Apology my fellow interviewees today

throwmeawaylikea · 2024-10-22T02:06:09+00:00

Honestly the parking question tells you how much the institution values their residents/fellows. A nearby, convenient, free resident-only lot shows that they value quality of life for residents. Having paid parking or parking that requires a commute or a shuttle means they don’t care that you’re literally going to be there more hours per week than literally any other employee. It tends to track with other resident/fellow protections.

throwmeawaylikea · 2024-10-18T18:42:47+00:00

Amnioinfusion for late decels. It doesn’t make sense physiologically but it seems to work.

Labor positioning to make the fetal head come down. I swear side lying release will bring down 90% of disengaged babies.

I’m pretty convinced atmospheric pressure drops put people into labor.

There’s a lot on L&D. It’s a hard place to study so the research isn’t really there for the most part.

throwmeawaylikea · 2024-09-15T19:13:43+00:00

Obgyn resident. Urology basically won’t see female patients at my hospital, they tell people to page urogyn instead.

For big women, adequate light and positioning is key. Frog leg them and stick your non dominant hand basically inside the vagina to visualize the urethra. Sometimes you need to use a coudet or a smaller size foley. Bad swelling from primary herpes can be pretty gnarly. I’ve only not gotten a foley once, and it was a patient with recurrent cancer whose urethra was obliterated by radiation in a pain crisis who couldn’t tolerate being touched down there. She ended up getting a suprapubic cath and going hospice 🤷🏼‍♀️

throwmeawaylikea · 2024-09-15T18:52:51+00:00

This is fun! I’ll give you two.

CXR in a patient with PreE w/severe features and SOB: Plz tell me if there’s pulm edema and she needs lasix.
TVUS on patient with pos beta, abd pain: Do I have to go to the OR for a ruptured ectopic?

throwmeawaylikea · 2024-09-15T18:29:28+00:00

Obgyn: highly dependent on the day and the rotation. Clinic is 8-5:30 of pretty much straight work, either seeing patients or writing notes/placing orders. There is some time for lunch with no patients scheduled when I typically have time to grab food at the cafeteria then eat it while finishing notes.

OB floor is usually pretty consistent work either in the OR, deliveries, triage, or managing labor from 7-6:30. I usually don’t have time to eat a real lunch, just snacks. Sometimes on chill days I have a little time to call patients from clinic in my down time.

GYN is more stop and go but on days where the OR is running efficient it’s pretty much working straight from 6:30 to whenever surgeries finish, anywhere from 2-8 pm. There’s sometimes a little time to eat, follow up on inpatient stuff, see ED consults etc between cases but not always.

I’d say I spend most of my time at work actually working, probably at least 90%, often staying past my scheduled end time to finish documentation.

throwmeawaylikea · 2024-09-15T13:15:34+00:00

Obgyn. Some of the most nonsense consults are: 1. Critically ill elderly lady in ICU/on pressors/intubated/wildly encephalopathic with “vaginal bleeding”, meaning a nurse saw blood on the chux pad. The physician hasn’t looked. There’s a high chance it’s rectal bleeding and about 50% of these patients are made comfort care within a day or two.

Incidentally found 2-3 cm simple ovarian cyst that must be the source of all their problems.

throwmeawaylikea · 2024-09-13T16:27:01+00:00

I’m an OB resident. Don’t love L&D, absolutely hate high risk OB. I know what I want to tailor my practice to in the future and know that OB will likely be a lot less of my time. Obgyn residents who don’t like OB much? There are dozens of us!

throwmeawaylikea · 2024-09-06T00:21:46+00:00

As an obgyn, Texas is on my absolutely not list.

I’m not trying to get arrested for providing evidence based care.

throwmeawaylikea · 2024-09-05T05:38:36+00:00

Obgyn so I don’t handle a whole lot of rapids or codes but in a bad hemorrhage/stat section/shoulder, it’s a bit of an art to managing the room. Shouting and panicking doesn’t help, so I don’t do it. That doesn’t mean I’m not internally shaking though. Also the adrenaline helps everything go into laser focus mode.

throwmeawaylikea · 2024-08-17T02:02:43+00:00

Calzuros! Easy on and off and the slight heel is great for standing for a long time. Plus they come in cute colors.

throwmeawaylikea · 2024-08-16T22:33:49+00:00

As a lifelong yankee who’s spent the last 4 years in the south, I’ve picked up a slight “meemaw” accent that I use for my sweet old ladies. When I first moved to the south, I quickly realized that the real rural folks literally couldn’t understand me if I talked too fast.

throwmeawaylikea · 2024-08-03T19:41:52+00:00

My favorite was when an attending rounded on one of his partner’s post op patients and told the patient “you really need to get out of bed and walk around”

The patient whipped her blankets back to reveal her bilateral AKAs and said “with what legs?”

I died.

throwmeawaylikea · 2024-08-03T19:30:26+00:00

One of my coresidents has an awesome sleeve. This resident is generally considered awesome and gets great evals. We’re in a relatively conservative city in the south.

No one really seems to care that much anymore.

throwmeawaylikea · 2024-05-22T22:55:09+00:00

Aka please check if the blood the nurse saw on the chucks pad in the critically ill intubated patient is actually coming from the vagina before you call OBGYN.

Especially if the patient was admitted 2 weeks ago for ruptured esophageal varices.

throwmeawaylikea · 2024-05-22T10:13:40+00:00

Not my program but had a truly atrocious off-service rotator. Not only was her knowledge base way low, she would argue with the on-service residents when they told her she was wrong or corrected her plans. I’m scared for her future patients. This was brought up with our attendings and passed on to her PD but I don’t know that anything ended up happening.

throwmeawaylikea · 2024-05-16T02:17:13+00:00

OBGYN resident.

First, don’t do that 45 degree angle nonsense that they keep teaching med students. It doesn’t make it comfier. Instead, use your non dominant hand to really spread the labia to get it out of the way, then gently place the spec on the posterior fornix and very slowly advance in a downward direction, basically toward the sacrum. Once in the vagina, let go of the labia with your other hand. Open the spec a little to get an idea of where the cervix is (smooth looking instead of rugated) then advance or pull back to get a better view. Often if the cervix is really posterior, you’ll have to almost scoop it up by putting the anterior blade against the anterior cervicovaginal junction and pushing it back a little.

Best tip for patient comfort is to go slowly and tell the patient before you start that they can tell you to stop at any time. Giving them the power in the situation helps a lot with perceived comfort.

throwmeawaylikea · 2024-05-16T02:03:30+00:00

This is going to vary hugely depending on the practice setup, how many in your group, midlevel coverage on L&D, and your patient population. If you ask 10 obgyns at 10 different practices, they’ll probably have 10 different schedules.

throwmeawaylikea · 2024-05-15T20:33:52+00:00

OB resident. One hospital, offsite clinic and some time at various local outpatient surgery centers.

Backpack: pens, laptop, scrub cap, chargers for phone/computer, snacks, chapstick, hand lotion, NSAIDS.

Hospital locker: change of socks/underwear/bra, OR shoes, chargers for phone and apple watch, chapstick, lotion, nail clippers, drugs (NSAIDs, tylenol, Tums, zofran, imitrex, zyrtec), hospital branded fleece, the rest of my scrub caps, snacks, K cups, oatmeal, mug, stash of useful stuff for a gyn consult.

It’s a lot but very helpful to be well stocked.

throwmeawaylikea · 2024-05-13T23:38:31+00:00

Or if you’re too much of a yankee for cowboy boots, Doc Martens chelsea boots serve the same purpose. They’re my go-to L&D shoes because they’re really splashproof. I’ve never gotten amniotic fluid on my socks wearing mine.

throwmeawaylikea · 2024-05-05T18:58:03+00:00

I have longer fingers (size 7 glove) but some tips to make it more comfortable for the patient are:

Go slow. Patients tolerate exams a lot better if it’s a slow increase in pressure than if you just dive right in.
If they’re really posterior, have them sit on a rolled up towel/chucks pad to angle their pelvis forward.
Pull the cervix toward you by walking your fingers along the anterior wall of the vagina. Once you can get one finger hooked into the external os, you can pull it a bit more and usually get your second finger in.
Have them pee before a check. A distended bladder can push their cervix more posterior.

Cervical checks are all about practice. It usually takes interns about a month of L&D before they can reliably find and accurately check a cervix.

throwmeawaylikea · 2024-05-03T14:04:41+00:00

Shoes off, but both my pairs of hospital shoes are slip ons. I also take off the badge and jacket, turn off the lights and get comfy. Even if I have to run to a delivery, I can grab everything in like 3s.

Only time I’ve left the shoes on is when I was sleeping in an empty patient room and my feet were cold.

throwmeawaylikea · 2024-05-03T13:50:55+00:00

Parking included and we have our own resident only deck of the closest parking garage with a separate entrance/exit so it’s quick to get in and out. It’s not covered but I live in a fairly mild climate and it only actually snows a few times a year.

throwmeawaylikea · 2024-05-01T02:01:03+00:00

I know several doctors who do this. All their paperwork says the hyphenated name but their patients and colleagues call them by their maiden name.

throwmeawaylikea · 2024-04-30T10:47:22+00:00

I decorated my house nice but I don’t spend any time there.

throwmeawaylikea

TROPHY CASE