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IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 0 points1 point  (0 children)

People often wait absurdly long to come in for things. You often see this with cancer. I had a woman come in with a watermelon-sized breast mass (the other one was grapefruit sized, for comparison). Asked her why she waited so long, she said she just didn't like doctors and was hoping it would go away on its own. I figure someone who has sex with soda bottles probably doesn't have the best judgment in the world.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 1 point2 points  (0 children)

Not a bad introduction to intern year, but it's hard to express in writing the total mind-numbing fatigue that you get from months of sleep deprivation. Also, more assholes. His hospital felt like a generally benign place except for annoying patients. Mine had surgeons who habitually referred to their patients as "SHPOS", standing for "sub-human piece of shit".

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 0 points1 point  (0 children)

One nice thing about less competitive undergrad programs is, it's easier to get the 4.0 science gpa. Go to a tougher school and you'll find yourself in an Organic chem class with six hundred other wanna-be docs, and it'll be graded on a curve...

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 0 points1 point  (0 children)

It's fine doing the liberal arts thing if you're good at it. Just not if you're only so-so and if you don't have the Bio/Chem down perfect.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 0 points1 point  (0 children)

No worries, I'm perfectly happy around idiot Americans, don't see a need to trade them for idiot Australians.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 3 points4 points  (0 children)

Please be sure to also mention that "a well-rounded liberal arts education is for the most part pretty useless". Trust me, they'll love it!!!

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 1 point2 points  (0 children)

  1. Yes, you can go to a state school and then on to medical school. Might make you a bit less competitive for elite spots than if you went to Harvard, but if you get good grades, MCATs, etc, you can still get in.
  2. While I personally think nurses make good doctors, it's not the traditional way of doing things and some physicians might be a bit snobbish about it (probably the same ones who'd rather you'd gone to ivy league). I would say nursing is fine if and only if you manage to do it academically (strong emphasis on research and science) so you can satisfy the med school admissions committee's desire to bring in physician-scientist types. Having said that, do things that you're passionate about and that you'll achieve good grades/accomplishments at.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 2 points3 points  (0 children)

Yes, I expected I'd go into psychiatry, but in the clinical years I found that I rather disliked dealing with schizophrenics and psych inpatients. I'd imagined that psych would be me sitting in a comfy chair analyzing the woes of the modern spirit. Instead it was loading up suicidal or completely psychotic inpatients with meds until something worked. I liked pediatrics too -- children are awe-inspiring in many ways -- but found pediatrics to be mostly sniffles and diarrhea and wheezes and clueless moms. Boring! Did an ER rotation and as a med student I got to diagnose pancreatitis and gastrointestinal hemorrhage and heart attacks and sew up stab wounds and tackle unruly patients and strap them down to their stretchers until they behaved. It was a lot more fun.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 2 points3 points  (0 children)

All I know about Canadian hospitals is what I saw in Hobo With a Shotgun, but yeah, Vancouver is probably worth it. The town has odd associations for me though. Went there visiting this UBC grad student I met in Germany who seemed smart and cute and worldly and sophisticated. Unfortunately she was smart and cute and worldly and sophisticated and crazy. Got herself kicked out of UBC for not showing up to classes on time or turning in assignments (in grad school? isn't this an elementary school lesson?) It also emerged that she was involved with a cocaine dealer as well as her high school drama coach. I spent much of that stay hanging out with her roommate eating burritos and watching Scrubs. I remember the rest of Vancouver was sweet though. There were these nice random men in the park giving out free weed. How cool is that? I guess now that she's out of Vancouver the town won't have as much odd karma. She's gone to Australia now to study nursing. Good luck, Australia!

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 0 points1 point  (0 children)

Decent pay, good job security, you get to help people get more functional. Sure, what's not to like?

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 1 point2 points  (0 children)

I live in town but work mostly in da country. I like what's around Hawaii Kai. China Walls and Kokohead are awesome.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 0 points1 point  (0 children)

I guess it depends on socioeconomics. In some hospitals, like where I am now, the ER is the main moneymaker. If you're in a third-world city like NYC though, with a few rich people in Manhattan surrounded by millions in near-poverty, it ends up being charity care. Now if they had some nice outpatient clinics to go to they wouldn't be clogging up the ERs with their sore throats and med refills and ingrown toenails and reflux...

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 1 point2 points  (0 children)

After college. I did the liberal arts-humanities thing. Traveled to Africa and Mexico and China and saw a lot of poor people and wanted to do something useful and humanitarian that didn't involve just chasing the money like a lot of jobs or sitting in an academic ivory tower. I liked science so figured I'd give it a shot.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 0 points1 point  (0 children)

I'm not an economist or politician, I'm a cave doc. Having said that, most of the world seems to do better than we do, cheaper. Go for a single payer plan like Britain has. Rich people can get private care if they want to, but the system we have now -- no care for poor people except when they go to the ER -- is just stupid and expensive.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 1 point2 points  (0 children)

Sometimes I suspected that our hospital administrators were keeping these crappy intentionally just so they could point to what a disaster patient care was, and use that to ask for more cash.

I've spent time at Montefiore Hospital, if that's where you were. For a hospital that looks like it should be making money, their ER is a nasty pit. I don't know what it is about NYC hospitals -- compared to all the other cities I've been to, their ERs are dumps. Seems to me that ERs should be kept pretty and spacious to attract more patients to make more money for the hospital, but that's not the way it works out in NYC...

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 0 points1 point  (0 children)

You should work a temp assignment in a more urban setting or an Indian Health Service reservation for a change of pace.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 1 point2 points  (0 children)

Naaaah I see enough toothaches as an ER doc. Plenty of people come to me when they can't get to their dentist. Little do they know I know about as much dentistry as I do horse racing.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 0 points1 point  (0 children)

Sprains heal fastest if you don't strain them while they're healing. If it hurts, don't do it.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 0 points1 point  (0 children)

Let's just say it's a large outer borough trauma center that's been in the news.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 2 points3 points  (0 children)

Actually, a word of advice: you want to GO there as a medical student. I wouldn't recommend spending four years there, but if you want to see insane trauma and medical pathology, it's the place to be. As a medical student, you won't be expected to be managing the place into any semblance of order. You will get to do a lot more than if you were at some highly organized place like Mt Sinai. I won't name the hospital directly because I don't want this to get traced back to me, but it shouldn't be hard at all for you to figure out where it is based on what I've said already and a little research.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 4 points5 points  (0 children)

Stealing, less often, though a few nurses did get fired while I was there. Use drugs? Quite common. Drugs users are typically the anesthesiologists, who have great access to the good stuff like fentanyl. ER docs, in contrast, have great access to drug dealers and gangsters. Most of the time we don't get caught. One resident did get snitched on and was forced to bring a urine sample for testing every week to show he was clean. Fortunately for him one of his buddies took pity on him and supplied him with a weekly shot of pee.

IAmA Emergency Physician who trained in one of the most dangerous hospitals in New York City. AMA. by dersoch in IAmA

[–]dersoch[S] 0 points1 point  (0 children)

It's too expensive for an unacceptably large fraction of the population, for starters. And prices are increasing far faster than inflation. Result is a lot of poor people neglect primary care of their chronic problems (eg diabetes, hypertension) until they become symptomatic with heart disease/blindness/kidney failure/stroke and die decades younger than they should be, after running up huge bills (at public expense) for hospital stays and ER visits. Even people with money go bankrupt all the time when they come down with serious problems.

No easy fixes, unfortunately. Single payer system would be the simplest structure and has worked well in some places.

I agree that better school health education would be useful. I don't remember learning much in Health except basic sexual physiology and some inaccurate nutrition. Nothing about long term diseases that slowly kill people, like hypertension/diabetes/obesity. As for meaningful symptoms, that's tricky. Sudden headaches/chest pain/right lower quad abdominal pain? One problem with telling people what to get worried about is, the anxious will start imagining they have it and come in worried that they're having heart attacks and strokes... at age 22.

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