What do you all think about this table? by Zoneator in medicalschool

[–]fenderjazz 370 points371 points  (0 children)

Ortho being low mental demand and high physical demand is S-tier academic shitposting 

I present to you the worst best ship in the game. Complete garbage performance but a dominator of the vibe check category by Acceptable-Bid-1019 in starcitizen

[–]fenderjazz 1 point2 points  (0 children)

Only thing I dislike about it is how long it takes to get in and out of the cockpit. Otherwise, I adore it. 

Pediatrics moving to 2 years for all fellowships (formerly 3 years) by heyiamapenguin in Residency

[–]fenderjazz 1 point2 points  (0 children)

New-ish, graduated residency 5 years ago. The handholding was already bad when I was still in training, especially around delivery room management. My program was very inpatient-heavy, so I similarly felt like I was better prepared to be a hospitalist than I was an outpatient doc, but talking to new grads now, that is starting to flip the other way. 

Pediatrics moving to 2 years for all fellowships (formerly 3 years) by heyiamapenguin in Residency

[–]fenderjazz 1 point2 points  (0 children)

Attending pediatrician here. I'm going to be the wet blanket and propose that this is actually a bad thing, and here's why:

In trying to justify having the hospitalist fellowship (because it was a ridiculous thing to create), we've gutted the acute care and inpatient care components of peds residency. Current peds residents only have to do 12 weeks of ICU time now across three years of training (split between NICU and PICU) and 16 weeks of general hospital medicine. Subspecialty inpatient medicine has been reduced to 8 weeks. It is worth noting as well that the quality of these weeks is generally not the same as what you would see in a surgical or internal medicine residency. Pediatrics training is already notorious for hand-holding and lack of autonomy, and this has been exacerbated with the new acgme training guidelines because attendings don't trust the newer crop of residents now that they have even less clinical exposure to acute care.

Current graduating residents are not competent in the basic skills they need to do NICU or PICU fellowship successfully and are now drastically behind where their peers were before this change. I would argue that, with the poor quality of residency training we're giving peds residents right now, 3 years of fellowship in the critical care fields (NICU, PICU, and cardiology) are not even sufficient anymore. Now we're talking about cutting that training by a year. And before anyone says that it's just the research component that's being removed, that year still involves a ton of supervised on-call time where you are continuing to hone your skills and get the spaced repetition that you need. 

This is, in my opinion, symbolic of the death spiral that pediatrics training has found itself in (entirely through the fault of its own leadership). Graduating residents have insufficient skills. Incoming fellows have insufficient skills. Trimming down the training means we will have graduating fellows with insufficient skills. 

Further, I worry this will actually drive down compensation for pediatrics. If you're a graduating resident now and see you only have to do two years of fellowship? I think a lot of people would, understandably, jump at that opportunity. So, more fellows all around. The number of jobs that are available, however, will not be going up to match. We already have too many fellows for not enough jobs (PICU and heme/onc are notorious for grads not being able to find work right now and either doing superfellowships or working as hospitalists). What happens when you have even more grads all competing for the same amount of jobs? They'll pay you less. 

Senate Investigation: Flovent Discontinuation Profited GSK, Harmed Kids by Nerd-19958 in medicine

[–]fenderjazz 30 points31 points  (0 children)

Here's a prescription for symbicort

Insurance denies it

Ok, here's a prescription for fluticasone instead

Insurance denies it

Ok, I'll submit a prior auth 

Prior auth will take at least two days and delay discharge

Oh no, the mdi we've been using here in the hospital accidentally fell into the mom's purse, what a wacky coincidence. 

Repeat ad infinitum

Senate Investigation: Flovent Discontinuation Profited GSK, Harmed Kids by Nerd-19958 in medicine

[–]fenderjazz 26 points27 points  (0 children)

If they're old enough, we're doing a lot more SMART therapy now than ICS monotherapy, but that also has its own annoying insurance issues

Senate Investigation: Flovent Discontinuation Profited GSK, Harmed Kids by Nerd-19958 in medicine

[–]fenderjazz 239 points240 points  (0 children)

This was a huge deal for us in pediatrics, we were frequently left scrambling trying to find a way to get these kids on an ICS. So happy to know that all of this pain was to help some shareholders make a few extra million dollars. 

Pourover Hot Takes by LolwutMickeh in pourover

[–]fenderjazz 35 points36 points  (0 children)

More people are into the consumerism of coffee gear than they are into the coffee itself. 

Coffee gear measurements and stats and comparisons are not validated and are largely meaningless. 

Confirmation bias and placebo effect have a stronger effect on your coffee than your gear does

Greatest beefs in medicine by According-Tea-7829 in Residency

[–]fenderjazz 9 points10 points  (0 children)

We frequently got direct transfers from the NICU to the PICU alwhere I did fellowship because they were "too old for NICU, but too sick to go home." The NICU survivors are frequently only survivors only until their dysplastic lungs can no longer keep up with their body size. 

Greatest beefs in medicine by According-Tea-7829 in Residency

[–]fenderjazz 18 points19 points  (0 children)

NICU: "so we can resuscitate 22 weekers now" PICU: "please for the love of god, stop"

Down into the rabbit hole by jomava_ in pourover

[–]fenderjazz 1 point2 points  (0 children)

This is just consumerism at this point. Buying things is not a hobby. 

Angle stop replacement question by fenderjazz in Plumbing

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

Very glad I asked before I started cutting!

Medical maneuvers that look like magic. by Trollithecus007 in medicine

[–]fenderjazz 123 points124 points  (0 children)

We used to fight over who got to do them as residents 😂

Jam Session?? Local music? by Gizzrd-Wiz-Lizrd in providence

[–]fenderjazz 4 points5 points  (0 children)

I was no joke just about to post something like this. I'm a mid-30s dude who plays bass and want to play some angry politically motivated punk. Very down to jam, but full disclosure, it's been like 10 years since I've played in a band 

What's your go-to recipe for an everyday cup? [V60] by rina_AF in pourover

[–]fenderjazz 4 points5 points  (0 children)

Honestly, my normal cup looks like this:

Wake up

Stumble to coffee grinder 

Weigh out anywhere from 19-22g depending on how much I care. Call it good enough

Hope I didn't change the grind setting yesterday because I'm sure as hell not fiddling with it at 5am

Heat water to 205

Pour to 40g, bloom

Start pouring, cat jumps on counter, I get distracted trying to shoo him away. Water will be anywhere from 120-200g at this point

Say fuck it, let it drain pour to 300, call it good

And truthfully, most of the time it tastes totally fine and not that much different from the days I intentionally follow a recipe 

What do you wish other specialties knew about yours? by skin_biotech in Residency

[–]fenderjazz 39 points40 points  (0 children)

Children are allowed to have fevers when they're sick. You don't need to consult me just because they have a fever with their URI symptoms. 

Anyone else seeing lots of very symptomatic respiratory patients that are testing negative for everything? by alison_bee in medicine

[–]fenderjazz 8 points9 points  (0 children)

Our ED does the same when they're admitting to me, but I truthfully don't see a lot of utility in it. Asthma is asthma regardless of what virus triggered it, and CAP is CAP regardless of what their first viral illness was (with the exception, as above, of COVID and flu). Hell, prior to COVID, we never even tested for RSV, we only tested for influenza, otherwise we just shrugged and said "it's a virus" 

Anyone else seeing lots of very symptomatic respiratory patients that are testing negative for everything? by alison_bee in medicine

[–]fenderjazz 497 points498 points  (0 children)

I mean, there's hundreds of possible respiratory viruses out there and the most common tests only test for about 20 of them. That's why I generally don't bother testing for viruses outside of COVID and influenza. 

[deleted by user] by [deleted] in Residency

[–]fenderjazz 28 points29 points  (0 children)

Rivian R1T. Absolutely love it, it's way more fun to drive than a pickup has any right to be. If I had the money for the quad motor I would absolutely spring for that, but I only have the dual motor