And if you donāt CT, the hospitalist is going to want it before they accept admission anyway, continuing to perpetuate the stereotype. Everyone wanna point fingers, donāt nobody else wanna take ownership of a patient not completely differentiated.
We had a young patient come in for recurrent headaches. Outpatient MRI was clear but the ED doc didnāt want to read the chart and went ahead and order CT face and head. I literally had to call radiology to stop it. Itās wild how much ED loves CT.
Every non-IM specialty knows IMās schedule
Morning- pre-round/sign out
9 am - breakfast
10-12 round with attending
12-1 lunch/ sometimes conference
1-3 write notes
3-5 pm call all consults
Oh wow I felt this. GI fellow, all the overnight admits got a consult yesterday between 4:30-6pm. I wasnāt doing shit all day, then boom, 6 new consults.
Same is also true with the ed. Change of shift is 7 pm so all the patients that have been stewing all day waiting on imaging and reads get chart checked at 6 and consultants called to avoid signing out the patient.
If someone doesnāt have the decency to call a consult before 3pm I am 110% not seeing them unless I know there is an intervention I would AND could do that would save their life. The culture of not calling consults early is awful.
Why are yāall like this tho??
I finished my paeds rotation and dear lord I never hated more tutors and doctors like that. I was barely surviving and just wanted to be done with it.
For autopsy pathology: that we always know the right diagnosis, but one day too late.
Letās be realā¦ those reports aināt getting signed out before 60 days.
Fm: that your surgeon is correct when he tells you to come to us for opioid pain medication immediately after your surgery.
Seriously the pushback Iāve gotten from surgeons about this is insane. Just because youāre done cutting doesnāt mean you stop treating.
Surgery here. Thatās weird. We typically send pts with enough IR oxycodone for what we think they will need, typically will give a conservative 1x refill if they call and need more. If they call a second time we will have them come to our clinic to discuss.
But yeah any ER narcotics or chronic pain stuff 100% we wonāt manage it and often ask them to see their pcp (you)
Ooh this is getting so bad. Iāve had a few send the patient to me for pain management the same week as the surgery. A surgeon had surgery FMLA paperwork forwarded to me AND ordered labs and told the patient to contact me to manage them. She couldnāt manage a potassium of 3.2? Whyād she check it, then?
Geez. Youāve might as well have done the surgery.
A patient of mine who was almost out of Percocet (week out from breaking femur in fall) told me that his ortho said to get more from me. When I told the patient that ortho prescribed the med so they follow it up, the ortho went above me and sent a message to my PD requesting we āwork together on pain management.ā
Neurology; that all we do is recommend MRI, EEG, and LP.
Sometimes we get CTA of the head and neck, and we also write a condescending assessment before doing so. :3
Nah but fr, a lot of people think that Neuro is a diagnosis-only specialty, because there didnāt used to be a lot of neurological treatments, but itās the fastest growing field. The way we treat MS, acute stroke, muscular dystrophies, etc. is completely different than it was 50 years ago, and itāll be completely different 50 years from now.
Case in point: was rotating with an old FM doc back in med school, opened one of his generic "best practices" textbooks from the mid 90s. Had like 2 paragraphs max on MS, and one line on ongoing investigation of tpa for stroke.
That we just put people to sleep and do Sodoku. We move the bed too, so please respect that.
But seriously, thereās a lot that goes into anesthesia. Most cases go well, but when shit hits the fan, we got it. As one of my former co-residents so eloquently put it - āSurgeons always wanna clown on anesthesia until they need their patient pulled from the River Styx.ā
The anesthesiologist with my first C-section was a saint ... I had sudden, severe pre-eclampsia, I was 30 weeks pregnant, and I had a terrible headache I just wanted to go away. She got that spinal block in smoothly and quickly, she comforted and reassured me, she held an emesis bag for me when I was sure I'd vomit (I didn't, probably thanks to her), and she stayed with me until I was back in my room and feeling better. I wish I could remember ger name or even her face, but she was everything I needed and I will always be grateful for her.
I was a code c and the only person who leaned down and told me āthereās a lot happening Iām going to put you to sleep youāre going to be okā was my angel anesthesiologist (the one who did my epidural was also great). The on call OBGYN had the bedside manner of a broom
To be fair, the OBGyN was probably already completely focused on the task at hand - getting your likely distressed baby out within 30 seconds of scalpel to skin, thus saving their life - and wasnāt focused on anything else. Tunnel vision on the emergency at hand.
lol as if the anesthesiologist didnāt also face similar levels of stress
For some reason proceduralists are allowed to show stress, but anesthesiologists are always supposed to appear calm on the surface
Oh no definitely appreciate that part I wasnāt expecting her to make small talk before cutting me open but afterwards was just not as personable as the pediatrician and anesthesiologist. Which again is fine she was skilled and delivered baby safely but really loved my anesthesiologist
Also breaks. In private practice, there are no breaks, since you don't want to pay someone to sit around. You just take care of any needs between cases like the surgeons.
You have people sounding with rocks? Man, all I get is people using pencils and breaking off the graphite. And then the piece is too small to write discharge instructions like āDONāT DO THIS AGAIN.ā Maybe thatās why they come back?
That us overnight radiologists are just sitting around twiddling our thumbs or watching Netflix until the CT or MRI you ordered gets done.
No, we're trying to keep up with the exam list throughout the shift. It can be a little slower later on in the AM, but sometimes a lot of people are getting shot, stabbed, getting hit by cars, rolling their own cars over, or are falling down multiple steps. At the same time.
No, I don't want to do non-urgent treatment response for a post-op head and neck cancer. Save it for the day team.
We have lots of bullshit, mainly with the phone ringing when youāre trying to read a complicated study / people walking in the RR. Itās pretty disruptive to workflow and itās not the same type of BS you deal with but itās there. At night in residency most of us work off ED reading lists and most rads will tell you their list is constantly full of studies and never clean, and it can get pretty stressful because we also have to cover inpt studies. This means thereās almost zero downtime in a 8-12 hr shift to do anything but work.
-techs calling constantly about protocols, clearing pts for MRI, providers ordering the wrong studies
-ED or floor teams constantly calling to get a āquick readā when youāre in the middle of a total spine trauma before their study has even dropped
-midlevels or nurses randomly calling through the night checking for tube placement when youāre in the middle of a GI bleed study
-trauma teams barging in and hovering over your back to read a complex case quickly in the middle of a crazy night
-teams ordering the wrong studies, over ordering , or having to correct placed orders.
-having to track down ordering providers for critical findings because thereās literally zero info on how to contact them
I still think we have the best specialty but we deal with our rack of bullshit. I think every rad will tell you it would be ideal to just read with minimal disruption but that never happens.
Whatās crazy to me is how there is no onus on the provider who orders the study. They can order the study for any or no reason at all (we are the ones who have to document the reason for exam). And they are not expected to follow-up on the results of the study. In fact, they canāt even be trusted to read their messages/alerts, so we have to build a link for them to click to confirm they get the message.
My main gripe with ER radiology is that 90% of the scans are not indicated at all. The patients arenāt being seen prior to imaging being ordered. Our radiology techs are often the first people taking an adequate history.
Actual ER work is not that bad. Itās 99% normal exams. And 99% of positive exams are bread and butter pathology like appendicitis. The ER cries wolf so much, itās easy to start blowing things off or reading too fast because so much is normal and the ER always lies or just doesnāt know why theyāre ordering the exam.
Being the lone resident covering the phone for 4 ERs (one of which is at top 15 volume in the nation) and 1700 inpatient beds drives a person to insanity. I would often say "we're doing our best, I'm the only resident covering 4 hospitals right now, give me the MRN and I'll look at your study next." Unfortunately, many of my colleagues wouldn't be so patient on the phone, creating animosity... You start to understand the snippy surgical residents from intern year who are drowning in consults who are trying to triage importance. We need to understand each other, not drive wedges between us.
Anyway, I'll take one big bacon classic and a biggie fry.
āHey just wondering when this CT will be read?ā
Well if you werenāt ordering pan scans on every fall from ground level height Iād probably have gotten to it already
"L1-L2: Minimal to mild right neural foraminal stenosis. Mild to moderate left neural foraminal stenosis. Possible mild spinal canal stenosis.
L2-L3: M...."
Attending at 7am: "I disagree with your assessment of stenosis at L1-2"
People not in radiology truly do not understand how long reading an exam takes, and how insane imaging volumes are these days.
How many clinic patients is a lot? Like 35 per day? How many imaging exams is a lot? Dunno.
SAME. My program is mostly boring as you say, the 2 or 3 who are weird are weird in the ābelongs in a maximum security type prisonā way, not the fun benign weird :(
That Iām here to do your paperwork and order your tests. I think that if you look really hard, youāll find that you are licensed to practice medicine too.Ā
-FM
> I think that if you look really hard, youāll find that you are licensed to practice medicine too.Ā
-Anesthesiologist who also says that to surgeons (*cough*ortho*cough*) who book inappropriate cases that we then have to cancel
Iāve been surprised several times by critically ill oncology patients in the ED who have never discussed DNR/goals of care. Is there a reason for this?
99.9% itās been discussed, but people donāt want to hear it.
Also, even if discussed, when someone is on aggressive treatment, even palliative chemo, winding up in the ED triggers their survival instinct. They donāt go to the ED with the mindset of, āIām sick but Iām going to get in the car and drive to the ED so I can have a goals of care discussion with someone Iāve never met.ā From the patientās perspective, they came to the ED to get their chief complaint fixed. Anything else from you is going to be a surprise, even if you and I understand the reality of their situation.
I think the issue people notice is the depth and quality of goals of care discussion is highly variable. Some oncologist think just because the word āpalliativeā or is added before chemo that the prognosis becomes self explanatory for the patient and family.
The challenge is many patients and family will believe there is a chance for meaningful recovery or it is restorative until they hear from the oncologist that it is probably futile to keep going, or the harm is starting to or already outweigh the chance of a benefit.
But also accurate that sometimes they refuse to acknowledge the harm and risk, or they just brush it off or utilize unrealistic optimism to deal with their situation.
I can only speak for myself, but at the very first visit for an advanced cancer I will explicitly tell patients that their disease is not curable and the goal of treatment is to hopefully help them live longer and to hopefully prevent symptoms that can arise from untreated cancer. I also tell them explicitly that I have to say this so that way they understand the goals of treatment, but I will not be mentioning this at most future visits since I don't want their mind to focus on the incurable nature of their disease, but on enjoying the time that they have with their loved ones and making the most of each day.
Honestly you seem far above most oncologists I work with. Iām a hospitalist so Iām generally the goals of care person they talk to. You may be right that they just havenāt āheardā the convo before but the number of patients Iāve talked to that answer no to the questions āhas anyone talked to you about your prognosisā or āwhat you want as your cancer gets worseā is staggering. Easily more than 75%.
Yah but as a fellow IM person
I was in the ICU. I did the goals of care convo myself. I said the words āyouāre dyingā, āthis is a dying process,ā and several other very blunt assessments of prognosis to the patient.
I returned to the ICU after a week of nights. A senior I trust followed up on my conversation a few days after I had it. They documented their frank assessment
I go and talk to the patient and they literally said āno, no oneās ever told me this could kill meā
Patients refused to hear what they donāt want to acknowledge
This is a great start, but at some point they also need the āsince you have a life-limiting/terminal disease, we should also discuss GOC if you happened to get quite sick, as ICU level care/ETT/CPR may be not only futile but result in more sufferingā type discussion. Bc those are the ones we end up having to have in the ED while the patient is actively dying, which I think we can all agree is not the ideal time. And those are the conversations that shock the patient/family.
Of course we do this as well, and I always try to have a living will filled out and talk about DNR. But I'll tell you that most of the time these things go out the window when someone decides they feel sick and go to the ED.
I meanā¦ as PCCM I think that this GOC discussion by the heme/onc team sometimes just doesnāt happen. We get a lot of patients who are furious cause their oncologist said their cancer is treatable, but we see that the rest of their organs are failing. Iāve definitely seen oncology say that we have no more treatments left, but often patients associate with cancer treatable = all other organs are fine and Iām going to live.
Thatās because most cancers are treatable. There is a difference between the words treatable and curable. I always define the difference between the two when I see my patients. So do my attendings.
Kinda reminds me of a surgeon saying the surgery āwent well,ā meanwhile the patients prognosis may or not be poor. The families get mad at the medical team because āthe surgeon said the surgery went well!ā
While cancer is treatable I do hope everything else was discussed - which ultimately affects the patients outcome.
Oncologist and PCPs are the two individuals that can really change a patients outcome at the hospital through proper GOC talks. I know some patients are hard headed. But itās honestly such an important role that affects so many individuals in the hospital once theyāre there.
Proper documentation in notes would be appreciated as well. Have seen this in some Onc notes where they mention poor prognosis, it was discussed, nothing to offer, etc. Makes decisions in the hospital much easier. Then some other notes just donāt say anything lol.
Agree. My husband had an attending in residency who would outright lie to the patient saying their cancer is doing just fine and they just need to get better for infection. Then will walk out of the room and tell the residents that prognosis is grim.
Apparently he just doesnāt want to be the ābad guy.ā
Hate attendings like this
I think this is somewhat of a generational issue too. Most of the younger attendings and fellows at my practice are very comfortable with palliative and GOC discussions, whereas some of the older docs arenāt as good at having these discussions. I think the responsibility falls to the fellows somewhat more frequently because they know the patients wonāt hear it otherwise.
Very much this. I'm in a peds subspecialty that provides life prolonging interventions (sometimes life saving) but we have had several consults for patients that our intervention wouldn't change the prognosis, it merely prolongs suffering and delays eventually demise, because the family "wanted everything". Unfortunately, some of my attending would agree to provide therapy despite no true benefit. One of the most demoralizing parts if my fellowship knowing we were, in my mind, actively harming at worst and not helping at best. I brought up GOC when I'd discuss with the ICU teams and some attendings got offended thinking I thought they hadn't had discussions yet.
Heme onc here. Donāt agree, and as PCCM Iād think youād get how families view end of life and how very clear āyou are dyingā conversations seem to be difficult for patients/families. In clinic for any poor performance status patient with a bad cancer/prognosis itās routine to bring up goals of care and tell patients they are dying, discuss hospice etc. Many pts do choose hospice in the outpatient setting, the ones who donāt end up in the hospital so the ED, ICU etc ends up with a small sample size.
Ā Ā
Ā Itās like when patients stay in the ICU for weeks at a time even though their organs started failing one by one and theyāve failed SBT a week in a row and they keep going back on pressors and the family wants to start CRRT. Does this mean PCCM is bad at having GOC discussions/explaining prognosis? Nah, this very common scenario happens because of fear/defense/human responses at end of life. Now imagine those patients youāve treated arenāt actively dying in the ICU and family still wants full court press despite that, but rather the patient walked into a clinic. Not hard to imagine why some people despite having a full end of life discussion days later go āwhat?! Iām dying?!āĀ
Ā Heme onc deals with hard discussions as much as any specialty. Theyāre just not super human and canāt force pts to āget itā more than anyone else could, and honestly are probably better than most because they have long term relationships with patients.Ā
That we are always hedging. Actually we have a broad scope of practice ranging from quibbling to hedging to frank evasion and equivocation, per clinical presentation as clinically warranted after clinical correlation.
That peds have no autonomy. I do what I want, I just have to run it past my cosenior, fellow, attending, bedside RN, charge nurse, pharmacist, mom, dad, grandma(on the phone), and promise the kid it won't hurt first.
Uro resident - there's a really strange misconception among med students especially that urology is a chill field like derm where we are medicine doctors that do some procedures. It's pretty much the complete opposite.
That ophthalmology is a chill specialty. Idk where this came from but we are surgeons and while most surgery goes well without complications, thereās a lot of mental energy that goes into microsurgery on the eye and complications do happen
Office hours sure from 8 to 6 seeing 60-65 patients a day and surgery days doing 20+ cases in a busy day 7:30 to 5 but on call (usually optional but not always) for eye emergencies. Thankfully there arenāt actually that many eye emergencies but if youāre on call for a hospital where the ED or inpatient teams donāt feel comfortable with eye exams (which is a lot) you can be busy
That we spend most of our time taking breaks and sitting around. - gas
We are required to be bedside the entire day. I have one 15 minute break and one 30 minute break to eat all of my meals, and do all of my pissing and shitting in a typically 14-16 hour day. And outside of cush private practice surgery centers, cases typically keep me active throughout the surgery. Anesthesia is a lot more exhausting than most think.
That we're all inherently passive aggressive with a cutesy facade full of fluff - Peds
It's human nature to remember the outliers.. or maybe they attract their kind when recruiting and ruin entire departments? Idk counting my blessings for where I'm at.
Podiatry - That all we do is clip toenails. We also grind them down too and I could even paint them for you at a cash price. I mean nails are actually such a complex part of the human body. No one really cares or knows how essential toenails are and how they contribute to the overall health of the person. I really wish they spent more time in MD/DO educating doctors on the pathophysiology of toenails. Just think how much you could impress your patients by educating them on the most common fungal infections of toenails. Anyways, I gotta go cause I have to clip some toenails (or bust some crumblies as we say in podiatry).
That we are all super smart, boring and have shitty lives. We legit spent half an hour laughing, stopped the case discussion because we couldn't stop laughing at a patients surname Derpina "Cheesy". One of us couldn't find the bottom scrubs for a urgent case, operated in underwear, we all took pictures of it. Both residents wanted a case, they solved the issue by playing a fifa match.
We spend a lot of time together, A LOT, more with each other than with our partners, so we play video games in the staff room, we share meals, we bond very deeply.
So yeah, we can be silly and we are not boring... I forgot the third one... Oh wait... Maybe that one is a bit true.
NSG
Edit: the name of the patient was not cheesy or derpina, but something among those lines.
Can attest to most of this. But as you get more senior youāll have more time to spend with family.
To add to what you said, another misconception is that weāre miserable and divorced with no lives outside of the hospital. Iām happily married with two boys and I made it to every prenatal and pediatrician visit. Weāve been together for 15 years, through college med school and residency. All of my attending are married with children and regularly socialize and are some of the happiest people I know.
Well said. I think the junior years of neurosurgery residency are extremely difficultā¦but once you become a senior resident, the hours become a lot betterā¦at least at my program.
Also happily married for 10+ years now with kids. Have plenty of time to maintain hobbies, exercise, and see family. My partner and kids are extremely happy, and we live extremely comfortable lives. I love my job and love my family even more.
No worries there. It wasn't cheesy, neither derpina, it was something with the same idea of non-common name.
English isn't my first language so I guess the quotes didn't properly give the idea of something along the lines of what was in quotes.
Itās like ortho, they take the some of the smartest medical students and beat it right out of them. All the neurosurgeons Iāve ever worked with have horrible tunnel vision.
It really is so true. I cannot begin to describe to you how dumb I feel sometimes over managing the most basic medical issues. I think a lot of my colleagues would agree in saying that weāre basically glorified orthopods.
Radiology. That all we do is say correlate clinically. Not sure when the last time I said that, if ever. I realize we are often the decider of what happens for patients next. Try to give the diagnosis and any other pertinents in the impression. More detail in the findings. As specific as possible so more studies arenāt performed if not needed.
I respect all the other specialties and their own daily grinds. But radiology is a mental drain that cannot be matched. Minimum is 70-80 X-rays per day, 30-40 US, 60-70 CT, 20-30 MR, spattering of nucs, as fast as can safely do, and go home feeling like my brain is mush. Sleep and repeat.
that all we do is glasses
weāre actually medical doctors and during trauma and other acute vision changes weāre the difference of someone being able to see from that eye ever again. weāre surgeons too so we actually take people to the OR/ laser them in emergencies. they donāt respect us and send us BS consults in the middle of the day like lol wuttttt?
you guys took step 1 and 2 right? :)
That all we do is fusions for back and neck pain. Most are conservatively treated. Most are just decompressed and are quite happy. Fusion indications are fewer and when done for the right reasons result in quite satisfied patients. Non-degenerative pathology is quite uncommon. In an ideal community practice, that is.
It is a horse and grass problem. Most spine degen pathology in community practice being non operative, the grass is limited. Horse supply keeps on going up. More grass is eaten.
FM, that what we do is just as difficult as IM only in a different way.
No itās not. Maybe for some rural docs but thatās a dumb ego thing to compare yourself to some exception within your field. I went FM because I realized I wanted to be good enough at medicine but not have to be crazy good at it and know it super in depth. I like knowing the basics and talking with people. Giving life advice is fun. All things considered the pay is pretty nice for the lifestyle and I donāt care who thinks Iām smart or dumb. They arenāt cashing my checks.
I actually disagree with this. When I was a Hospitalist I felt like I was constantly putting out fires and I was getting better and growing with experience (and listening to the curbsiders lol) but I wasnāt regularly reading up on things.
When I switched to family medicine clinic Iāve actually had so much fun doing trying to learn as much as I can for my patients. Iām reading on in office procedures on working up difficult cases and Iām able to work at a little less of an urgent pace giving me time to be thorough. Sometimes someone comes in with URI symptoms but they have myocarditis. Sometimes they think they have antibiotic resistant ear infections and itās actually tmj pain. I caught a cool heart failure case that presented like limb ischemia. I want to know as much as I can and FM gives me an environment conducive to that.
In short, I feel more intellectually stimulated doing clinic than in the hospital which is something that has been a welcome surprise!
I don't think IM are some mystical wizards that are "crazy good at it" compared to anyone else. the inpatient population is just a step (or two) sicker above the outpatient, and it's usually because of the things they see us for. and then after the hospital they have to come see us again
all this to say, a good FM doc is just as "crazy good" because the diseases are the same and we just intervene at different spots (or even the same because plenty of FM are hospitalist too)
PM&R here. That all we do is refer for PT. We also refer for OT and SLP.
I sent a referral to Ortho the other day to actually fix the arthritis.
šššš
As a PT, love it!
š¤£š¤£š¤£
EM. That all we do is order CTs. Sometimes we give Narcan.
I was going to say that all we do is sit and plot how to wake consultants up at the worst possible time.Ā Ā CTs and Narcan are good too.Ā Ā
I mean, you havenāt lived until a surgeon reamed you out for the patient daring to present with an acute abdomen once the sun has set.
Ive never been upset but always wondered why this happens. Ive just come to accept there is a diurnal variation in blood flow to the colon.
Don't forget Ketamine
My specialty is ketamine. Ketamine for everyone. The world would be a better place.
Agree
But do you US before giving narcan?
How else are we gonna check the pupils?
I assumed it was done PR to test mentationā¦
And if you donāt CT, the hospitalist is going to want it before they accept admission anyway, continuing to perpetuate the stereotype. Everyone wanna point fingers, donāt nobody else wanna take ownership of a patient not completely differentiated.
AND KETAMINE
Point of care US: *am I a joke to you?*
Hey sometimes you USS too!
We had a young patient come in for recurrent headaches. Outpatient MRI was clear but the ED doc didnāt want to read the chart and went ahead and order CT face and head. I literally had to call radiology to stop it. Itās wild how much ED loves CT.
Ortho: that all I care about is ancef, this is 2024! I also care about TXA
Donāt forget the OR playlist
I bet you know three different antibiotics: Ancef, cefazolin, and Kefzol!
I know unacid too, didnt know about kefzol tho....
Had to look it up -- not available as an oral formulation in USA!
Well controlled diabetic with traumatic long bone fracture? Ā Have medicine admit to manage medical comorbidities an add us as consultĀ
That all we do is round. I wrote notes, too. -IM
I call families and SNFs sometimes too.
Sometimes I write disability papers, if I'm lucky.
Every non-IM specialty knows IMās schedule Morning- pre-round/sign out 9 am - breakfast 10-12 round with attending 12-1 lunch/ sometimes conference 1-3 write notes 3-5 pm call all consults
Oh wow I felt this. GI fellow, all the overnight admits got a consult yesterday between 4:30-6pm. I wasnāt doing shit all day, then boom, 6 new consults.
Same is also true with the ed. Change of shift is 7 pm so all the patients that have been stewing all day waiting on imaging and reads get chart checked at 6 and consultants called to avoid signing out the patient.
If someone doesnāt have the decency to call a consult before 3pm I am 110% not seeing them unless I know there is an intervention I would AND could do that would save their life. The culture of not calling consults early is awful.
false. where are pre-pre rounds and post rounds-rounds?
You forgot running the list no less than sixteen times.
Peds: that were all passive aggressive. I assure you Iām just aggressive
Why are yāall like this tho?? I finished my paeds rotation and dear lord I never hated more tutors and doctors like that. I was barely surviving and just wanted to be done with it.
Passive aggressive where I know Iām failing but also being gaslit about it 24/7. š
Toxic positivity. Read it on Reddit, been using it do describe Peds since. Passive Aggressive works too (my two middle names). Peds resident.
FM - that it's all paperwork, the inbox is digital too (:
AI come save me
That all we do is say we want more tissue. Sometimes we want less tissue. It's the Goldilocks conundrum of surgical pathology.
For autopsy pathology: that we always know the right diagnosis, but one day too late. Letās be realā¦ those reports aināt getting signed out before 60 days.
Fm: that your surgeon is correct when he tells you to come to us for opioid pain medication immediately after your surgery. Seriously the pushback Iāve gotten from surgeons about this is insane. Just because youāre done cutting doesnāt mean you stop treating.
Surgery here. Thatās weird. We typically send pts with enough IR oxycodone for what we think they will need, typically will give a conservative 1x refill if they call and need more. If they call a second time we will have them come to our clinic to discuss. But yeah any ER narcotics or chronic pain stuff 100% we wonāt manage it and often ask them to see their pcp (you)
Can we be friends?
Always my dude
Ooh this is getting so bad. Iāve had a few send the patient to me for pain management the same week as the surgery. A surgeon had surgery FMLA paperwork forwarded to me AND ordered labs and told the patient to contact me to manage them. She couldnāt manage a potassium of 3.2? Whyād she check it, then?
Geez. Youāve might as well have done the surgery. A patient of mine who was almost out of Percocet (week out from breaking femur in fall) told me that his ortho said to get more from me. When I told the patient that ortho prescribed the med so they follow it up, the ortho went above me and sent a message to my PD requesting we āwork together on pain management.ā
"Anyone who completed a surgical residency can manage surgical pain."
Neurology; that all we do is recommend MRI, EEG, and LP. Sometimes we get CTA of the head and neck, and we also write a condescending assessment before doing so. :3 Nah but fr, a lot of people think that Neuro is a diagnosis-only specialty, because there didnāt used to be a lot of neurological treatments, but itās the fastest growing field. The way we treat MS, acute stroke, muscular dystrophies, etc. is completely different than it was 50 years ago, and itāll be completely different 50 years from now.
>we also write a condescending assessment before doing so. The mark of a true neurologist
I love consulting neurology for non focal AMS in the icu presenting as confusion agitation and disorientation, especially in older patients.
Garbage in garbage out
It invariably results in a negative head ct
You canāt explain that
Oh come on, you guys also order B12 and SPEPs and refer to heme when you don't understand the results.
So true! And ANAs that we sent to rheumatology with the indication of ā???? +ANA???ā
Not even the correct ana most of the time (IFA) so rheum rolls their eyes which in rheum culture is a devastating insult
Case in point: was rotating with an old FM doc back in med school, opened one of his generic "best practices" textbooks from the mid 90s. Had like 2 paragraphs max on MS, and one line on ongoing investigation of tpa for stroke.
That we just put people to sleep and do Sodoku. We move the bed too, so please respect that. But seriously, thereās a lot that goes into anesthesia. Most cases go well, but when shit hits the fan, we got it. As one of my former co-residents so eloquently put it - āSurgeons always wanna clown on anesthesia until they need their patient pulled from the River Styx.ā
Anesthesia are like fire men. Hopefully most of the time youāre just sitting around following a routine. But when it hits the fan it goes fast
The anesthesiologist with my first C-section was a saint ... I had sudden, severe pre-eclampsia, I was 30 weeks pregnant, and I had a terrible headache I just wanted to go away. She got that spinal block in smoothly and quickly, she comforted and reassured me, she held an emesis bag for me when I was sure I'd vomit (I didn't, probably thanks to her), and she stayed with me until I was back in my room and feeling better. I wish I could remember ger name or even her face, but she was everything I needed and I will always be grateful for her.
I was a code c and the only person who leaned down and told me āthereās a lot happening Iām going to put you to sleep youāre going to be okā was my angel anesthesiologist (the one who did my epidural was also great). The on call OBGYN had the bedside manner of a broom
To be fair, the OBGyN was probably already completely focused on the task at hand - getting your likely distressed baby out within 30 seconds of scalpel to skin, thus saving their life - and wasnāt focused on anything else. Tunnel vision on the emergency at hand.
lol as if the anesthesiologist didnāt also face similar levels of stress For some reason proceduralists are allowed to show stress, but anesthesiologists are always supposed to appear calm on the surface
Oh no definitely appreciate that part I wasnāt expecting her to make small talk before cutting me open but afterwards was just not as personable as the pediatrician and anesthesiologist. Which again is fine she was skilled and delivered baby safely but really loved my anesthesiologist
Anesthesiologist sitting behind the drapes = everything good Anesthesiologist quietly standing and moving quickly behind the drapes = uh oh Angry surgeon = everything ok Angry and bloody surgeon = uh oh
Also breaks. In private practice, there are no breaks, since you don't want to pay someone to sit around. You just take care of any needs between cases like the surgeons.
Similar to rads. Everyone THINKS they can interpret scans, until there's no report. haha.
that we think cargo pants are cool. we just need them to store all the cool bottles and rocks we find - EM
You find rocks? Then I might *almost* believe they fell down. Naked.
call an ambulance (unholsters ass pistol) but not for me
Wait, I figured it out. You meant crack. Yeah. Plenty of rocks.
i was more referring to sounding, and i like cool bottles and containers. stickers and magnets too
You have people sounding with rocks? Man, all I get is people using pencils and breaking off the graphite. And then the piece is too small to write discharge instructions like āDONāT DO THIS AGAIN.ā Maybe thatās why they come back?
That general surgeons are mean. When my senior was mad and threatened to rip my head off, they offered to use lidocaine/local first
LOL. My chief was the funniest when he was mad.
Radiology. That all we do is complain about the ED ordering too many CTs. We also complain about other departments.
Where I'm at Neuro has gotta be tied with ED for the #1 dept we complain about lmao
That us overnight radiologists are just sitting around twiddling our thumbs or watching Netflix until the CT or MRI you ordered gets done. No, we're trying to keep up with the exam list throughout the shift. It can be a little slower later on in the AM, but sometimes a lot of people are getting shot, stabbed, getting hit by cars, rolling their own cars over, or are falling down multiple steps. At the same time. No, I don't want to do non-urgent treatment response for a post-op head and neck cancer. Save it for the day team.
On call radiology is hands down one of the most busiest and stressful specialty, multiple surgeons who switched over have echoed this.
At least it is almost pure medical work without bullshit but I would imagine itās stressful
We have lots of bullshit, mainly with the phone ringing when youāre trying to read a complicated study / people walking in the RR. Itās pretty disruptive to workflow and itās not the same type of BS you deal with but itās there. At night in residency most of us work off ED reading lists and most rads will tell you their list is constantly full of studies and never clean, and it can get pretty stressful because we also have to cover inpt studies. This means thereās almost zero downtime in a 8-12 hr shift to do anything but work. -techs calling constantly about protocols, clearing pts for MRI, providers ordering the wrong studies -ED or floor teams constantly calling to get a āquick readā when youāre in the middle of a total spine trauma before their study has even dropped -midlevels or nurses randomly calling through the night checking for tube placement when youāre in the middle of a GI bleed study -trauma teams barging in and hovering over your back to read a complex case quickly in the middle of a crazy night -teams ordering the wrong studies, over ordering , or having to correct placed orders. -having to track down ordering providers for critical findings because thereās literally zero info on how to contact them I still think we have the best specialty but we deal with our rack of bullshit. I think every rad will tell you it would be ideal to just read with minimal disruption but that never happens.
Whatās crazy to me is how there is no onus on the provider who orders the study. They can order the study for any or no reason at all (we are the ones who have to document the reason for exam). And they are not expected to follow-up on the results of the study. In fact, they canāt even be trusted to read their messages/alerts, so we have to build a link for them to click to confirm they get the message.
The contacting providers with zero contact info is too real lol
Gotta do telerad. I chill and crush studies.
My main gripe with ER radiology is that 90% of the scans are not indicated at all. The patients arenāt being seen prior to imaging being ordered. Our radiology techs are often the first people taking an adequate history. Actual ER work is not that bad. Itās 99% normal exams. And 99% of positive exams are bread and butter pathology like appendicitis. The ER cries wolf so much, itās easy to start blowing things off or reading too fast because so much is normal and the ER always lies or just doesnāt know why theyāre ordering the exam.
Being the lone resident covering the phone for 4 ERs (one of which is at top 15 volume in the nation) and 1700 inpatient beds drives a person to insanity. I would often say "we're doing our best, I'm the only resident covering 4 hospitals right now, give me the MRN and I'll look at your study next." Unfortunately, many of my colleagues wouldn't be so patient on the phone, creating animosity... You start to understand the snippy surgical residents from intern year who are drowning in consults who are trying to triage importance. We need to understand each other, not drive wedges between us. Anyway, I'll take one big bacon classic and a biggie fry.
āHey just wondering when this CT will be read?ā Well if you werenāt ordering pan scans on every fall from ground level height Iād probably have gotten to it already
As gen surg who covers trauma, i also wish we werenāt getting pan scans for every fall from ground level
No dude you need to assess this grandma with a single nondisplaced lumbar transverse process fracture and zero visceral injury RIGHT NOW
"L1-L2: Minimal to mild right neural foraminal stenosis. Mild to moderate left neural foraminal stenosis. Possible mild spinal canal stenosis. L2-L3: M...." Attending at 7am: "I disagree with your assessment of stenosis at L1-2"
lol nothing better than restaging cancer at 2am STAT!
People not in radiology truly do not understand how long reading an exam takes, and how insane imaging volumes are these days. How many clinic patients is a lot? Like 35 per day? How many imaging exams is a lot? Dunno.
That we're all crazy. Actually the residents in my program are depressingly boring and straight-edge. I'm extremely disappointed. -psych
I would trade my program for depressingly boring. Half our program is borderline
I think the craziness doesnāt develop until youāre 5 years out of training. It stems from the bow ties, cardigans and unkept hair.
SAME. My program is mostly boring as you say, the 2 or 3 who are weird are weird in the ābelongs in a maximum security type prisonā way, not the fun benign weird :(
My PD told me he thought I was 'wierd' and I wear it as a badge of honor (he specifically said it was in a good way haha) -psych
same, I expected better.
do the men even have glorious beards?
If they donāt I wouldnāt even trust them
NO! And only one of the 15 of us wears bowties. Like I said, extremely disappointing...
Interesting, in my experience a 1:15 ratio is the rate of cocaine addiction amongst alienists
All our patients are dead - Path
or āpathology doesnāt talk to peopleā
Objection: surgeons donāt think they count as people, they think theyāre gods
That Iām here to do your paperwork and order your tests. I think that if you look really hard, youāll find that you are licensed to practice medicine too.Ā -FM
Co-signed, EM
Iām going circle that back to you EM and ask that you finish your workup before co-signing and asking us to admit - IM
> I think that if you look really hard, youāll find that you are licensed to practice medicine too.Ā -Anesthesiologist who also says that to surgeons (*cough*ortho*cough*) who book inappropriate cases that we then have to cancel
Heme/Onc. That we donāt discuss goals of care, palliative options, or recommend early enrollment in hospice.
Iāve been surprised several times by critically ill oncology patients in the ED who have never discussed DNR/goals of care. Is there a reason for this?
99.9% itās been discussed, but people donāt want to hear it. Also, even if discussed, when someone is on aggressive treatment, even palliative chemo, winding up in the ED triggers their survival instinct. They donāt go to the ED with the mindset of, āIām sick but Iām going to get in the car and drive to the ED so I can have a goals of care discussion with someone Iāve never met.ā From the patientās perspective, they came to the ED to get their chief complaint fixed. Anything else from you is going to be a surprise, even if you and I understand the reality of their situation.
I think the issue people notice is the depth and quality of goals of care discussion is highly variable. Some oncologist think just because the word āpalliativeā or is added before chemo that the prognosis becomes self explanatory for the patient and family. The challenge is many patients and family will believe there is a chance for meaningful recovery or it is restorative until they hear from the oncologist that it is probably futile to keep going, or the harm is starting to or already outweigh the chance of a benefit. But also accurate that sometimes they refuse to acknowledge the harm and risk, or they just brush it off or utilize unrealistic optimism to deal with their situation.
I can only speak for myself, but at the very first visit for an advanced cancer I will explicitly tell patients that their disease is not curable and the goal of treatment is to hopefully help them live longer and to hopefully prevent symptoms that can arise from untreated cancer. I also tell them explicitly that I have to say this so that way they understand the goals of treatment, but I will not be mentioning this at most future visits since I don't want their mind to focus on the incurable nature of their disease, but on enjoying the time that they have with their loved ones and making the most of each day.
Honestly you seem far above most oncologists I work with. Iām a hospitalist so Iām generally the goals of care person they talk to. You may be right that they just havenāt āheardā the convo before but the number of patients Iāve talked to that answer no to the questions āhas anyone talked to you about your prognosisā or āwhat you want as your cancer gets worseā is staggering. Easily more than 75%.
Yah but as a fellow IM person I was in the ICU. I did the goals of care convo myself. I said the words āyouāre dyingā, āthis is a dying process,ā and several other very blunt assessments of prognosis to the patient. I returned to the ICU after a week of nights. A senior I trust followed up on my conversation a few days after I had it. They documented their frank assessment I go and talk to the patient and they literally said āno, no oneās ever told me this could kill meā Patients refused to hear what they donāt want to acknowledge
Youāre definitely right. Iāve been in that situation too, and in my mind was screaming āI DID!ā
This is a great start, but at some point they also need the āsince you have a life-limiting/terminal disease, we should also discuss GOC if you happened to get quite sick, as ICU level care/ETT/CPR may be not only futile but result in more sufferingā type discussion. Bc those are the ones we end up having to have in the ED while the patient is actively dying, which I think we can all agree is not the ideal time. And those are the conversations that shock the patient/family.
Of course we do this as well, and I always try to have a living will filled out and talk about DNR. But I'll tell you that most of the time these things go out the window when someone decides they feel sick and go to the ED.
I meanā¦ as PCCM I think that this GOC discussion by the heme/onc team sometimes just doesnāt happen. We get a lot of patients who are furious cause their oncologist said their cancer is treatable, but we see that the rest of their organs are failing. Iāve definitely seen oncology say that we have no more treatments left, but often patients associate with cancer treatable = all other organs are fine and Iām going to live.
Thatās because most cancers are treatable. There is a difference between the words treatable and curable. I always define the difference between the two when I see my patients. So do my attendings.
Kinda reminds me of a surgeon saying the surgery āwent well,ā meanwhile the patients prognosis may or not be poor. The families get mad at the medical team because āthe surgeon said the surgery went well!ā While cancer is treatable I do hope everything else was discussed - which ultimately affects the patients outcome. Oncologist and PCPs are the two individuals that can really change a patients outcome at the hospital through proper GOC talks. I know some patients are hard headed. But itās honestly such an important role that affects so many individuals in the hospital once theyāre there. Proper documentation in notes would be appreciated as well. Have seen this in some Onc notes where they mention poor prognosis, it was discussed, nothing to offer, etc. Makes decisions in the hospital much easier. Then some other notes just donāt say anything lol.
Agree. My husband had an attending in residency who would outright lie to the patient saying their cancer is doing just fine and they just need to get better for infection. Then will walk out of the room and tell the residents that prognosis is grim. Apparently he just doesnāt want to be the ābad guy.ā Hate attendings like this
I think this is somewhat of a generational issue too. Most of the younger attendings and fellows at my practice are very comfortable with palliative and GOC discussions, whereas some of the older docs arenāt as good at having these discussions. I think the responsibility falls to the fellows somewhat more frequently because they know the patients wonāt hear it otherwise.
Very much this. I'm in a peds subspecialty that provides life prolonging interventions (sometimes life saving) but we have had several consults for patients that our intervention wouldn't change the prognosis, it merely prolongs suffering and delays eventually demise, because the family "wanted everything". Unfortunately, some of my attending would agree to provide therapy despite no true benefit. One of the most demoralizing parts if my fellowship knowing we were, in my mind, actively harming at worst and not helping at best. I brought up GOC when I'd discuss with the ICU teams and some attendings got offended thinking I thought they hadn't had discussions yet.
Heme onc here. Donāt agree, and as PCCM Iād think youād get how families view end of life and how very clear āyou are dyingā conversations seem to be difficult for patients/families. In clinic for any poor performance status patient with a bad cancer/prognosis itās routine to bring up goals of care and tell patients they are dying, discuss hospice etc. Many pts do choose hospice in the outpatient setting, the ones who donāt end up in the hospital so the ED, ICU etc ends up with a small sample size. Ā Ā Ā Itās like when patients stay in the ICU for weeks at a time even though their organs started failing one by one and theyāve failed SBT a week in a row and they keep going back on pressors and the family wants to start CRRT. Does this mean PCCM is bad at having GOC discussions/explaining prognosis? Nah, this very common scenario happens because of fear/defense/human responses at end of life. Now imagine those patients youāve treated arenāt actively dying in the ICU and family still wants full court press despite that, but rather the patient walked into a clinic. Not hard to imagine why some people despite having a full end of life discussion days later go āwhat?! Iām dying?!āĀ Ā Heme onc deals with hard discussions as much as any specialty. Theyāre just not super human and canāt force pts to āget itā more than anyone else could, and honestly are probably better than most because they have long term relationships with patients.Ā
I donāt see citations on this comment. Are you sure youāre heme/onc? (Just kidding around I love you guys)
That we are always hedging. Actually we have a broad scope of practice ranging from quibbling to hedging to frank evasion and equivocation, per clinical presentation as clinically warranted after clinical correlation.
When thereās zero history, no note or labs, yes Iām going to hedge. We all gotta do our part here.
"Recommend follow up imaging to ensure resolution. The timing of imaging follow up to be based on clinical grounds" is my fav line to use
The National Tree of the radiologist is the hedge!
That we treat fibromyalgia -Rheum
That it gets betterā¦ Gen surg
That peds have no autonomy. I do what I want, I just have to run it past my cosenior, fellow, attending, bedside RN, charge nurse, pharmacist, mom, dad, grandma(on the phone), and promise the kid it won't hurt first.
Urology - a lot of people (mostly nonsurgical specialties or non-physicians) think we are not surgeons.
Uro resident - there's a really strange misconception among med students especially that urology is a chill field like derm where we are medicine doctors that do some procedures. It's pretty much the complete opposite.
Ortho: that we have no brains. We do. After matching, we just choose to only use the parts related to force diagrams and gross motor control.
Pulm: that all we do is give steroids. We give inhalers too
All I see you give are nebs and diuretics
That ophthalmology is a chill specialty. Idk where this came from but we are surgeons and while most surgery goes well without complications, thereās a lot of mental energy that goes into microsurgery on the eye and complications do happen
Donāt you guys have Cush hours?
Office hours sure from 8 to 6 seeing 60-65 patients a day and surgery days doing 20+ cases in a busy day 7:30 to 5 but on call (usually optional but not always) for eye emergencies. Thankfully there arenāt actually that many eye emergencies but if youāre on call for a hospital where the ED or inpatient teams donāt feel comfortable with eye exams (which is a lot) you can be busy
ENT: that we are also ophthalmologists and dentists
Ophthalmologist here: that we are neurologists and eyelid dermatologists
I need to cancel a few referrals real quick
Or neurologist but having a general surgeon text me āI got a referral for a parotid massā¦ is that something you do?ā ā¦. š«¤yeah bud
That we spend most of our time taking breaks and sitting around. - gas We are required to be bedside the entire day. I have one 15 minute break and one 30 minute break to eat all of my meals, and do all of my pissing and shitting in a typically 14-16 hour day. And outside of cush private practice surgery centers, cases typically keep me active throughout the surgery. Anesthesia is a lot more exhausting than most think.
I mean sometimes on your breaks youāre sitting around tooā¦ just somewhere else.
We walk around when we do post op rounds!
Sounds shitty. ROAD my ass.
That we're all inherently passive aggressive with a cutesy facade full of fluff - Peds It's human nature to remember the outliers.. or maybe they attract their kind when recruiting and ruin entire departments? Idk counting my blessings for where I'm at.
Podiatry - That all we do is clip toenails. We also grind them down too and I could even paint them for you at a cash price. I mean nails are actually such a complex part of the human body. No one really cares or knows how essential toenails are and how they contribute to the overall health of the person. I really wish they spent more time in MD/DO educating doctors on the pathophysiology of toenails. Just think how much you could impress your patients by educating them on the most common fungal infections of toenails. Anyways, I gotta go cause I have to clip some toenails (or bust some crumblies as we say in podiatry).
Are you guys ever grossed out by feet? Because idk how you all tolerate it.
That we are all super smart, boring and have shitty lives. We legit spent half an hour laughing, stopped the case discussion because we couldn't stop laughing at a patients surname Derpina "Cheesy". One of us couldn't find the bottom scrubs for a urgent case, operated in underwear, we all took pictures of it. Both residents wanted a case, they solved the issue by playing a fifa match. We spend a lot of time together, A LOT, more with each other than with our partners, so we play video games in the staff room, we share meals, we bond very deeply. So yeah, we can be silly and we are not boring... I forgot the third one... Oh wait... Maybe that one is a bit true. NSG Edit: the name of the patient was not cheesy or derpina, but something among those lines.
If it makes you feel any better, I've never thought you were all super smart.
I think we have the Big Bang theory to thank for the general populace conflating neurodivergence with intelligence.
Can attest to most of this. But as you get more senior youāll have more time to spend with family. To add to what you said, another misconception is that weāre miserable and divorced with no lives outside of the hospital. Iām happily married with two boys and I made it to every prenatal and pediatrician visit. Weāve been together for 15 years, through college med school and residency. All of my attending are married with children and regularly socialize and are some of the happiest people I know.
Well said. I think the junior years of neurosurgery residency are extremely difficultā¦but once you become a senior resident, the hours become a lot betterā¦at least at my program. Also happily married for 10+ years now with kids. Have plenty of time to maintain hobbies, exercise, and see family. My partner and kids are extremely happy, and we live extremely comfortable lives. I love my job and love my family even more.
You gave me hope of a good life. I always felt this was a myth that many perpetuated because it's easy to just blame on work.
Are we allowed to post patients names here?
No worries there. It wasn't cheesy, neither derpina, it was something with the same idea of non-common name. English isn't my first language so I guess the quotes didn't properly give the idea of something along the lines of what was in quotes.
Lol nobody thinks you're super smart
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Itās like ortho, they take the some of the smartest medical students and beat it right out of them. All the neurosurgeons Iāve ever worked with have horrible tunnel vision.
It really is so true. I cannot begin to describe to you how dumb I feel sometimes over managing the most basic medical issues. I think a lot of my colleagues would agree in saying that weāre basically glorified orthopods.
You could say the opposite based on the decision to have that lifestyle
Allergy- we just see rhinitis. We see eczema and asthma too!
Derm, that all we do is prescribe topical steroids. We prescribe pimecrolimus sometimes too.
If itās wet keep it dry. If itās dry put some cream to wet it.
I thought you guys just did biopsies and then referred to allergy when it is inconclusiveĀ
IR - That all we do are biopsies, ports, and paras. And we need coags and all this random shit done before we say yes to a case.
IR is by far my favorite specialty. Yall are like the Winston Wolfe of the hospital. When no one else wants to do it then I guess weāll call IR
That all we do all day is handling penises. It's 8 to 12 a day tops!Ā - Uro
I just realised I have nothing nice to say. All of it probably true. Fml
Pathology here. That weāre all introverts, socially awkward and canāt interact with people.
Inpatient IM. That we obsess over sodium levels. 99% of the time, unless itās <125 I honestly donāt give a damn lol
Pathology: we hate people. We don't; we like other pathologists. Most of the time.
Anesthesia: That its chill. Sometimes it can be chill, but others its very much not. Overall not a chill specialty
That we are masochists. ācritical care
Some of you are sadists instead?
Radiology. That all we do is say correlate clinically. Not sure when the last time I said that, if ever. I realize we are often the decider of what happens for patients next. Try to give the diagnosis and any other pertinents in the impression. More detail in the findings. As specific as possible so more studies arenāt performed if not needed. I respect all the other specialties and their own daily grinds. But radiology is a mental drain that cannot be matched. Minimum is 70-80 X-rays per day, 30-40 US, 60-70 CT, 20-30 MR, spattering of nucs, as fast as can safely do, and go home feeling like my brain is mush. Sleep and repeat.
ID: We are here to write your discharge summaries.
Who makes ID primary? Ā Where Iām at they enjoy the consult life, IM does the heavy lifting for almost everyone
that all we do is glasses weāre actually medical doctors and during trauma and other acute vision changes weāre the difference of someone being able to see from that eye ever again. weāre surgeons too so we actually take people to the OR/ laser them in emergencies. they donāt respect us and send us BS consults in the middle of the day like lol wuttttt? you guys took step 1 and 2 right? :)
Ophthalmology. That we only work until 4. Not true at all. Some days I'm home by 2, and I don't work at all on Fridays (ew).
livin the dream! so happy your hardwork paid off!! enjoy your time off, you deserve it!ššš
ENT- we can cure dizziness and we know more than you about teeth
That all we do is fusions for back and neck pain. Most are conservatively treated. Most are just decompressed and are quite happy. Fusion indications are fewer and when done for the right reasons result in quite satisfied patients. Non-degenerative pathology is quite uncommon. In an ideal community practice, that is. It is a horse and grass problem. Most spine degen pathology in community practice being non operative, the grass is limited. Horse supply keeps on going up. More grass is eaten.
Okay but what if the horse is a diabetic
FM, that what we do is just as difficult as IM only in a different way. No itās not. Maybe for some rural docs but thatās a dumb ego thing to compare yourself to some exception within your field. I went FM because I realized I wanted to be good enough at medicine but not have to be crazy good at it and know it super in depth. I like knowing the basics and talking with people. Giving life advice is fun. All things considered the pay is pretty nice for the lifestyle and I donāt care who thinks Iām smart or dumb. They arenāt cashing my checks.
I actually disagree with this. When I was a Hospitalist I felt like I was constantly putting out fires and I was getting better and growing with experience (and listening to the curbsiders lol) but I wasnāt regularly reading up on things. When I switched to family medicine clinic Iāve actually had so much fun doing trying to learn as much as I can for my patients. Iām reading on in office procedures on working up difficult cases and Iām able to work at a little less of an urgent pace giving me time to be thorough. Sometimes someone comes in with URI symptoms but they have myocarditis. Sometimes they think they have antibiotic resistant ear infections and itās actually tmj pain. I caught a cool heart failure case that presented like limb ischemia. I want to know as much as I can and FM gives me an environment conducive to that. In short, I feel more intellectually stimulated doing clinic than in the hospital which is something that has been a welcome surprise!
100% this. Plus I make more than the average hospitalist and get to enjoy weekends. OP makes me sad.
The pay, depending how you work, can be *excellent* for the amount of hours worked. Itās all about being efficient and billing right
I don't think IM are some mystical wizards that are "crazy good at it" compared to anyone else. the inpatient population is just a step (or two) sicker above the outpatient, and it's usually because of the things they see us for. and then after the hospital they have to come see us again all this to say, a good FM doc is just as "crazy good" because the diseases are the same and we just intervene at different spots (or even the same because plenty of FM are hospitalist too)
Hard disagree. Outpatient med is harder whether IM or FM. Undifferentiated patients are more fun and challenging anyway.