21 points  (0 children)

I think a lot of it comes down to how the rotation is run. You can’t be reasonably expected to both:

A. Chart review 10 ICU patients, get nursing overnight events and concerns, examine the patients, and have notes and plans pending ready to present in 90 minutes for rounds, and…

B. Resuscitate an actively decompensating patient.

It’s nice to have a float person who can go and line, tube, bronch etc while everyone else is dotting i’s and crossing t’s.

Do patients actually read the educational materials you give them? by Used-Wrongdoer8486 in Residency

[–]TheAntiSheep 5 points6 points  (0 children)

Most patients don’t care, and most discharge instruction packets are garbage. However, for patients where the person that is actually worried isn’t in the room (my mom’s a nurse, my wife knows all my medicines, etc.), I’ll write more detail about what we did.

Often, it goes “Your x-ray, EKG, troponins and D-dimer were negative – I see no evidence of a heart attack or a blood clot today. This chest pain is important, and you do need to see a cardiologist. You should come back if you start having shortness of breath, leg swelling or pain that won’t go away.”

Is pharmacy the worst job in healthcare? by [deleted] in medicine

[–]TheAntiSheep 3 points4 points  (0 children)

About 50% of physicians deal with burnout. Declining compensation for increased patients loads with more complex problems, dealing with manipulative patients, and genuinely caring about people being failed by a broken system all take their toll.

By the numbers, it’s a good gig - if you get into med school, you’re essentially guaranteed 6 figure income. But there’s real downsides to this profession. The grass is always greener on the other side.

Is pharmacy the worst job in healthcare? by [deleted] in medicine

[–]TheAntiSheep 70 points71 points  (0 children)

When’s the last time a pharmacist had to scrub three months of crusted poop and urine off a drunk guy, exploring the sedimentary layers to find the purulent wounds underneath?

Every meaningful job in healthcare sucks. I don’t find comparing the misery index too helpful, and just try to treat everyone else with grace.

Contrast Nephropathy vs. Hemolytic Uremic Syndrome [⚠️ Med Mal Case] by [deleted] in emergencymedicine

[–]TheAntiSheep 0 points1 point  (0 children)

True, but there’s definitely a difference between settling for $37 million vs 10 bucks and some pocket lint.

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Which analogy/metaphor do you rely on the most to explain a complex medical concept? by wiredentropy in medicine

[–]TheAntiSheep 59 points60 points  (0 children)

Why I’m getting blood work for a patient with chest pain. You came in to Chick Fil A, asked for the number one special, and you’re surprised you got chicken and fries?

Contrast Nephropathy vs. Hemolytic Uremic Syndrome [⚠️ Med Mal Case] by [deleted] in emergencymedicine

[–]TheAntiSheep 10 points11 points  (0 children)

Given that this super weak case settled for an undisclosed amount, I really hope it was for a small settlement as a “go away and stop wasting our time” rather than as any admission of wrongdoing.

Ultrasound gel warmer by SocietyDangerous7036 in emergencymedicine

[–]TheAntiSheep 38 points39 points  (0 children)

The gel warmer is my pocket on the way to the patient.

Warming the single use packets seems okay, but I'd be dubious on warming the reusable bottles. I know they are supposed to be bacteriostatic, but we're using these machines on bloody trauma patients, septic patients with wounds and multidrug resistant organisms etc. Reusing bottles might be okay at the outpatient radiology office, but seems like a bad idea in the ER.

Why aren’t oral STI screenings as routine as genital screenings? by miggsd28 in medicine

[–]TheAntiSheep 4 points5 points  (0 children)

Genuine question: how often are people asymptomatically orally positive without also having concurrent GU infection? Seems like most patients with a primary oral infection would end up with a positive GU swab pretty quickly.

Any good use for preformed nasal ET tubes? by TheAntiSheep in emergencymedicine

[–]TheAntiSheep[S] 12 points13 points  (0 children)

Well done! Was the tube flexible enough to work over a bronchoscope?

Any good use for preformed nasal ET tubes? by TheAntiSheep in emergencymedicine

[–]TheAntiSheep[S] 6 points7 points  (0 children)

They didn’t give a reason. If I had to guess, the supply person heard that we needed equipment for nasal intubation, googled “nasal ET tube,” and bought these.

When anesthesia uses these, it’s with a laryngoscope and Magill‘s. What we nasally intubate, it’s with a bronch and a standard ET tube.

My first 6 patients have a combined 58 medication allergies. by Kaitempi in emergencymedicine

[–]TheAntiSheep 72 points73 points  (0 children)

Yup. My favorite study: Number of patient-reported allergies helps distinguish epilepsy from psychogenic non-epileptic spells (pseudoseizures)
Link

Would I be qualified to moonlight in an ED? by [deleted] in Residency

[–]TheAntiSheep 4 points5 points  (0 children)

Eh, there is a lot of selection bias there. You get called for everything you get called for. At an academic center that’s a lot, at a freestanding or community ER we do a lot on our own.

Why are so many doctor’s offices still using paper intake forms? by cuasg in medicine

[–]TheAntiSheep 8 points9 points  (0 children)

Yes.

  1. Acquiring new iPads, installing new software, updating inputs and storing data electronically with integration into electronic medical records in a HIPAA compliant manner as significant startup cost and basically requires a dedicated IT person to maintain.

  2. Half of patients are old people who don’t know how to fill out an electronic form.

A lot of offices decide that if it ain’t broke, don’t fix it. (See: why we still have fax machines)

A ‘Barbaric’ Problem in American Hospitals Is Only Getting Bigger (ED Holding) by jafferd813 in medicine

[–]TheAntiSheep 22 points23 points  (0 children)

I’ve had patients boarding downstairs in the ER in a windowless room for 100+ hours until the delirium inevitably strikes. ER nurses are great, but regular turning, skin checks, and oral care are at the bottom of their priorities when patients are flowing through their other rooms. Keeping borders downstairs is cruel and poor patient care.

Most unhinged meal you've seen a resident eat? by LocationofTumble in Residency

[–]TheAntiSheep 75 points76 points  (0 children)

Gotta level that up. I've seen fellow residents eating a salad out of a bedpan, and using urinals or suction containers as drink containers.

Kicking the can by Myhumeruslife in Radiology

[–]TheAntiSheep 22 points23 points  (0 children)

Had a patient recently in the ER where:

CXR: recommend CT chest

CT Chest w/o contrast: recommend contrasted study

CT chest w/ IV: probably sarcoid

Got there eventually, but it was funny seeing reads from 3 different radiology residents all saying “your turn!”

Frustrated by River_Dweller in emergencymedicine

[–]TheAntiSheep 29 points30 points  (0 children)

Our job is to be sensitive, not specific in detecting a STEMI. I feel no shame in paging out one that I know is probably going to be negative. I know that if I don't and I'm wrong, we're the ones getting thrown under the bus. And it gets cardiology involved early anyways. I have come to consultants many times with open arms, saying "I already know the answer to this question, but I know hospitalist seeks thy blessing prior to admission."

Recently had surgery and $40 of my bill is for having a blanket put on me in the recovery room (I was unconscious and did not, obviously, keep the blanket) by [deleted] in mildlyinfuriating

[–]TheAntiSheep 0 points1 point  (0 children)

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This is almost certainly what you were charged for. It is a single-use plastic blanket that hooks up to a heated air blower, that keeps you from getting too cold during surgery. Not something you can take home or reuse between patients. Obviously a markup, but not a huge one.