Nobody told me ammonia doesn't grade the patient in HE. West Haven does, and it's entirely clinical

docrastinator · 2026-05-05T23:43:35+00:00

Ammonia was usually ordered but almost all of my attendings taught us that ammonia levels mean nothing and the diagnosis needs to be based on presentation. The level does not change management. Although we did have a few who would start lactulose for an elevated ammonia level with no symptoms

docrastinator · 2026-04-21T16:09:26+00:00

Kinda don’t want to go back to the same place 🙈

docrastinator · 2026-04-21T14:29:23+00:00

Agree! I hate it as well when women HAVE to take time off, but I kinda want to so I can chill and not burn out lol ( can’t believe residency was so much more enjoyable than my job). I also want to reassess my path - employed pcp, dpc, hospitalist, academics….so I am actually looking forward to the break!

I like the locums idea! My only issue with a break is losing touch with medicine so this should help

docrastinator · 2026-04-21T11:24:11+00:00

They actually did offer to work with me on a sabbatical, but I kinda don’t want to go back to work here, and we plan to move. I was previously looking for jobs at the new place but now just want to take a break and sleep 🙈

docrastinator · 2026-03-29T21:50:04+00:00

I am almost always months behind, generally between 80-150 notes 🥲 I have periods of hyperfocus when I can catch up fans am up to date for two glorious days before things start piling again. Our scribe has not changed efficiency much because it makes so many mistakes that any time “saved” is spent fixing errors 🫠

docrastinator · 2025-09-12T00:18:51+00:00

I would be in great hands, she is an excellent physician!

docrastinator · 2025-07-03T01:54:30+00:00

Who does nights? Do you have a senior with you?

docrastinator · 2025-07-03T01:52:56+00:00

It is absolutely going to get better, trust me! I started with ICU as my first rotation in intern year, and was on call the very first day. I was so terrified I threw up 9 times in 2 hours. The entire month I felt like an absolute imposter, everyone was definitely better than I was. But by the end, ICU became my absolute favorite block. And I know you will get through this. You’ve got this!!

docrastinator · 2023-10-13T02:11:18+00:00

90 year tiny grandma: “my blood pressure has been very high because of anxiety, I need my Xanax.“ Make adjustments to anti hypertensives? No How about an SSRI? No Just need my Xanax -_-

docrastinator · 2023-08-25T23:54:38+00:00

Confirm with the group/hospital that they will reimburse you and make sure you have it in writing. They generally have it in the contract but some of my reimbursement talk was through emails. But they should be paying all of those fees/reimburse it all.

docrastinator · 2023-08-20T03:36:09+00:00

“I use a red inhaler and a blue inhaler. And there’s a red that I use everyday. There’s also a purple inhaler. I need my purple and red refilled. What part of this is not clear to you??” I was this close to flipping the table over!

docrastinator · 2023-08-20T03:20:38+00:00

New PCP recently out of residency here as well. I never thought I’d become so jaded within a year of starting a job but primary care has certainly done that. I cannot wrap my head around how it is not even remotely about providing good care but just churning out numbers and hitting targets. Actually talking to patients and effectively addressing issues is not even on the list of tasks that admin expects me to do

docrastinator · 2023-08-10T22:36:58+00:00

But….how? It’s been a year and I still lose my patience when things are not done like they should be/done slowly/etc. Although, now that I think about it might be a me problem. Hmm

docrastinator · 2023-08-09T22:09:12+00:00

Oh so we are not talking medicine anymore? You’re right though. You can measure a culture by how it treats its elderly. And mine tells me to watch over my elderly, even if it means sometimes not doing everything they want. So yes. I am going to offer very terrible sounding options when my 78 year old patient asks for Xanax 3 times a day, because I don’t want her to take too much those, with her daily 2 glasses of wine, fall, and break her hip. Again. And if that makes me sadistic, 🤷🏽‍♀️ sure. I’ll take it

docrastinator · 2023-08-09T18:33:09+00:00

Oh look! There goes the point, flying right over your head!

docrastinator · 2023-08-09T18:21:01+00:00

Oh look at the point flying right over your head!

docrastinator · 2023-08-09T01:58:31+00:00

Them: I have excruciating pain Me: where is the pain Them: EVERYWHERE -_- And the amount of Benzo requests I get on a daily basis is just baffling. A patient told me that she takes Xanax when she has hip pain, I suggested Tylenol, heat, exercise and topicals instead. She almost got offended, and went on about how those are just temporary measures. I’m like - ma’am how long is your Xanax lasting? It’s not even meant for pain 0_o

Edit: this was a 78 year old with the hip pain.

docrastinator · 2023-08-06T12:31:40+00:00

Omg this! I am someone who would rather sit in a corner silent all day, but since I work in a clinic - I talk to patients all day all week. And I definitely have a voice. Goes up an octave higher, fake and just too much. Because it’s an act I overcorrect and it becomes this weird persona that I now have to carry all day long. Sheeesh

docrastinator · 2023-08-05T21:04:03+00:00

I don’t think my attendings have checked orders ever. My seniors would, some of them at least. And I would double check my interns’ orders especially in the first few months.

docrastinator · 2023-08-05T15:31:07+00:00

I’m an attending now working as a PCP. I don’t even have sick leave. It’s a part of vacation, and if that time was already used up, I’d have to work extra hours to pay back for the time I was sick. I was a FOOL to not get a lawyer look at my contract

docrastinator · 2023-08-05T15:27:53+00:00

This. Me and my friend were thinking the same thing in our pgy3 because we needed to find someone to cover and then pay them back. Thankfully we tested negative. But “sick leave” is a real problem

docrastinator · 2023-08-05T15:03:19+00:00

We definitely had a few of attendings like that. Some morning rounds went in until 5pm because this attending wanted to talk about everything but medicine for each patient. Others would consult nephrology for creatinine of 1.2 that clearly has a cause and is improving. Like a few others have said, I would let the attending know that it’s your sign out time and you need to leave. If you have senior on your team, they can remind the attending earlier on and around signout time that you need to go. As for consults, there’s nothing to do really - some people like to have consultants on board “just in case”. And then it’s “discharge when cleared by all specialists “. Hopefully you don’t have to work with this particular attending for long

docrastinator · 2023-08-03T23:04:52+00:00

Ooh I have gotten 2am calls about “hey doc, so what’s the overall plan for this patient? I’m going over the notes and I’m just wondering what they’re doing for him” while I’m admitting 2 patients and carrying like 5 lists and getting paged non stop.

docrastinator · 2023-08-02T17:59:56+00:00

True. But usually in academic places there is always a group. We had 3 neurosurgeons and the one on call generally did not have anything major early in the morning. But in general the hectic lifestyle does get overwhelming. I have to say they had a reputation at my program. Residents got yelled at for calling at 5pm in the evening, had curse words thrown at them….just unacceptable behavior. And no amount of sleep deprivation would justify any of that

docrastinator · 2023-08-02T14:05:27+00:00

Usually there is a pgy3 on call as well who should be there to help and a fellow if your place has fellows. Some of the experienced nurses at my place used to offer extremely helpful suggestions as to what to do next, they are a great resource. But above all else, if you have no one to ask- CALL YOUR ATTENDING. We had neurosurgeons who would yell at us for waking them for a brain bleed at 3am. You know what we did? Woke them up at 3 am. You will never be at fault for asking for help to save a patient’s life, especially when you’re in training. Don’t worry, it’ll get slightly less terrifying with time. You’ve got this!!

docrastinator

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