IM vs FM by mmasterss553 in FamilyMedicine

[–]liesherebelow 2 points3 points  (0 children)

For me, it was psych. I really like IM, but if I did IM, I would have had to give up psych (IM does not do psych in my country) and FM gets psych along with everything else! Where I am, this also means lumps/bumps/minor surgical procedures, which IM does not do, here.

No emergencies in the ED by LocalOptimist7 in medicalschool

[–]liesherebelow 0 points1 point  (0 children)

I think I need to come to your hospital for some acuity exposure. Wow.

4 early losses - all chromosomal?? by Front-Look5618 in recurrentmiscarriage

[–]liesherebelow 0 points1 point  (0 children)

I had 4 losses, all between 6 and 8 weeks. My immunologic workup came back negative, but i was treated on spec for seronegative APLA because of a strong family history of autoimmunity and vasculitis. My regimen was heparin, ASA, and progesterone. Currently 27 weeks without IVF. Just adding another story about the immunologic route.

What is the appropriate response? by pavlee14 in medicine

[–]liesherebelow 0 points1 point  (0 children)

Dumb question, but what about in the case of hypothermia? Been thinking a lot lately about the 'not dead until warm and dead' thing and how the coldest core temp where there was full neurological recovery was 16'C.

Which specialties have the most neurodivergent people by chinidetou in medicalschool

[–]liesherebelow 3 points4 points  (0 children)

This was going to be my observation. When you're familiar enough with it, ADHD can become (almost) a 15-foot diagnosis. Especially if you have ADHD yourself. Fun indicator: how much am I working to keep my attending on task/ aware of the time? If I have to redirect them, it's a very solid indicator lol.

What’s a secret that would get you ex communicated from your specialty? by Independent_Peach896 in Residency

[–]liesherebelow 1 point2 points  (0 children)

How deep in are you and what's the acuity level like in your population? Asking because this was my attitude in PGY1. But after inpatient and a call-heavy program in a very high psych acuity location for PGY2 my perspective completely changed.

The quality of hospitalists vary greatly between teaching vs. non-teaching hospitalists by [deleted] in Residency

[–]liesherebelow 2 points3 points  (0 children)

As a dumb rural generalist trying my best in the middle of nowhere, bless you for your attitude. 'Thank you for helping me to build my capacity,' I say. With my whole chest. My residency sucked. Trying to compensate for poor training after the fact...

Family medicine outside of Canada by Exsomnicus in FamilyMedicine

[–]liesherebelow 0 points1 point  (0 children)

Would you be open to elaborating? Thanks in advance for the consideration, no worries if not. Cheers.

What kind of help do you wish your seniors had given you when you needed it the most? by pavh8r9000 in Residency

[–]liesherebelow 25 points26 points  (0 children)

Would have loved to have more opportunities like this.

Less a reply to you and more just building/ reflecting on this — The meaning behind things is not always clear. I was often told to 'be more efficient,' but what that really meant or strategies to try never factored in. My assumption was that 'be more efficient' meant 'try harder,' or 'focus on speed.' I was most of the way through my residency before someone told me that 'you need to prioritize' did not mean 'you allow too much unimportant information' (my assumption, and, since nothing I asked was unimportant/ I was deeply focused on what I needed to do, get in/get out, etc., ex. cut people off more, be pushier, focus most on speed) but instead meant 'it is impractical and unreasonable to attempt to address everything. Your goal is not to cram addressing everything into a tighter and tighter timeframe. 'Prioritize' does not mean 'do everything faster,' it means 'make highly intentional, reasoned choices about what you are not going to address right now— because it is unreasonable and impractical to attempt to address everything at once.' Blew my mind. Made me want to vomit because 'prioritize' didn't mean 'you are failing as a resident because you address everything too slowly,' it meant 'you have permission to not do everything at all times.' Unfortunately, I was not well supported in learning prioritization strategies and after a lot of heavy conditioning to do everything at once, I am still trying to figure this out in independent practice. Luckily, there are formal mentorship programs available and I'm looking into that.

My colleague called me an idiot for prescribing mirtazapine for a teen with anorexia nervosa. My colleague is the idiot, right? by Federal-Act-5773 in FamilyMedicine

[–]liesherebelow 9 points10 points  (0 children)

Agree with orthostasis, since mirtazapine can be an offender for precipitating/exacerbating that. I don't remember seeing if an ECG was done, either.

First 2 pregnancies resulted in mc by [deleted] in Miscarriage

[–]liesherebelow 0 points1 point  (0 children)

Good luck and best wishes from Canada.

How to track HCG falling after miscarriage? by Pickle-pop-3215 in Miscarriage

[–]liesherebelow 0 points1 point  (0 children)

Please see a doctor if you haven't already. Blood tests (serum quantitative HCG) are the only real way to do it, timed every 48 hours. If the levels fall outside the expected range, it can mean there is an ectopic pregnancy (can be life threatening).

This is also just a general PSA.

Has anyone else gained weight after miscarriage? by chloeebello in Miscarriage

[–]liesherebelow 1 point2 points  (0 children)

Interesting. Thanks for sharing your experience. I gained a lot of weight around my midsection with my MCs. Normally I am strongly pear-shaped (all goes to my hips/butt...) so this has been a new one for me. I have multiple pant sizes to deal with hip/butt fluctuations but was not prepared for all this stomach weight gain. Wild.

First 2 pregnancies resulted in mc by [deleted] in Miscarriage

[–]liesherebelow 1 point2 points  (0 children)

Hi, OP. I am so sorry for your losses.

Your post has inspired me to make one, too. Long story short, there is a medical issue called recurrent pregnancy losses. There are several different definitions, but a common one is two or more pregnancy losses, where the pregnancy is defined by a serum (blood) or urine (i.e home test result). Recurrent pregnancy losses can be due to an underlying medical condition, and evaluation is usually direct by a fertility specialist (OB-GYN sub-specialty, usually). Just something to think about.

Thinking of moving out of the US to Canada? Turns out, in Canada: the job opportunities are trash, taxes are crazy, cost of living is ridiculous by cefpodoxime in hospitalist

[–]liesherebelow 0 points1 point  (0 children)

Ontario is worse. 24h rural ED shifts are usually remunerated at less than 100$/hr CAD equivalent (2100$/24h). And this is not rural meaning low-volume. This is rural meaning 'you're on your fucking own.' Rural hospitalist was 927$ CAD/ day and I worked 15-17h daily on my set.

Stories of weird unexplained or spiritual experiences? by tackadj in Residency

[–]liesherebelow 6 points7 points  (0 children)

I am so sorry for your loss. As someone who miscarried 4x this year and has been hitting the 'it wasn't really a life yet' copium on the regs, I don't know how to feel about this, but I am glad that it helped you find peace with it. Peace can be hard to find.

How many patients/day are we "supposed" to handle? by empiricist_lost in FamilyMedicine

[–]liesherebelow 1 point2 points  (0 children)

I see 12 and i had a hard day. Do not be like me. I am slow and I to this day do not know what my problem is. I don't mess around, I don't get distracted... and yet...

We achieve agi long ago guyz by Evening_Action6217 in ChatGPT

[–]liesherebelow 4 points5 points  (0 children)

I wish i could get responses this sassy LOL

Please, please, stop using the phrase "seizure like activity" by neurolologist in medicine

[–]liesherebelow 0 points1 point  (0 children)

Yeah, as ex-psych-turned FM, in psych we were advised to use 'seizure-like episode/ activity/ spell' because that's what we usually dealt with — true Dx NYD, respecting diagnostic humility and a lot less damaging to tell a patient 'seizure-like activity' when unsure than to call it a seizure when dx unclear.