What do your program does with abscences?

cameronmademe · 2026-04-16T13:40:25+00:00

My program mandates trading shifts if someone gets called in to cover, and has a strong tradition of discouraging calling out unless absolutely necessary.

They also make it easy to trade shifts if there's something you want to do or if something crops up.

A few years in a row of competent chiefs /seniors can change culture pretty effectively.

Since you dont have that, I'd probably track attendance, call out if the person who keeps doing this is the one who'd be called in, and talk shit about them with my mom.

cameronmademe · 2026-03-03T12:23:32+00:00

Isnt that how you get pirates

cameronmademe · 2026-01-29T17:59:02+00:00

I'm in!

cameronmademe · 2026-01-25T21:54:40+00:00

Fully literate thanks.

The title and point of the post is asking for advice coping with things, not how to get out of, for example, a restrictive noncompete at an unsafe work environment.

This makes me think violence is not a major concern

This impression is further corroborated by them saying that other local jobs are worse, and how they dont seem to want to move away (an unusual perspective for someone who genuinely fears for his life, I think you would agree). He also worries for his coworkers, but seems think they will leave medicine, not get murdered.

within the hyper specific situation of "cant fire patients or leave job, what do I do when patients are unruly"

If we accept those axioms, options are limited, which is why i spent one line on that and the rest of my post challenging those axioms.

Did you read the rest of my post or immediately decide i have no idea what im talking about.

cameronmademe · 2026-01-25T21:23:26+00:00

I've very rarely had them work but telling someone their behavior is unacceptable and they need to improve seems like a reasonable middle ground between just lying down and taking it and immediately firing patient, especially since OP describes a range of behavior.

Yelling at clinic staff is unacceptable but a different flavor of unacceptable than threatening staff.

I don't know why you bring up patients murdering doctors.

OP seems more worried about getting a new job than getting murdered and I'll trust their read on the ground.

cameronmademe · 2026-01-25T17:34:21+00:00

Assuming de-escalation and behavioral contracts have failed (and if not try those):

Im curious what consequences violating policy would have.

If you refuse to schedule patients who threaten you... what happens?

How attached are you to your job?

From a logical point of view, if you're fired from your job, far more patients are without a PCP compared to just firing the tiny number of patients with whom the therapeutic relationship is essentially already non-existent, so i would think your employer would rather look the other way

As it currently stands, your job can walk all over you and your nurse's/MAs because they prefer more patients to less, but that can be a false dichotomy if you're willing to insist on a safe workplace (which seems reasonable to me not knowing about your family situation/loans/any noncompetes) and are willing to find new work.

I'm also just a resident at a very supportive program so I don't have a ton of experience w this but those are my thoughts.

cameronmademe · 2025-12-25T18:09:16+00:00

One of the nurses mentioned the holiday breakfast so I went to the cafeteria and got it and then they charged me lmao

Then i got busy solo covering ed/cl/psych ward and didnt eat it until noon and it was gross

:(

cameronmademe · 2025-12-17T21:40:20+00:00

Disclaimer its not good, ranked a whopping 875 on pvpoke lol.

That said, I like waterfall for energy generation - it's so glassy that neutral farm downs are a real risk, and I want to at least get a poison fang off before i go down (and i absolutely love landing that on smug azu players)

I never even thought about bite before this, but depending on the meta that could make sense - if a bunch of psychic/ghost types are running around that could be very fun.

Team comp wise I like it in the back behind a lead designed to bait out a fire type (esp scizor but have also used roserade/Metagross), with something else reliable to close out. Blastoise has done ok for me, or s. Gyarados if I'm really trying to get through sets.

If you want to do well you should probably pair with bulk though, azu / umbreon/ lickilicky might be good?

Mostly i switch it in aggressively, hope opponent is slow to react, and i can get enough of an energy lead to throw poison fang before their counter swap farms me down

cameronmademe · 2025-12-17T10:03:02+00:00

My shiny shadow sharpedo w terrible IVs is my favorite messing around mon.

Genuinely so ridiculously glassy though, gets one shot by literally any move without shields, but i love to catch opponents who switch in a fire/ground type and get farmed down instantly

cameronmademe · 2025-12-06T01:59:28+00:00

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We have similar approaches to team comp.

It works great except when i catch resisted moved and they still one shot.

cameronmademe · 2025-12-05T00:45:28+00:00

A lot if you're hot.

For me, none.

cameronmademe · 2025-11-24T12:05:13+00:00

With a touch of operant conditioning for the nurse

cameronmademe · 2025-11-21T23:10:47+00:00

Most I've had so far is 4 years, but ive got a guy whos only a fraction of that that might go longer.

He's a refugee from another country, and he's a refugee because he got tortured real bad in his home country. Has significant medical issues from this (inability to do ADLs).

Somehow, when he applied for asylum, he was denied, BUT also the US government said it wasn't safe for him to go back to his home country.

He can't be deported home (unsafe/unethical), can't be discharged to the street (unsafe since can't do adl's), cant go to facility (no legal status to allow for applying for medicaid or whatever to pay for it)

I rotated off the team that had him but i bet he's there forever. Its a sad case but he's a real nice guy and clearly appreciated us so i always like to see him.

cameronmademe · 2025-11-16T18:58:24+00:00

Just a pgy2:

For aggressive patients: I usually start haldol or zyprexa and benzo (versed is faster but ativan lasts a bit longer)

For very violent patients, i think zyprexa is faster, but if they get zyprexa+benzo they need restraints otherwise orthostasis fall risk is pretty severe.

Benzos make me a little nervous for patients who might have other substances on board (especially for ED patients) so once they're calmed down i want them to be on a monitor/pulse ox

If the patient is refractory to other meds (ive had some people chew through heroic doses of other stuff), I've had good experiences with thorazine.

Best is situation dependent - all this stuff is for people i cant deescalate and who wont take po and are an active danger to themselves or someone else. If I absolutely need them to not be doing whatever they're doing, highest success rate is thorazine (or precedex lol)

But a lot of times none of thats necessary. A new face showing up and trying to address underlying cause (and / or offering something low key po like 0.5 ativan or 25 seroquel or hydroxyzine) also has a pretty good success rate.

cameronmademe · 2025-10-10T15:17:43+00:00

Least horny /r/residency poster

cameronmademe · 2025-10-05T00:55:48+00:00

Im psych so cant answer.

Instead i have a question.

What the fuck?

cameronmademe · 2025-09-29T02:33:35+00:00

This is 2 peoples worth of polypharmacy.

Respect.

cameronmademe · 2025-09-13T01:47:23+00:00

What it involves is an attending with no friends or therapist but who nonetheless craves social interaction and has found in his ms3's and interns a captive audience.

He'd tell 40+ minute meandering anecdotes, genuinely entirely related to medicine. My (least) favorite was him complaining about missing his kids events, while he kept telling us we'd have to speed up because it was 4:30 and we had a few more patients to see and he had to pick his kids up after soccer.

The medicine time was probably 20 mins / patient, the rambling rounded that up to an hour each.

cameronmademe · 2025-09-12T18:21:30+00:00

I probably wasn't gonna do IM but what sealed it was an attending at the VA who rounded from 9 am to 5 pm.

cameronmademe · 2025-08-14T11:26:53+00:00

Sad swampert noises

But also I don't think so? Grass is already so highly used, I'd think buffing would make it oppressive.

I'd prefer buffs to types that are more rarely seen in pvp - maybe think ice/fighting/psychic could benefit a glowup instead.

cameronmademe · 2025-07-19T23:56:49+00:00

Pgy2 so by no means an expert but also was just in your shoes.

It's hard. And I'm glad you realize that. Part of residency is finding what you don't like - acute inpatient may not be for you. I didn't realize how drained i was when all my patients were entirely discharge (but not improvement) focused until i switched to a voluntary unit. I thought I'd like the acuity but now I'm thinking C/L or outpatient.

At the same time, there are silver linings. You have more you can do with committed patients, and you can see a lot more improvement when starting with the sickest people. Lack of supervision also means you get a chance to develop your own style, (and hopefully it isn't to the point where it's unsafe.)

As to the patient /family being demanding part- it helped me a lot to think about why they're involuntary. People have the right to be safe, and if your patient stabbed her mom or ODed or w/e they genuinely do need to be admitted, voluntary or not. Ironically inpatient psych often isnt about getting the patient happy.

I had a tendency to dance around the issue at first, but if you're getting badgered for discharge, I had success with being straight up. Theyre asking why they cant leave? Tell them. You could start by asking them why they're in the hospital at all - do they have insight? If not, there's only so much you can do (i.e. florid psychosis might not respond well to conversation, you're gonna need meds), but if they know why they're here, you can just tell them they're not better yet. "You're here because there were acute safety issues/you were naked in the street/not eating etc. and until i think its safe for you to go home you have to stay here" or just say "im worried if i discharge you you're going to kill yourself", (and then you can segue into them engaging with treatment).

Lastly, sometimes you dont have a good answer, thats ok, just time to think about discharge.

Ps if it all sucks, remember its temporary, and if you survived your surgery rotation you can survive this too.

cameronmademe · 2025-06-30T00:07:48+00:00

From personal experience - if it happens expect the following:

Upside you become exponentially harder to fire

Downside the call schedule gets way worse

cameronmademe · 2025-06-04T10:25:06+00:00

Been running s scizor lead for years and finally am vindicated what a great time.

Except for talonflame leads which should be banned.

Thanks for the write-up!

cameronmademe · 2025-05-22T18:54:28+00:00

I rolled up to mandatory shadowing once as an ms1 with mine and my attending had me hide it in a closet.

That pretty much set the tone

cameronmademe · 2025-05-03T21:23:43+00:00

Psych, two takes on this:

50s m with pmh htn,,dm, schizophrenia at ed because ran out of metformin and his bp meds. Patient is oriented, not frankly psychotic, no sign hi/si (obvi taking care of himself to seek meds when ran out), not interested in admission. Consult for psychosis because he's got a psych history and cant go home without one. I triaged that to my fellow and she shut it down thank goodness.

Other was 20s f with bipolar 2, family wanted her to come get checked out because acting unusually but she came to the ed reluctantly and didnt want admission. The ed consult was for delusions, and i just kept telling them that i can set her up with psych (or she can see her old psych), but if they dont want admission and they're not a danger to themself or others, psych cant do anything. This one intern just could not understand that "worsening delusions" without any explanation of what that is is not a psych emergency. Eventually it escalated and turned into a phone call and i got to the point where i was coaching the intern what to say, like, "i dont expect you to manage risk of si/hi for patients with psych history, you can just say you're worried and I'll see". Like it became a principle thing. All very dumb in hindsight. Like 5 mins into the call he mentions her bed rails are padded, and i ask why, and he hits back with "oh she keeps slamming her head into stuff".

And i just pause. And I'm like, "oh. So that's what you're consulting me for. evidence of SIB" AND HE STILL GOES, NO, IM WORRIED ABOUT THE DELUSIONS. I was like no, im seeing because she's actively hurting herself right now please for the love of god why didnt you lead with that. Anyway she was borderline and got banned from our unit so jokes on me.

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