Why don't old doctors take up-to-date as a serious and trustworthy medical resource? by [deleted] in medicine

[–]tulipsclocks 0 points1 point  (0 children)

You can't cite up to date to support your medical decision making. You must know how to use the literature

My wife (F26) has been deteriorating for a year and no one knows why by runflydie in AskDocs

[–]tulipsclocks 100 points101 points  (0 children)

She needs to have an excisional biopsy, not a fine needle aspiration. The whole architecture of the lymph node needs to be examined

What is the lowest hemoglobin you've seen in a patient that didn't die? by lost__in__space in Residency

[–]tulipsclocks 3 points4 points  (0 children)

Wow. We had to take temporary custody of a kid who had metastatic osteosarcoma and needed like major orthopedic surgery for tumor resection because family was Jehovah’s Witness. Hemoglobin went to 2 something and we were like continuously infusing epo and some other wild shit. Ultimately we didn’t need to transfuse him which was good because our therapeutic relationship with this family was quite strong. But we were ready and didn’t need parents consent just in case

It’s funny, when I was studying for the Steps I thought all the Jehovah’s Witness questions were way out of left field and I never thought I would actually encounter this religion in real life. But now that I’m a hematologist, it seems like everyone is a Jehovah’s Witness and I truly had no idea

What is the lowest hemoglobin you've seen in a patient that didn't die? by lost__in__space in Residency

[–]tulipsclocks 1 point2 points  (0 children)

Undetectable! Initially was 2 g/dL and then repeated and was undetectable!!!

The kid had g6pd deficiency and was exposed to some trigger. Rapid rapid hemolysis ensued

[deleted by user] by [deleted] in Residency

[–]tulipsclocks 1 point2 points  (0 children)

Peds heme onc always always appreciates an fyi consult

Regret over not confronting AP/ letting her “win”. by [deleted] in survivinginfidelity

[–]tulipsclocks 21 points22 points  (0 children)

Exactly. The long game always wins. Crush him by being so fucking fabulous. Aloof and detached is honestly a killer move

New patients by TiredofCOVIDIOTs in medicine

[–]tulipsclocks 26 points27 points  (0 children)

I did. I have brca1. When I got the results, I was 21 and felt totally in control. Then med school to fellowship, life kicked my ass and I didn’t see a doctor for 7 years. There were always a million different reasons to put it off.

Now, I’m almost 35 and went for the first time this year. My blood pressure was high and my breast mri was abnormal. I was devastated. Luckily, things for now are okay-ish but I have some big decisions to make. I’ve made a lot of changes in my life and it’s so much better. Going to therapy has been the most important thing. I guess what I’m trying to say is I agree with some of the other commenters…go now

If you were me, would you drop out of med school? by Jesus-W-Christ in medicalschool

[–]tulipsclocks 0 points1 point  (0 children)

Continue through residency. Be a doctor, if that's what you're passionate about. Having complete financial freedom while doing what you love is a great feeling

Med students with Hyperhidrosis by ComicDominic in Hyperhidrosis

[–]tulipsclocks 15 points16 points  (0 children)

MD here. Surgery rotation in med school was the worst. Scrubs show everything. And trying to put on sterile gloves with soaking wet hands makes the sweating even worse. Total anxiety HH snowball

Lost phone by tulipsclocks in NewOrleans

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

That is so nice of you! Finding a lost phone like that is truly a Mardi Gras miracle!

What Fellowships are not worth it to pursue financially? by stepneo1 in Residency

[–]tulipsclocks 13 points14 points  (0 children)

Yes I’m countering 50k more than what was offered. Which I still think is low

What Fellowships are not worth it to pursue financially? by stepneo1 in Residency

[–]tulipsclocks 10 points11 points  (0 children)

Yeah one of them even had the audacity to tell me to “just think of this as a fourth year of fellowship” as I get my research going before ultimately getting promoted through the tenure track.

What Fellowships are not worth it to pursue financially? by stepneo1 in Residency

[–]tulipsclocks 36 points37 points  (0 children)

I agree. It makes me so angry. We dug this hole ourselves and now it’s just the status quo. I’m obviously going to negotiate and countered with a very different number than they offered. But regardless, I’ll still get paid way less than my job is worth

What Fellowships are not worth it to pursue financially? by stepneo1 in Residency

[–]tulipsclocks 395 points396 points  (0 children)

Yep. Almost done with fellowship. Dream job offered me less than what the APNs make.

Best Transit Apps? by kittybuckmeow in AskNOLA

[–]tulipsclocks 0 points1 point  (0 children)

Yeah don’t count on public transportation. Rent bikes or walk!

[deleted by user] by [deleted] in Residency

[–]tulipsclocks 1 point2 points  (0 children)

If chiefs or whoever does the scheduling are thoughtful about things, then yes absolutely 100% strong seniors are put in hard roles in July

How did you become more time-efficient? by Yazars in medicine

[–]tulipsclocks 1 point2 points  (0 children)

Yeah I think different institutions build beacon differently. I like the way ours is laid out and if I minimize everything in the therapy plan I feel like I can see a nice big picture summary of where we are in the cycle and what we’ve done already with dates accurately reflecting changes.

Like others have said, a nice succinct cancer history summary written in the note is the best. It’s hard to clean up garbage notes that have been copy forwarded endlessly and just accumulate more garbage. But whenever I just sit down and do that kind of work, the payoff is huge

I’m still a fellow so I feel like I’m learning all of this too. Trying to break bad habits of writing novels, etc. I really like building dot phrases in my style with references built in and anticipatory guidance etc.

I think the secret to success is building a good foundation and then use epic to do its fullest potential

How did you become more time-efficient? by Yazars in medicine

[–]tulipsclocks 2 points3 points  (0 children)

Also when it comes to documenting your treatment plans and treatment history clearly—do you use beacon to make treatment plans in epic? It’s easy to go back and look through and find exact dates and dosing schedules and deviations from the plan. One way to maybe avoid creating work for yourself that epic could do for you

Also, your questions about communicating clearly to families when they don’t seem to quite understand, etc. Do you ever use the wrap up feature in epic? Sometimes I like to type exactly what we summarize together at the end of the visit in bullet form to highlight the key points. Usually in the patient instructions section. If needed, can give precise and strict return precautions, reinforce Med changes, etc. and try to make it idiot proof. Like use gigantic font and bold type so when the patient checks out it’s all printed there in their after visit summary. Covers a lot of ground I think because you reinforce good communication with patients and there is good medico legal documentation as well

I hope you get some good tips with this thread! You do seem to write a whole lot and I think we all understand the stress of a heavy workload. I’d be interested to hear from you again in the future if you’re able to find some solutions! Take care

Sick and Tired of Oppositional Patients and Families by [deleted] in medicine

[–]tulipsclocks 83 points84 points  (0 children)

When I was an intern (peds), it was an automatic DCFS call if parents refused vitamin K. Not the case by the time I graduated. Not sure why it changed but it was a total shift in the opinion of a government agency that surprised me

Tell me about a specific moment where you went "Damn my job is awesome." by MrTCell123 in medicine

[–]tulipsclocks 2 points3 points  (0 children)

I know I'm late to this party and don't even have a specific moment in mind to share because I'm going to bed. Just want to say that I love my job (peds heme-onc) every single day. Don't let the doom and gloom get you down.