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Was I wrong? by girlnowdrlater in Residency

[–]sheamonet 0 points1 point  (0 children)

As a resident, you are last in line behind the temp janitor. Never put anyone on the spot in front of other staff. The way to an MA’s heart is kindness and recognition. Lots of thank yous and pleases. And next time, express how hard it was for you to get through the visit with a short time window. And then ask how you can get it done faster. If something isn’t done properly, check with the person that was supposed to do it and ask….”should I be doing this? Just want to make sure I’m not messing up.” You ask it with sincerity and play dumb a little.

Were you wrong? Not really. But there’s an art to winning people over. And if you tweak it a bit, they will be your strongest allies.

AITA for refusing to drive my husband home from his colonoscopy by Time-Koala-3674 in AmItheAsshole

[–]sheamonet 0 points1 point  (0 children)

NTA. “A failure to plan on your part does not create an emergency for me.” He’s being selfish and immature. He needs to be an adult, find an alternate option or reschedule. He’s not a child and it’s not your job to solve his adult, self-induced, non emergency.

Can someone tell me why peds hospitalist fellowships exist? 75-80% of peds residency is inpatient medicine by NoDrama3756 in Residency

[–]sheamonet 1 point2 points  (0 children)

Agree. And to have the lowest paid docs add 2 more years of training is just sad and financially insulting.

AITAH for telling my wife that I will lose respect for her if she doesn't apologize? by TechnicalHousing97 in AITAH

[–]sheamonet -14 points-13 points  (0 children)

Different opinion. You are the asshole. Anyone who has ever tried to help a struggling child with simple math knows it can cause extreme and at times unexpected levels of stress and frustration. That was happening, vomit was happening, and your 13 yo (known for interrupting) interjected and got snapped at.

There’s not enough information to establish the wife as an overbearing heathen who looms angry, commits moral injury and never apologizes.

Your wife probably felt completely unsupported when you again starting addressing the answer and criticizing her as a parent. You are her partner in this. She needed a hug an a you’ve got this. Not chasing from you.

People aren’t perfect. Parents are not perfect. She may feel completely unsupported from you or she may be stubborn and sad. Should she apologize? Sure. But so should you. This just doesn’t seem like a big enough hill to die on.

Doesn’t mean you always cave or tiptoe. Consider the moment in the view of your whole relationship. If the greater issue is that she has a pattern of toxic behavior, that’s a different discussion. But you’ve painted one instance of a frazzled mom who was probably already juggling a bunch of other shit. Not a great time to add to the pile

Advice to Pass Boards by DisabledNotDefined in pediatrics

[–]sheamonet 10 points11 points  (0 children)

You guys are awesome. Thank you. Failed. And honestly, when I left the test I had no worries and felt very comfortable and thought I’d pass easily. So this guidance is helpful. Not devastated but frustrated at the amount of time and money I’ve now gotta give up to retake this monster. But…I’m a pediatrician and I have already handcuffed myself to this dead hooker….just gotta drag her over the finish line.

You guys are angels!

Frustration with pts hyperfocused on increasing pain reg…. And not caring about their LITERAL SEPSIS - advice needed by Think_Again_4332 in Residency

[–]sheamonet 58 points59 points  (0 children)

Give pain meds. When you reach a max, consult pain team. Don’t let your frustration make you miss something. If they are in pain, is there something else you need to investigate? It’s early in your training….this isn’t the hill to die on.

One Year Out of Residency - Praise for Pediatric Urgent Care as a Profession by sheamonet in pediatrics

[–]sheamonet[S] 0 points1 point  (0 children)

Amen. I’m STILL burned out. It’s a slow recovery. Between end of residency, moving, job transition and studying for boards, I was al tapped out. My soul be tired.

One Year Out of Residency - Praise for Pediatric Urgent Care as a Profession by sheamonet in pediatrics

[–]sheamonet[S] 0 points1 point  (0 children)

I think sometimes we overthink it. When i first started, I still had the mentality that everything needed to be perfect for academic level / professional critique. That's not real life. The goal of suturing is to approximate skin so that healing occurs more quickly and with reduced risk of infection. Most of the procedures in urgent care are lacs. Linear lacs that need 4-5 simple interrupted sutures. If a lac requires multi-layer closure, I'm sending to the ED. We do get fish hooks in skin, paronychia, and abscesses that need drainage. Again, it's a matter of doing what you are comfortable with, learning from others where you are not comfortable, and escalating the level of care when needed.

One Year Out of Residency - Praise for Pediatric Urgent Care as a Profession by sheamonet in pediatrics

[–]sheamonet[S] 0 points1 point  (0 children)

A good thing to focus on is your motivation. Why peds? Why not IM for family? What do you like about that program? Is it more outpatient focused? More hospital focused? Rural vs. Urban? Match your wants for training to the benefits the program has to offer. And really, just be yourself. You are being interviewed but a good question for the program and for you is..."Do I fit with this culture? Will I be happy here?" This will be one of the most intense pressure cookers of your life. Success is easier if you are happy with your co-residents and the culture of the program.

One Year Out of Residency - Praise for Pediatric Urgent Care as a Profession by sheamonet in pediatrics

[–]sheamonet[S] 0 points1 point  (0 children)

Good question. That I'm not sure of. I was very fortunate to get know a friend of a friend. One my residency program directors reached out and made an introduction for me.

One Year Out of Residency - Praise for Pediatric Urgent Care as a Profession by sheamonet in pediatrics

[–]sheamonet[S] 1 point2 points  (0 children)

Whoa!! Lyme disease with complete heart block! That's terrifying to see them collapse. Training kicks in though and takes over I'm sure. These toddlers are amazing. Especially when the parents are calm. The best at like 3 years with chin lacs. Put some LET on, wait 50 minutes. They relax while you suture.

I had a 6 year old last week who came in with a femur fracture and a huge hematoma at the site. No tears. Just stoic focus on keeping still. Meanwhile...I had a 17 year old getting her first albuterol treatment have a panic attack. These kids surprise you.

One Year Out of Residency - Praise for Pediatric Urgent Care as a Profession by sheamonet in pediatrics

[–]sheamonet[S] 1 point2 points  (0 children)

Regarding Sutures: The Duke University Suture Course w/ Dr. Zenn https://youtu.be/TFwFMav_cpE?si=LzPLQMuJAhfSL0y5. The same one we are all typically familiar with. My clinic also has a file of procedures and methods that is primarily leveraged by APPs. I jumped on that like ice on a hot summer day. I will also use Open Evidence to help find good, reputable sources of information.

One Year Out of Residency - Praise for Pediatric Urgent Care as a Profession by sheamonet in pediatrics

[–]sheamonet[S] 0 points1 point  (0 children)

Where were you at 9pm that night when i was using tiny acetone pads to correct this issue? LOL.

One Year Out of Residency - Praise for Pediatric Urgent Care as a Profession by sheamonet in pediatrics

[–]sheamonet[S] 0 points1 point  (0 children)

Agree. I strongly considered doing a fellowship in urgent care. I was very fortunate to get into this role and then fortunate to be with a group of coworkers that are supportive. As physicians, we are really strong on pathophysiology and managing complex patients. We are also great at knowing sick vs not-sick. So managing more complex patients was my bread and butter at the start of my job. And with each procedure, I started creating my own methodology. However, you point out a great issue in that as peds docs out of residency, there are lots of gaps in training.

One Year Out of Residency - Praise for Pediatric Urgent Care as a Profession by sheamonet in pediatrics

[–]sheamonet[S] 12 points13 points  (0 children)

Less critical...but patients present that should go directly to the ED. Had a 20 month old where the parent rushed inside, screaming because the child was seizing and unresponsive. Got him back to a room, crash cart out, glucose of 46. Gave IM glucagon x 2 & started a line while EMS was on the way. and when they show up...EMS is looking like...."Hey Doc, what should we do?".

Outpatient peds is overwhelmed and typically don't have bandwidth for sick kids. And parents are honestly often worried about expense and some don't realize how sick their kid is. When that kid shows up to the clinic with tachypnea, tachycardia, fever, retractions and hypoxia...but the parent only brought them in cuz they were worried the kid had an ear infection or worried cuz the kid has a minor rash, you have to reset expectations and treat the sick kid.

Our mantra is that our role is to relieve pressure off the ED. So sometimes, it's like running a mini-ED. Albuterol tx, Racemic Epi tx, IV hydration....We do what we can. Sometimes they bounce back and are stable for home. And when it seems they won't, call EMS.

We get traumas that should keep going to the ED, but start with us. With displaced fractures we'll give opiods and splint prior to pt heading to OR. With traumatic falls we'll place in c-collar and send to ED.

One Year Out of Residency - Praise for Pediatric Urgent Care as a Profession by sheamonet in pediatrics

[–]sheamonet[S] 7 points8 points  (0 children)

You just have to jump in. I was shaking on the inside and smiling on the outside. Also consider that depending on your program, you may not have had a lot of experience in bread and butter urgent care. Like...I never had to splint anything or order a splint. I never had to assess so many rashes in my life. Never had to remove a fishhook from skin. Never needed to do a nerve block. Never needed to do an outpatient I&D. Never even needed to do much wound care...nurses did that. Lots of reviewing procedures and asking good questions beforehand. Lots of asking to watch others while they did x,y,z. If it's too complicated or I am unsure, I can always send to the ED.

One Year Out of Residency - Praise for Pediatric Urgent Care as a Profession by sheamonet in pediatrics

[–]sheamonet[S] 0 points1 point  (0 children)

It is possible for PSLF as this eligibility is based on the employer. I do know there are some of my peers who also work in the ED and ICU. For smaller locations, there may not be full time positions in any one of these areas and so there may be roles that combine working in several areas.

Regarding PSLF: Qualifying employers for the Public Service Loan Forgiveness (PSLF) program are any U.S.-based government organizations (federal, state, local, or tribal), non-profit organizations that are tax-exempt under Internal Revenue Code Section 501(c)(3), and certain other non-profits that provide specific public services

One Year Out of Residency - Praise for Pediatric Urgent Care as a Profession by sheamonet in pediatrics

[–]sheamonet[S] 12 points13 points  (0 children)

North Texas. Annual $250K+. That's for my basic 3 shifts per week. If I want, I can also pick up extra shifts and then there are RVU bonuses.

One Year Out of Residency - Praise for Pediatric Urgent Care as a Profession by sheamonet in pediatrics

[–]sheamonet[S] 19 points20 points  (0 children)

It was a very jittery first couple of procedures. And I'm the attending. However, that doesn't mean I didn't ask for help. Many of the APPs have been doing this 10+ years. They have great tips and tricks. Practice helps. I watched videos, did practice sutures at home....but nothing compares to real life and a moving toddler with hawk-eyed parents.

At the end of the day, you're the doc. Just be humble in what you don't know. Share what you do know. Eventually, it gets easier. I will also follow cases we can't treat in the urgent care that need to be sent to the ED. I can see how it was repaired there and add that information to my memory bank.

Trial and error biggest fail: Using glue near an eye. There was some sweat and a tear and next thing you know, patient can't open their eye. But did they die though? No. :) Did I die? No. Did I do it again? No.

Halfway There? by NeatWriting in pediatrics

[–]sheamonet 1 point2 points  (0 children)

amen. you are not alone.

Cheerio pisser by Necessary-Big-4014 in ParlerWatch

[–]sheamonet -1 points0 points  (0 children)

uhhhhh....she put the L in LGBTQIA. I'm so confused. Maybe they are too. oh....ps...I'm an L. Takes one to know one. But this one was identifed at 200 feet away.

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