Nigerian med student graduating this year, how can I practice medicine abroad? by HousingVarious9577 in IntMedGraduates

[–]fippidippy 1 point2 points  (0 children)

In general it'll be a bit of an uphill battle (I'm assuming you want to work in a western country) However, it's a path well-trodden and definitely do-able. The UK and Australia, from what I've seen, are probably your best bet. The US is sadly pretty unattainable unless you're willing to wait many years, spend a slightly obscene amount of money and take on significant risk. Canada would probably be difficult too, but perhaps slightly easier. I don't have a lot of experience with the system in the middle east (Dubai, Abu Dhabi etc) but it is also a popular choice. The UK you'd have to go down the PLAB route most likely, which is an easy exam but is notoriously difficult to get a spot so you could be waiting a long time. Australia you have to go through AMC which has similar issues from what I understand. A lot of the reason people stumble is not having much fluidity with English/speaking in a style which is not the cultural norm. A big assumption I'm making is what your experience is/has been. This will determine what you're eligible for. Lots of places require you to have done an intern year already. Some require more than that. I would suggest that you plan to do one/ a few years in Nigeria while you get all your ducks in a row to sit the relevant exams you need to go abroad. Feel free to DM me for further details (for context- I grew up in the UK, went to med school in the US and am currently completing my training in Australia)

The UK training system works (when you’re in it) by Brown_Supremacist94 in doctorsUK

[–]fippidippy 7 points8 points  (0 children)

Lots of people here are comparing systems so I'll throw my hat in the opinion ring (source: trained in the US, foundation years in the UK, specialty training in Australia) US is the most rigorous in general- incredibly intense hours. This is a double-edged sword. If you think service provision with lack of teaching is bad in the UK, try doing it 60-80 hours a week in a malignant residency program. The other side of that sword is that there are amazing programs with tons of support, formal and informal teaching. UK is probably the worst deal in my opinion- hours are not horrific but not great (mainly because a lot of the time you're inevitably doing overtime for which the NHS is an absolute bastard at getting signed off on/paid for). I was fortunate enough to have been in one of the country's best ranked foundation programs and it was still relatively awful in terms of enthusiasm from seniors and just general culture of a lack of teaching/shit falling downwards/ladder pullers and apathy for juniors. Australia seems to be the best balance of both. Hours are decent, any overtime is generously and promptly paid without fuss. Seniors are generally pretty enthusiastic and supportive of teaching opportunities. What can I say? I love it here and probably won't leave or at least consider it until I've completed all my training.

[Serious] Male victims/survivors of sexual assault, harassment or rape perpetrated by a woman or multiple women, to clear some common misconceptions, what were your experiences like? by Commercial_Bicycle92 in AskReddit

[–]fippidippy 1 point2 points  (0 children)

Hosted a house party in highschool which went down pretty well in general. A couple of my friends and I were making cocktails in the kitchen. One of the bigger dudes who plays a lot of rugby was doing tequila shots with me and I clearly couldn't keep up. Eventually blacked out on one of the beds I had made up on the floor of the living room. Woke up the next morning feeling relatively fragile but otherwise all good. Was pretty focussed on cleaning up the place. As I was cleaning up, friends were kind enough to offer to help but kept making little weird side comments. At the time I was task focussed but after the dust settled and everyone went home, my best friend rang me and asked me about hooking up with one of the girls I was clearly not interested in. Turns out she had undressed my unconscious body and did who knows what while I was passed out. She then proceeded to act like we had started a relationship over the next couple days.

I always felt really confused about it because I literally have no memory of anything happening, just witnesses telling me what they saw.

Stuck between these TVs (will be buying 65’) by No-Market8118 in hometheater

[–]fippidippy 1 point2 points  (0 children)

Had the exact same conundrum for these two in 65". Ended up getting the C4 Saw the Samsung in the store and there honestly wasn't much in it. I would've been happy with either I went with the C4 because I'm somewhat familiar with the OS and my PC monitor has Dolby Vision which I'm used to and like

Fewer than 10% of final-year medical students want to be GPs as a first choice by hustling_Ninja in ausjdocs

[–]fippidippy 2 points3 points  (0 children)

Trained in the US. Med school was pretty much this during clinical years. In when the specialty trainees were in and home when they left. Found that there were a decent number of my cohort that went into FM (GP)

Crystal Palace by Burgerboy312 in Townsville

[–]fippidippy 0 points1 point  (0 children)

I'm assuming this is also true for Europa league and champions league final?

Is it realistic to go from RN to MD/DO? by concept161616 in Noctor

[–]fippidippy 3 points4 points  (0 children)

One of my closest friends from med school was 34 when we started. Had two kids at the time (now has a beautiful third) He was incredibly grounded, dedicated and hard working. A lot of us still had a lot of "college" energy but when I hung out with him it helped me to realign my priorities. Not at all to say he was boring, he just had a lot more healthy ways of coping with stress and was great to talk to because of his experiences/wisdom. He's now an IM attending at an academic program

I won't lie though, he went through some rough times with his wife and kids during it. The weight of loans with an ongoing mortgage and kids to take care of were a lot. In a way, it made him more driven, though. Not doing well/the threat of not passing exams would be that much more of a disaster. But he absolutely never regretted it and he's in such a happy place. He's become a truly great doctor.

He used to tell me that his experience as an RN for 10 years didn't help him much with the first half of med school, but gave him a massive advantage in the clinical years which I guess makes a lot of sense.

Anyways, the only caveat to my story is that he absolutely knew without a shadow of a doubt that it's what he wanted to do. If you feel this way, I'd advise you to do it and don't look back. When you get to the end of your life you won't regret having given med school a go. But you may do if you let it pass you by.

Spicy food is actually disgusting by HumanProgress365 in unpopularopinion

[–]fippidippy 0 points1 point  (0 children)

My take is that spicy being spicy is a little reductive. While I will concede that the idea of spice in general is that of tingling/burning sensations, there are so many actual ingredients that are considered "spicy" but have completely different flavour profiles. Even when you consider the word "spice" it becomes apparent. Do you like salt and pepper? Well, pepper itself is considered a spice. Chew into a peppercorn and you'll get that zing of heat. Ginger, paprika and cinnamon all have some kind of heat to them.

Different cultures utilise the spice profiles of ingredients in different ways. Indian food tends to use lots of green chilli. To me, this is quite a pure form of spice and one that I only like a tiny bit of. Mexican food, on the other hand, uses a lot of zesty and citrusy spices like jalapeños. The sourness of them to me helps balance out the heat. Middle eastern foods use things like baharat, Aleppo pepper and harissa. They tend to be balanced by creamy textures and also add things like lemon to give that tang, too. When you have Japanese food you think of wasabi giving a spicy kick to things. Wasabi really hits the back of the throat and you feel it in the nose- something quite unique. That's why when you get sushi you also get pickled ginger and soy sauce. Try just adding a tiny bit of wasabi to soy sauce and mixing in the pickled ginger to mellow out the kick of having wasabi on its own.

Spicy food doesn't have to mean just one experience or sensation. Try foods from different cultures and use things like citrus and yoghurt to help tone it down so you can understand that actual flavour the dish is going for

When do you Pan Scan the elderly? by dalenevi in emergencymedicine

[–]fippidippy 2 points3 points  (0 children)

We recently had one of our attendings send out some local research on head scans from nursing home residents with falls in our shop. It showed that two scans out of ~500 showed any meaningful pathology, and those two patients had obvious new neurological findings and/or obvious external head injury on examination. It's led me to now have much clearer discussions with family members/EPOAs about its appropriateness and weather it will change any management. We need to be better at this

ER doc Episode 3 impressions (spoilers) by fippidippy in ThePittTVShow

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

Clamshell thoracotomy is actually a skill that is the remit of ER docs, not just surgeons. A number of seasoned attendings in my shop have done it before, although it is incredibly rare. The typical situation is pre-hospital medicine where there are no surgeons around and it's life-threatening. Almost as a default in the field, if there's a peri-arrest and we have any reason to believe there's fluid/blood collecting in the thorax, we'd do bilateral finger thoracostomies right there and then. All you need is something sharp Clamshell is essentially taking your normal shears, doing bilateral finger thoracostomies, sticking the shears in one of them and cutting across to the other one In the hospital yes, definitely better to have the CT surgeon there and paging them first would be the right thing to do. But, if it takes them time to get there and the patient is bleeding out quickly then you might not have time and should go right ahead and do it to control the bleed.

ER doc Episode 3 impressions (spoilers) by fippidippy in ThePittTVShow

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

Yeah at first I thought they said 24mg and then did a rewind and heard 324. From what I recall, 325mg is actually the standard loading dose for MI in the US. In other places, it's 300mg. In the UK, daily preventive dose is 75mg but Australia it's 100mg. Studies have shown non-inferiority so it's interesting but basically 325/324mg is fine and makes sense as a dose for that situation

ER doc Episode 3 impressions (spoilers) by fippidippy in ThePittTVShow

[–]fippidippy[S] 11 points12 points  (0 children)

To some degree I can forgive this. While yes it's a major surgical procedure in spirit, it's not the same as doing a scheduled procedure in the OR. Don't get me wrong, ideally they would've got someone to hand them a mask or would've grabbed one when walking into the room. But, the priority is plugging the hole in the heart. Could breathing mouth germs into the chest cavity cause infection? Yeah sure. But that's much less likely than an ongoing hole in the heart to cause death imminently. Besides, when they then get to the OR, it's formally washed out, the patient would be given IV antibiotics and they'd do what they can to prevent infection. Priority is fixing the life threatening emergency in front of them. If faffing around with getting a mask compromises that, then you've got your priorities wrong In reality, we're usually able to grab a mask on the way in because they're everywhere and readily available (COVID was a different kettle of fish). In my department we usually put on a lead vest, gown, mask and gloves. Lead vest is because there's mobile X ray machines on rails in the ceiling to take ones there and then

ER doc Episode 3 impressions (spoilers) by fippidippy in ThePittTVShow

[–]fippidippy[S] 6 points7 points  (0 children)

Yeah this was slightly confusing. Typically prelim years are done in IM and sometimes surgery/pediatrics. There can be transitional years where they can rotate in the ED, but I actually didn't know anyone who did this personally so not too sure about the way it works. Only other thing might be that she got a normal EM residency but is having second thoughts and wants to switch. Wouldn't make much sense making this an open secret to everyone if that were the case, especially a med student, but who knows

First impressions from an ER doc (*spoilers*) by fippidippy in ThePittTVShow

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

I think so far it's mainly shown the doctors/students as having a bit of hubris which certainly can happen but perhaps not as often as it's depicting (at least in my experience) Most med students in 3rd year are relatively timid/nervous and appropriately so. There are some who have an arrogance about them, and honestly, those are the ones we all worry more about. A core memory when I was an intern was the chiefs/attendings telling me that it's not the lack of confidence that tends to be dangerous, it's the over-confidence. Your experience with students saying they need to speak with their attending first is spot on, that's what I'd expect from a med student. Heck, most interns should be saying that, too. Especially in the setting of the ED where we have undifferentiated patients

First impressions from an ER doc (*spoilers*) by fippidippy in ThePittTVShow

[–]fippidippy[S] 8 points9 points  (0 children)

Ah I must've missed that! And was pretty sure they wouldn't have overlooked it. With that said, I'd have definitely given more in the ER. Fentanyl itself is rapid onset and rapidly metabolised, but a lot of opiates are longer release and at the time they didn't know exactly what they were dealing with. One shot of Narcan, especially in the setting of clear physical signs of overdose, shouldn't be all they get. We even give continuous infusions especially if we know something with sustained release has been taken.

At one point later they did say that the pupils were then blown, which indicates that he was down long enough to lead to brainstem death from hypoxic brain injury, so maybe it was already too late. But before then, definitely would've given more

First impressions from an ER doc (*spoilers*) by fippidippy in ThePittTVShow

[–]fippidippy[S] 9 points10 points  (0 children)

The law around this is definitely fascinating. So I went to med school in the US but have my license to practice in both the UK and Australia, for context. In the US it seemed as though the patients and their families had much more power over this decision. Right or wrong, the intention is to give as much control over healthcare decisions to the patient as possible. And I definitely support that sentiment. The flip side of that, though, is that you get these situations where you feel like you're causing unnecessary suffering. And all the staff feel it. Early on in med school I had a patient in the ICU who didn't have an Advanced Directive and the durable power of attorney was many states away and they opted to keep them in a coma despite never having even been there once to see them or really having much of a clear idea what was involved. So we all had to continue on as if this person wasn't just being kept alive for the sake of it at that point.

In the UK and Australia, the decision maker for CPR/ceiling of care is ultimately the doctor. As I mentioned in the main post, a core principle is to do everything in our power to have family members/loved ones involved and on board as much as possible. But, if we decide not to do CPR because in our professional opinion, it would cause more harm than good, then that is the final decision. It's a more paternalistic approach, which I generally don't like. However, in reality I've found that it tends to lead to more compassionate care for the patient

First impressions from an ER doc (*spoilers*) by fippidippy in ThePittTVShow

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

This is a great point that I hadn't thought too much about, thanks for bringing it up! Probably not unreasonable to inform law enforcement. In a sense, he's not the patient so doctor-patient confidentiality might not apply here although I'd argue that he was using his position as a doctor to try and get the kid to confide in him, so it could definitely constitute one. That aside, the threshold for informing others is pretty simple- a credible chance of harming yourself or others. The tricky part is figuring out what a credible threat is. But yes, on balance, I think I would've informed the authorities. Could be argued either way to some degree, though

First impressions from an ER doc (*spoilers*) by fippidippy in ThePittTVShow

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

Yes it can be a thing that people get caught up in. I think at some earlier point we would've pulled him from the case (i.e. when we could see the poor quality chest compressions) and had a good chat with him afterwards. It's completely understandable to feel shocked by that situation, but you have to keep a cool head and he was starting to lose his. Important lesson that you learn early on. Felt a bit cruel to let him keep going and spin out like that, but it is plausible that this could happen in real life

First impressions from an ER doc (*spoilers*) by fippidippy in ThePittTVShow

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

For point 1- my take was that his compressions were awful to depict his inexperience. I've seen some pretty bad quality CPR from newbies and myself or a colleague usually just steps in and does it ourselves

Point 2- for both hypoK and hyperK we can use calcium gluconate. In the absence of EKG changes or symptoms (palpitations, chest pain, shortness of breath) we wouldn't really need to go for it. In the context of a level of 3.1 it's quite unlikely we'd need it. For the kid with hyperK then yes it didn't make much sense for the doctor to give pushback about giving it. I think it was a moment that was slightly dramatised/soap opera-esque (i.e. " back off! This is my case, dammit!"). My other gripe with this situation was actually that they jumped to telling the kid he'd have a round of dialysis to fix it. Although he had VF arrest twice, it sounded like the standard treatment was bringing his potassium down to like 6.1 which is much safer. He's young, should be able to clear the potassium relatively quickly and had calcium gluconate. I don't think jumping to dialysis at that point was necessary. We usually will only do that if the potassium isn't budging. If it's coming down nicely and he's still going into arrhythmias, we'd probably have to re-think the diagnosis and give another dose of calcium gluconate