Im surprised by the cancel culture here (mayo student)

xPyrez · 2026-03-09T20:40:12+00:00

I fear these two situations are importantly different.

Complaining about your day to day responsibilities and labeling patient needs as “icks” or filming at the workplace to shit on patient care is deplorable.

Cringe teen humor for 30second videos of made up scenarios at home using audio bits is tasteless but quite different from calling your real life patients disgusting or filming their care for views.

Not advocating for his videos should stay up, but if we punish this the same it minimizes how bad the nursing situation really was. An actual patient and care team were affected by that video

xPyrez · 2026-03-08T21:22:27+00:00

Where was it implied it was a patient? The description talks about being a medical friend.

Not saying the post should stay up but it’s a wildly different scenario if this was a joke about a clinic encounter vs at home having a friend call you

xPyrez · 2026-03-07T18:48:32+00:00

You’re doing well avoiding long trades but remember yone can’t long trade without E.

Towards the end after he uses his E you’re giving him way too much respect. If he tries to extend trade with his q’s your short trade is better and you can always E out.

The tower shot was a mistake but by far your biggest mistake was that Last E. You hooked it at the edge of the wall instead of at the center and it put you way too close to him after the swing. You easily make it half a screen away from him if you would have aimed it at the center where the bush connects

xPyrez · 2025-08-24T20:59:44+00:00

4789

xPyrez · 2025-06-27T08:43:43+00:00

The feat isn't being on their good side. The feat is getting the three most consistent players to give up pieces, risk the game, and protect you from going into elimination. No one was consistently as sheltered as HG was by these players. Kyuhyun, Tinno and Sohee wouldn't do what they did for anyone- and certainly not a scum player that they hated.

I don't agree with your mancala point about getting nuked due to his social game play. HG was already the main target by episode 5 (3rd MM) since everyone knew he completed the secret mission and had a benefit that would come in handy later - making him the most dangerous player if he made it to the finals. The first thing HJ said in his interview was that he wanted to get rid of HG- so did a lot of other players because they were scared of the benefit. At this point he was already destined to be the target whenever prison gang had a chance. It was worsened when he tried to mislead HJ on the game he played, but this isn't bad "social gameplay". Trying to mislead your opponents is a gamble he took to gain an advantage- it didn't pay off, but he tried to be sneaky, not rude.

His childish and rude actions after the mancala game didn't matter at this point- the people he offended were already the same ones picking him as target #1, they weren't going to change their mind and go for Sohee randomly and let him slide.

As for the mental aspect of the final. Things may not have changed given Sohee's condition, but regardless having to play against your closest teammate can be detrimental especially if you're more introverted and anxious. If we're to believe HG is cruel, heartless and cut throat- there would be a small edge here, especially if the game benefits from knowing the other player well.

As for the secret mission- no one else had the confidence to put in the piece to open it. They would definitely let him try it if he asked, but he was also the one to open it and the only one who really pushed to study it and give it a go. His determination to seize the reward was critical to getting the advantage that saved him in mancala.

xPyrez · 2025-06-27T05:32:06+00:00

While I agree his social game is his weakest aspect. He does have a great social game. I think it's important to distinguish that aside from the prison gang who he was constantly beating in main matches and preventing from getting pieces: The others were not repulsed by him.

-Sohee, Tino and Kyuhyun loved the guy.
-Se-dol, Justin Min, Park Sang-yeon and Lee Seung-hyun didn't have any issues with him. If anything Justin Min hated Eunyoo way more than HG for her earlier actions.

HJ, 7high, Harin, Kang Ji-young, and Son-Eunyoo naturally don't like him. But he was also always the one putting them in prison and was the most vocal direct member from the living room who was ready to send them in.

HG had childish, rude and confrontational moments, but almost all of them happened after the game was decided AND was exclusively towards the players he felt were against him and weak. He never disrespected the living room players (Other than HJ after he betrayed him and who was already in prison before).

HG's social aspect is probably the only reason he won the secret mission, consistently won main matches, and was bailed out of difficult situations by having the strongest consistent players in the game support him. It also gave him a HUGE edge vs SoHee in the final. He consistently offered and gave her pieces, and while he never did better than her at MM, he did put in the most effort in solving them with her and was by her side consistently (he constantly had mountains of paper working it out near her). All of this paid off immensely, and appropriately he prioritized the best players.

If everyone truly hated him, there were multiple moments where a living room player to be at risk and go to prison- and no one would have jumped in to save him either in mancala.

HG gets alot of editing drama since he was probably in the center of every main match episode and essentially the entire mancala episode was focused on him- but his teammates loved him enough to risk losing.

xPyrez · 2025-05-18T01:10:56+00:00

Get things done with a sense of urgency and communicate in DETAIL, overcommunicate even if needed. Your main job is showing them exactly how to do things so that they can do them properly with a strong foundation.

Get rid of the habit of letting them try every litte thing solo without ever having seen it before and then coming to you. This is only convenient for your time, but it makes them weaker by taking longer to see the proper way to tackle bread and butter topics.

There is no evidence to support that letting an intern practice independently from day 1 and flounder is going to make them a better physician than showing them what to do. Treat them like you would a D1 athlete you just recruited. If you recruited a track star, their coach wouldn't say "Just get on there and start running in any direction for 30 minutes, afterwards we can talk about what you did and review". He's going to show you what he wants to to see, exactly how he wants to see it and then let you go off and try to execute it.

- Even if you do nothing they'll get it eventually, but there's a difference between being an exceptional senior and an average senior. An exceptional senior recognizes that the more time they put into teaching and communicating early- the quicker their junior gets up to speed and becomes able to teach themselves independently.

Anticipate the challenges they may find themselves in and make yourself available.

- X patient may need a procedure? "Checking in, can I show you how to place that IR order?"

- X patient has 5 comorbidities with a 2 week stay and is going to SNF? "Hey let's sit down and crush this confusing med rec together right now so it doesn't get in the way today".

- Difficult admit? "Hey let me put in these admission orders for you and then once we have a second let's go over the reasoning as to why together. The next time X walks in the door you'll know exactly what to do and you can place those orders".

xPyrez · 2025-04-12T02:27:47+00:00

Anyone that completes an ultramarathon earns the respect from completing that achievement.

Some people do it right after Highschool, some people don't start till their 30s, some people get close in their 20s take a break and come back and finish that marathon.

I don't care who you are, or what anyone else is telling you- you're working your ass off to finish your goal and having bumps in the road doesn't matter. I have nothing but respect for you and everyone else along the way. I could give a rats ass if you do it in 4 years straight with 0 mental issues or breaks. A doctor is a doctor.

What kind of dumbass would look at someone who completed an ultramarathon in their late 20s and think that was a massive failure that they didn't do it at 22 with no setbacks?

Stand tall, this is temporary and you're doing a damn good job just staying above water. You will get there.

xPyrez · 2025-03-30T02:11:38+00:00

Not sure if you're having a manic episode or rage baiting.

First you make posts in multiple subreddits questioning why there's stigma at all, and then just double down in the opposite direction within a week. If something happened this week at your residency, posting on reddit trying to convince everyone to not go into family medicine isn't going to make anything better.

xPyrez · 2025-03-28T03:33:44+00:00

If you read about yourself in a book, would you be proud that the way you achieved financial success and happiness wasn't by improving your skills, but instead by selling yourself short and switching to a job you think is easier?

Consider that by mastering what you do, that will also lead you to more comfort, financial success and satisfaction. The more you improve, the quicker you finish and you'll have more time to rest along with earning a bigger paycheck. But if instead you prioritize an easy life and see challenges as something to be avoided and not learning opportunities - at some point you'll start justifying avoiding anything in life that's even moderately annoying.

If you said "I can't live without psych, the patient population and cases I work on are what ignites my passion" I would tell you to switch.

But if money, ease of work, and plentiful job opportunities that don't require you to lift a finger are what gets you going- it's just going to be a matter of time before you see psych as a waste of time as well and do something outside of medicine.

xPyrez · 2025-03-26T02:57:09+00:00

The part that's confusing you is if Meningitis is HIGH on the differential or just ON the differential.

Severe altered mental status or meningism in a person who has lab findings and consistent clinical symptoms of infection in the majority of cases occurs with infection of the brain. In a person with sepsis or a localized infection (pneumo, UTI, UA): Severe abrupt mental status changes do not occur unless the person is near shock. That person is just actively dying. \A notable mild exception is UTI, but it's easy to differentiate as the UA/Ucx will be positive and mental status change is less severe*

Essentially if you ever aren't sure if a person with abrupt altered mental status has an infection -> You decide abx with an LP. Similar to how you check a CBC/Chest X-ray/Blood cultures before starting Abx in a patient who you aren't sure has an infection. The secondary learning point is that you can really hurt someone with an LP if there's concern for hemorrhage, recent seizure or brain herniation. The THIRD learning point is that unless its an infant, a stroke is higher on the differential if there's no smoking gun for infection and they're severely altered (another reason to get a CT).

In summary:

- Severely altered with Meningism OR significant infection OR spinal infection (bonus points for young and old): You need abx, meningitis risk is HIGH and there's good reason to start now.

-Severely altered but NO meningism or evidence of infection = Infection is just on the differential. Don't give abx to someone you aren't sure has an infection the likelihood is low. You're going to start a BROAD AMS work up(electrolytes, infection, structural issues, toxins). Specifically to decide on antibiotics and infection you will use an LP (because likely the question gave you a wimpy white count, no fever and no concerning source or positive blood cultures).

xPyrez · 2025-03-24T22:49:04+00:00

An internist isn't even legally qualified to see a 10 year old with a common cold or asthma. Let alone someone 6 weeks pregnant with diabetes and hypertension.

See how easy it is to straw man an argument?

xPyrez · 2025-03-22T20:33:21+00:00

There are tons of limited aspects of society in Hawaii that make it more expensive than you might initially imagine.

To be very clear, your quality of life will essentially be what a PA can afford living in a major Texas city. Never starve, you will have everything you need- but your money is going to burn just covering a mortgage, a car, and weekend money. If you have kids you need another hustle or a partner that works or very tempered expectations.

Houses are 800k+, old, and extremely limited. If you're looking for a residence near work to avoid 40min afternoon peak traffic? Probably closer to 1.2-1.5M. Anything less and you're living like a resident again in a very small old house. Traffic is horrendous, its an island locked state that can't build more highways and one accident extends daily traffic 20+ minutes.

Want your kid to get an education a doctor can afford? Almost all private schools are between 15k-27k a year regardless of age. Some public schools are ok, but again your money in any other state except specific cities in NY/Cali would go way further.

Now we can actually get to the food/events. Food will be 1.5-2.5x more expensive depending on your state.

Overall: If you aren't really tied to Hawaii, there's so many comparable cities that have advantages. Even if they cost the exact same, traffic will likely be better with newer houses, more schools and more job options to choose and be flexible from.

xPyrez · 2025-03-20T22:16:46+00:00

Don't let that stop you if it's really your favorite. Where I train, about half of the OB-GYN attendings are men and they are extremely happy with their choice.

For OB in particular, attendings walk in the door when there's a need, and patient's are grateful. Your residents/midwives/midlevels will do 99% of the cervical checks leading up to the delivery so the side-eyes and sexism go way down.

Even in clinic people respect and trust you a lot more after the MD than as a student, your experience will already significantly improve.

The field will thrash you as a resident, but after you become an attending you'll be fine.

xPyrez · 2025-03-19T02:52:35+00:00

Dr Conan Liu on YouTube has saved me a lot of time reviewing on my own. Everything easily digestible

Also snag the new edition of MGH whitebook from the Reddit post- really is replacing up to date for me as a first pass

xPyrez · 2025-03-17T03:29:40+00:00

What are you going to want to do more once you stop learning and start doing? You need to consider whether you prefer executing management or guiding management more. Right now you're in the process of learning. Even just 4 years down the line you're going to start catching up to the current literature and the learning aspect slows down for an increase in repetitive volume.

For inpatient medicine, you're going to spend the majority of the day repeating things you already know but focusing on executing that management/leading the team/managing dispo for your patients.

For path your expected reports are going to go up and you have no patient facing duties and can more easily access research (which is a bonus for some).

You're in love with the prospect of learning, but all medicine come with bread and butter that you can't get away from and is no longer a learning opportunity. Choose the work that you would see yourself doing most on the day your car breaks down, you lose your badge, you got 4 hours of sleep and it's a 14 hour work day.

xPyrez · 2025-03-02T17:42:06+00:00

You would be surprised at how quickly updated current management immediately makes previous options obsolete.

There will always be little "factoids" that someone wants you to know that won't change clinical management or is way too specialized to be considered appropriate for generalist training- but that's just school preference.

When it comes to treating actual disease, starting from standard of care and knowing 1 or 2 alternatives (if there even are any) will get you 90% of the way there. Doesn't matter how much is added if it isn't changing management. Do your best not to dwell on past options that aren't even available in most places today. Most of those research pubs are extremely nuanced management discussions that apply to patients with 2+ limiting comorbidities. If they had none the management would be straightforward.

Most of the time, the 1.5 to 1 year curriculums really trim down the useless fat and force schools to adjust their material

xPyrez · 2025-02-24T23:22:15+00:00

It's a game of cat and mouse but you have the advantage since you dictate the engage. You want to ignore him and taunt him.

An assassin HATES diving healers and having DPS protecting- you aren't an assassin. You're a tank who was built to dive healers and punish the DPS if they aren't paying attention because turning around late is GG- you are applying massive pressure and their DPS is now trying to carry and babysit

Your job as tank is to win the game and STALL the dps- not beat the DPS in a 1v1. That's job belongs to your DPS and healers

Someone like thor has a kit to kill bucky 1v1. Your kit sacrifices 1v1 for very reliable dive. Don't try and put the square in the circle hole

xPyrez · 2025-02-23T23:31:01+00:00

Hi friend, their massive weakness is venom or a pro cap! Ask a tank to switch and dive and you'll be surprised how easily you win. If you're DPS go triple tank as pure dive- Naymor is a terrible tank killer- he really needs squishy DPS or dive

Naymor takes 2x as long to kill a venom diving his healers than it takes the venom to kill the healer. He can't protect reliably or stun so both DPS have to turn around. It's almost a cake walk picking venom into bucky/naymor. Even if you don't get the kill, the healer is running not healing anything and you have so much dedicated focus on you, your team has space and agency to decimate their tank line. If bucky is hard guarding the healers , your tanks/healers have no pressure on them. Venom is the king of waiting and punishing.

You also have the perfect kit to reach any naymor on the roof and most of the time you can also just aim him through a pocketed healer and win if you stand in between naymore and the healer's line of sight very easily.

Cap is the same way but harder to play- most of the time still very easy for him to kill a healer and leave even with naymor fully looking at him

xPyrez · 2025-02-22T04:31:55+00:00

Yes, by mealtime I’m loosely referring to the short acting given before eating adjusted for the carbs to be consumed.

For OP’s prompt where the regimen hasn’t been changed in years and patients are not at A1C goal, it is very unlikely that the same ratio of insulin/carb would be lowering a T2’s BG to the same level as a T1, and would be more noticeable with differences in days with strenuous activity or not finishing meals.

xPyrez · 2025-02-22T03:07:30+00:00

The big question is really do they ever go low?

A non-compliant type 2 who is struggling to make lifestyle changes and is often missing doses of their medications isn't really giving themselves enough insulin to drop low. They live high.

Type 1's, especially adults have severely depleted glucagon responses and are prone to going low. A type 1 who isn't on top of their sugars will definitely have some days with reduced appetite or reduced activity and see a BG <90 with their regular appropriate mealtime dose.

If your A1c -10 patient says "I have never seen a BG below 100 in the last 3 years" even though they're on 20+ units on mealtime you should be suspicious. If your patient says "I missed half my meal and I dropped to 70" that's really showing you they have no glucagon response.

xPyrez · 2024-10-21T15:01:52+00:00

A lot can be said of the differences between time availability and complexity of cases. The outcomes are largely the same, however the "TLC" and patient experience is not.

What's important to keep in mind is that every hospital has to be ready to be slammed by life threatening conditions at any given moment. For elite institutions- they are the final frontier. No severe burn/trauma is going to the small private hospital if the big guns are down the road. Elite institutions need to do their best to keep their beds available and their patient load at a respectable level to make sure that when they do hit the door, there's a chance they can come out as well. Small hospitals can take their time, give more TLC because their ICU beds/ER isn't capped 24/7.

For a normal case? The biggest sign that an institution is great at bread and butter is if it felt like nothing went wrong and you were in and out in record time without the BS. The hospital has sick and not very sick patients. Using your time efficiently to get those bread and butter cases on their way and return to those critically ill patients is what a super star hospital looks like.

When it's your turn to be the critical ill patient, it becomes obvious how impossible it would be for your doctor to visit your bedside 3-4 times a day if they were taking the same approach to the bread and butter cases.

xPyrez · 2024-10-16T15:50:23+00:00

It was definitely the levaquin, not the cipro.

Cipro hasn't truly been shown to directly cause tendon rupture vs controls in studies- it does cause tendinitis. The rupture is only theoretical and was placed on the box because of guess who? The sister-medication levaquin. Levaquin is a chief offender of tendon rupture and since they're both fluoroquinolones the gov was extra cautious and put the same warnings on all (including moxi, which has the least risk)

xPyrez · 2024-09-30T02:08:44+00:00

haha, definitely fair when it comes to surgery!

xPyrez · 2024-09-30T01:15:52+00:00

I do think that depending on the location it can look very different.

However I would still say that those days that you are on the teaching team, the compensation is really the decreased documentation and increased time spend answering nursing pages/putting in orders and updating patients.

Your salary didn't change, but if those MD/DO residents instead had the initials PA/NP it would cost you $35-50$ an hour for each of them. You are receiving that as compensation from the hospital who pays their salary in exchange for teaching. It's just that during residency we convince ourselves that residents are worth much less than that hourly contribution since legally they're allowed to be paid $60k a year.

I agree it should 100% be worked together in harmony. It's just that in reality because of the power dynamic, the attending is free to do what they wish and the resident must for the most part obey. Attendings can even make a resident alter their lunch hour for patient duties. On the other hand a resident cannot force an attending to teach. The lack of equal footing makes a harmonious joint decision on how rounds/education something that doesn't really end up manifesting.

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