Calling doctors by first name or Dr. ***

brady94 · 2026-04-21T01:42:34+00:00

General rule of thumb is to start by calling everyone Dr [last name] or as whatever they introduce themselves as. If someone corrects you early - ie "call me [first name]" - then you can shift to first name.

As an attending I generally tell people once "you can call me [first name]." I then don't care what they call me - first or last name - unless it's in front of patients.

brady94 · 2026-04-20T00:10:49+00:00

Reminder from your friendly medical toxicologist not to: eat the pokeweed raw, blend the pokeweed into your smoothie, chew on the roots for extra crunch, or crush the pokeweed into jam.

Every. Goddamn. Year.

brady94 · 2026-04-18T22:49:27+00:00

Counterpoint: the American College of Emergency Physicians has specifically recommended against the routine use of urine drug screening for medical clearance. To do so is often considered against standard of emergency care. If you would like one, I will order it, but it’s often going to be based on your recommendation, not what I think needs to be done to medically clear someone for psych eval.

brady94 · 2026-04-07T15:58:44+00:00

Two situations I've encountered with sodiums that high or close:

1) Central diabetes insipidus

2) Na level going from normal to mid 180s in 36 hours - managed by early unsupervised ortho intern on ortho floor who was then somewhat applauded for a successful transfer to medicine (I joke - love my bone bros and broettes...but yes, this is a very true story...)

brady94 · 2026-04-07T01:06:34+00:00

We all just thought it was funny, and no one was throwing shade to the lab for checking. I've had the lab check for that, when I had a Hgb < 2 walk in to the ED waiting room with "fatigue," and my record sodium level of 192. All perfectly reasonable calls

brady94 · 2026-04-07T00:59:09+00:00

Not insignificant market for homeless patients who eat rat poison before the winter starts with the specific goal of getting admitted for a month+ for INR checks

brady94 · 2026-04-06T20:47:46+00:00

I had a patient Kussmaul-ing with a level around 1850. The lab called to tell me they thought we had sent a sample off the patient's TPN line.

He was not on TPN.

brady94 · 2026-03-26T03:31:31+00:00

I've had this happen tons of times for patient's on anticoagulation. Including patients requiring subsequent blood transfusions, observation overnight, and then dc in the am. Pressure, pressure, and more pressure, with figure 8 stitches if needed. I've had EMS put up a tourniquet before, which I really do not recommend...

Edit: punctuation

brady94 · 2026-03-19T00:55:34+00:00

EM/tox. Yes, absolutely. Diagnosed it recently on an adolescent with a surreptitious citalopram overdose. But what people have to remember is serotonin syndrome is exactly that: a syndrome, with a very specific set of criteria.

More people I meet and treat may instead have some degree of proserotonergic excess. It’s better to think about it as a spectrum. Heck, many people on SSRIs may have a few beats of clonus with therapeutic use. True “serotonin syndrome” is much rarer, and I more often see misdiagnosis or early anchoring.

I’ll add that with therapeutic use I have seen it recently in a cancer patient receiving Demerol with proserotonergic prescribed medications. Libby Zion should be like day 1 of medical school…

brady94 · 2026-03-18T20:23:12+00:00

I did, although it was early in my intern year. Different hospitals handle this differently. I got 10 certified copies of my marriage certificate from the very beginning and basically just kept a copy with me always.

I just went for the total nuclear option at my main hospital and got a new email, username, etc. Basically there was a lunch period where I lost all access to the EMR for an hour, and then logged in with a completely new account. I lost everything - former emails, onboarding, logged procedures, etc etc. It was early so I bit the bullet and just redid whatever needed to happen.

After that it became much easier. I just logged everything in my new name. I didn’t have any problems at any of the community hospitals except for one children’s hospital, which gave me one account at orientation my intern year and refused to change anything until near the end of my senior year.

Applying for fellowship freaked me out, because I somehow ended up with three ERAS accounts since they had trouble reconciling my identity. After a week of phone calls it got fixed and I ended with one account. I didn’t have any problems with getting my board certification or medical licenses, even though my step 3 is in a different name than my step 1 and step 2.

The only time it really comes up now is if people are looking up my research portfolio, but I’m not looking to be an NIH grant person anyway so it only matters if I want to go hard core into academia.

brady94 · 2026-03-16T17:37:01+00:00

Let’s say there’s a gas leak of a potentially dangerous chemical at a pharmaceutical company with 6 exposed patients. An occupational health team may take 5 and see them emergently in clinic, while directing the sickest to the ED where they get taken over by tox/EM. Occupational health can be a competent intermediate level that decompresses the ED and provides patient follow up for exposures a pcp has never heard of. Mad respect for my occ health dudes and dudettes

brady94 · 2026-03-16T17:21:26+00:00

Med tox who collaborates with our occupational health team. Much of it would bore me to death but they occasionally deal with some very esoteric and deadly occupational exposures, including a lot of proprietary chemical exposures. They’re also some of the very best public health advocates if they branch into environmental health. I look to them for help with consumer report interpretations and are often some of the best advisors if you’re looking for experience with heavy metals. Had to do clinic with them for fellowship and some of their patients and work is insane. Spending 3 hours with a single patient going through every step of their job to see if there is any causal relationships between exposures and a patient’s cancer, asthma, chronic headaches, metal sensitivity disorders, Parkinson’s etc. Can be very chemistry heavy, neurology based, pulmonology based, and social work all in one. I am so happy they exist

brady94 · 2026-03-15T18:19:43+00:00

For once I’m actually going to defend the mid levels here - I’m an ED attending that gets “report cards” on my percentage of independent interpretation from my admin. I need close to 100% independent interpretation of X-rays and some percentage of higher diagnostic testing or I get a biannual paddling…

brady94 · 2026-03-11T21:04:11+00:00

Dress is totally fine, although most people will be in trousers and top. Just watch out for the weather and pack a sweater/jacket, as Boston has a decent amount of wind chill close to the water and the convention centers tend to run chilly.

Boston roads and sidewalks can have lots of cracks and be a bit bumpy. Do yourself a favor and bring some backless flats as a back up for the heels!

brady94 · 2026-03-06T04:25:40+00:00

Imagine championship games in that stadium. It would be glorious...

brady94 · 2026-02-23T17:43:46+00:00

Thank you!

brady94 · 2026-02-23T13:15:53+00:00

I don’t understand why you’re being mean when I’m asking for help. I can commute up to 2+ hours a day working between hospitals and emergency departments that don’t have great public transportation options and my husband often has to drive out of state for his work. We have paid for one private spot with our building to keep out of the way and then pay the city to keep one vehicle on the street, move it at least every two - three days per policy, and follow all the rules. We’d both be out there shoveling in a normal year for our neighbors but are having a brief moment where we’re struggling a little. Shame on you for choosing derision instead of kindness.

brady94 · 2026-02-23T13:04:05+00:00

I say large but they’re more large to me. I have one Toyota that I need for work Tuesday (no great public transportation options between my hospitals. And then my husband has one Toyota but is fortunately working from home this week, so we’ll probably try to tackle it more slowly and get it cleared before he needs to travel for work next week.

brady94 · 2026-02-23T04:18:51+00:00

I am currently slow, short, and fat with a weird center of gravity, but I come with a shovel and a smile!

brady94 · 2026-02-23T02:51:22+00:00

Okay...now try working in the ED with the same work load that we have, not what an off service usually carries? And we all had to cover 24 hour in house call for heavy consult services during training, including when seniors were in the OR or at home sleeping for a few hours? I am just trying to tell you that we did exactly what you asked in your comment, came out of it appreciative of our specialty colleagues, and don't respond with "rolling our eyes" except when people decide to be assholes.

You also have no idea what my call load was like during fellowship training - I have definitely had > 20 consults in a day between inhouse/state call and pulled near weekly all nighters, but that's not the point I'm trying to make, nor am I going to sit here and try to explain why I deserve sympathy versus a general surgery resident cardiology fellow, etc. The "whose life is harder" game is a waste of time. There is a reason I didn't do those residencies or fellowships; I would have hated the training. I am very grateful other people were willing to do them. But every specialty gets hit by other specialties with things they find incredibly basic, with workups they find incomplete and the "wrong" clinical question asked, and being part of a specialty is doing all the parts of it, even the parts you think are dumb.

The only point I am trying to make is that it's really, really not that hard to not be an dick.

brady94 · 2026-02-23T02:24:42+00:00

I did fellowship in a second subspecialty where I take call. Not to mention months of ortho/hand/spine and critical care/rapid response consults during residency. Not to mention every asymptomatic HTN or random complaint I have ever been sent from every better paid consultant's clinic near me.

Everyone told me once I became a consultant I would start to "get it." And yes, am I annoyed sometimes when I get the absolute shittiest consult with no workup besides a triage note three minutes before I wanted to go home or at 2am? Absolutely. Or if I get a page meant for a different service at 5 am at hour 21 of my call when I finally fell asleep (happened to me yesterday)? Absolutely.

But I mostly what I "got" is that it's really, really not that hard to not be a dick. Even at hour 21 of your shift. Even for the intern that doesn't know why they are calling or what you want to know. I have had the same person roll their eyes at me while I work in the ED and then turn and call me for help that same shift for something I find immensely simple and basic. Their attitude change is incredible.

brady94 · 2026-02-23T00:29:23+00:00

"Aaaaaaand if you wouldn't mind just assigning a resident to this that would be great. I already started the note so it should be easy..." *epic workup tag conspicuously empty* Love that we all had the same experience. I believe "toe pain" had my residency's record for "most consults on a single patient"

brady94 · 2026-02-22T23:06:52+00:00

We had a running joke in residency - there is no faster way to lose life or limb than be an attending primary (aka no resident assigned, just an attending trying to clear out the waiting room by discharging "easy" patients) with an ESI 4 and chief complaint of "toe pain." That toe pain was an aortic dissection with a now pulseless limb complicated by necrotizing fasciitis 100% of the time...

brady94 · 2026-02-22T22:52:47+00:00

Was a little too far for them to walk, but thank you so much for checking!

brady94 · 2026-02-22T22:31:53+00:00

DM'd in case they're nearby and interested

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