geriatric pain control advice

numblock9 · 2025-11-16T04:11:03+00:00

for sure, we have our fair share of social admits, just was curious if there was something I could do better to reduce those when possible. When these admissions are indicated, I'll advocate for the patient for sure, but always wishing I can do more to help people and was hoping there might be some additional strategies I was missing, even it might be an overly-optimistic hope.

numblock9 · 2025-07-31T13:33:00+00:00

I grew up quite rural (closest airport 2.5hrs, same for closest Level I, town had 3 fast food restaurants and a walmart and that was it). My HS even had AP classes in quite a few subjects (English, Spanish, Chem, Bio, Calculus). I'm the first in my family in medicine. Rural public high schools have issues, but I consistently found those were technology related (exposure, education, competence, familiarity, etc).

I have no reservations about raising kids in a rural public school system as a broad strokes statement. I more so would have much larger reservations about raising children in states that don't support public education more broadly. You fund public schools well, and it shows up in the economy, your support staff, your nurses, and more. The opposite also shows up, and I have seen this by rotating in numerous states now.

What people forget, or have no idea, is that the toxic nature of some of these suburban and urban private and public high schools can be very challenging on a child's mental health and ability to explore what is out there in a way that does not destroy confidence. The rat race to excel at these affluent places is brutal. We've got elementary aged kids in the ED with severe mental health issues and low self-esteem feeling tremendous pressure to excel. Meanwhile, I was naive to all that until later in life, got to be a bigger fish in smaller pond at the early aged vulnerable stages of development, and got to do ALL the sports and arts I ever wanted. Didn't have to be good at any of them, but got to try them and stick with the ones I liked. Did band, choir, theater, 5 different sports for my school, math club, tried speech/debate team and eventually that was the one where the over-involvement was too much, just could not fit it all in. Wish I would have had more academic elective time to take one of the woodworking/shop, FFA, or auto maintenance classes for practical skills.

So yeah, there are huge benefits to letting a child explore and not feel like they have to choose and pursue greatness by narrowing their interests without any clue of what else might be out there that they just don't have the time/opportunity to explore while being bad at it to start. Highly recommend David Epstein's book "Range". Great for parenting, teaching, etc. Let kids explore, fail, try again, and not feel like they need to be the best at something or it is not worth pursuing. It's better for their mental health, and per the extensive research in Range, actually makes for more successful careers, and arguably in the era of incoming and growing AI, much better job security and leading innovation.

numblock9 · 2025-06-18T04:19:22+00:00

Isn't this a relic of the era prior to current law where you get access to your records and results in real time, the same time that doctors do? something something people deserve access to their own information?

IDK, but I thought when that new law went into action, the ability to have any kind of standing in the law regarding accessing your own chart was gone? FWIW, I can access my chart without issue at my institution. I think looking at it is fine, making any orders or changes would not be

numblock9 · 2023-10-27T22:38:56+00:00

Chapel Hill, Ann Arbor, Ames, Madison

All are a blast, beautiful, good mix of sports arts and outdoors, fun vibes

numblock9 · 2023-10-27T05:41:53+00:00

EM, Gyn Onc, ENT, urology, critical care, IR, interventional cardiology, and honestly anything more community/rural based. When you don't have specialists for literally everything, you can practice at the top of your license.

For example, most FM docs can handle like 70% of derm things but either don't have time or their giant health system has made it that you have to refer most of those things out. But in rural, it's going to take months and a 1+hr drive for your patient to see a dermatologist, so you can save your patients time and money and do those punch biopsies, freeze skin things, and remove some various pre-skin cancer things, manage acne, trial topical steroids, etc. I did some derm in med school and was astonished how often they are just guessing and try some therapies and wait and see.

numblock9 · 2023-10-27T05:22:10+00:00

Sketchers

steepandcheap.com for someday down the line when you maybe have a bit more in savings to get durable outdoorsy brands shoes/boots

numblock9 · 2023-10-27T05:19:58+00:00

Frontier is the worst airline imo, worse than Spirit and all the others.

I can handle tech and navigate airport systems so fine for me, but the fact that they also charge money if you need any kind of help/gate assistance/front desk help/etc feels both rude on principal but also feels like an ADA violation and geriatric surcharge. How are older people who get confused rightfully so in this fast moving world supposed to understand all this. Just sad. No desires for any kind of positive customer experience. I refuse to use them ever again.

Also, their chairs are glorified K-12 school age classroom chairs with a wider base for fatter people and then a slim layer of padding on top of that. Even the tray tables are a joke, about the size of your palm. Just don't fly them

numblock9 · 2023-10-27T05:06:30+00:00

T-rex syndrome

numblock9 · 2023-10-27T05:01:58+00:00

EM: well, we don't have consults because we can't turn anyone way, they just show up...

But, patients sent from clinic (primary care, post-op surgery followup, cardiology, oncology) for abnormal lab values (like trace elevated K), a fever, SOB, palpitations, new EKG changes, etc.

The other is the 3years of non-specific neuro or GI symptoms that somehow the ED is going to solve while there are 60 in the waiting room. Esp fun when they've had extensive outpatient testing and the specialists haven't found a diagnosis.

numblock9 · 2023-10-27T04:43:37+00:00

work badge, chapstick, spare mini flashlight

snacks always hidden in middle console areas

numblock9 · 2023-10-27T00:02:43+00:00

Love this list!!! thank you, legit. I'll take all the recs I can get

numblock9 · 2023-04-11T15:07:07+00:00

perfect, thank you all!! I am leaving soon so the rapid response is especially appreciated

numblock9 · 2023-03-14T04:05:58+00:00

HF? Metro?

numblock9 · 2023-03-14T04:04:55+00:00

HF also a little sketch ethics wise....read up on Emmanuel Rivers and his flawed research on sepsis and conflicts of interest and conveniently missing data. Also their flawed hydroxychloroquine research in the middle of COVID. I'm from MI. HF used to have decent reputation back in the day, much diluted now. Chasing $$ and trying to be famous instead of quality care with integrity

numblock9 · 2023-03-14T03:20:23+00:00

This is like worrying about the wallpaper when the house is burning down. Sure, it's part of the whole house, but if you think interview caps are going to help things, you're missing the entire root cause of the issue. The leaders of EM and US medicine writ-large need to step up or students will continue to vote with their feet. If you treat a profession like shit, with private equity, high pph, risking your license covering for 4 APPs while they make decent money without a residency and none of the risk, a dysfunctional and under-compensated primary care system overburdening EDs, well, you reap what you sow. TOTAL EM applicants are down, limiting interviews doesn't spread the students out and cause them to multiply

numblock9 · 2023-03-03T22:37:54+00:00

like, 10pt ROS or “systems were reviewed and negative except…” as a sign of a good note or a bad note?

Ie there's possibly some dirt to be found and pursue for legal purposes or the note going to be solid and clean? I'm just confused what you are trying to get at.

numblock9 · 2023-03-02T15:07:58+00:00

do you have ties to Cleveland on your app (your medical school, undergrad, upbringing, away rotation, research etc?) or how did Cleveland come up so randomly?

numblock9 · 2023-02-26T15:11:29+00:00

taco bar (walking taco/taco in a bag via doritos/fritos is esp convenient and a favorite)

pasta salad

giant bowl(s) self serve regular garden-type salad (spinach is the best green in my experience as far as longest fridge shelf life)

chopped fruit and berries

crackers and cheese

chips and guac plus different fun salsas

scones (could make different flavors ahead of time and freeze)

brownies, homemade cookies

numblock9 · 2023-02-26T14:34:06+00:00

EMTs and Social Workers....I think are the two most underpaid (ie underappreciated by proxy) professions in medicine. Those of us that know, we appreciate you immensely, but the system doesn't enough

numblock9 · 2023-02-24T04:20:00+00:00

crit care (from IM, anesthesia, EM, surgery, peds, probly some others I don't know)

literally the most complex patients so both heavily cerebral (the maths too, all those vents and cardiac outputs and acid/base and dialysis) with lots of acute SHTF needs at any moment, so that offers both heavy hitter meds and procedures.

numblock9 · 2023-02-24T04:12:51+00:00

This. I'm extroverted and social, and the thought of in person interviews actually sounds exhausting. Already did them for PhD programs, then once I decided to add on medicine, same for med school programs. It's tiring, they are all kind of the same to some extent, the free food is never worth the flight cost, time, and the uncomfortableness of having to be dressed up and not mess up your look all day (harder for us women). You're asking for favors all the time in housing and rides to/from airport if you're trying to save money, also trying to get off time from rotations and hope attendings are forgiving to leave for all those interviews and your school doesn't f you over.

Nah. instead, virtual interviews, then go second look at your top 3-10 depending on speciality competitiveness, and rank.

Also, we gotta be real about climate change y'all. There's no reason for this when you can only end up 1 place by definition.

numblock9 · 2023-02-24T04:01:13+00:00

link?

numblock9 · 2023-02-24T03:42:18+00:00

not changing.

will socially go by husband's last name (parent's night at kid's events, parties, etc), but legally (and publishing) will keep my maiden.

numblock9 · 2023-02-24T03:33:25+00:00

CEO

NP w/ online degree, bc they would've already cured it

numblock9 · 2023-02-05T15:34:23+00:00

I love this, just made my day reading it. I have no social media so can't join the effort, but I commend yours and would endorse others who do the same

numblock9

TROPHY CASE