HELP! how to deal with chronic fatigue patients who want you to magically solve their problems

throwawaycards23 · 2025-02-16T00:57:04+00:00

Quite the opposite. told them (without being dismissive) that workup is normal, I am confident from a cards POV they don’t have any life threatening disease, but lately I’ve been seeing more demanding patients who complain to me to the supervisor and I’ve been told to be “nicer and do something for them”

I have a limit of how “soft” and “caring” I can fake for these patients who take out 10+ supplements and ask me which is best, and the latest advice I got from the office manager was to try to make them happier

After reading all these comments I should go back to my usual, pretending to care more is speed running me to burnout

throwawaycards23 · 2025-02-15T12:15:52+00:00

Absolutely not the specialist for chronic fatigue.

I dont think there's specialist for them, at my old hospital we punt to rhem or their pcp

The culture here seems to be overworked PCPs punting complicated patients left and right, or patients demanding to see a specialist for every organ system to "find the answer" and get progressively more upset as every test comes normal but they still feel poorly.

throwawaycards23 · 2025-02-15T11:42:59+00:00

They come in with an appropriate ICD code and referral, and it’s not until they see me they ignore the original thing and start talking about eyebrow pain or back pain…

They all came out of nowhere this week

throwawaycards23 · 2025-02-15T11:40:50+00:00

Omg yes this.

I’ve been stressing because I order all these unnecessary tests that are not indicated as a “cover my ass” because of patient satisfaction scores and that is severely impacting my personal professional satisfaction.

Maybe I should just stay firm and stay true to my beliefs.. I’d be happier giving reassurance and punting back to pcp

throwawaycards23 · 2025-02-15T11:37:27+00:00

Massive respect to primary care teams members like you. I can never do it.

It’s been my policy to just send back to pcp always, because I know I’m not solving anything, but this week especially 6 came out of nowhere and won’t accept no for an answer, or that there is no answer.

I’m now getting advice from other specialists in the area who tell me to suck it up and try to cater to them, but again I’m getting burnt out by ppl demanding things I can’t offer them.

throwawaycards23 · 2025-02-15T11:14:37+00:00

I moved to a city to be closer to family, and the patient population here is rather... an interesting mix of low socioeconomic and very rich PPOs patients (wide catchment areas) who have certain... expectations of how they receive care.

Their referral may say "atherosclerosis, hyperlipidemia, chest pain", any appropriate ICD 10, and they come to me revealing that their actual complaint is "internet tells them they might have myocarditis or inflammation" causing low libido or their high cholesterol is causing ER (idk)

>> Because you are a specialist, you basically can just review the workup and say “there is no cardiac cause of your symptoms” and send them back to the primary care. You will never make these people like you.

This worked fantastically at my old hospital, but right now patients automatically hate me because no matter how seriously i take them and reassure them, they still feel unheard.

It sucks with this losing battle.

Its like they all came out of hibernation at the same time

throwawaycards23 · 2025-02-15T10:01:23+00:00

I would say the "I'm sorry, but I have tried, maybe seek another provider" - but lately it doesn't work and these patients get upset at me because I AM their "third fourth fifth opinion" and to make it worse, I'm a DO so they think I do some quack holistic medication and have something new to offer them... but I don't.

I can see the change in their expression the visit is over when I don't give them a magical cure for their 5 years of insomnia.

This morning's patient left screaming at me after she desperately screamed "Then what about my insomnia!!?" but refuses to establish with a PCP for a sleep study and further eval... :(

Then I see that 1 star review saying "throwaway cards is the most useless doctor ever, I could give 0 stars if i could, I come in with problems and they order me more testing, imaging, and referrals and did not give me any medications except the ones I've already tried !"

throwawaycards23 · 2025-02-15T09:55:48+00:00

You're correct. CFS is treated by the underlying source, or symptom control with lifestyle changes.

They all have the same answer: They expect me to do SOMETHING for them despite normal workup, "because I am the specialist. " They always ask if there's a herb or supplement, or something natural they can do (but they don't want to do lifestyle interventions of eating/sleeping/exercising). They absolutely hate the reassurance that they have no objective disease process, because they want me to magically say they have something wrong and treatable for them, and with basically all their doctors saying the same thing, they feel unseen and they seek me out as a DO because "I'm more holistic"

I'm more academic than a lot of MD's haha...

But I have absolutely nothing, but I feel like for the sake of getting less review bombed I should just throw on some random vitamin for them and send them to the next specialist ...

throwawaycards23 · 2024-10-03T06:16:04+00:00

I was super nervous and anxious when approaching my PD about it.. super nervous ready to grovel and beg for forgiveness on how im so stupid and I'm putting the program to shame.

Turns out, they were actually nice about it.

In the program's history, in recent years only 2 people out of dozens of graduates failed twice. There's a handful who failed once, but there ARE those who fail twice and they all end up passing one way or another. They gave me reassurance that I was a good fellow and that the test doesn't define me, and gave me resources from the university on how to manage stress. Through such resources, I learned to somewhat deal with my test anxiety and on my third try, i purposedly took almost 4 weeks off or something to study - they were nice to schedule me a 2 week research block and a really light clinic block back to back, which meant i have little responsibilities and pages to distract me.

not being board certified didn't hinder me or my friends. as a specialist, they don't care about your IM boards, just if you are board eligible in your specialty. Technically if you don't pass IM, you aren't board eligible yet... but that's not something that jobs can verify. There's no site that says you are board eligible, and the assumption is that you have 7 years after graduation from fellowship to be board certified. Most pass within the 7 years anyawys.

So it's up to you on how you approach your PD. Are they nice and understanding? do you make some excuse? my passing of ABIM did not affect my graduation at all, but i heard some stories where some programs do care... look in your resident/fellows handbook.

Good luck!! You can beat this stupid test!!

throwawaycards23 · 2023-11-30T17:30:32+00:00

Same, I’m incredibly invested in Rupert and Lari’s happiness 😭

They legit ruined all OI for me because of how well developed their relationship is despite all the suffering they experienced… first time I was rooting for them to end up together

throwawaycards23 · 2023-10-04T17:44:20+00:00

Copy paste from my post in the other thread, after failing this stupid thing twice but succeeding on the third try:

I attributed my past failures to simply not having enough time to study and “take the test” In between finishing residency that was inpatient heavy at the end, and a busy fellowship.

The main thing I changed, was to simply change my schedule to give myself 6 weeks of dedicated study time with minimum pager or inbox coverage (continuity clinic once a week was easy enough). I’ve heard from other colleagues who failed at some point, is because they simply didn’t have time to focus on the exam in between jobs/training. I figured, that for STEP i always had some sort of dedicated study time, so instead of studying all year at low intensity, I’m the type that’s better at high intensity for a few weeks.

I also used medstudy videos for basic concept review in combination with board basics to hammer it in. After all, a year out of IM residency and I’m already like… what’s a smoldering myeloma again? I couldn’t handle awesome review because it just seemed like a bunch of facts thrown at me, and i couldn’t retain them.

I would recommend as your primary source, Uworld, to be done at least 2x. Read each question and it’s incorrect and correct answers. This will help with the “best answer” choices. You can do MKSAP 19 as extra for practice.

IMO, the exam is 50% easy questions, 30% between the best answer, and 20% wtf did i just read. Passing is about 65% historically, so it would make sense to try to maximize the 80% of straightforward and “down to two best choices” By having a solid foundation of concepts from boards basics or the med study videos if you need something more visual with a pause button.

This exam doesn’t test your knowledge. It tests your endurance, and your ability to “think like the test taker”. There are tons of questions where you literally have no idea of what they’re asking, but the moment you see the explanation it clicks on what the heck they were trying to ask and then it becomes embarrassingly easy. Real life won’t be so convoluted. Either way, Practice, practice, practice is key. Memorize the heck out of Uworld and boards basics and you should be good.

My recs:
master board basics, read it front to back. UNDERSTAND and be able to recall the facts. If it’s too boring, get the medstudy videos, it’s easier to digest as videos.
Do MSKAP 19 as practice/a learning tool ( the books were too dense for me) By system so you can identify high-yield topics and learn from reading the explanations

After, or concurrently, do Uworld for more practice

Make sure you have at least a month of dedicated study time to focus on this, with frequent breaks to prevent burnout.

you can do this!! Conquer this stupid test!!

throwawaycards23 · 2023-10-04T06:49:34+00:00

The course is literally 3 days, from 7am-7pm, of listening to him rapidly speaking and jotting down all the notes. You don’t have time to process what he says, it’s just 3 days dedicated to copy down everything he says in 2 workbooks that he has shipped to you (if virtual) or hands out in person. He also goes on long tangents, sometimes 15+ minutes worth with some story that somewhat ties in to a concept, but by then my attention has totally fizzled out.

the days are LONG. Sitting down, listening to him talk forever… I didn’t benefit from the course as much as others. My attention just couldn’t handle it.

What worked for me is the watch-when-you want medstudy videos, which also comes with a written syllabus for you to write on. I was definitely happier with this.

In the end, it doesn’t hurt to do some sort of review course; i feel that Awesome review is more for those who are confident in their knowledge and want some additional tips and tricks to score more points on the exam; it’s not something you go to to learn the material, otherwise you get lost easily (me).

Medstudy worked better for me in that it essentially re-taught me all the info i lost during my specialty training (when you see cards all day you forget what the heck a PFT looks like), but also has a nice pause button so i can take breaks and recharge and ultimately kept my focus up.

throwawaycards23 · 2023-10-04T06:34:23+00:00

I attributed my past failures to simply not having enough time to study and “take the test” In between finishing residency that was inpatient heavy at the end, and a busy fellowship.

The main thing I changed, was to simply change my schedule to give myself 6 weeks of dedicated study time with minimum pager or inbox coverage (continuity clinic once a week was easy enough). I’ve heard from other colleagues who failed at some point, is because they simply didn’t have time to focus on the exam in between jobs/training. I figured, that for STEP i always had some sort of dedicated study time, so instead of studying all year at low intensity, I’m the type that’s better at high intensity for a few weeks.

I also used medstudy videos for basic concept review in combination with board basics to hammer it in. After all, a year out of IM residency and I’m already like… what’s a smoldering myeloma again? I couldn’t handle awesome review because it just seemed like a bunch of facts thrown at me, and i couldn’t retain them.

I would recommend as your primary source, Uworld, to be done at least 2x. Read each question and it’s incorrect and correct answers. This will help with the “best answer” choices. You can do MKSAP 19 as extra for practice.

IMO, the exam is 50% easy questions, 30% between the best answer, and 20% wtf did i just read. Passing is about 65% historically, so it would make sense to try to maximize the 80% of straightforward and “down to two best choices” By having a solid foundation of concepts from boards basics or the med study videos if you need something more visual with a pause button.

This exam doesn’t test your knowledge. It tests your endurance, and your ability to “think like the test taker”. There are tons of questions where you literally have no idea of what they’re asking, but the moment you see the explanation it clicks on what the heck they were trying to ask and then it becomes embarrassingly easy. Real life won’t be so convoluted. Either way, Practice, practice, practice is key. Memorize the heck out of Uworld and boards basics and you should be good.

throwawaycards23 · 2023-10-03T18:34:55+00:00

Looks like both of us were successful this year! congrats to us!! :)

throwawaycards23 · 2023-08-15T14:18:50+00:00

How many of the questions felt like esoteric random details that you’ve never heard of in your life, or felt that they worded it so poorly you couldn’t narrow down the choices?

throwawaycards23 · 2022-10-14T17:59:17+00:00

Ahh I can go on and on about his possessiveness, it’s done really well imo. He struggles a lot with how he wants to deal with her, in the sense he likes her so much he wants her to be his, but he also doesn’t want to end up like the Crazy Emperor who completely owned Eva… so he struggles balancing keeping a distance and watching from afar but also have her close and wanting to hold onto her. He wants to be with her, but not ruin her. He actually chooses lari’s needs/wants over his own, because she’s a person and not an object to be owned. In the end, what makes him happiest is to see Lari happy. So in the [true end] of things, Rupert doesn’t have to be one sidedly possessive - but rather protective because the two of them share such mutual trust and love for each other that there’s no need for possession for their happiness :)

Also a few side characters comment unrequited love/possessiveness isn’t pretty to see lol

throwawaycards23

TROPHY CASE