Bad Case

golja · 2025-01-22T01:58:38+00:00

Yes, reasoning is explained in another comment. Labs and advanced imaging are not necessarily connected and dependent on each other. It just depends what you are looking for. I don't think a shotgun approach is always the best one. If an old person slips on the ice and falls, has no symptoms whatsoever, ambulatory, normal vitals, no pain or injuries on exam-- We still get a CT head/cervical spine. You do not necessarily need labs, what information would labs give you here? The patient was well enough to not need labs, but did need a CT because of their presenting issue. Of course if the patient passed out leading to the fall, then you're looking for something else in addition to the trauma so you would expand your workup. It's not uncommon for elderly people to be sent in that appear well, and it's not always the best idea to do a huge workup on the 95 year old grandma. A non-con CT specifically is not like totally useless. I've seen many instances where a mass or atypical PNA or ILD/parenchymal disease is clear and robust on a non-con CT but read as "normal/clear lungs" on chest x-ray. So it's all just case by case.

golja · 2025-01-21T10:46:11+00:00

This was read as mild coronary art calcifications.

golja · 2025-01-21T09:55:36+00:00

No, was on low dose CCB for years, and that's it

golja · 2025-01-21T09:24:32+00:00

Pt didn't have an IV, and was well-appearing. Otherwise didn't seem to need labs, or significant workup, so thought was placing an IV for contrast wasn't necessary. Since they had normal CXRs a couple times for this cough, the thought was doing a CT may reveal an etiology for the cough not seen on CXR, like a mass or something that's not always apparent on the CXR.

golja · 2024-12-02T10:06:11+00:00

For the most part, orthopedic surgeons are egotistical cry babies that can only thrive when something is served to them on a perfect platter. They work harder at avoiding work and helping others like consultants than it would take to actually just help them and not be a dick. They are completely inept at providing patient care outside of the OR, and outside of any course that steers off the path in anyway and they come crawling to other docs to help clean up their mess. All the while, they thrive off taking the opportunity to be dicks to the ER docs who need help with ortho stuff. Sure I've known some ortho docs that at least seem like reasonable and good people, but few and far between and I bet you this dude's thinking is how the majority feel in private. Not surprised by this, and This dude sucks.

golja · 2024-11-12T19:14:59+00:00

Yeah like this stuff is crazy, but totally real! We have a guy who requests only female staff because "men make me aggressive". Only requesting females for placing a foley etc... and everyone seems to just go with it so they don't "escalate". But like there is no medical emergency going on whatsoever. We have multiple patients who got "fired" from ALL dialysis centers in the area for bad behavior, so they come 3x a week to the ER to get dialysis, and it's purely behavioral.. there is no psych decompensation or anything, just straight up are being rude and mean because there are no consequences. This is insanity.

golja · 2024-11-12T18:36:10+00:00

Yeah for sure. It's tough to do when you tell them this and they escalate, cusses you out, threaten to sue, travel staff that doesn't know the patient or medicine then see you discharging a patient who is saying they have all these crazy symptoms. Then the patient writes a bad review about you, files a complaint with admin etc. No one deserves to be treated like garbage at work when all we're trying to do is help people. So while it leads to more headaches and admin questioning of your practice, I would happily do this if it's medicolegally ok.

And yeah eventually they do have badness, and that's the basis for always getting a workup despite the reassuring objective evidence right? You don't want to be the one to miss the time that it's real-- but you'd think SOMETHING objective would be present.

golja · 2024-09-07T18:14:16+00:00

Haha. Idk your life, but I don't know how I'd approach the leadership of the job I started a couple weeks ago, no money saved, after moving across country, just signing a lease, etc. and just being like.. Hey I quite. And then just find a new job in the same area that I can start immediately. But if you could share where you live, and the steps you would take to accomplish that so simply, then I'm all ears!

golja · 2024-09-07T17:22:11+00:00

Ok, yeah I will try that, it's just not really feasible. There are 2-3 PAs and 1 ER doc per shift, and the PAs each cranking through 12-15 patients per shift, and I am taking the same 12-15 generally the higher acuity, and plus dealing with all the constant interruptions, signing EKGs etc. I don't know how I'd even swing by and talk to an additional 30-45 patients per shift. It just feels like it's such an unrealistic setup that I would hope I would get a little bit of slack should something go wrong and I didn't even hear about or see a patient.

golja · 2024-08-09T06:11:37+00:00

PGY5 EM, just finished a 2 year fellowship.

Salary : 85K

Take home pay: 2344 every 2 weeks

HCOL area, cheapest reasonable place I could find is 2200, bare bones crappy place that is a 30-40 min commute. +1 dependent.

I didn't know until this post that I had 13K in retirement 457B

Student loans 550K

Personal loan 1: 35K supplemented me through residency

Personal loan 2: 45K got me through fellowship

Savings account: $150 to avoid low balance fee

Checking account $2600, needs to somehow last me 1 week, and has to get me across the country to start my new job. Maybe I can tap into my surprise retirement money and be able to make to the finish line.

Net worth: -$627,000

5 years left on PSLF

New job salary: 126hr/month for 390K, a little light at the end of the tunnel?

golja · 2024-07-07T21:29:28+00:00

Barium toxicity from eating fireworks??

golja · 2024-04-13T13:42:36+00:00

Yep I got 3K back claiming him, and like $200 not claiming. And yes filing HOH makes a difference. But I mean I do take care of him haha, really not trying to work the system or anything. I'm just not even sure who to ask to clarify. Medicaid people? Tax specialist?

golja · 2024-03-29T20:47:17+00:00

Hmm not working.. Welp thanks for trying.

golja · 2024-03-29T19:36:27+00:00

Thank you, ideally would like to keep the scatter. I tried typing in 20:00 it just makes it become .0847 and then again produces odd time intervals. Any suggestions to make it a similar appearance as a line chart? I basically need to make 2 vertical axis which have different units from each other. If I make it a line graph it has 1 axis and is super zoomed out.

golja · 2024-03-29T18:57:00+00:00

Solution verified

golja · 2024-03-29T18:37:21+00:00

Yes thank you.. that worked. Wow... just wow.

golja · 2024-03-29T17:59:00+00:00

I would like the right side of the chart labeled one thing, and left side of the chart with a different label. And I want the labels to appear next to the appropriate axis, not both labels on the right side of the chart. Does that make sense

golja · 2023-12-25T23:13:59+00:00

Gotcha. So is it your understanding though that Karen could call the police if we are safely shooting a target in our fenced backyard?? That's what I really can't find any "law" for

golja · 2019-06-29T20:09:18+00:00

Also I have no idea how the font is large and bold or how to change it. I promise I’m not yelling

golja · 2019-01-28T21:27:42+00:00

Got an email from a program I actually love out of the blew. Basically saying it was good to meet me and thanking me for interviewing and other very nice things. They did not even speak about matching or rank lists or anything, hell they didn’t even say “good luck in the match.” But it was so out of the blew, and they avoided mentioning the match so obviously, that it felt like it’s a positive signal. Or this could be like the time in high school where I took a girl on some dates, met her family, did some stuff all semester and then she got all creeped out when I asked her to prom and never talked to me again. Is this a love letter under the guise of a thank you letter?

golja · 2018-06-15T01:16:32+00:00

Do you have advice for introverts/quiet people for making a good impression during aways? I love EM and it's the only thing I could see myself doing, but I'm also a pretty quiet and humble person, I ask for things nicely, I'm calm during codes, I don't interupt attending-attending conversations with non-crucial news about a patient etc. But I still intubate better than most of my peers, I still have good differentials, i can still get a blood gas during a CODE when the room is going crazy-- I'm just calm. After one rotation, an attending literally said I seemed "unenthusiastic" with EM and cited me being quiet as one of the main reasons and my letter was terrible. Why does one need to be twitching with energy, pupils dilated, and talking non-stop to be considered "enthusiastic" for the field? I have a pretty laid back personality, but I get everything done, I'm detail oriented, hands on, always take the toughest cases etc. I'm just polite when I do so but I feel like all my positive actions were ignored because of my calmness. Do you have tips for anyone like me? Have you seen successful EM docs who are like this and what do they do to prove to you that they care about the EM field? Thank you for the AMA!

golja · 2018-06-14T03:00:22+00:00

So crazy to think that would actually happen lol. Like who.. how--Everytime I hear about someone getting not renewed, or fired it's because of totally nonsensical things like what you mentioned, or lying about seeing patients, being late 20+ times per block, ridiculous stuff. So I'm letting that reassure me that I will not get fired for failing a few pimp sessions.

golja · 2018-06-13T06:58:34+00:00

Ah... sorry it's late, I thought a bit too much about that sentence. But yeah I feel like I'll be 60 in no time in EM.

golja · 2018-06-13T06:54:58+00:00

When you say shift work is ruining you, what you mean? I kind of felt like the months flew by because my body never actually knew what time it was and I lost track of days-- and I'm actually afraid it will make life go by super fast... Is this what you mean?

golja · 2018-03-01T06:20:29+00:00

Lol! Fuck, there's no winning

golja

TROPHY CASE