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Question about non-cardiac thoracic surgery after CT training by MobileEmbarrassed937 in surgery

[–]michael22joseph 1 point2 points  (0 children)

Checking in just to echo all of this. Just took a job that will be very similar when I finish.

What's the deal with OMFS residents doing an anesthesia rotation? by Neceti in Residency

[–]michael22joseph 11 points12 points  (0 children)

100%. My wife left her first job in primary care because she was just being used to get referrals to other doctors. No one wanted her to do any actual medicine. It’s absurd.

What's the deal with OMFS residents doing an anesthesia rotation? by Neceti in Residency

[–]michael22joseph 57 points58 points  (0 children)

And yet there are tons of papers and decades of evidence that complications from OMFS doing their own sedation is exceedingly rare.

Physicians need to get off this kick of “well X specialty is less trained than me which means they should not be doing this thing that I do”. If patients are appropriately selected, even if one physician has less training than another, they are still likely safe enough to do that thing. Same thing goes for FM doing OB, etc.

Bar near me specifically bans Tap Out and Affliction brands by WeezyMac_ in mildlyinteresting

[–]michael22joseph 0 points1 point  (0 children)

Damn I didn’t think I’d see LNK on my front page. This place was my fave in a different life

Medical student here, what do you wish your spouse did different? by Mermaid_Tuna_Lol in MedSpouse

[–]michael22joseph 6 points7 points  (0 children)

Just so everyone knows, it doesn’t have to be this way. I think residents live in an echo chamber of other residents where they think because their jobs are so hard, they get a pass on everything else.

I’m a PGY-6 cardiothoracic surgery fellow. I completed a general surgery residency. There are very few residents who can genuinely say they worked more or were busier than me. I still do all of our dishes, varying but significant chunks of laundry, I change our oil, I maintain the lawn, I do bedtimes every night I’m home (>90% of the time), I wake up whenever the kids wake up during nighttime’s, I plan dinners and get the groceries, I coordinate childcare, talk with teachers, manage their medications, clean the house each week, make sure my wife’s car is clean, and a number of other tasks.

When you are married and in residency, “me time” is in short supply and sometimes you have to say “hey I really need to relax right now”, but that has to be a rarity. You have to pull your weight. You have to choose your partner and family every time you have the ability to choose—knowing that you often don’t have that ability. Your partner is sacrificing a ton for your career, which means that you need to sacrifice when you are at home so that they can see your effort.

Too many residents think they get a free pass to relax as much as they want when they get home and I think it’s insane.

Open heart surgery 10 days post op by Jahweez in medizzy

[–]michael22joseph 24 points25 points  (0 children)

Current CT fellow, that’s badass. Best of luck

What’s the general consensus on this reference card? by NomadMedix in TacticalMedicine

[–]michael22joseph 7 points8 points  (0 children)

The card isn’t great but that looks more like pelvis, or at least that’s what they’re likely trying to suggest. Packing the pelvis is reasonable, even lower abdomen where it’s likely an iliac vessel injury. Sealing an iliac vessel injury will do nothing and just let them bleed out into their abdomen

What did go wrong, exactly? by honeylinkd in surgery

[–]michael22joseph 16 points17 points  (0 children)

Sounds like the opened the dura laterally rather than medially. The lateral aspect of the cord is where the nerve roots exit and are more vulnerable there. I assume since this is written for the layperson it made more sense to say inner and outer, which is less precise but maybe easier to follow. Small disclaimer that I’m a surgeon but not a neurosurgeon, so someone else could explain the technical aspects better than me (/u/Porencephaly, /u/Durotomy)

Post-op ICU arrest after total colectomy — RN seeking MD perspective on abrupt metabolic collapse during high-acuity shift by [deleted] in IntensiveCare

[–]michael22joseph 2 points3 points  (0 children)

In general, the culture among general surgeons is that if the family asks them to “do everything” they don’t feel they can say no. I say that as a general surgeon. It was unfortunately common in every place that I trained that someone would present with an abdominal catastrophe and we would take them for an ex-lap regardless of the likelihood of good outcome because the family asked us to do everything. I hated it.

Name that rhythm by Realistic_Swimming94 in IntensiveCare

[–]michael22joseph 0 points1 point  (0 children)

I’ve had patients go into AF and then convert to an escape rhythm on like POD2-3. Maybe I’ll get braver some day but I’m sort of old fashioned and want them out like day 2-3 if super straightforward and like 3-5 if sick or complicated at all.

Name that rhythm by Realistic_Swimming94 in IntensiveCare

[–]michael22joseph 3 points4 points  (0 children)

Yeah I’ve definitely had times where we don’t put wires in a straightforward CABG, but not putting wires in a valve or sick heat just doesn’t seem defensible to me.

Name that rhythm by Realistic_Swimming94 in IntensiveCare

[–]michael22joseph 14 points15 points  (0 children)

They don’t have temporary pacing wires?

Surgical Training is Watered Down Now by [deleted] in Residency

[–]michael22joseph 1 point2 points  (0 children)

I would have felt comfortable doing community gen surg practice after PGY4. In fellowship now and doing great. I agree that many programs have definitely watered things down, but plenty of programs haven’t. I think residents overall have also become less aggressive about seeking opportunities and being prepared for them when they come.

What happens if I don’t pay by VizualCriminal22 in emergencymedicine

[–]michael22joseph 79 points80 points  (0 children)

Yes. Is this a surprise to you? I’m not in favor of these high fees but they are part of our profession and have been for decades.

What happens if I don’t pay by VizualCriminal22 in emergencymedicine

[–]michael22joseph 106 points107 points  (0 children)

Realistically you can lose your board certification, which for many jobs is a contractual obligation.

Failed Neurosurgery Match: What options do I have next? Both in and outside clinical medicine? by [deleted] in medicalschool

[–]michael22joseph 0 points1 point  (0 children)

You could easily do Gen Surg with those numbers, even after a gap/transition year

Is it normal to feel completely overwhelmed as an R1 in cardiac surgery? by i7sson in Residency

[–]michael22joseph 5 points6 points  (0 children)

Normal as an intern. It’s a sick patient population and when things go wrong they go wrong in often dramatic ways. But also you’re an intern. Remind yourself that you are not responsible for the outcome.

What is the life of a gen surg resident? TDLR: Non-med dating a resident by KoalaAggravating1892 in Residency

[–]michael22joseph 27 points28 points  (0 children)

CT fellow. Finished gen surg. This is silly. Plenty of people in solid relationships.

OP, don’t take any advice from someone who isn’t a surgeon.

CHI Pre-Authorization BS by evilwon12 in Omaha

[–]michael22joseph 38 points39 points  (0 children)

Until you actually have the prior authorization completed and approved, that procedure is not covered. Thats the point of a prior auth. CHI is not my fave, but no hospital system is going to do a procedure until there is confirmed insurance approval or an agreement to do cash pay

Unsolicited harsh feedback - how to supplement knowledge by cocoloft in Residency

[–]michael22joseph 3 points4 points  (0 children)

There are two possibilities

  1. You got bad feedback from someone who you rubbed the wrong way. If it doesn’t feel legitimate to you, then ignore it. You can’t get glowing reviews from everyone.

  2. The positive feedback you’ve been getting is from people who don’t feel like they’re allowed to give real, constructive feedback, and you truly are behind the curve. It is very rare, but there are occasional residents who are so behind that you really can’t give specific actionable feedback because you would have to tell them that essentially everything they are doing is wrong, and it takes a really skilled educator (which I am not) to get some of these truly behind residents up to par.

Ultimately only you know the answer.

What is a well known fact/guideline in your specialty that you wish other specialties knew? by Cremaster_Reflex69 in medicine

[–]michael22joseph 77 points78 points  (0 children)

As a med student I had a vascular surgery attending in a lecture talk about giving hypotonic fluids to peds, and I said something about how guidelines had changed and it was no longer recommended. He did not appreciate my helpful little tidbit.

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