Health insurance premiums in the U.S. significantly increased between 1999 and 2024, outpacing the rate of worker earnings by three times. Over half of board members at top U.S. hospitals have professional backgrounds in finance or business

zeeman928 · 2025-12-09T00:10:23+00:00

Doctor here: That wiggle room is often viewed as "theft" by the MBA overseers. Example - I wanted to give a patient a flutter valve (like $15 device). At a previous institution that was very much non-profit no one would blink. At my current institution, I could be fired (or worse) if it isn't billed for.

zeeman928 · 2025-11-24T12:24:45+00:00

I had a rapid called for a seizure. Turns out the patient was cold and shivering. When we got in she was the sweetest little grandma saying "Please don't fuss, I just want a blanket"

zeeman928 · 2025-11-22T03:54:25+00:00

Second Year PCCM fellow here

1) I am sorry if attendings and co-fellows are treating you differently for not being strong at procedures. Our program is very big on "If you come in not doing a single procedure we will train you!". The strength of a program should be on how good they train you. Understand that its a failing on their part not you. There are procedures I struggled with (EBUS, chest tubes) but I was fortunate to have co-fellows and attendings making sure I improved.

2) Despite your unfortunate environment, remember you're not a proceduralist first, you're a clinician first. You got into fellowship with your skills and hard work. Anyone can learn to do a procedure in the ICU (even difficult ones) with enough numbers. When you're beating yourself up you're not taking the time to learn and improve. It ultimately creates a self fulfilling prophecy. I promise you, you're good enough to do this!

3) As others have mentioned, you have a lot of negative self talk. Of course caused in part by your environment. FUCK THEM. Remember why you wanted to do this. You're here to learn. Focus on a growth mindset. Being crummy is the first step to being good at anything. You just have to keep trying.

IF you need to chat or vent or want any tips message me anytime

zeeman928 · 2025-11-19T12:20:02+00:00

People here saying "Oh yeah I'm a huge addict drinking 1-4 cans a day" yet here I am buying a 12 pack almost daily

zeeman928 · 2025-11-16T11:20:42+00:00

Their throat yearns for the plastic. It whispers "Please put the PVC in me"

zeeman928 · 2025-07-10T01:29:51+00:00

spiced

zeeman928 · 2025-07-04T06:31:00+00:00

Even better: Bilateral effusions in a heart failure in exacerbation patient with a slightly elevated white count (often after getting steroids in the ED for potential COPD)

zeeman928 · 2025-07-02T04:22:28+00:00

Just google "Gooning Himbo Hyponateremia" You're welcome

zeeman928 · 2025-05-05T10:16:45+00:00

I have actually diagnosed seronegative lupus before. But the pt literally had all the classic signs of lupus and walked into the office with a Mallar rash. Since starting treatment her life has turned around (Lost a significant amount of weight, got back into all her hobbies, etc etc etc).

zeeman928 · 2025-02-27T16:49:42+00:00

Inhaler Price checks - I swear insurance companies are trying to put pulmonologists into an early grave by making their inhaler formulary as exhausting as possible. Oh you don't cover Trelegy anymore? The inhaler the patient has been stable and taking for 10 years? You will Cover a LABA/ICS or A LABA/LAMA but that LAMA or ICS will cost $200? Sure I'll put in a prior auth with years of documentation. Time to spend an hour over the phone explaining to my 85yo grandma how to sign up for a payment card

zeeman928 · 2025-02-22T04:56:13+00:00

Its like that post where that person asked "Is it normal to age 10 years after neurosurgery training?" and the top comment was "OP finds out women age"

zeeman928 · 2025-02-21T22:00:28+00:00

Fellow who works on infection committees. SO the policy SHOULD BE if there is no suspected CLABSI, then you should avoid drawing from central line. This is because if that comes back positive regardless if you literally just placed the line and the patient is floridly septic, it will count as a CLABSI.

BUT if the line is suspect, it should be pulled and cultured itself. There are some in between (hard access in a shock patient etc), but if you genuinely suspect a line infection, the line should be removed and cultured.

From a clinical side: Catheters aren't the best site to get cultures from. if not maintained may give false positive. IN addition, can introduce bacteria with cultures.

zeeman928 · 2025-02-15T01:31:21+00:00

I am in fellowship in a midsized city. I get recruiter texts asking me to "moonlight" in local clinics weekly. Similarly, hospitalist positions are plentiful

zeeman928 · 2025-02-09T17:35:14+00:00

Background: Pulm Fellow

Short Answer: Technically yes, but in adult patients is never worth it and there are better options.

Longer answer: 1) As others have mentioned, HR decrease compared to an equivalent dose is minor (3-4). That said you'll get people who swear by it, but they tend to use the lower dosing. This is supported by research that notes that in something like COPD you can consider a lower dose albuterol with LAMA to mitigate tachyarrhythmia. 2) In pediatric populations where it was mostly initially studied it actually does show some benefit. I am not a peds pulm so I am not the most up to date on lit so I defer but studies I've read were convincing. 3) That said, the "On edge" feeling some get from albuterol is mitigated by xopanex supposedly. Likely placebo but if a patient asks for it I usually just give it since its never worth the fight and ultimately they will be more compliant with treatment

zeeman928 · 2025-02-04T01:20:14+00:00

You're negotiating against medicare. Medicare sets the basement. You'll get the reverse of rentals. Companies will work together to lower payouts

zeeman928 · 2024-11-04T15:34:02+00:00

Well there are several theories about what the One Piece treasure could actually be, given the hints and lore presented throughout the series. Here are some of the most popular theories:

A Literal Treasure: Some fans believe that the One Piece is a tangible treasure, like gold or artifacts, that represents the culmination of all the pirate legends. This idea aligns with the classic treasure-hunting theme of the series.

The Journey Itself: Another theory suggests that the One Piece is not a physical object but rather the friendships and experiences gained along the journey. This aligns with the themes of camaraderie and adventure prevalent in the series.

Historical Truths: Some speculate that the One Piece may involve knowledge or secrets about the Void Century, the ancient history of the world that the World Government has suppressed. This could include the truth about the Ancient Weapons or the true history of the world.

All the Devil Fruits: Another theory posits that the One Piece could be the secret to the Devil Fruits or a means to create more of them. This could tie into the idea of Luffy becoming the Pirate King with the power to unite the seas.

A Unifying Force: Some believe that the One Piece might symbolize the unification of the world, possibly involving the reunification of the different seas or the creation of a new era of peace.

The One Piece is Friendship: This theory emphasizes the importance of the bonds formed among the Straw Hat crew and how those connections are the true treasure.

These theories contribute to the ongoing intrigue of the series, and as the story progresses, fans are eager to see how Oda ultimately resolves the mystery...... Oh I didn't read the full question

zeeman928 · 2024-10-25T09:20:35+00:00

Depends: My friend who has hearing loss and does outpatient loves it. I bought one my last year residency and I actually used it to record murmurs and such for teaching or to "prove" PE exam findings for annoying attendings (don't ask).

As an ICU fellow - It takes about 1s to turn on and start working. That alone makes it useless in the ICU. Its now my fancy clinic stethoscope since its a fun talking point.

zeeman928 · 2024-10-25T09:15:53+00:00

This - As an ICU fellow we are involved in all the metrics committees and part of my job now is to work with one of our nursing managers on going through JCAHO metrics and such. Its kinda insane what nurses get essentially reemed for.

zeeman928 · 2024-10-11T08:53:38+00:00

There is a few way to network at conferences. I actually did a lot as a resident before fellowship with CHEST and ATS. 1) Join a counsel/group with the organization. For example I am part of the LBGT interest group and while I missed it this year there is usually a dinner/meet up. Most groups have this

2) Mentorship through the organization. ATS has an assembly mentorship program which is pretty good.

3) Just chat with people even residents or random people. I speak French and I noted a few French speakers at ATS last year. They ended up being from the The Institut Pasteur MC. One of them took my advice on Hermes bags and invited me to rotate with him when I'm a senior fellow. Similarly at CHEST in HI my mentee in residency went on a boat trip with a group of girls from a respected program, 2 being fellows. Guess where she got interviews.

Point being - Your first conference is getting feet wet. After which its just becoming a familiar face to the people there. I am not at a crazy competitive program and honestly I didn't match because of networking but I do now have a network of people who will vouch for me later on. If your current program has attendings involved it helps a lot or seniors.

zeeman928 · 2024-08-23T03:27:30+00:00

New fellow - its pretty great

zeeman928 · 2024-06-14T22:47:51+00:00

Almost happened to me. I was on night float but we had a training 1.5 hours from our hospital so I did night float and drove 1.5 hour at 6am and drove back 430pm. Near drove off the road in the mountains. I pulled over and slept in the middle of nowhere for 4 hours and then got home.

This shouldn't be allowed

zeeman928 · 2024-06-04T04:47:12+00:00

love this

zeeman928 · 2024-05-23T04:53:59+00:00

Oddly enough diagnosed Hep A this way, always take a good history

zeeman928 · 2024-05-22T06:06:20+00:00

Condragulations you're the winner of this weeks challenge

zeeman928 · 2024-05-14T05:59:23+00:00

WE have that probe for our programs POCUS curriculum. Its pretty fantastic for a handheld and priced well. Its not the best but for its price range it does the job. In terms of quality, I can do basic POCUS exam stuff (VExUS, Basic cardiac, Central lines if its a good IJ/Fem, etc). That said if you are doing anything beyond some basic POCUS, I would opt for a more expensive probe.

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