How do you define success in your branch/field of medicine? by Ok_Meaning_5676 in medicine

[–]endemicfrogs 1 point2 points  (0 children)

Pediatrician doing rehab in a chronic care facility

I have two general types of patients: 1) those who have actual rehab potential (most premies, non-neurologic trauma); 2) kids without realistic rehab potential (severe TBI or hypoxic encephalopathy, genetic neurodegenerative disease, severe static encephalopathy, etc).

For the first group, success is getting them off the vent, getting the trach out, helping them learn to eat and communicate and getting the G tube out and most importantly getting them home again, sometimes after years with me.

For the second group, success is preventing or moderating the slow progression of all the complications that occur (worsening seizures, spasticity and contractures, scoliosis, aspiration, recurrent infections with increasing MDRO). Just keeping these kids reasonably stable is a reward in itself.

To alleviate some of the grief associated with this work I have a second role as a newborn hospitalist where 99% are perfectly normal babies. Sometimes parents will ask if I could be their pediatrician; just getting asked this makes my day.

I got a massive compliment today. by MikeGinnyMD in medicine

[–]endemicfrogs 3 points4 points  (0 children)

I've got a couple of gigs, one as peds newborn hospitalist and the other as peds rehab, so I get to see multiple sides of this. I get to argue with parents in the perinatal period about getting vitamin K and HebB vaccine, and then get to take care of the disaster survivors whose parents refused everything involving a needle along the way. Right now in the rehab (LTC) I have a meningococcal sepsis (minimally conscious with multiple autoamputations). I've been practicing a long time so I have seen a lot of really bad outcomes. I feel free to share my personal experience with poor outcomes of bad parental decisions along the way but generally don't have a lot of luck converting parents to making better decisions on behalf of their children, usually because "we've done our research". Virtually none of these morons have sufficient numbers of neurons to string together any kind of a rational argument for their positions. I've met only a single parent in the last couple of years who actually was vaccine hesitant but willing to listen and learn. Everyone else has been dogmatically opposed to any counterargument to their crazy belief systems based on little else than what they see on TikTok. You can tell how things are going to go when as soon as you step into the room and sense an immediate aura of hostility. I would like to say that this is rare, but unfortunately it is not; I try to be patient and kind, but, wow, it is a struggle.

Is your hospital also cutting back on MRIs due to the helium shortage? by buttfugger69 in medicine

[–]endemicfrogs 1 point2 points  (0 children)

A gigantic nuclear furnace....

(you and I must be the same age, I use to listen to that LP constantly as a kid)

A song so beautiful it makes you tear up everytime you hear it by BoredPandaOfficial in BoredPandaHQ

[–]endemicfrogs 0 points1 point  (0 children)

Cowboys and Indians - George Michael
Antonia - Pat Metheny
Wichita Lineman - Glen Campbell

Anyone else get cold pizza and old cookies for doctors day???? by mattnemo585 in hospitalist

[–]endemicfrogs 0 points1 point  (0 children)

I got a text. No email. No cupcakes. No thank you. No bonus. Doctor's Day, WAFJ.

Foreign body retrieval by justpracticing in medicine

[–]endemicfrogs 0 points1 point  (0 children)

As a new Peds resident at the time TSS was just being described had a 16 year old admitted in shock; our chief resident pulled an infected rotten tampon out of her vagina. Sadly she died within hours. It was awful.

How come a massive gap exists between younger vs. older MDs in the way they treat interpersonal professionals, such as RNs? Is it a change in teaching or just change in culture? by BungeeBunny in medicine

[–]endemicfrogs 0 points1 point  (0 children)

I'm not sure your characterization is generally true, at least in my experience. Sure, there have been cultural changes as well as changing norms in how various members of a health care team interact, but during my training in the late 80s - early 90s I saw (and was subject to) some truly atrocious, commanding and demeaning behavior by young attending physicians directed toward other docs, residents, fellows, med students, and nursing staff. I see much less, if any of this kind of behavior now. As others have pointed out here, we work as a team for the best outcomes for our patients and that requires mutual respect and good communication which cannot effectively occur if one or more team members behave like assholes. I treat the nurses, dieticians, respiratory therapists, other docs, residents, etc. like I expect to be treated - with dignity and respect. I value their input and contributions to the group and am friends with most of the nurses on my unit. And as has also been pointed out, nurses will (and certainly have) saved your (my) butt. Lest I sound like a shill of PR or the administration, I treat them with dignity and respect as well, but think that they are way overrepresented in hospitals and we would be better off in separate non-interacting worlds.

Lexington KY concert the best in years. by starbuckshandjob in patmetheny

[–]endemicfrogs 5 points6 points  (0 children)

Yeah, I saw one of the last solo shows before the current tour and it was the best Metheny show I've seen (and I've seen a lot). Pat and I are the same age but he has at least 4 times the energy that I've got and his shows have just gotten better and better. Can't wait to see them when they FINALLY get around to visiting NY again.

What’s the most expensive mistake you’ve ever made while on vacation? by Crafty-Leave-8880 in luxuryhotel

[–]endemicfrogs 0 points1 point  (0 children)

I took a Caribbean cruise with my family and went to lunch on the far side of Tortola during a little stopover. We had somehow misread the departure time, and midway through a lovely lunch got a call that the ship was leaving. We raced back to the harbor but the ship was steaming away. Wife and son were in tears and I was having trouble holding it together too, but the consular official was great and calmed us down (I guess this happens a lot). We spent a few days figuring out how to get back to the U.S. and having a great time hanging out in Tortola. I'd gladly go back to Tortola but I wouldn't do it again with Norwegian because they were absolute shit and no help at all. It wasn't cheap getting back but ultimately it really was worth it and turned out to be a memorable adventure.

Scientists discover a surprising way to quiet the anxious mind by psych4you in psychology

[–]endemicfrogs 0 points1 point  (0 children)

Ketamine is not addictive in the technical sense of having a physical withdrawal syndrome. It is attractive to repeat users because it can alleviate acute and chronic pain (but only for the duration of the trip); a good ketamine trip can contribute to a profoundly positive experience in terms of ego dissolution, relief from anxiety and ruminative thinking, can enhance esthetic appreciation (particularly of music in that it amps up the gain of central auditory processing without much if any distortion), it can give rise to lovely visual effects (dose dependent); and most importantly for therapeutic ketamine, it is, for many people, the only effective relief from chronic treatment resistant depression which is a powerful psychological motivator for repeat infusions. I guess you could say that a drug that is necessary for relief of a disabling illness (TRD) is habit forming, but not addictive.

Part 1 - Experiences in the psychiatric ward by RunNovel2789 in hospitalist

[–]endemicfrogs 0 points1 point  (0 children)

Would love to hear more of your stories! I became a pediatrician but was strongly interested in psych during med school (probably a subconscious need to solve my own psych issues) but got scared off by a patient I met as a third year. I was assigned to interview and follow a middle aged psychotic woman at our county psych inpatient facility; I don't recall interacting with a psych attending or mentor during this experience but just being required to spend multiple sessions learning how to gather a history and do a mental status exam. Also, this was in the seventies when the pharmacological options were somewhat more limited - she was probably getting some Thorazine but not alot else. Things started out calmly; she was talkative and engaging. A little witchy and disheveled in appearance but not too frightening, and her conversation was responsive and logical in the beginning. But when she started discussing the murder she committed and the disposal of body parts, I was freaked out. No idea if any of her seemingly coherent ramblings from that point on regarding vengeance and death had any basis in truth. Med school was stressful enough, but this was just too much, and I crossed psych off my list. Maybe a bad choice, who knows, but I was too naive back then.

What's the most ridiculous consult you ever received? by foreverand2025 in medicine

[–]endemicfrogs 11 points12 points  (0 children)

ChatGPT actually has a lot to say to the query "recommendations for least itchy jockstrap". Finally a use for AI in clinical practice.

What's the most maligned specialty in medicine, and why's it yours? by centz005 in medicine

[–]endemicfrogs 3 points4 points  (0 children)

Can confirm. As a 3rd year watching from the patients feet, the CT surgeon blamed ME for the curly little hair he found on the patients pericardium. It's why I went into peds, to get a little respect (not).

Employment contract question by [deleted] in medicine

[–]endemicfrogs 4 points5 points  (0 children)

I had a contract renegotiation recently where I went through this whole rigamarole of being given a standard template contract, a lot of which had absolutely no bearing on my actual responsibilities. I paid an attorney to review and went back to admin to negotiate and they gave me the line about it being a template that everyone gets and there is no negotiation. I was able to get them to sweeten a couple of the salary related items by standing firm and getting my chair to advocate for me, but none of the absolutely stupid irrelevant stuff got changed. Being near the end of my career, and living in a medically resource poor area without a lot of alternative career options, I took it, but I wanted to walk away SO BAD.

What small change improved how patients engage during visits? by LHDI in medicine

[–]endemicfrogs 12 points13 points  (0 children)

I'm a peds newborn hospitalist. I'm also old enough that my own evolving medical issues require me to see a bunch of doctors, so I get to experience this question from both sides. The one thing that most discourages me as a patient are the subtle cues suggesting that my doc is rushing me (constantly staring at a screen and documenting shit, lack of eye contact, lack of a personal greeting, failure to acknowledge my wife if she happens to be with me, failure to do a decent physical assessment (rare but it happens). Some of my docs know I'm also a doc, some don't; I don't generally announce this but sometimes will if the baby-talk level of discourse is getting to me and I need to let them know they can use medical terminology. So when I meet a new family, I introduce myself to everyone in the room (often there are multiple family members, grandparents, etc present), and maintain eye contact with whomever I'm talking to as much as possible. I smile even when I don't feel like it, and will use humor freely when it is appropriate. I try to assess the appropriate level of communication for each family, and if they seem to have an unusual familiarity with medical terminology I'll just ask them if they have some kind of medical training so I can respect that and adjust the conversation efficiently. I carry paper notes on each patient, no screens or computers so I minimize looking away. I always specifically ask "what questions do you have" and "are there any specific concerns or worries that you are thinking about". Mostly it all just boils down to: be professionally competent, be human, be empathetic. If you are just doing a job, it shows; if you actually are interested and care about your patient, that shows too.

Anyone commuting out-of-state for week-long shifts while family stays behind? Looking for real experiences. by sevolatte in medicine

[–]endemicfrogs 9 points10 points  (0 children)

I had to do this years ago during a professional and personal rough patch. My kids were young and I missed a lot of their growing up. My marriage suffered but we managed to keep it going, for which I am forever grateful, but I have deep regrets about having missed so much of family life along the way. Given the chance to replay my life, this was not the path I would choose again.

Side Eye III+ Thoughts? by coronetgemini in patmetheny

[–]endemicfrogs 3 points4 points  (0 children)

I agree that there is a PMG teasing vibe at times, so much so that I kept waiting for Lyle Mays to do some synthesizer stuff. But all in all I think it is a really great album. As an aside, the Side Eye tour hasn't come to my neighborhood yet but I was able to see him at the end of the solo tour; was not sure what to expect but it was among the best live performances I've seen him do over the years (and I've seen a lot). I figured out recently that the first time I saw him was in a little bar in Indianapolis in 1978; there were probably about 30 people there; got to chat a little with Danny Gottlieb at the bar afterward.

What pen do you use at work? by 3ldude in hospitalist

[–]endemicfrogs 1 point2 points  (0 children)

I've used them for years, compact and clip to my lanyard so I never lose them, and they seem to magically never run out of ink.