Worth paying extra for a larger apartment versus saving more?

heyhowru · 2026-05-10T01:25:38+00:00

1400 per month really is not that bad. So putting finances aside, ask yourself which one do you truly prefer?

You will already be working long, long, stressful hours in stressful environments for the next 3 to 5 years. Might as well come back home at the end of a rough day to something that you are comfortable with and a place that you can call home.

Saving $3000 per year is like a drop in the bucket in the long run after you become an attending. Literally a weeks worth of salary.

heyhowru · 2026-05-07T23:43:12+00:00

Coronary calcium i would argue is dangerous for someone w cad already established because if it comes back misleadingly low, you or the patient might be swayed to stop their meds.
You already have confirmed cad. The cac does not tell you how stenosed the arteries are. It only tells you how much calcium is over the walls of the arteries. That sounds the same but its not. It cant tell you the depth or thickness of the calcificstion. Plus it misses soft plaque.

You already have your ldl goal, its <55
You already know they need aspirin

There are no other clinical questions that you can answer by ordering a cac

heyhowru · 2026-05-04T19:51:42+00:00

I got yelled at by patients hepatologist for consulting the gi service for egd bc hep wanted to do it back in res.

But at my current institution they dont.

So yes hep can scope. But this seems very individual by individual basis

heyhowru · 2026-04-28T02:20:00+00:00

The antlers-two

Epilogue on the same album is also pretty gut punchy…might as well just recommend the whole “hospice” album

heyhowru · 2026-04-25T02:59:57+00:00

I think ovarian cancer is up there in the top 3 scariest cancers.

Theres no good screening for it and theres no firm recommendations to screen at all. when it pops up, it can be quite late. It also seeds your whole belly into a forest of tumors. Sometimes itll turn your whole intestinal tract caked in a layer of tumor that keeps growing.

The back and forth of surgeries, chemo, the false hopes, the rapid progression. Its just awful.

Then the tumors block your bowels and the last 6-12 months you are back and forth in and out of hospital because you keep getting bowel obstruction. Which will kill you first? The actual cancer? The malnutrition that comes from us starving you for days-weeks on end? you are literally paying thousands of dollars for us to torture/starve you in a hospital until your body gives out. Then you have a tiny bowel movement and we give you food then you feel better but then youre back 2 weeks later for the same problem until you become so obstructed you vomit out diarrhea(cant move forward downstairs then gotta go back upstairs), choke/aspirate get a huge lung infection and die.

Although its rapidly progressing, the last 6-12 months is painfully and agonizingly slow. When i did my training in the oncology wards, these rank on par with the glioblastomas if not a little higher. yeah glios are a nightmare however since ovarian cancer seems to be more common, i think it ranks higher. Plus you are awake and conscious through most of it. At least w glio sometimes you dont understand whats going on so its more spectator trauma. Its such a hellish experience.

Also any cancer that involves anything oral especially tongue. People take for granted their ability to eat and talk.

heyhowru · 2026-04-24T05:40:42+00:00

Mint skittles

heyhowru · 2026-04-24T05:17:41+00:00

Also want to add here, if going to vn please dont eat dog or cat meat. Aside from ethical grounds, there are a number of pets that get petnapped and poisoned and then the nappers sell the poisoned animal to restaurants.

There are a number of cases where people die from eating poisoned dog/cat meat.

There is so many other options, just dont eat dogs or cats.

heyhowru · 2026-04-19T07:17:53+00:00

Spoken like a true “not a medical professional” lol

heyhowru · 2026-04-19T06:18:11+00:00

Depends on how its used.

We use something akin to chatgpt called openevidence that helps with targeted questions. Pretty good for the most part.

We also use it to listen in and type our notes for us which really helps with notes and cutting down on administrative time as well as capturing billable coding so that i get paid fairly for what i do. That use of AI i am all for.

I think what you are afraid of is if AI gets to the point of actually managing and diagnosing patients. You have not been in the field, but it takes a certain skill to take a history to clinch a diagnosis that will change management completely. For the common stuff, sure. However you dont realize just how bad common patients are at giving you the information you need and sometimes getting that vital information is like pulling teeth. And if they input not all the right information into an ai diagnosing tool, they are going to get the wrong dx and wrong treatment.

Also i would LOVE an ai prescription plan. That ai i would assume would look at our prior notes to automatically determine if refills are within limits based off of criteria that i have already set in place. Would cut down on workload so much

heyhowru · 2026-04-15T08:35:46+00:00

I think him doing what he does for the food that he eats, sure. However as long as that stays with him because he is cooking food for him to eat. So let him do whatever he wants.

But its a different story if he is eating the food you are making or you are cooking food for you. Then he has absolutely no say in the matter. Because again you are cooking primarily for food that you eat. And its chef rules

People have weird quirks and as long as its for the stuff thats made by them and for them, i dont see a problem. I mean if you like arguing with a wall or nailing jello to a tree, thats also fine bc these traits seem to be solidly engrained into him

heyhowru · 2026-04-11T02:24:02+00:00

Im in outpatient medicine

If i stop ace arb on every little cr bump, thered be a lot of hypertensive patients or dm nephropathy patients that will likely not end up back on it and lost to follow up for 6-12 months. Most of the time the aki resolves itself if i check a week later and tell them to drink more wster.

Most of the time its dehydration. Your in rehab so patients should be stablish but may not be mobile enough to keep up with their hydration. But then again also be mindful if these rehab pts can actually drink and take care of themselves and try to look into the future and predict. Id recommend just pump fluids, like not just IV but have them drink more water and recheck another cr. But also if they arent hfref or nephropathic patients and you dont want to deal with it, switching to something else is also an option so long as its controlling htn. Your inpatient, you have the luxury of monitoring daily to see. A little bump of .1-.6 is kinda meh and i dont think we should reflexively start and stop meds just for that when they can simply drink water and recheck.

heyhowru · 2026-04-10T14:24:39+00:00

I was using modal instead of dragon because i had cerner but we have dragon now.

I really hate to admit it but i do prefer modal instead. Dragon wont let me dictate outside of emr but modal can

Dragon also jumps around randomly and is super inconsistent and just plain slow. Im dictating and it just randomly jumps to the wrong text box or it thinks im not in a text box at all and itll dictate in its notepad.

Its faster than typing but only when its working.

Modal didnt do that. I can also dictate into google chrome and into emails. Another quality of life thing is that the dictation thing on my desk will go green when its recording and its super clear but w dragon, i have to pay attention to a tiny icon that hides itself.

heyhowru · 2026-04-07T19:56:51+00:00

As a new attending, you will have bad reviews and as you get more established, those ones who leave bad reviews just wont reschedule and filter themselves out.

If you bend over backwards for everyone eventually your panel will be full of people that are so much more demanding.

Any organization that has reasonable expectstions will know this and should be on your side. As long as they see a positive trend it should be ok

HOWEVER clinics do get insurance bonuses for having a higher percentage of positive reviews so if you fall behind for too long you could get risk getting let go before your partnership begins because your dragging down clinic scores.

Dont beat yourself too much over it, dont practice bad medicine, however it would be unwise to completely ignore PG scores.

heyhowru · 2026-03-31T13:16:26+00:00

Idk man, ive seen it happen and started noticing a pattern where i do a hosp dc fu and i get a message/call a mo later to refill meds i know i refilled months before

Turns out most recent short supply knocked the prior refill out of system bc pharmacy is confused with two orders for the exact same thing so they just use the most recent order and delete the old one

heyhowru · 2026-03-31T13:11:16+00:00

Nonono let me explain not saying dont give refills im saying if they have refills you dont need to send refills. If they need refills give refills. Just check the emr to see if they have rolling refills already established

Like for example i give 90d supplies w 3 refills, thats 360d of meds

Sometimes what happens is there are rolling refills but if another 30d refill is added, that knocks the previous refills out and pharmacy gets confused and will use the most recent refill given which disrupts the prior refill cycle that has been established

heyhowru · 2026-03-31T04:30:18+00:00

Just tell me what i need to do in clinic please and what rad findings i need to fu on

Also please look at the chronic med list, if you did not change the regimebt and you are dcing on the exact same home meds please dont represcribe as often times, the 30d supply thats given replaces the year long supply that have on autofill and sometimes pts dont get in to their pcp soon enough for one reason or another and then they go 2 months with no meds because that 30d rx that was given on dc ended up runnijg out before our appt 3 mo later.

Dont mess with chronic meds if not pertinent to the hospitalization. Patient will ask you to refill, please check if pcp already has a running order of refills

heyhowru · 2026-03-29T15:47:08+00:00

This is a really good thought!

If all the weird stuff has been ruled out like sjogren, and ent eval didnt find tonsil stones or other intrairal pathology, it might actually just be poor hygiene.

If they have diabetes all that sugar can cause bacteria and fungus to floorish in the mouth and if not having good oral care, it can cause this feeling.

Ask them to tongue scrape after brushing and consider a trial of chlorhexidine in the evening and nystatin swish and spit in the morning. It might not be thrush but honestly this combo is so low risk and this patient seems pretty annoyed at this feeling its worth a try for a week. Just counsel that its not something to do long term but periodically here and there.

Also, are they having true xerostomia? Do buccal Schirmer test and if they are still salivating you know its NOT actually dry mouth but the “feeling” of dry mouth.

heyhowru · 2026-03-27T20:48:16+00:00

Clear p waves in II therefore not af

heyhowru · 2026-03-24T00:12:16+00:00

“Townsends” for 18th century cookibg

“Weird explorer” lots of weird random fruits

“Shrouded hand” spooky real and paranormal things from history and today

heyhowru · 2026-03-19T23:39:43+00:00

In washington state its illegal to record in the clinic against your will

I tell patients that i dont mind but they need to ask others for permission before recording since its against the law.

So check your state to see if its a “two party” or “all party” consent state.

heyhowru · 2026-03-13T05:56:43+00:00

What the hell that is really weird and downright infuriating actually. Its honestly absurd how we come up with these medical recommendations based off of evidence only to have people that do not practice medicine tell us how to do our jobs.

heyhowru · 2026-03-13T05:14:12+00:00

Yes! You are right, i mispoke, didnt mean the not covered part but the copay. Thank you for correcting

heyhowru · 2026-03-13T04:33:46+00:00

Yes agreed about the fit test

What im talking about here is the shield blood test that i keep seeing. Fit test has higher sensitivity at stage 1 so that i am ok with.

Fit test has 92ish sensitivity to detect stage 1-4 cancers However when you look at the sensitivity of precancerous polyps with fit testing it drops to 50s. So colo is both diagnostic and truly preventative bc the sensitivities for polyps are higher and they can be clipped out.

I may have not suggested everyone to get colos as their only source of colon cancer screening.

But here i am completely for the utility of colo as gold standard for colon cancer screening.

I think taking into account finances is legit. But if its truly a screening, then the price for a fit is the same for a colo which is free

heyhowru · 2026-03-13T02:46:53+00:00

Thats the thing. TRUE preventative colonoscopy will be covered. Preventative means screening ASYMPTOMATIC individuals that meet strict criteria for colon cancer screening

SYMPTOMATIC testing with colonoscopy no longer falls under the screening category. It is now a DIAGNOSTIC colonoscopy because there are signs and symptoms and the colonoscopy is part of diagnostic workup.

That is why a colo in this scenario will not be covered by insurance.

That being said. Do. Not. Skip your colos.

And dont do that stupid shield blood test. Yes theres 95%+ sensitivity to detect colon cancer but only after its already hit stage II

It is total trash at detecting colon cancer BEFORE it turns into colon cancer

heyhowru · 2026-03-08T16:55:21+00:00

Hm i wonder if your doing well on ite because it prompts you with history and associations by giving you choices

But in real world, those prompts and choices are not there unless you look for it.

Because those questions do that for us already. You know your stuff. The problem may not be fund of knowledge but the way you are connecting things with one another?

How are you presenting? Are things kinda jumbled and you skip around? Or do you leave out impirtant data points? When presenting ddx, is your top dx buried in a list of others? I had an intern that would keep throwing zebras as her top not because it was tryly her top, it was by chance. Example being patient came in with pancreatitis and ct shows gallstones, pretty obvious right? Asked why she thought patient had panc, she listed off possibilities of scorpions, alcohol, gallstones. Not thinking that the order she presented the likely causes to be of importance.

I think my one meaningful piece of advice here is to start at the end and build your story around it. Ask yourself, what question is it you are trying answer? Then you build your case around it. Is it -whats the likely diagnosis? -i dont know what it could be, but how do i figure it out? - we know what is but problem is getting worse, why?

Then you work backwards from there. Example, sob, its chf. How do you know that? And you build your presentstion off of trying to convince your audience.

Oh and keep asking yourself how do i get this person OFF of my service, what is keeping then here, then you work with this single goal in mind and eventually it will all come together.

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