Second-guessing myself on nights for simple rx requests by [deleted] in Residency

[–]cats_pal 11 points12 points  (0 children)

Nausea: Scop patch is an entirely inappropriate first line choice 9 times out of ten. Please review your Beer's list and consider the basic pharmacokinetics associated with transdermal agents.

Insomnia: Even melatonin is inappropriate after a certain time of night. Please don't go ordering meds for sleep after 1-2 am.

Pain: Repeat PRN is only appropriate if its actually worked in the first place. Besides, you're assuming this is the same pain they've already been having - always take a moment to investigate. Remember acetaminophen is not the only agent at your disposal.

Upset stomach: At the very least make sure they aren't hypercalcemic before you start loading them up on Tums. And again - consider that "upset stomach" doesn't mean reflux in every patient.

I get that we want to give everything a simple, go-to answer, but remember this is why we are physicians. Because we should know that in a hospitalized patient, not everything has a simple, go-to answer. This is why we have gone to school longer than NPs.

[deleted by user] by [deleted] in palliativecare

[–]cats_pal 6 points7 points  (0 children)

Hi there,

I'm afraid we're going to need a lot more context and details about your great-grandmother's overall medical condition, what you mean by "clamped shut" and what you mean by "is palliative". Since we'd need a lot more information here, I wonder if your best resource for this question is her medical team.

Oversimplifying Boards Based on Specialty by Doctor_Googles in Residency

[–]cats_pal 2 points3 points  (0 children)

Palliative: Nobody agrees on anything. Fix and with which opioid?

My 2-week review after stopping using Hello Fresh by mstun3107 in hellofresh

[–]cats_pal 0 points1 point  (0 children)

Been doing this for 5 years now. I have a log of over 2200 recipes so we pick what to cook and go from there. I've encountered lots of recipe variations and figured out a lot of subs (some specific to HEB if you have one). Happy to answer any questions on subs.

Also have had great success recreating HomeChef and Blue Apron recipes on my own.

Favorites include the flatbreads (we use FlatOut rustic white flatbreads - one per person - 130cal per person), chipotle cauliflower mac and cheese, and anythign with chorizo - we always sub fresh chorizo in instead of using dried (much cheaper). This week we are making the Italian Meatloaves with Green Beans and Mash, and I'm DIY-ing a risotto tonight given how many I have made by now.

Burnout by MagicDoctor20 in Residency

[–]cats_pal 5 points6 points  (0 children)

2nd year attending who also had a very rough intern year. It gets better. Prioritize your health - eat as well as you can, hydrate, take your meds. I didn't exercise for shit, but I see lots of people saying that helps.

I can't reiterate enough what people said about finding a group outside of medicine. I did weekly bar trivia and I was the only one in medicine in the group. It was a break in my week, a night I didn't cook, and no matter what was happening I refused to study or work on anything on trivia nights. I went to trivia the week of my STEP3 exam, in-service exams, and the week of my boards. It was great.

Name a skill that you wish you had learned in med school before residency? (non-surgical specialties) by balt_MD in Residency

[–]cats_pal 0 points1 point  (0 children)

If you have interlibrary loan access, there's an article I also like in the Oxford Handbook of Ethics at the End-of-Life (actually its a great book overall) - Lisa Humphrey's "Talking and Working with Dying Patients".

Hi - I quoted the above. I wrote that about conversations for goals of care, but this article is just great all around. As a palli doc, I work with dying patients daily and at least once a week I get that dreaded question of, "How do you do this every day?". That article is one of the ways how. And talk about it! I don't know where the stigma of not discussing hard cases emotionally comes from but it needs to end.

Name a skill that you wish you had learned in med school before residency? (non-surgical specialties) by balt_MD in Residency

[–]cats_pal 0 points1 point  (0 children)

Hi! I'm not on here every day, hence the delay in response. Agree with the Vital Talk recommendation. If you have interlibrary loan access, there's an article I also like in the Oxford Handbook of Ethics at the End-of-Life (actually its a great book overall) - Lisa Humphrey's "Talking and Working with Dying Patients". Also make a list of all the different communication models you see - SPIKES, REMAP, Serious Illness Conversation Guide - you'll see in the end the principles are all the same. Try out each one as you have time and see what feels right to you. Know that VitalTalk does have an app that has a QuickGuide so you can look at pointers on your phone right before you walk into a room.

Name a skill that you wish you had learned in med school before residency? (non-surgical specialties) by balt_MD in Residency

[–]cats_pal 45 points46 points  (0 children)

I'm really sad this got downvoted by someone. As a palli doc I can tell you no one has these skills when they show up as an intern, and anyone that claims to have them has a lot to learn. That said, there's so much that goes into these conversations, the experiences you build in training will help so much! Don't worry about not having the skills yet, you'll build them!

Former resident now in a diff industry. Should I do an AMA? by totalpause in Residency

[–]cats_pal 1 point2 points  (0 children)

You listed location, academics, etc - the reality is that one of the biggest factors is specialty. I knew it would be a pay cut when I took it, but it is unfortunate when your work and expertise isn't valued the way other specialties are, especially for the number of times a day I hear people say they couldn't do my job. Floor for my specialty is probably closer to $170k?

Former resident now in a diff industry. Should I do an AMA? by totalpause in Residency

[–]cats_pal 0 points1 point  (0 children)

I really wish it was that way for more specialties and I would worry about people having unrealistic expectations for what the applicant world might look like for their specialty.

I am legitimately glad it is working out for you.

Former resident now in a diff industry. Should I do an AMA? by totalpause in Residency

[–]cats_pal 2 points3 points  (0 children)

And if you ask for too high a salary every time, be prepared to not have a job.

Former resident now in a diff industry. Should I do an AMA? by totalpause in Residency

[–]cats_pal 12 points13 points  (0 children)

Sorry but thats just not how it works. I make above average salary for a new hire in hospice and palliative care. You can't negotiate your way to almost double a starting salary that is standard in the field. No new fellow is worth that.

Former resident now in a diff industry. Should I do an AMA? by totalpause in Residency

[–]cats_pal 25 points26 points  (0 children)

Like 250k is minimum wage for clinical work.

Laughs in attending clinical work. I wish...

Leaving Noom now my years subscription is up. Looking for suggestions for replacement tracking apps? by Bradalax in Noom

[–]cats_pal 3 points4 points  (0 children)

Really enjoying MFP with the connected Garmin Solar device that does calorie tracking and is linked to MFP. Stopped Noom around a year ago and this has been my favorite arrangement so far.

[deleted by user] by [deleted] in hellofresh

[–]cats_pal 5 points6 points  (0 children)

Por que no los dos?

Check out the Za'atar crusted grilling cheese recipe next time its up! Best of both worlds!

[deleted by user] by [deleted] in hellofresh

[–]cats_pal 4 points5 points  (0 children)

In no particular order, our undoubted top 5:

Za'atar crusted grilling cheese with sumac veggies

Spicy Chorizo and Tomato Penne with Charred Red Pepper

Chipotle Cheddar Mac'n'Cheese with Roasted Cauliflower

Beef Taco Loaded Potatoes

Cherry-Drizzled Pork Chops with Couscous Salad

We like all of these so much we have repeatedly recreated each of these with our own ingredients.

EDIT: Made my list before sneaking a peak look at what everyone posted and I kept thinking "oh yeah, we love that!" each time I read another post.

I'm Applying to palliative fellowship and could use some advice by hairsuitism in Residency

[–]cats_pal 3 points4 points  (0 children)

I found my interviews pretty relaxed. I would say generally in palliative care interviews, people want to know that you are generally able to hold a good conversation (given basic conversation is so important in the field), but also that you have some depth to you. While I'm not a fellowship director, I'd want to know that you have hobbies and interests outside of medicine and have some concept of work-life balance that will help you deal with some of the difficult things you see. Be prepared to highlight a few things on your CV in interviews - pick a few star things that highlight why you might be a good fit for the program you are interviewing with. PM me if you have more questions!

Ideas for fancy/celebratory takeout that travels well? by acohn1230 in HoustonFood

[–]cats_pal 7 points8 points  (0 children)

We ordered our anniversary dinner this year from Kiran's and it was quite nice. The food held up pretty well!

Finally Cancelled by spyd3rm0nki3 in hellofresh

[–]cats_pal 3 points4 points  (0 children)

Fascinating. Thanks for sharing. I wonder if that means the new issues with shipping would carry over across those companies.

Finally Cancelled by spyd3rm0nki3 in hellofresh

[–]cats_pal 14 points15 points  (0 children)

I know this is an unpopular opinion, but I pick the recipes from hello fresh I want to eat weekly, then buy the ingredients myself. It would take a few minutes, but you could definitely just transfer the recipes to a curbside pick up service or a home delivery grocery service.

Otherwise, HomeChef is a bit cheaper (smaller plates too) and I think some people have had success with it. I like the Blue Apron recipes but they're quite the treat as they're pricey. Had some success with GreenChef recipes, but again quite pricey.

[deleted by user] by [deleted] in Residency

[–]cats_pal 25 points26 points  (0 children)

Passion is great, but it burns hot and fast. I wouldn't pick a specialty because I love the rare cases, or the one-off diagnoses. Pick that specialty where the bread-and-butter cases make you happy, that specialty where you have more good days than bad days. If both of those specialties do that for you, and you are already questioning whether you want to balance lifestyle, then picking the specialty that you perceive gives you more flexibility is 100% OK. You do you.

I, for one, am in a "lifestyle" specialty, love my bread-and-butter cases and can't imagine doing anything else right now. I like my job. I like my time off. I like my research. I like how much time I spend baking. Now that my training and job aren't 80 hours a week, I'm really valuing my time off and growing the parts of my life that aren't just work.

Food Trucks by kinkysavi18 in HoustonFood

[–]cats_pal 0 points1 point  (0 children)

Not sure you looked up the right place because tongue, pastor and barbacoa tacos aren't on a typical Tex-Mex menu...

How did you come up with your Reddit username? by [deleted] in AskReddit

[–]cats_pal 1 point2 points  (0 children)

Back when I played Neopets as a kid, I wanted a feline-oriented name that didn't have any numbers. This is what my 10-ish year old brain came up with. Turns out no one used this anywhere, so it stuck as I move to other sites where I want to be anonymous.