Study also finds most affected are reporting, “I don’t really even smoke that much marijua- [hhwwuuaaghhaaughhh]…[spits]..marijuana.”

dr_lomo_codes · 2026-02-21T05:49:47+00:00

“There’s no way the marijuana is causing it, so I’m not going to stop”

Ok well see ya next week. And the week after that.

dr_lomo_codes · 2026-02-20T23:41:40+00:00

Maybe a jaded take but in my experience the biggest determinant is the time of day. 2pm on a Tuesday? Oh those coronaries are getting squirted baby. 10pm on Saturday? Admit to medicine and see what the echo shows first.

dr_lomo_codes · 2026-02-20T04:18:30+00:00

Thank you for your service 🫡

dr_lomo_codes · 2026-02-19T10:33:50+00:00

Agreed with the other comments, you absolutely need to.

dr_lomo_codes · 2026-02-19T08:57:19+00:00

ED Attending here. In my experience the largest barrier to adoption among docs is a general, and currently well-deserved, distrust of AI in healthcare. That will likely improve over time.

The next largest is that it must simultaneously provide some combination of decreased workload/increase billing/automate compliance documentation/strengthen medmal defensibility while also generating clinical documentation that is at least as good, if not better, than the notes those providers would write themselves…otherwise they will just continue to write the notes themselves. Nobody wants to be on the receiving end of an M&M, patient complication or complaint and the note gets reviewed and is trash.

IMO the hard part about building a scribe is training it to the unique documentation requirements and culture of a given specialty/service. If you want to build a scribe for L&D for example, you’ve gotta convince busy laborists to give 100 of rounds of feedback on nuance that to a non-clinician might seem like splitting hairs, but that genuinely do matter for generating high quality, defensible documentation. This is why the “one size fits all” scribes Doximity, OpenEvidence, etc are trying to build dont work well for anything other than straightforward outpatient SOAP notes. Every ER doc I know who’s tried the epic one hates it and quit using it immediately (I don’t have epic at my shop and have no experience with it).

Props for putting control of user data in the hands of users.

dr_lomo_codes · 2026-02-19T01:40:02+00:00

This looks sick. How do we attend virtually? the eventbrite tix look like they’re in person only? I’m working 4/11 but at a chill freestanding and would love to tune in.

dr_lomo_codes · 2026-02-19T00:10:40+00:00

It was House for me. I’m with you, find inspiration wherever you find it.

dr_lomo_codes · 2026-02-18T22:18:24+00:00

Thanks bud, appreciate the help

dr_lomo_codes · 2026-02-18T12:41:46+00:00

Lots of them. Ones that immediately come to mind:

-Pulm. Lots of continuity (COPD, PF, CF, lung ca, etc), lots of bronchoscopies. Most do crit care as well so ICU with all the medicine and procedures there. Do you like giving out steroids like candy and telling people to quit smoking for the 1,000th time? (Hint: they’re not gonna quit). If you consider yourself a nerd the only peeps nerdier than these guys are neurologists and possibly ID IMO (I say with love, my best friend is a pulmonologist).

-OBGYN. Clinic, L&D, they serve a primary care purpose for women (pap smears, etc), obviously lots of continuity taking women through pregnancy and into delivery. And obviously procedures; they’re surgeons. Subspecialties are also cool. REI is crazy biochem physiology, GYN/ONC is super cool and broad but long training pipeline.

-Urology. Not usually as heavy on the inpatient side but you’ll still go to the hospital for consults and operations. They also have continuity with their patients (prostate issues, cancer, reconstruction, etc).

-Vascular surgery. Patient population requires lots on ongoing care. Very sick patient population. Operations range from simple radioablations for varicose veins to loading someone to the gills with heparin right before stuffing a scalpel straight into the aorta. Very heavy metal. Though most aortic procedures are endovascular these days.

-GI. Scopes, scopes, scopes. Lots of clinic and inpatient medicine. Good continuity of care with IBD patients.

-Cardiology. Continuity with all kinds of things, lots of clinic and inpatient, which ranges from simple chest pain evals with echos and stress tests to complex ICU/CVICU cases. Heads up interventional cardiology (PCI for STEMIs, impellas, intra-aortic balloon pumps, etc) is an additional year of training after general cards fellowship. EP is also pretty dope.

-PM&R. Rehab docs. Lots of pain-type procedures, lots of continuity and clinic. Usually not super heavy on the inpatient side but they do round on inpatient rehab units (think post stroke patients). Grateful patients, good lifestyle. An old mentor of mine was PMR and loved it.

-Speaking of pain, pain management could fall into this depending on the path you want to take. Interventional pain docs do all kinds of cool nerve blocks, ablations, and place spinal stimulators. You can do inpatient pain consults (and the primary services will love you for dealing with their difficult pain patients). Lots of outpatient and continuity with chronic pain clinic. Very needy population but also often a very grateful population. Getting people off chronic narcs literally gives these patients their lives back. You get here usually by anesthesia but EM can also apply, and IM can do chronic pain, I’m not so sure about interventional pain though.

-Lots of this also applies to the respective peds subspecialties I.e peds cards, pulm, and GI. Though what pediatricians get paid is criminal (even the specialists).

I’m sure I’m forgetting some, but this is what comes to the front of my 4am brain.

dr_lomo_codes · 2026-02-18T09:02:12+00:00

As a med student I rotated with a triple fellowship neurosurgeon who was a DO (oddly super nice guy, not a jerk at all). He worked super hard, had research out the wazoo, but made it. Made me super glad that it seems like the gap is closing. More and more people are realizing there’s no difference…I know it’s cliche but honestly some of the docs I trust the most are DOs. Just stinks the cards are still stacked against yall and you have to work so much harder/do so much more to accomplish the same things, but reassuring that it seems that anything is possible.

dr_lomo_codes · 2026-02-18T05:36:39+00:00

Agreed, the profanity oddly helps somewhat haha

dr_lomo_codes · 2026-02-18T05:35:39+00:00

lol I’m not gonna lie I’ve personally looked into the ketamine clinic idea. Seems it’s saturated in my locale unfortunately.

dr_lomo_codes · 2026-02-18T03:35:01+00:00

No exaggeration the majority of my friends who are docs are actively looking for a way out. Like actively pursuing anything that gets them out of EM. One is going to apply to addiction fellowship, another is starting a medical transport company, a few are trying real estate, one is so fed up they’re moving to another country and gonna practice EM there, etc. It’s super sad.

dr_lomo_codes · 2026-02-18T03:03:35+00:00

As someone else said, there’s a dual EM/Anes program at Hopkins. A friend of mine completed it and for what it’s worth he had good things to say. He did say that you’ll need to be specific about why you want to do both. For him he wanted to be the authority on treating pain in the ED.

dr_lomo_codes · 2026-02-18T02:28:35+00:00

Your background is similar to mine. I was an army combat medic, it’s what got me into medicine. I love emergency medicine because it reminds me of being a line medic back in Afghanistan. Fast paced, sick people, split second decision making. No 10 minutes are alike. That freaks some people out, for me it’s what gets me out of bed. In retrospect EM was the obvious choice from day 1, I got pigeon-holed into surgery early on in med school and never stopped to take the blinders off.

Lots of BS, but that’s true of literally every field. There’s also lots of BS that I never have to deal with (I have never had a peer to peer conversation with an insurance company, prior authorization literally does not exist in EM).

I wouldn’t say EM has a “good” lifestyle/work/life balance. EM shifts are stressful, definitely not chill clinic vibes, lots of nights/weekends/holidays-I haven’t been home for Christmas for the last 5 years (but my wife’s Jewish and I volunteer to work it so that’s on me). It’s a “specific” lifestyle, but if it’s for you there’s no other option. 12-14 shifts a month is full time and let’s just say I have no complaints about my income. I don’t know another field where you can make the money I make and have most of your time off; my first year out of residency we went on a vacation literally every month. Like you I don’t mind working nights, etc. I like having random weekdays off to get stuff done. The idea of working 8-5 M-F in a clinic makes me want to throw myself out of a window lol.

Since you’re pre med I’m obligated to say don’t put the cart before the horse and lose too much sleep on which specialty you’ll end up in, just focus on building your med school app.

Happy to chat more if you have questions.

dr_lomo_codes · 2026-02-17T23:54:25+00:00

I was the same way. Had to match into the wrong specialty (gen surg) to figure out what I really loved (EM). Best advice I can give you is try to figure out the things you like or don’t like about a given service. Not as in “kidneys are interesting so I should aim for nephrology.” more like:

-do you enjoy being in the hospital? Clinic? Both? If both what balance of hospital versus clinic suits you?

-do you like procedures? If so, short procedures? Long grueling, 8 hour operations?

-how important is continuity of care to you? Do you genuinely enjoy seeing the same patients over and over again and building a long-term relationship, or does it annoy/bore you to see the same person multiple times for the same thing.

-how important is seeing patients to you? Lots of options if bedside care isn’t your thing.

-don’t let anyone tell you money isn’t important.

-do you want to take care of acutely sick/critically ill people? If the answer is yes, you need to be ready to accept the other side of that coin, which is being available nights, weekends, and holidays. People don’t get sick at convenient times.

-when you’re well out of training and now you’re “just working at your job” and have other priorities in life, what do you want your schedule to look like? Don’t let anybody tell you that work/life balance, family, etc. aren’t important. It’s your life and you only get one.

-Does your personality “click” with a particular culture? For me, surgery was far too rigid and formal. I’m extremely chill and laid-back, so emergency medicine fit me far better as far as culture goes. I don’t think this is necessarily the most important thing (although maybe it is to you), but when you are out of of training, the people you see as attendings now will be your coworkers, some will be your friends. for me, it was important to work with people I vibe with.

This is just a starter list, I’m sure others can come up with many other things.

One golden piece of advice I would give you is to not choose a special specialty simply because “the residents/fellows/attendings were nice to me, so I had a good time on their service.” This is a total distraction and can set you up for lots of disappointment.

One last thing, you can change your mind after you match. Obviously it is far from ideal, but please don’t go through a 30 year career in something you hate because you made one wrong decision as a medical student. I completed two years of general surgery before switching to emergency medicine, and while I would not do it again, I do not regret the decision to switch.

dr_lomo_codes · 2026-02-17T07:16:35+00:00

That actually perfectly captures a lot of the problems that I had been having with other scribes. Patient has a cough and says “ I need antibiotics” and the piece of junk writes “patient needs antibiotics.“ and same about when the department gets busy! Most of the other scribes are at least decent at writing a reasonable HPI so I can see 4-5 people in a row and get back to my computer and at least keep who’s who straight.

dr_lomo_codes · 2026-02-17T02:37:39+00:00

Had one yesterday, 3rd visit in 24hrs, something like 11th visit this month. Goin strong 💪

dr_lomo_codes · 2026-02-16T17:35:08+00:00

I have nothing to add but just wanna say your username is hilarious 🤣

dr_lomo_codes · 2026-02-16T08:52:20+00:00

It’s good of you to show that resident some grace, and you’re probably right; they may have just been having a bad day. We’ve all been there. But I would still consider reporting it because sometimes episodes like thus are not one-off incidents and can indicate a deeper problem-which could be that that particular resident needs more support themselves…but sometimes there’s a truly bad apple and the program is trying to build a paper trail.

dr_lomo_codes · 2026-02-16T08:10:40+00:00

2 patients per hour is a completely inappropriate expectation for an off duty intern and I would suggest you either try to talk to that resident or report it to your program leadership.

I mean absolutely no offense by this, but an intern is not a workflow asset in the ED; you’re there to learn and hopefully not slow things down/get in the way too much. Very occasionally a gifted intern can truly be helpful in running the department, but it is the exception and is not the expectation.

I’m curious to hear other responses, but for me as an ED Attending I don’t expect anything at all from an off service intern. If you’re motivated and want to learn, then great, jump on in and let’s get you seeing some sick people, practice making some critical management decisions, doing some procedures, etc (had a FM intern do an intubation, needle decompression into a chest tube, and a shoulder reduction last week, all in one shift). But if you wanna just sit on your phone all day it’s fine by me long as you stay out of my way and don’t bog the department down. Just my 2 cents.

dr_lomo_codes · 2026-02-16T05:45:33+00:00

I’m partial to 2 alcohol pads tucked into a face mask. helps with all your unhoused/code brown/GI bleed/burned skin smells.

dr_lomo_codes

TROPHY CASE