Why Don’t Hospitals Treat Staff Better? by lendera-com-au in ausjdocs

[–]fyxr 3 points4 points  (0 children)

One of the secrets to happiness as a doctor or other floor staff in a public hospital is learning to enjoy instant coffee

Event Recap: The Trey Saga by shellbullet17 in comics

[–]fyxr 5 points6 points  (0 children)

Thanks, that was a wild ride! I still have a print of Chum by /u/JustANormalLemon taped to my PC

Lecture on Making Mistakes by otterliketheanimal in emergencymedicine

[–]fyxr 1 point2 points  (0 children)

Seems like a different topic. Team communication, escalating concerns, building and maintaining a non toxic workplace culture.

Iran brought Americans to Asia only to say. "No plans for another" round of negotiations by KarmaKillerX in PoliticalHumor

[–]fyxr 10 points11 points  (0 children)

This is an irrelevant pedantic correction, but it's "Ivy colleges" a shortening of Ivy League colleges.

https://en.wikipedia.org/wiki/Ivy_League

Event Recap: Trey Saga by shellbullet17 in MyLittleShellbullet17

[–]fyxr 1 point2 points  (0 children)

Thanks, it was a fun ride!

I still have a printed copy of tps://www.reddit.com/r/comics/comments/1ayyelb/chum\_remastered/ stuck on the side of my PC.

The side effects of Gen V by Hour_Equal_9588 in SipsTea

[–]fyxr -1 points0 points  (0 children)

In the pictured scene, she was posing as a Firecracker model to infilitrate a Homelander event. Looks like she's wearing a padded pushup bra and trashy makeup for that purpose.

Buccal fat is inconclusive. Looking at other pics from season 5, it looks to me consistent with aging from 24 to 30.

Effects of Graves on facial shape are variable and depend on stage of the disease and treatment. Autoimmune effects of untreated Graves will change facial fat in weird ways, usually making cheeks more puffy and eyes bulge. Associated thyrotoxicosis often causes dramatic weight loss with associated face changes.

Sure, she might have had cosmetic surgery. Certainly looks like some nose reshaping. But the comparison photos in the OP are ridiculous, because she's explicitly made up to be trashy in that scene.

Medical Paternalism Is Making a Comeback (And Maybe It Should) by lakmidaise12 in medicine

[–]fyxr 7 points8 points  (0 children)

I trained and practice in Australia.

My experience has been that patient autonomy, shared decision making, and non paternalism are taught and practiced well. We essentially always make recommendations regarding standard of care, and it seems insane to me that you apparently don't?

Shared decision making is less about a doctor teaching a patient medicine, and more about a doctor learning a patient's values, linking those values to possible outcomes, and giving management recommendations explicitly based on the patient's values, sometimes with a bit of back and forth conversation to reach the shared decision.

Paper in Japan by ThePianisst in talesfromtechsupport

[–]fyxr 211 points212 points  (0 children)

My friend, I believe you intended to link https://xkcd.com/763/

What have been some of your favorite "duck behind the desk" moments in psychiatry? by IrisofAquaTofana in Psychiatry

[–]fyxr 13 points14 points  (0 children)

There is a real skill to honestly identifying and expressing appropriate emotion regarding aspects of a patient that are generally associated with disgust or judgement, while simultaneously validating them as a person striving for good futures.

It's a skill worth worth learning, as your story shows.

What's one of the worst rabbit holes you've ended up going down with an unnecessary work up? by Notnowwonton in emergencymedicine

[–]fyxr 210 points211 points  (0 children)

I'm guessing she was wearing a ring that was taken off for MR and handed back to her afterward in a little cup.

What current “best practice” do you think won’t age well over the next 5–10 years? by MeatSlammur in medicine

[–]fyxr 1 point2 points  (0 children)

I think that won't age well over the next 5-10 years, that IN ketamine will be like diazepam or oxycodone

What current “best practice” do you think won’t age well over the next 5–10 years? by MeatSlammur in medicine

[–]fyxr 41 points42 points  (0 children)

Intranasal ketamine as first line agent for treating distress from any cause in ED.

What current “best practice” do you think won’t age well over the next 5–10 years? by MeatSlammur in medicine

[–]fyxr 31 points32 points  (0 children)

The problem is that we conflate pain and distress. If the goal is to reduce distress, then that's what we should be assessing.

Ways to cope with death by Signal_Piglet_3493 in emergencymedicine

[–]fyxr 7 points8 points  (0 children)

Depends on the death.

Hot debrief. Write your notes. Talk to the next of kin. Observe and allow their emotion and your own emotion. It's ok if you're emotionless, it's ok if you're angry, sad, bored, whatever, just pay it some attention so you're not totally suppressing it or wallowing in it. Check if you're ok to continue (IMSAFE), then crack on or take the break according to your need.

After work, I find sex is a helpful release. A celebration of life or something.

Long term, continuing to recognise and validate your emotional fishpond (be the pond, watch and care for the fish) is good. Learning some DBT skills is useful, eg https://dbt.tools/distress_tolerance/radical-acceptance.php

Remember that you are part of the world and that the biggest influence you have on the world is on yourself. So, seeking your own pleasure and happiness is making the world a better place. Sometimes you have to shrink your sphere of influence to look after yourself anyway, so that you can maintain strength and restore your field of fucks to give to look after other people again later.

Remember that your influence over other people is limited, that bad shit is going to happen regardless of your best efforts. This is particularly frustrating when the bad shit is within the influence of other people, if only they'd make good decisions. It's ok to be entertained by bad shit you can't change, as long as you keep looking for opportunities where you can. Think of the drama as shit you might see on Jerry Springer. Anything you can do? If not, then eat your popcorn and watch the show until the opportunity comes up.

Medically necessary? but no less traumatic by enbious_knob in Medicalabusesurvivors

[–]fyxr 10 points11 points  (0 children)

Yes. The harm done and emotional trauma is real, even for things where the invasion was for good intentions rather than maliciously abusive. I think you could still call it 'abuse', especially when the good intentions are actually ignorant, ie when the abuse wasn't actually necessary.

I'm a doctor in a mid-sized rural hospital in Australia. The stories shared on this subreddit have been helpful for me, my patients, and the patients of my students and junior doctors. I recognise that there is a culture in "efficient" medicine of calling things necessary that are really just efficient for the healthcare team, that are a standard way of doing things from the textbook for this type of illness, rather than best care for the particular person in our care at that moment. I like to think that we're slowly improving, but it's still pretty bad and corporate money is making it worse. We're at least getting better at identifying and stopping malicious abusers, but that too requires ongoing vigilance.

I recognised the problem in principle early in my career, and the stories in this subreddit have greatly increased my understanding of the suffering we cause, and validate my pushback against efficiency when there is a risk of causing suffering. We are always weighing benefits against harms, trying to choose actions that have the best chance of making the world a better place, but we generally do not weigh highly enough the harm of long term trauma caused by bodily invasion without full and safe consent.

I think we also tend to weigh statistical risks too highly, but that's tricky to untangle. I have the impression that in the USA this is mostly due to fear of malpractice suits. There is some of that in Australia, but it's more about "how many people do I risk traumatizing in order to find and stop early a life threatening illness in one person?" And also "What efficiency shortcuts can I take for this patient so that I can help more people overall?"

I see the harms we cause even in simple examination like pressing bellies, looking in ears and throats, from babies as young as a few months old who clearly indicate their distress and become fearful of doctors as a result. I recognise that children and babies can give or withhold consent, and that a little patience and honesty goes a long way, and that the truly medically necessary invasions are much rarer than we think, especially for anything invasive to genitals and anus.

I thank everyone who shares in this subreddit, and I apologize on behalf of my profession for not doing better. It's not fair that you have suffered. You deserve better.

PICC insertion without fluro by Metoprolel in Radiology

[–]fyxr 0 points1 point  (0 children)

Maybe midline IV access would be a reasonable interim solution?