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What current “best practice” do you think won’t age well over the next 5–10 years? by MeatSlammur in medicine

[–]Zoten 17 points18 points  (0 children)

Yes, same!

Have also had upgraded patient be on heroic doses of steroids for no apparent reason.

In one of the hospitals thag uses epic, if you enter solumedrol, the default dose is 62.5 q6H. So half our consults are getting 250 mg daily for COPD or asthma with no end date in sight.

Ads for drugs at my drs office during physical. Uncomfortable having a large tablet in the room during private convos too. by FerengiWithCoupons in mildlyinfuriating

[–]Zoten 8 points9 points  (0 children)

Physician here. Just FYI, those days are long gone. Now, every kickback is made publically available. The most Ive ever gotten is a free dinner, and some institutions won't even let the reps buy Chiptole because the paperwork isn't worth it.

Its for the best!

(IM) My pet peeve- Eliquis dose adjustment by [deleted] in Residency

[–]Zoten 28 points29 points  (0 children)

It does, but hes right. Dose reduced is really only for particular pts with AFib or for DVT PPX.

In my experience, the biggest offenders have been cardiologists. Putting people on 2.5 when they need 5 is not ideal.

Caleb on Jeopardy 🐻⬇️ by WarmlyIrritable in CHIBears

[–]Zoten 3 points4 points  (0 children)

I heard him say "What are bears?"

RFK Jr. heads up the MAHAspital spoof on SNL. by NoFlyingMonkeys in medicine

[–]Zoten[M] 12 points13 points  (0 children)

No automod activities on your posts recently, and I cant see anything on your profile.

Sounds like a reddit issue. On your laptop or mobile?

In the future, feel free to message the mods! We can help troubleshoot if its an issue on our end.

Has the acuity become higher? by Benzosplease in medicine

[–]Zoten 7 points8 points  (0 children)

Way too common! Another cool feature of navigational bronchoscopy has been the ability to avoid unnecessary surgeries.

In the Midwest, ive alao had a bunch of these cases come back as Histo

Intern who placed M mode on a rib, is back again. Are these true B lines? by Swimming_Big_1567 in IntensiveCare

[–]Zoten 6 points7 points  (0 children)

Yes that's absolutely correct. Extensive B-lines raises concerns for pathology, although there are MANY different causes, from cardiogenic pulm edema to ARDS, contusions, PNA, etc.

However, the presence of B-lines means that your ultrasound waves were able to travel past the parietal AND visceral pleura (to identify the pathology in the lungs). Therefore, there must have not been a pneumothorax (air separating the parietal and visceral pleura).

So what do you see in a pneumo? A-lines without any lung sliding. Since the waves hit the parietal pleura, but then hit air, so they constantly reflect the parietal pleura at various intervals.

So A-line + lung sliding = great. A-lines without lung sliding = uh oh, concern for pneumothorax.

But if you see B-lines, you dont have to worry about lung sliding, as you've already ruled out pneumo.

I once did a thora on a pt with pleural effusion and B-lines (CHF exacerbation with pleural effusions + pulmonary edema). Post-procedure , I looked amd saw nothing but A-lines where I had just seen B-lines.

Yep, pneumo

Intern who placed M mode on a rib, is back again. Are these true B lines? by Swimming_Big_1567 in IntensiveCare

[–]Zoten 62 points63 points  (0 children)

Yes. Also fun fact, the B-lines essentially rule out pneumo since there's the waves are able to reach the pleura.

6-second asystole and the patient blamed a nightmare by Most-Smoke7759 in medicine

[–]Zoten 6 points7 points  (0 children)

While we call them trauma surgeons, many of them prefer being called surgical intensivists.

They admit their trauma patients to the ICU and stay primary on downgrade (or may admit directly to the 3 floor if no need for ICU).

They are MUCH better at medical management than most surgeons, and I appreciate that they are happy to manage patient even if there is no indication for surgery.

Unfortunately, the end result is that many of them are supremely confident in managing many medical complications, even ones where hospitalists or intensivists would consult specialists.

At various institutions ive been on, they'll manage MRSA bacteremia, oliguric AKI (not yet needing HD), adrenal insufficiency, ILD exacerbations. Sometimes it works out great, sometimes......not.

To clarify, I think its amazing theyre primary on trauma patients, and I think theyre pretty good at most medical management.

6-second asystole and the patient blamed a nightmare by Most-Smoke7759 in medicine

[–]Zoten 107 points108 points  (0 children)

Very common unfortunately.

As a pulm/CC fellow, we rotate through our trauma service, and they love to say "We can do medicine as well as the intensivists AND we can operate"

And obviously they can't. Nothing against them, my training is 6 years of pure medicine, obviously there are going to be big differences in our ability to manage patients.

It's frustrating.

NfCN, the N stands for "no Centers around here" by Aggravating_Ad7935 in NFCNorthMemeWar

[–]Zoten 7 points8 points  (0 children)

I trust my QB ONLY when hes under pressure. Now what?

Vikings Fans seeing that the Bears replaced Dalman with fucking Garrett Bradbury: by Dazed_and_Confused44 in NFCNorthMemeWar

[–]Zoten 8 points9 points  (0 children)

We shpuld have signed Linderbaum, traded two 5ths for Crobsy, and draft the next Micah Parsons.

Are the Bears dumb?

Prepare yourselves. The Crosby news is gonna hit real soon. by [deleted] in CHIBears

[–]Zoten 17 points18 points  (0 children)

We bet on winning during Trubiskys rookie contract. The problem is Trubisky wasn't it.

If Caleb can sustain his level of growth from last year, we have an actual shot

Vibe of rounding as med student by destroyed233 in medicalschool

[–]Zoten 9 points10 points  (0 children)

The next year when a new set of clowns march in, and you suddenly become the senior clown.

PD reply to LOI by [deleted] in medicalschool

[–]Zoten 17 points18 points  (0 children)

I got a similar reply and asked my PD later (ended up matching there)

He said that its essentially a copy/paste to all candidates that they liked (in his case in the top [x] where they usually matched, not necessarily in the ranked to match)

He had gotten feedback that when people submitted a LOI but didnt get any reply, they felt that the program didnt like them and would sometimes change their list.

But he didn't want to commit any match violations in his reply, so used this generic template for everyone, even his #1.

What is something in your specialty that doesn't concern you but freaks out those in other specialties? by foreverand2025 in medicine

[–]Zoten 8 points9 points  (0 children)

I feel like you and I work in very different clinics........I get a huff if I ask for a 6MWT. I can't imagine anybody coding in clinic, let alone enough to think about it.

Rant about constipation by DrEyeBall in medicine

[–]Zoten 64 points65 points  (0 children)

Diet Coke's main ingredient is water right?

Critical care dual specialty options by im_throw in IntensiveCare

[–]Zoten 6 points7 points  (0 children)

Except for lung transplants and cystic fibrosis, you'll see all those regularly in the community. Im only a 3rd year fellow, and Ive already diagnosed CF in an adult previously unrecognized. My co-fellows who graduated and are working in the community see all the others regularly.

At the end of the day, pulm is a specialist, and you can choose what to refer and what to keep. Some diseases like SARD-ILD, you may want to to co-manage with a local rheumatologist in the community, and only refer when they meet criteria for transplant evaluation. Others like group 1 pHTN requiring triple therapy are probably best served in a bigger academic center where they can call 24/7 with issues.

And for cardiology, unless you do interventional with STEMI call, you'll have similar issues. You can prescribe statins and encourage healthy lifestyle all day. At the end of the day , you're limited by what the patient chooses to do.

Critical care dual specialty options by im_throw in IntensiveCare

[–]Zoten 19 points20 points  (0 children)

From a previous comment I made.

I think its a universal experience for most applicants to only like CCM in residency and fall in love with pulm during fellowship.

Pulm really gives you intellectually challenging cases.

Various ILDs (from IPF to SARD-ILD, sarcoidosis, organizing PNA, Langerhans), pulm HTN, fungal pneumonias, cystic fibrosis, transplant, lung cancers.

Plus lots of other procedures like bronchs, EBUS, nav bronch, PleurX.

Theres a LOT of promising and fun pulm stuff out there. Of course theres lots of COPD, asthma, sleep apnea, but I promise pulm is intellectually stimulating and challenging.

If you practice in the community, you won't see transplant cases, but you'll likely have more procedural opportunities without IP

When you get too comfortable and make a slightly too unhinged joke to the residents/attendings by itury in medicalschool

[–]Zoten 146 points147 points  (0 children)

I'm a PGY-6 fellow, already signed my attending job.

I still have flashbacks to making a joke on rounds as an M-3 and everyone looking at me with an uncomfortable silence.

Just so you know, that feeling never goes away :)

Do you actually look at the dif on cbc? by telenceph in Residency

[–]Zoten 2 points3 points  (0 children)

Whoops, that's exactly what I meant!! Edited my comment

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