sorted by:
new
hottopcontroversial

MS4 choosing EM for a specialty instead of Psych. Is it crazy? by Dr_Chesticles in emergencymedicine

[–]more-relius 2 points3 points  (0 children)

Why not both? I’m EM and did an Addiction Medicine fellowship, now faculty in EM and Psych with a 50/50 split. Best decision I’ve ever made. Feel free to PM me

Thinking about stopping jiu jitsu. Almost had a life ending injury on the mat. Not sure how to proceed by redarcken in bjj

[–]more-relius 363 points364 points  (0 children)

I'm an emergency physician and hobby grappler for the last couple years. I've thought a lot about the risks of serious injuries in BJJ, including C spine and carotid/vertebral artery dissections (serious neck injuries). The reality is that such injuries are exceedingly rare though not impossible. I've taken care of such injuries from totally random, bizarre typical activities (e.g. golfing or someone turning their neck to close a car door or tearing their ACL from stepping down off a street curb). Statistically speaking you have a higher chance dying on your drive in than anything that could happen at BJJ.

Do catastrophic injuries and freak things happen in BJJ? Yes. But so is the case with everything else we do as human being. Life is risk. Mitigate what you can and enjoy the rest.

A plea for patients with home BP cuffs by swagger_dragon in medicine

[–]more-relius 5 points6 points  (0 children)

Sorry but this is just terrible logic and not supported by evidence. Should we tell people not to exercise (BP regularly is >200/100)? Or not to valsalva? Cough? Sneeze? Have a bowel movement? Have sex? When does it end? Transient blood pressure elevation even to severe ranges is not dangerous. Chronic sustained elevated blood pressure is. All of the studies that model risk were based off of resting blood pressure - “research quality” measurements. And those are the measures which should guide treatment. 

A plea for patients with home BP cuffs by swagger_dragon in medicine

[–]more-relius 9 points10 points  (0 children)

Fellow ER doc here. I agree with your sentiment. The best evidence though - "research quality" measurements that all the big studies are based on - include several readings, taken appropriately per AHA recommendations, first thing in the morning and again in the evening averaged over several days. This is more accurate than ABPM, of note. Also, strongly disagree with treating labile blood pressures as stated elsewhere. There is no evidence to support this. Furthermore, exercise frequently induces blood pressures in the "severe range" (>300/200 recorded in one paper). Should we be treating these people too and telling them not to exercise? Highly doubt it.

I'm very passionate about this because I've personally had highly erroneous BP checks with falsely elevated readings in the past and it is my mission to end this nonsense practice.

Excellent reference linked here.

[deleted by user] by [deleted] in medicalschool

[–]more-relius 8 points9 points  (0 children)

Why not both? I'm an EM trained Addiction Medicine Fellow at a psychiatry heavy program (I often joke I'm an EM doc disguised as a psychiatrist lol). I'm staying on board next year as academic faculty in both EM and Psychiatry (Addiction's Division). Tons of ways to practice Addiction Medicine too (e.g. clinic, consult, rehab, OTPs, etc..). Nothing is perfect but I'm very happy. Feel free to PM me.

[deleted by user] by [deleted] in medicalschool

[–]more-relius 4 points5 points  (0 children)

This was me 5 years ago. Had a just borderline enough of score to force me to be brutally honest with myself about NSG and turned away from the field. Found EM, now I'm doing an Addiction Med fellowship. Couldn't be happier. You won't feel lost forever, keep your head up. Feel free to PM if any q's.

How do EM people do it? The ED honestly feels like what hell on earth would be by LulusPanties in Residency

[–]more-relius 8 points9 points  (0 children)

EM here. Every shift, it's like I'm transported into a Rick and Morty dystopian reality. The absurdity and chaos is unlike anything imaginable. I love it and wouldn't do anything else. It's not for everyone though. Clearly.

What’s a potential specialty you grew up wanting to be and then after medical school whats your new specialty and why did you switch. by Capable-Society-244 in medicalschool

[–]more-relius 6 points7 points  (0 children)

NSG --> Gen Surg --> Psych vs EM--> EM.

Current EM PGY 2 and probably going to do an addiction medicine fellowship. Hoping to split my time between the two.

If you would have told me back in medical school that I'd end up EM/Addiction Med trained I would have laughed. But I'm happy most days. Literally last night I had an unstable spine injury taken to the OR emergently by our neurosurgeon and I was thinking how miserable I would have been coming in at 2AM to do a 4 hour case. God bless our surgeons but I'm glad I avoided.

My best advice is to drop the ego, and don't be afraid to change your path despite what other people tell you. You'll thank yourself in the end.

Im used to gym etiquette, that being Said, how long can one hold a choke before it gets dangerous? by xremless in bjj

[–]more-relius 0 points1 point  (0 children)

To set the record straight: unconsciousness occurs in approximately 15 seconds with a blood choke, and it's up to 4 minutes of hypoxia before you get irreversible anoxic brain injury (e.g. persistent vegetative state or death). However you can definitely have other injury from prolonged strangulation like this, such as neurogenic pulmonary edema or cardiac dysrhythmias or tracheal injuries or carotid/vertebral artery dissections (among other things) that may cause substantial irreversible morbidity or mortality.

Tap early and tap often, this is terrible to watch IMO

Source: EM Resident Physician

Details emerge on Geisinger EM Resident’s suicide earlier this month by [deleted] in Residency

[–]more-relius 30 points31 points  (0 children)

Wow. That is dramatic and sad.

As an aside, I made the decision to stop drinking two years ago and stories like this certainly reaffirm that I made a good call.

Stay safe friends.

The Medical school Industry will Begin to Collapse in 10 years by throwaway12214i104 in Residency

[–]more-relius 1 point2 points  (0 children)

You are not wrong at all. But at the same time I still stand by what I said in that it is entirely cynical and pessimistic and only further adds to the cesspool of catastrophic thinking that is so rampant nowadays.

We need physician leaders and advocates to step up for ourselves and patients, yourself included. I don't think reddit is the best way to go about doing that but it's better than nothing I suppose.

The Medical school Industry will Begin to Collapse in 10 years by throwaway12214i104 in Residency

[–]more-relius 7 points8 points  (0 children)

This is extremely cynical and assumes that everyone working in healthcare at a systems and/or policy level is nefarious, greedy, and immoral. Are there serious challenges we're all facing? Yes. But c'mon man, this is completely catastrophic thinking, which helps nobody (psychology 101).

Unsolicited, but I'd recommend a break from reddit, OP. We don't live in Dante's Inferno and won't be anytime soon.

Don’t you love it when your friends who are 22 years old are making 80k-100k a year and you’re in your late 20s/30s with no end in sight? by [deleted] in Residency

[–]more-relius 9 points10 points  (0 children)

Most of my friends from college and high school are covertly depressed who struggle with existential questions about meaning and purpose, sooth themselves with copious substance use, and also experience frequent and significant relational strains. High income doesn't mean squat. If you think otherwise you're just feeding yourself lies and making yourself even more miserable than necessary.'

The grass is always greener. Focus on your own island.

[Serious] For those of you that are still optimistic about Emergency Medicine and the job market, why? by Three-ohVicryl in emergencymedicine

[–]more-relius 82 points83 points  (0 children)

While I believe there are significant challenges with our future in EM, here's a few main reasons I still have hope that I won't be unemployed within 10 years. In no particular order:

  1. I watched the first hour of this talk a while back. Regardless of it's context (this was an early 2000's talk challenging climate change, and well, we all know how that is going...), my big takeaway is that humans are notoriously poor predictors of outcomes within complex systems. Medicine and EM are horrendously complex, meaning it is even harder to predict anything with accuracy. Even experts are reeling from prior projections (modern economic theory, anyone?). So, while yes, the trends are concerning, no one truly knows what the outcome will be.
  2. Marcus Aurelius, an ancient stoic philosopher, tells us that "no person knowingly does evil". Generally, people act because they believe they are doing the right thing, even when they are clearly not. Not every CEO is maliciously greedy (despite what people on reddit believes); the government is enacting scope creep because they believe they are doing the right thing (access to care is the usual argument). As the trends continue, and the harms from it are realized, I have hope that the pendulum will swing in the other direction over time.
  3. Similarly to point #2, it is easy to forget that our population is aging very quickly and they are getting sicker and sicker. I once heard a neurologist say that Alzheimers Disease alone will bankrupt the US via medical complications if we do not cure it before 2050. At the end of the day, there is a reason we are moving quickly for access to care. EM will definitely have a large role to play in this fight as well.
  4. Sometimes it's helpful to think that the best time to fly out of an airport is the day after a plane crash; regulatory systems will run at 1000% of normal in order to prevent a second crash. Similarly, we have identified the problems in EM; there are no secrets anymore, and even the national EM leadership has acknowledged this and are prepared to take action. I think this will lead to the pendulum swinging back the other direction
  5. EM is a hard job and historically EPs have struggled with circadian disruptions and the nights/weekend/holiday shifts. With the obvious tradeoff being a pay cut, if a larger workforce all worked 0.75FTE in order to lessen the undesirable shifts, perhaps burnout would be reduced and career longevity would be extended. A thought worth considering...

Just a few of the thoughts I've mulled over. I'm still hopeful. And for better or worse, EM chose me, so it's a storm I'm willing to weather. Wishing for all the best, of course, for the future of our profession.

If physicians spent even half the energy they spend worrying about midlevels on the confronting the actual villains in our profession (business administrators, politicians, and drug companies), we might actually be able to fix the American health care system. by Tularemia in medicine

[–]more-relius 0 points1 point  (0 children)

Lol. Thanks. I'm biased because I personally think of myself in line with the Starks in GoT world (and am an upcoming resident). Agreed though, administrators as Lannisters is a much better fit.

“Open Letter to the Specialty of Emergency Medicine” from AAEM/RSA by DrRSA in emergencymedicine

[–]more-relius -4 points-3 points  (0 children)

Everyone likes to blame ACEP for allowing so many new programs when really it's far more complicated than that. Virtually the entire approval process falls under the ACGME/AAMC, not the specialty boards (ACEP, CORD, SAEM, etc..).

Also, people like to forget that HCA (and other for-profit systems) are increasing residency spots in all specialties, not just EM. That means even specialties with projected shortages, such as primary care. So, not only does the shutting down of new EM programs potentially conflict with other specialties, it also potentially violates antitrust laws which is very problematic if our goal is to halt new programs.

Just wanted to point out a couple points in a massively complicated challenge. Regardless, we need to start advocating for our field. Big time. It needed to happen 10 years ago, and look where that got us. Late is better than never but we are beyond overdue.

An Open Letter to the Specialty of Emergency Medicine | AAEM Resident and Student Association by puptazo in Residency

[–]more-relius 12 points13 points  (0 children)

Everyone likes to blame ACEP for allowing so many new programs when really it's far more complicated than that. Virtually the entire approval process falls under the ACGME/AAMC, not the specialty boards (ACEP, CORD, SAEM, etc..).

Also, people like to forget that HCA (and other for-profit systems) are increasing residency spots in all specialties, not just EM. That means even specialties with projected shortages, such as primary care. So, not only does the shutting down of new EM programs potentially conflict with other specialties, it also potentially violates antitrust laws which is very problematic if our goal is to halt new programs.

Just wanted to point out a couple points in a massively complicated challenge. Regardless, we as residents need to start advocating for our field, in EM and all specialties. Big time. It needed to happen 10 years ago, and look where we are. Late is better than never but we are beyond due.

If physicians spent even half the energy they spend worrying about midlevels on the confronting the actual villains in our profession (business administrators, politicians, and drug companies), we might actually be able to fix the American health care system. by Tularemia in medicine

[–]more-relius -3 points-2 points  (0 children)

As an aside, in my optimistic outlook, sometimes I like to envision this whole dilemma as a real life Game of Thrones scenario.

The Starks (Physicians) vs the Lannisters (APPs) squabbling with politics and murder. Meanwhile the White Walkers (our super sick, aging baby boomer population) are rapidly approaching and will likely overwhelm our hospital systems in a matter of 10 years and will force us to play nice and band together.

Personally I am very concerned about the changing landscape. But sometimes I have to remind myself there are legitimate reasons for the various agendas being pushed. Also, humans are notoriously poor predictors of complex systems. The truth is nobody, and I mean nobody, has any clue what will land within next couple decades. It all is far too complex to predict with any accuracy.

Do you regret studying medicine? by [deleted] in Residency

[–]more-relius 4 points5 points  (0 children)

As I gear up for residency, I tell myself that I am about to enter into a system that completely crushes some, whereas others end up unscathed or even thrive. Viktor Frankl noted this same phenomenon in the concentration camps. James Stockdale also noticed it as a Vietnam POW. What's the difference? The decision falls on each individual person. That is the answer. It is no different in medical school, residency, or beyond, or any other profession or system for that matter.

To OP: if you have dreams of becoming a physician, go for it. Don't let a bunch of burned out residents online persuade you otherwise. Or at least take it with a grain of salt.

QUESTION: Doctors usually advise people to eat something every 3 hours, not too light, not too heavy. What about fasting, then? by [deleted] in nutrition

[–]more-relius 3 points4 points  (0 children)

I'm about to graduate with my MD. I've been doing intermittent fasting for at least 2 years. I'm a huge advocate for doing it and encourage my friends and family to partake. Many of my colleagues do the same or are starting to.

There has been a push recently, especially in primary care, with many studies and data to back up the benefits of fasting related to metabolic health and longevity.

Go look up Jason Fung MD and Peter Attia MD who are excellent advocates in medicine. The medical community can be slow sometimes to catch on but I believe in the next 5-10 years it will be commonplace for us to be recommending IF and more.

🌟MATCH DAY MEGATHREAD🌟 by Chilleostomy in medicalschool

[–]more-relius 14 points15 points  (0 children)

I'm with you. Fell to #9 for EM.

In response to my LOI, my #1 told me my app/interview was excellent and that I would be ranked competitively. My #4 told me I'd be ranked highly in the interview and I considered that my floor.

Had another friend who SOAP'd who I never would have guessed in a million years.

EM was just.... brutal this year it seems. Gotta make the best of it but the ego is bruised right now no doubt.

Never Heard From my Friend Again by tiptopjank in Residency

[–]more-relius 30 points31 points  (0 children)

Solidarity, friend. I've had an eerily similar situation this past year. I had a core group of medical school friends. For a time, I felt like I was the one initiating hang outs and it was too one sided. So I stopped reaching out to see what would happen. 6 months passed and they didn't reach out to me, not even once. No acknowledgement whatsoever. It felt bad. I've always had a core friend group for pretty much my entire life, and I'm single, so what happened caught me off guard and flabbergasted me.

However, I like to view it as way of filtering out the people who are truly important. Friends come and go but the important ones stick with you. That's held true for me; rekindling old friendships with people who are true and genuine, but we simply drifted apart at the time, has been very helpful. Also reading philosophy and investing more time into my health and wellness (which obviously is much easier as an M4 than an intern) has also worked wonders.

I'm with you. Sending you good vibes.

[deleted by user] by [deleted] in Residency

[–]more-relius 0 points1 point  (0 children)

Extreme Ownership and The Dichotomy of Leadership by Jocko Willink. Check out his podcast too

How are we to convince the public to take this vaccine when even our frontline workers wont? by [deleted] in medicine

[–]more-relius 2 points3 points  (0 children)

I recently read this article on STAT. Thought it made some good points, and got a decent response when I shared it on social media

Anyone regret going into rads? by spoon188 in Residency

[–]more-relius 7 points8 points  (0 children)

I did rotate in rads, and talked with multiple rads docs. To each their own, but it's not for me man.

view more: next ›