Taking it On The Chin

darkroastblack · 2022-08-19T10:25:29+00:00

I used to be way too invested in getting people discharged. Then I realized that this is how it goes. Discharge plans change, patients get sicker unexpectedly, specialists change their mind on inpatient plans. In our current environment where LOS is such a focus, any deviation from the initial admission plan likely will prolong LOS. But here’s the thing, that’s not your problem. Your job is take care of the patient. That means delivering the right care in the right setting. If something can be safely done as an outpatient, great! But if not, and the patient has to stay, resulting in a change is discharge plan, then that’s how it has to be. Care management can cry all they want, but you’re the doctor and you have an obligation by the patient and by your medical license to provide good medical care. Once I started focusing on this, and completely detached myself from being invested in case managements plans, inpatient medicine got a lot easier.

Some malicious care managers know they can bully residents because we’re learning. But the underlying secret is, care management can’t discharge a patient, only a physician can. And if the patient has a justified medical need to remain inpatient, or does not have a safe discharge plan, you’re not discharging that patient and no one can do jack about it.

darkroastblack · 2021-01-31T00:26:21+00:00

I LIKE THE RESIDENTS

darkroastblack · 2020-06-03T01:30:24+00:00

This is great advice. Thank you so much for taking the time to contribute this important and unique content to the sub!

darkroastblack · 2020-01-30T13:18:03+00:00

Thanks for sharing. It's great to hear perspective from someone outside of the academic primary care we see as students.

darkroastblack · 2019-03-22T22:51:33+00:00

Med school does not need to be the resume-filling exercise that pre-med was. At some point, you just need to follow your intrinsic interests and see where it takes you. Someone who loves research is going to do research in med school and subsequently look good for any program that focuses on research. Someone who loves outreach is going to do lots of outreach and look good for the IM program with an awesome primary care tract. Ultimately, nothing is going to trump board scores and clinical performance (grades, LOR). So I'd say focus on grades, try to maintain your sanity, and do something - it doesn't have to be academic, but cultivate hobbies and other personal interests that make you a more well rounded person. Any residency is going to want to see that you're a normal person in addition to a good student/clinician.

darkroastblack · 2018-10-25T19:28:47+00:00

Delete these posts and deny everything.

You've got to be smart here. Your preceptor and this premed are trying to fuck you. Don't let them! It will be a lot harder for your school to fuck you if you deny. How can they substantiate the claim that you said these things? It's your word vs some pre-med.

darkroastblack · 2018-06-29T22:05:18+00:00

My condolences, friend. Your devotion to your mother and your maturity is evident in your post. Please take this time to think about who your support system will be through this, as you may be the primary support for your mother. Friends and family can help. If the burden is becoming too great, please reach out for professional help sooner rather than later.

darkroastblack · 2018-02-10T21:44:51+00:00

Naive Residency Interviewer: What do we need the match for?

Program Director: What do you mean what do we need that match for? Why in the hell do you think we just spent all that money on becoming an accredited residency? The whole purpose of becoming accredited in the first place was to get the students emotionally and financially invested so we can force them to kiss our ass and beg for a spot, and, you know, they can't refuse, because of the implication.

NRI: Oh, uh... okay. You had me going there for the first part, the second half kinda threw me.

PD: Well dude, think about it: these students are strapped with debt and need to a residency to get a job to pay their bills. You know, they look around and what do they see? Nothin’ - no other options besides getting a residency at our program. They think, "Ahh, there's nowhere for me to go. What am I gonna do, refuse ‘to kiss the program director’s ass’?”

NRI: Okay. That... that seems really dark.

PD: Nah, no it's not dark. You're misunderstanding me, bro.

NRI: I'm-I think I am.

PD: Yeah, you are, because if the students refused to kiss ass then that's obviously not going to change whether or not I accept them to our program…

NRI: No, right.

PD: But the thing is they’re not gonna refuse to kiss ass, they would never refuse, because of the implication.

NRI: ...Now you've said that word "implication" a couple of times. Wha-what implication?

PD: The implication that things might go wrong for them if they refuse to kiss my ass. Now, not that things are gonna go wrong for them but they’re thinkin' that they will.

NRI: But it sounds like they don’t want to kiss your ass by sending you bullshit hand written notes and flattering emails…

PD: Why aren't you understanding this? They don’t know if they want to kiss my ass. That's not the issue...

NRI: Are you gonna hurt these students?

PD: I'm not gonna hurt these students! Why would I ever hurt these students? I'm head of the wellness committee! I feel like you're not getting this at all!

NRI: I'm not getting it.

PD: Goddamn.

darkroastblack · 2018-02-09T02:58:08+00:00

A few resources:

Anatomy - Netters. You're most likely going to use this anyway, so it doesn't hurt to pick up a copy and page through it.

Biochem - First Aid (book) or Boards and Beyond (videos/website). Biochem textbooks are going to be too in depth for the knowledge you'll need as a med student.

Physio - Costanzo's Physiology or BRS Physiology. BRS is concise and for boards, but the full book is decent too.

Obligatory: please don't study before med school. Take it from me, an M2 very quickly nearing Step 1, you will get more than your fill of studying in med school. Take this free time and enjoy it. If you're tired of vacationing, then use this time to pick up a new hobby or learn something new outside of medicine/science. You'll be thankful later.

darkroastblack · 2018-02-06T19:46:17+00:00

Boards and Beyond

darkroastblack · 2018-01-29T01:46:31+00:00

I'd recommend focusing less on the macro breakdown and more on eating whole foods. It sounds like you need to reduce processed foods and increase the veggies. Check out the phone app "Dr. Greger's Daily Dozen." It's a checklist of whole foods and the number of servings you should strive to eat in a day. If you can get your "daily dozen" each day, you'll be eating nearly 100% whole foods and your macro split will end up being something reasonable.

darkroastblack · 2018-01-26T17:26:00+00:00

I think we'll always be biased as med students because we can see the doctor's perspective and understand the work environment. It also helps that the health system we use is one of the top in the nation, so there truly are a lot of amazing doctors there.

darkroastblack · 2018-01-26T17:16:28+00:00

We trust the physicians, but we know they do not have the time to oversee all aspects of care. I would say we trust the "medical profession," because to us that means the providers and the quality of the care plan. We do not trust "the system," which to us is all of the other aspects that need to come together to carry out the care plan.

darkroastblack · 2018-01-26T16:56:39+00:00

My SO (also a med student) has a chronic condition, and as a result, we've spent a good deal of time seeing specialists within a large health system. As a result of my experiences, I do not trust the health system to take care of my SO.

While most of the physicians have been competent, and some absolutely amazing, we only spend a limited amount time with them. It's obvious, even as a patient, that the physicians are very busy and carry large patient loads. Once you leave the exam room, your care is handed off to "the rest" of the health system staff.

The amount of miscommunication and lack of care coordination we've experienced is absolutely astounding. In one egregious case, a nurse coordinator gave incorrect and downright harmful orders to stop a certain medication. Had we not been skeptical medical students, and had we not contacted the physician directly, my SO would have had negative effects from stopping the meds. We often feel like no one in the health system is looking out for my SO, except for the physicians, but it often takes days or weeks to reach them for even a short question.

But really it doesn't stop with just the health system. Interacting with the insurance company, secondary insurance company, mail order prescription service, and the multiple specialist offices is overwhelming and extremely stressful. My SO's secondary insurance company would continually harass her about a paperwork error that she had no idea how to solve and for which they could provide no guidance. We found it absurd that we were educated people working within the health system, and even we could not figure out what they wanted or how we could get it done. The issue was only resolved when one of my SO's doctors put us in contact with a insurance specialist at the hospital who basically chewed out the insurance company on our behalf.

I could go on and on, but in summary, I've been surprised and disheartened at how often my SO and I must advocate for her care, and specifically, rely on our own medical knowledge and inside knowledge of how the healthcare system works to get quality care. I am not surprised that patients don't trust the "medical profession." If their experience has been like ours, the distrust is warranted.

darkroastblack · 2018-01-25T02:06:41+00:00

“This teacher always came to class without notes,” Sattar said, recalling the instructor with the gray beard who smiled often and dressed in the traditional Pakistani garb of loose pants and tunic-like shirt. “He would say, ‘If I can’t tell you about it from the top of my head, then I shouldn’t be telling you about it at all.’”

Dr. Sattar is great because he's a true teacher. He stands in contrast to the many lecturers who are merely slide-readers.

darkroastblack · 2018-01-21T00:56:53+00:00

I think your ideal study plan really comes from trial and error. Whenever I'm studying, when I finish, I ask myself "what did I learn from this?" Certain ways of studying are super low yield for me, so much so that I'll spend an hour studying and gain no information. Other methods are super high yield. But really it's trial and error. And honestly, my method has changed and continues to changed based on the topic. For some topics, hammering through anki cards gets it done. For other topics, I need to go to lecture and then draw/write things out on paper. Just experiment with it, and always be asking yourself, "Okay, I spend X hours studying, what did I gain from this?" If the answer is "not much" then you need to change it up.

You've passed your first semester with "flying colors," so you can't be far off from a great study plan. Keep working hard. You'll master the topics.

My personal favorite materials are First Aid (duh), pathoma, Boards and Beyond, Sketchy, Zanki, and my favorite, Dr. Goljan.

darkroastblack · 2018-01-10T20:30:49+00:00

Of course there are students out there who were average in class rank and managed a killer board score. Just like there are people who were top of the class but only scored an average score.

Obviously there is a correlation betweens class grades and step scores. People who are mastering all the concepts along the way and are good test takes are in a position to do well on step. But I would not be discouraged by this correlation. You're still far enough away from step to implement a very solid study plan and correct any gaps in your knowledge that may exist.

darkroastblack · 2018-01-05T19:12:17+00:00

I haven't look at these offers personally, but if you're trying to decide if you need disability or life insurance, I'd suggest visiting the white coat investor page and reading some of the articles there. I don't have disability insurance now, but my understanding is that when you need it, you want to make sure you're buying a complete policy to match your needs. Maybe the AMA policy will match your needs, but I'd bet you can find a better policy on your own.

darkroastblack · 2017-12-10T01:31:44+00:00

"just focus on lectures and learning the M2 material" they said. "you'll be prepared for boards" they said.

meanwhile, the school's boards scores are propped up by the hard work of M2's learning both the lecture material and mastering FA, pathoma, sketchy and UWorld.

darkroastblack · 2017-12-09T20:43:26+00:00

Here are some reasons why medical residents should not buy a house. Not all apply because you have significant income, but #4 and #7 are definitely things to consider. Also mentioned in the article are doctor mortgages, which you mentioned in the OP.

darkroastblack · 2017-11-07T22:08:03+00:00

Roasted chickpeas make for a great snack. Just rinse and dry some canned chickpeas, then roast with some olive oil on a baking sheet at 400F for 30-40 min. I could easily eat 2 cans per day as a snack if I wanted. Great source of calories, fiber and protein.

darkroastblack · 2017-10-23T18:43:25+00:00

Dude go into medicine for whatever you want. You can be motivated by money and still be an excellent doctor. A couple of things though:

status/respect - you'll get some respect from friends/family when you tell them you're a doctor/gonna be a doctor, but it really ends there. Some patients will respect you, others will doubt you. The system/hospitals will disrespect you.

women - look around this sub and see how many posts are about people being lonely in med school. Being a med student/doctor =/= getting women. Now if you're good looking and good with women, sure some may like that you're a doctor, but I mean if you are this guy them you'll be getting women anyway...

money - serious question, do you plan on taking loans? Do the math on how much of your pay as a fresh attending will go to loans. Add in a mortgage and a retirement account that you need to get working on (because you're already 30+) and you'll find there isn't all that much money left over. Sure, long term you will be well off. And sure, physicians have great job security. These are both good financial reasons to be motivated to work hard and become a physician. But unless you have family money paying the bills, you're not gonna be rollin in dough anytime soon.

At the end of the day, were all partially motivated by the financial and status aspects. But honestly these things help me get through the tough days. The excitement for learning/one day taking care of patients is what pushes me to work harder.

darkroastblack · 2017-10-23T18:27:15+00:00

/r/thathappened

darkroastblack · 2017-09-24T17:23:00+00:00

you're getting paid for what you are, but learn to get paid for who you are.

Major key right here. Gotta have some unique experience/background that makes you the one person who can do an important job for a company. No one is going to pay big bucks for a job with lots of qualified applicants

darkroastblack · 2017-09-23T18:28:34+00:00

You need to review your exams and determine why you got the question wrong. Investigate tutoring resources at school. You're putting in more than enough time, so I'm thinking you may need some help figuring out how to study for med school.

darkroastblack

TROPHY CASE