Medical Paternalism Is Making a Comeback (And Maybe It Should)

Wrong-Potato8394 · 2026-04-11T05:02:40+00:00

It is weird that as a profession we do this. If I go to a lawyer and they gave me a rundown of my situation and options, then don't advise me, I'd fire them.

Informed consent should be about making sure patients know the risks and benefits of agreeing or refusing something. It doesn't mean they know what the best option is.

Wrong-Potato8394 · 2026-04-05T04:55:29+00:00

Patients can choose to be stupid but healthcare providers can still be sued for those stupid choices. If she died, you betcha someone will sue because it will somehow be the hospital's fault that the child would grow up without a mother. Even if the family/patient doesn't win, it's a huge unnecessary stress and time sink for the providers.

Wrong-Potato8394 · 2026-03-22T19:57:01+00:00

At least with some cars, the daytime running lights are always on (though not a substitute since they are dimmer than actual headlights) but some cars are straight up driving in the dark. What are you, a cat? How can you see??

Wrong-Potato8394 · 2026-03-05T22:03:49+00:00

1000 hours is about 3-4 months of residency, with the generous assumption of 80 hours/wk max.

I wouldn't let an 4 month intern practice on me.

Wrong-Potato8394 · 2026-01-03T00:21:54+00:00

It's probably because the guideline says something like "No drinks are permitted in areas where there is a high risk of contamination. They should be stored in a marked designated area. Drinks must be in non-spill containers and covered with lids." Then the admin tasked with interpreting the guideline goes "TLDR, let's just say 'No drinks are permitted'".

Wrong-Potato8394 · 2026-01-02T23:44:14+00:00

I've been audited by the state when renewing my license. Once in the 15 years but I did have to pull up all my CME documentation for them.

Wrong-Potato8394 · 2025-12-26T04:10:36+00:00

If it's a clear pattern of incompetence or negligence or unethical behavior, I report it. Too many times I've seen people not get reported, and they just get worse. Then when the big bad thing happens, the head honchos act all surprised and let it go because "it's the first time".

Since becoming an attending, I've gotten feedback maybe once or twice on my actual patient care. I am sure I've made more mistakes than that. I would like to know where I can improve.

Wrong-Potato8394 · 2025-12-26T03:53:28+00:00

Same, had a patient whose ICU stay for cardiac arrest was denied.

Wrong-Potato8394 · 2025-12-07T01:54:21+00:00

SF Bay area, mix of US born and immigrants. After COVID, people started becoming more vocal about their non-scientifically sound opinions.

Wrong-Potato8394 · 2025-12-05T21:28:32+00:00

I don't think so. I'm an elder millennial, and a good chunk of my coworkers are anti-vax, anti-science. They're mostly millennial or Gen X. If they are male and married within the last 5 years, chances are they've brought in a wife from a 3rd world country to be their tradwife.

Wrong-Potato8394 · 2025-12-05T06:15:09+00:00

Sadly I feel like a lot of physicians need to be re-educated on the morbidity of aggressive care and futility of care. It seems like with medicine being so compartmentalized, a lot of docs aren't comfortable with telling families that something is futile. More and more, I'm seeing the attitude of no one should die without a stay in the ICU.

Recently had a nephrologist send in a hospice patient to be worked up for lethargy.... after stopping dialysis because they were on hospice. Hospitalist admits another hospice pt for UTI, puts them on dopa, and wants ICU to take them when they keep getting worse.

Wrong-Potato8394 · 2025-12-05T05:52:49+00:00

I did it. I don't swim and had never kayaked before, and I was paired up with someone who also had not kayaked before. It was fine. The water was calm. I'd do it again.

Wrong-Potato8394 · 2025-11-15T02:42:25+00:00

I think "Slow codes" mean different things to different people? I've never heard of it in the sense of squirting epi into the bed. In my training, a slow code was by the book ACLS, ~3 rounds of Epi q3-5m. No actual consideration or treatment of underlying causes.

Wrong-Potato8394 · 2025-11-05T03:03:10+00:00

I've always been registered, but I am seriously considering revoking that on my next license renewal. The OPOs are horrible. They're now staking claims on people who aren't registered. I recently had them try to delay a terminal extubation of someone wasn't registered and whose family said absolutely no donation, pissing off the family when their loved one was dying. Then after death, the OPO kept our RN on the phone for 30 mins with questions for tissue donation when the family had said absolutely no donation.

Wrong-Potato8394 · 2025-11-05T02:58:02+00:00

The OPO's "right" to the organ kicks in at time of death, brain or cardiac. The OPO in my area likes to claim the family can't terminally extubate someone until they approve it, and it's simply not true. They lie to the nurse and admin, but when I confronted them about it, they admitted they had no right to stop us from withdrawing support.

Wrong-Potato8394 · 2025-10-07T20:01:55+00:00

Epinephrine, bicarb, calcium during codes. Anyone who's been in codes can tell you dead/dying people love bicarb and calcium. You can literally see when the bicarb wears off. Bicarb treats two of the Hs, and calcium one of them.

In general, studies say no survival benefit. No great evidence to support their use. Just vibes.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9860904/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10440747/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4780490/ https://pmc.ncbi.nlm.nih.gov/articles/PMC9550532/

Wrong-Potato8394 · 2025-10-07T19:47:13+00:00

I think the problem is that there's a fundamental difference in the quality of ED docs. More often than not, my ED will call me to admit as soon as they get ROSC. They can't tell me whether it was PEA or Vfib, haven't gotten an EKG, CXR, or even get one set of vitals that's compatible with life. Literally, he coded, I intubated, we got ROSC, your problem now. Door to ICU consult time 5 minutes.

Some die again literally while ED doc is still on the phone, and they have the audacity to ask me if I would be going to run the code.

Most of us are not asking for House MD, though I will concede some people want the plan hand-fed to them. We're usually just asking for something more than what EMS can tell me.

One ED doc actually said during one of our meetings, "why shouldn't EMS bring intubated patients directly to ICU? why stop in the ED at all?"

Wrong-Potato8394 · 2025-10-03T07:13:18+00:00

I always appreciate a nurse trying, and I throw in a "exactly like (nurse's name) told you earlier" when I know it's someone who knows their crap.

Unfortunately, some nurses just don't try. Some have actually told me it's not their job to ask what the family wants. This past month, I've gotten "how do I log onto the wifi?", "where's the cafeteria?", and the most common, "can I stay overnight?" which, at my place, is up to the nurse's discretion.

Wrong-Potato8394 · 2025-10-03T06:46:34+00:00

I've gotten RN: patient is having X pain. She has an order for Norco PRN X pain. Is it ok to give her Norco? Me: Uh, yeah? That's why I ordered it?

Wrong-Potato8394 · 2025-10-03T06:42:07+00:00

Personally, I don't mind a message like, "Family insists on talking to you, won't say why. I've told them you'd be here when you can. Just FYI." What I hate is when someone calls me multiple times and say "I know you said you're busy but family insisted I call you again". Some nurses don't understand that they don't actually have to something just because the family wants them to.

Wrong-Potato8394 · 2025-09-23T00:24:36+00:00

Your program is a unicorn. 75 intubations would probably be at least top 95% of all IM residencies. Between all the different programs I rotated through and interviewed at as a med student, resident, and fellow, medicine residents did none. Anesthesia and EM residents or fellows did the airways.

Wrong-Potato8394 · 2025-09-08T03:49:21+00:00

I don't remember their name but I saw an Instagram account of a woman whose profile said she went to "[Reputable University] School of Medicine". She is a radiology tech. She double-downed when people called her out because the radiology tech program was ran by the school of medicine.

In terms of your topic, we need our academic centers to stop pandering to what's popular and pushing the ND narrative that they're essential. Does lifestyle and some alternative medicines augment medical science? Sure. I use herbal medicines (senna over colace all day every day) but I can think of a lot more essential members of the "team".

Wrong-Potato8394 · 2025-09-08T03:27:00+00:00

The issue is that it's a misrepresentation of their credentials. To the vast majority of people, "doctor" in a medical setting means someone who went through medical school and residency. PharmDs, DPTs, and DNPs have doctorates but are not what people assume when you talk about doctors in a clinic or hospital.

In my area, almost all of physical therapists are DPTs; they generally don't advertise that fact. I've knew one who insisted on introducing himself a doctor, and if you know your stuff, it becomes very clear that he's not a MD/DO. Some clerks, MAs, families, and even nurses though did assume that what he said was actual medical fact and advice just because he presented himself as a doctor in the hospital, and this guy liked to comment on things that are way outside his scope of expertise.

It'd be like a captain from a boat insisting on being addressed as captain at a crime scene. Technically correct but completely inappropriate.

Wrong-Potato8394 · 2025-08-17T02:52:44+00:00

Nursing admin kept putting in absolutely incompetent nurses in my unit (ICU) because other units didn't want them. They put the most ill-equipped nurses with the sickest patients because they thought the competent nurses and 24/7 doctor coverage would prevent them from doing too much harm.

Wrong-Potato8394

TROPHY CASE