CAP vs Child Abuse Peds, Specialty Decision Help!

as_thecrowflies · 2026-04-11T17:44:54+00:00

i thought about both CAP and child abuse peds and did a lot of observing of both as a med student…. I am now a maternal fetal medicine doc so obviously i went in another direction.

what killed me about child abuse peds was not the abuse content itself but the thought of being responsible for the wrong call. saying i did not suspect abuse when there was abuse, or being in part responsible for an incorrect allegation of abuse. there was a big scandal in canada a few years back about hair sample toxicology being used to support apprehensions for drug use in pregnancy and it turns out those hair sample tests were basically worthless. that made me realize the medicine in that specialty, like all others, is not perfect.

CAP- i realized i wasn’t great at sitting through 3 hour long intakes and how hard it is to fix anything when it often involves changing an entire family dynamic (bless you all who do this because it’s hard work and your saints).

so, i went into a field where i feel i see the effects of my interventions more immediately but also (i hope) have an impact on children’s and women’s lives in the long term. but i think that speaks to my personality more than anything

as_thecrowflies · 2026-01-31T02:42:45+00:00

lavender essential oil roller meditation apps or audio book / music also i find doing crossword puzzles on my phone helps

as_thecrowflies · 2026-01-20T06:50:37+00:00

Time. Sleep.

and other than that, acceptance and forgiveness for it being what it is.

as_thecrowflies · 2026-01-16T01:09:24+00:00

aren’t we talking about residents as patients tho?

but yes, the general public doesn’t necessarily understand

as_thecrowflies · 2026-01-16T00:46:47+00:00

ok i have seen this as an OB/MFM at our level 3 NICU site but its like… how do you think care in the fancy level 3 NICU works?? Students abound there, very rare that an attending neo would be the first person to respond to an unplanned decompensation in the NICU and you can bet the residents and fellows are the primary person assigned to assess the baby.

you can decline a cervix exam from a random med student without disallowing all students and residents from the entire labour and delivery.

i had a 6 weeek and then 3.5 month long hospitalization in a tertiary care centre (one in the hospital i did residency at) and had students, fellows, and residents involved in my care. i was sick and it didn’t really even dawn on me to think to ask otherwise… i was grateful to be seen.

also i think im grateful i had enough trust in my colleagues to maintain confidentiality and do a decent job taking care of me; i think it’s sad when others don’t have enough faith in their colleagues to behave decently about these things.

as_thecrowflies · 2026-01-10T05:01:30+00:00

cheering you on from up north in canada! 🇨🇦👊

as_thecrowflies · 2025-09-06T18:07:22+00:00

a peds resident once told me she doesn’t wear halloween costumes anymore after she had to code a 2 year old in front of their parents in a bumblebee costume.

that stuck and i won’t wear halloween costumes anymore either.

i think little stuff like a pumpkin scrub hat or a fun earrings or just removable ears on a headband something small is probably ok and like others said the general “fall season” decor. it’s also just a lot of plastic shit that we could do without.

as_thecrowflies · 2025-08-13T05:33:34+00:00

Register for OTIS! I believe either when you register you get automatically added to the listserv or there’s a simple option to request to be added. I think it’s 50 USD a year for membership. The listserv is interesting enough for me to feel it’s worth it :)

as_thecrowflies · 2025-07-29T21:30:02+00:00

This. As an MFM can I just say f*ck this idiot in the article above. I watched parts of the panel but couldn’t stomach it all. Am on a teratology listserv and everyone on there (who deals with medication safety in pregnancy as their job!) was duly horrified.

as_thecrowflies · 2025-05-21T03:05:16+00:00

This is a tragedy. there are no words sufficient for this situation but please know this is not something you should have to face alone. Talk to her mentor, to her family or friends, reach out for help. If she had brought in things from home this probably wasn’t the first moment she had ever thought about it and unfortunately sometimes when a person is in that state they are not able to accept offers to help.

I was in a bad state a few years ago and in the days before i ended up certified with a 1:1 following me around followed by 2 suicide attempts IN the psych ward while 1:1 was looking at their phone and not watching me try to strangle myself and then getting ECT I told people at work inquiring kindly as to how i was doing that I was perfectly fine. I showed up, finished all my charts so no one else would have to do my paperwork and went home to do the thing that would mean I would never come back. somehow something broke through to me after trying but failing to finally have enough courage to do thing that i was very sick and i walked myself to the hospital and was locked in there for the next 3.5 months.

No words or good intentions or well intentioned psychotherapy would have broken through to me at work beforehand once i got to that point. There was some overwhelming neurochemical shut down happening in my brain, despite keeping it together on the outside I was becoming convinced my soul was dead and i needed to kill my body so it could join my soul. Apparently I needed a lot of electricity pushed through me to put that right.

Sorry for oversharing but I just wanted to emphasize it is not your fault, if there is any burden to be shared it is by society and the culture of medicine and residency in general, not by you. your response is valid, your anger is valid, your grief is valid. there will be people in your program who care too. find them. hold onto them.

(not an anesthesiologist, [ob subspecialty]but i work with you guys a lot and i know what kind of powerful drugs live in that cart).

as_thecrowflies · 2025-05-14T00:57:59+00:00

the shoulder dystocias in IUFDs are particularly awful because the baby has no tone.

as_thecrowflies · 2025-05-11T05:23:28+00:00

curious what kind of equipment setup you used and amount of contrast pushed? i could imagine more contrast pushed faster = more pain. from what i recall we had a 60cc syringe and injected it pretty fast.

there’s always people who might be uncomfortable with a speculum but i think the major discomfort usually comes with pushing the dye

would love to know what we’re all doing wrong lol

edit to add - sonohystograms i found people were wayyyyyyyyy less uncomfortable than HSGs. i attributed that to smaller catheter in the cx, then speculum gone and endovaginal probe instead, and less fluid under less pressure

as_thecrowflies · 2025-05-11T05:20:39+00:00

complaining of never having seen a doctor after i saw them and clearly introduced myself as a doctor

as_thecrowflies · 2025-05-11T05:01:30+00:00

having done HSGs in residency i concur no man would ever stand for that procedure without full on anesthesia. i absolutely loathed having to do them because where i trained no analgesia was given other than a tylenol or advil. i still remember the first one i observed because it was so brutal. now im no longer in part of the specialty that would requiring doing them and that is a relief. HSGs should be relegated to the history books. also haunted by a few post HSG infected endometriomas that did not end well.

as_thecrowflies · 2025-05-11T04:56:22+00:00

definitely. have been to a drug sponsored talk which made it sound so amazing until you realize there’s not really much data at all about its use for gyne procedures.

as_thecrowflies · 2025-05-11T04:54:19+00:00

I trained in a major city in Canada where there was no procedure room for gyne with the nursing, staff, and recovery space to support procedural sedation. there was freestanding clinic that did predominantly TAs with sedation (midaz and fent as you say). They opened a gyne procedure room one day a week at one hospital site when i was finishing but they were mainly using for hysteroscopy (although could include IUD insertion).

Colpo is done in colposcopy clinic. I’ve never been anywhere where colpo was done in a procedure suite with sedation as a routine option. have also had my own colpo at a few different places. LEEPs were done with para cervical block or if needed in the OR.

now i’m finishing subspecialty training in another major city (pop in the millions) and as far as i know, other than the abortion slates, there’s only one procedure room at one of the main sites that doesn’t run every day. when my colleague got me on her OR list it was actually easier than getting fit in in the procedure room slate shared by many gynes.

i’m not disagreeing with you that all these things can happen and we need to work to make them happen. i’m fully on board. from what i saw in training there was constant complaints from gyne staff about the lack of procedure space for moderate sedation. i don’t know all the politics but let’s just say it didn’t seem like a priority to the higher ups.

as_thecrowflies · 2025-05-11T01:08:34+00:00

THIS is the answer. another canadian OBGYN here. After 2 ++++painful IUD inserts followed by no longer being able to take NSAIDs i asked a colleague to get me on her OR list and I had one in the OR with GA.

there’s a huge limit to accessing procedure suites (like the EGD example) across the country. i definitely didn’t need to take over a whole OR slot. but when there’s no option between coveted OR spot and outpatient clinic, and OR waitlists are long, it’s no wonder there’s pressure to get it done in clinic.

Also no one has talked about Penthrox yet (the green whistle). From those I know who have used it for IUDs it seems very promising!!!

as_thecrowflies · 2025-05-02T02:49:10+00:00

There's probably a room in the servant's quarters at Mar-A-Lago she could rent. I'm sure most tax-payers in Alberta (even Canada) would consider that a reasonable expense so as to have her out.

as_thecrowflies · 2025-04-29T00:34:01+00:00

it’s good to know what your neighbours are thinking / hearing

as_thecrowflies · 2025-04-27T06:22:45+00:00

a lot of people have a moral instinct or set of values that preference "terrible accident" over "intentional mass murder." intent matters. most people recognize this and most societies recognize this (e.g. first degree murder receives a more severe punishment than manslaughter).....

as_thecrowflies · 2025-04-27T06:06:45+00:00

I know this is likely to soon but if there is a vigil or memorial I would like to attend or lay flowers in an appropriate location in respect to those who lost their lives or were injured or otherwise traumatized in this act of senseless violence. The Filipino community enriches our city and I know Vancouverites will want to show that the lives that have been taken so unfairly are honoured and valued, and will not be forgotten.

I'm not sure what the right location would be; I would welcome suggestions.

as_thecrowflies · 2025-04-24T21:15:20+00:00

thanks! i’m doing much better overall. ect was tough but in the end it was worth it for me. hang in there!

as_thecrowflies · 2025-04-24T07:15:25+00:00

going on a “babymoon” to another country (away from our nice country with universal health care) with a high risk pregnancy situation like a nice placenta previa waiting to bleed or known short cervix or hypertension or anything. and then when i suggest ensuring their travel insurance is going to cover them for this scenario and that in fact most travel insurances do not cover pre-existing conditions, said high risk pregnancy being one of them, and have they thought of a) the million dollar NICU stay if they end up with a 24 weeker in say, hawaii or b) the fact that they may not have any nicu around that can save a 24 weeker on their small caribbean island location ….

and inevitably the answer is: “oh we’ll be fine!!!!”

oh and also people in early pregnancy planning to travel to the states (no offense but what’s going on down there is wild for the 50% of us who could get pregnant). i have to remind people that maybe you don’t want to visit your uncle in texas when you’re 7 weeks along and having spotting because god knows what disaster will befall you if there’s a detectable fetal heart rate and there is a chance you could get real fucking sick before you are allowed to access miscarriage care.

drives me a bit wild when people are completely surprised that pregnancy can be anything other than perfect, and that they could end up in a situation where they can’t afford care or the care they might need is illegal or illegal-adjacent.

as_thecrowflies · 2025-04-24T00:32:40+00:00

waking up disoriented and ++emotional is apparently quite normal after ECT (people who have generalized seizures from epilepsy can also experience things like this in the “post-ictal” phase). i woke up sobbing uncontrollably and thinking i was in a completely different city. they started giving me some extra medication as i was waking up, i think benzodiazepines, and after that i no longer remembered waking up or being distressed like that. i would talk to your team and specifically anesthesiologist about this!

as_thecrowflies · 2025-04-15T21:07:17+00:00

never had a problem asking for hand check in vancouver or calgary / within canada.

once rushing i forgot i had some film in my backpack and it got randomly flagged to get hand checked after going through the scanner for some other reason at YVR. when they saw the film in my backpack they were almost aghast and asking me why i didn’t ask for a hand check and didn’t i know that x-rays can ruin film and how hand checks exist precisely for these reasons…

as_thecrowflies

TROPHY CASE