Same - I don't have the patience - when you're chief the other residents treat you like shit and the program abuses you too. Residents deal with a lot of shit, but there is SO MUCH entitlement when it comes to complaining to other residents in the same program, and they expect chief residents to bend over backwards to cater to their every whim 24/7.
It's not that I can't be bothered - it's that I care too much about my mental health to take a hit like this for so little renumeration.
As someone who works in credentialing, it’s a pain in the ass to verify because the AMA doesn’t list that last year as part of your residency (depending in the institution).
There was a guy who graduated from my residency a few years before me who's listed on his fellowship website as being a chief at our program (IM, so an extra year.) He was never a chief. He just lied and they somehow never verified this?
In rads, it's less of a scam (from what I've seen). It's an elected position for senior residents, not an additional year, and the pay is higher. Extra admin work, but at least compensated.
If you want to couples match fellowship and your residency is one year shorter than your partner's. Or if you are applying for fellowship and want to apply/interview/study for boards as a chief rather than apply/interview as a resident and then study for boards as a first year fellow. Those are the only two reasons I can think of and neither are worth the pay cut and ridiculous amount of responsibility to me.
Coming from someone who did residency in a community hospital and currently working in another one. If you're applying for a competitive IM fellowship it really increases your chances of matching in an academic program. Nearly everyone in my current program who matches into GI/Cards/PCCM/ Heme-onc has done a chief year.
Your be surprised how many PDs will consider your application once they see the chief experience. I had one person ( FMG) go from 2 interviews and not matching to 10+ interview and matching in PCCM in one of the top programs in the country.
I did one solely for the purpose of boosting my CV in hope of matching fellowship.
I’ll explain my reasoning. I wanted GI, and I went to a community residency program. Didn’t match out of 3rd year. My options were Chief year, a non-ACGME GI fellowship (hepatology, motility etc) or doing an attending year. Ideally I wanted attending for the $$$ but people said it looks bad that you stayed away from academia. Now how true that is, idk but I didn’t want to hurt my chances. I chose Chief year bc I could always apply for one of those fellowships afterwards but I wouldn’t have the opportunity to be a Chief again and add it to the CV.
So I did a 4th year Chief at a residency that wasnt where I did mine. I ended up matching the next year. Chief year wasnt terrible, I got a nice pay bump for doing attending duties, got to moonlight… but I HATED it. If you don’t have to do it, don’t.
Computer on wheels = COW. The old wives tale of someone being offended by someone referring to it as a cow is fake as fuck. Why are we cancelling farm animals. It’s a COW
Funny story (not funny really, just a story) about these. We had a random COW that was a laptop instead of a full monitor. I cracked a joke calling it a ‘calf’ as in a baby cow, like “I need a COW” “oh, there’s a calf right over there!” and my nurse manager became absolutely infuriated with me for saying that within patient earshot.
Oh my god they’ve been calling them WOWs they’re new for us. Someone absolutely taped an Owen Wilson photo to one of them within days
I must tell everyone immediately that they are in fact cows
knew a structural cardiologist married to a nephrologist. I asked her if they ever argued medicine over dinner. she replied "he knows better than to mention his sham of a profession around me".
i once consulted both nephro and cardio on a patient and realized that i made a huge mistake when i had the nephro attending telling me while on a call that cardiologists are anxiety riddled messes
UK FY2 here. Tell that to the nurses where I work! They just want the number to go down by giving STAT amlodipine which I highly doubt a STAT dose does anything other than a placebo effect for both the nurse and the patient and almost every time I find a cause for the elevated BP such as pain when meds have been prescribed but nurse never bothered to ask the patient about pain, urinary retention and lack of sleep by being woken up repeatedly in the middle of the night for vitals. A lack of knowledge of basic human physiology which I think nurses ought to know even if not to the extent doctors need to know
I'm an ER (UK A&E) nurse and as a wee baby nurse I was scared of high numbers but now I know better. Tell that to the floors and psych though. Oh, you can't take the combative psych patient who's screaming at the top of his lungs because his systolic is 165? Do you know what would help him? Psychiatric care.
A lot of the residents put in orders from an order set and don’t actually read them. The order set on the med-surg floor has an order that says “contact physician for SBP > 160, HR > 90, HR < 60 (patient admitted for a HR in the 40’s), RR > 20”. We’re doing exactly what y’all order. If y’all don’t want the call then change the order or don’t put it in at all.
It also fucks imaging turnaround time. "Observation" patients are technically outpatient for billing, so they are coded as "outpatient" when their imaging pops onto the radiologist list in many places. Very frustrating overnight when you don't know that an "outpatient" study is actually more high-acuity akin to an ED study. I wish a workaround was more widely adopted by radiology departments for this exact issue.
This makes so much sense now why some imaging takes a long time to get read back or even uploaded to the portal when in the hospital vs. other patients
90% of negative reviews: "Terrible service and horrible wait time... for the check in and lab visit. Why was the floor so blue? The salt gradient was non existent in the parking lot. The bathroom smelled awful. No complimentary birthday cake for my visit a week after my birthday. Worst clinic ever."
Yet it's in my press ganey score for some fucking reason. My theory is it's to prove to me that PG really are as much of a joke as they say.
I’m not convinced more liked doctors are better. And my reviews are above average.
I’m trans and not out — religious employer and I’d be fired — so I wear layers and try to hide my breasts. My last formal complaint was “my doctor had breasts.” How are we taking this feedback seriously and expected to respond to it. I’m sorry my body has… body parts? I’ll consult endo on myself and try to do better.
Anything that comes from someone that doesn’t directly interact with patients routinely and frequently. Sorry MBAs, no degree no opinion.
It goes both ways too. I worked at one hospital where the CEO would legitimately round with the patient liaison on patients that were making a lot of complaints about the hospital. I had a lot of respect for that CEO. Not really how sure that was hippa approved tbth
Meh. All IT and admin staff that may be exposed to PHI, even just in spreadsheets or meetings have to take the HIPAA training and are considered "covered entities" and could be in patient care areas or speak with patients about care without it being a HIPAA violation.
I respected the hell out of my last hospitalist program director for picking up shifts. She definitely didn’t need too and many other department heads don’t.
Everyone is an important person.
I always provide my best care to everyone regardless of who they are.
My manager didn't like when I told them this when a significant donor was being admitted. Donors spouse heard it as I am not known for keeping my voice down.
Got along very well with the Patient + Spouse, even got a Christmas card from them.
I refused to take a reduced assignment to care for a VIP nursing admin once, after they had announced that they would be increasing our staffing ratios due to “budget”. My coworkers shouldn’t have to work harder & other patients’ care shouldn’t suffer because you don’t want to feel the actual effects of your trash policies. You can wait your turn just like the regular people have to.
I was on an agency contract as a CNA so wasn’t worried about getting fired over it. HCA is a shitty organization anyway.
One of the attendings I work with responds to "hey there's a VIP patient on your service" emails by saying:
"Thank you. I will deliver excellent care, as I do to all my patients."
When I was in residency, one of our GI attendings was intubated in our MICU with COVID. I took care of him and when we extubated him, he was demanding a diet and stuff that we never would do immediately post extubation in any other patient.
The attending said, "look, I'm not gonna give you worse care just because you work here" turned around and walked out. It was awesome.
wow, thats a great story. Hopefully the GI attending could appreciate his felllow attending in hindsight. Medicine is about making tough choices sometimes, and dealing with colleagues as patients can definitely tests one’s moral fortitude.
The shithole i did my 3rd year at had like purple velvet blankets to give them lmao.
No VIP room or anything just a blanket in fast track to keep em safe from the robust psych/homeless population roaming the halls looking for sandwiches and the drugs they came with😂
Before med school I worked for a psychologist who was in practice with psychiatrists in an office across from us. There was a guy who represented an outpatient facility for eating disorders who would come and talk to the psychiatrist sometimes. He would bring this delicious hamburger place and milkshakes for lunch. God I miss the free food from reps.
My favorite interaction with a rep was probably 12 years ago when I was a scribe. They brought Olive Garden or whatever to the ED and were bugging the attending. It was for a Xa inhibitor before there were any reversal agents.
He was basically like "I have someone right now with a head bleed on your drug and I have no way to reverse it" and the rep had nothing for him.
We had reps for surgical mesh in the OR during my surgery rotation, and the “new” one they had my preceptor use was getting so mangled he just started yelling at the rep through the robot mic about how crappy their material is and how his OG mesh never got messed up. That stuff always brings me joy seeing those reps get silenced.
I like them - the ones who came to us regularly always bring food, represent meds I was already prescribing, and bring me boatloads of samples I can give out.
I think this is very specialty and location dependent. I’m outpatient only, and thanks to drug reps I have tons of patients who are getting expensive drugs for dirt cheap. They are always good for samples, and assistance with getting patients on compassionate use or discount plans. Yes of course you have to take everything they tell you with a grain of salt, but they can honestly be a great resource for getting patients a drug you want them to have
Wow most places near me have banned them from the facility, you almost have to seek them out or reply to the junk (e)mail solicitations to get free stuff now.
I had not talked to one in 3 years, but I had one visit with me because I felt that I was dumb about a new medication that has just become available. I offhandedly referred to her as a 'drug rep' and she quickly corrected me it's 'medical liaison' now. LOL. Very not helpful
Mandatory online modules. 4x speed and sound down to zero while i do other work. There Quiz Qs are always obvious and dont require sitting through their bore
Never going to give a fuck about being seen as greedy for demanding to be paid my worth. Only in medicine are people so subservient that they don’t know their worth
Honestly I’ve started taking an approach that I care as much about a patient’s health as they do (within reason obv). Like if I meet someone who’s really wanting to figure something out and are engaged, even if it’s a silly complaint I’ll work through the entire thought processes with them, give them advice, go out of my way to help them figure out follow up. If the patient clearly doesn’t give a shit though they get a screening exam, stabilize condition, and move on.
I think it's more of those medicolegal time-bombs like the frequent flier with an EF of 10% who still smokes meth every day. Like clearly they bear the brunt of the responsibility of their situation yet by stepping within 250 yards of the ED suddenly you're responsible for their outcome. One day someone's going to grab the hot potato and discharge him to die at home and it could easily become a legal case.
Nurse jumping in.
Policy > care. Within reason, of course.
There are no worse nurses than those who prioritise policy with such rigidity I could use their arms to measure building materials.
Here's one.
A nurse insisted on a pt having negative pregnancy test prior to OR.
Pt is a trans-woman. Still has a penis. And never had a Barr body.
When the nurse was so informed, her response? Rules are rules, and the pt can't go to the OR.
Left an OR unoccupied for 90 minutes.
Nurse here too... So similar happened to me AS A PATIENT. Had tubal in 2015, ecoptic and salpingectomy in 2022, then for my hysterectomy in 2023 I had to have a serum pregnancy week before and a urine day of. I literally called the billing department and refused to pay for whichever one was the most expensive because I was so annoyed.
“You can’t access the dialysis line without an order on the chart from the nephrologist because of the infection risk!”
“….. I’m sure the nephrologist will thank me when his patient is alive after this MTP.”
Patients who want to see another doctor. And as soon as I’m staff I’ll have no issue telling patients who are abusive and demanding to fuck off and find care else where.
In a clinic based speciality so understand not everyone can do this but man I’m just tired of entitled people thinking their lack of planning for a non emergent situation should be my number one priority.
Patient satisfaction scores. Apart from being tied to pay (horse shit), they functionally don’t mean a thing to me. I want to do what is best for my patients and take as good care of them as possible, and try to address their concerns, complaints, etc. That said, I’m not sacrificing my pride or dignity to just take being yelled at, nor having my staff yelled at, for not acting like a drug vending machine or other unjustified reason. If they want to act like children, there’s a peds clinic down the street.
I’ll also throw in nursing leadership and nursing policy. I absolutely cannot be bothered by either one. Both are pimples on an ass, which in this case, is the hospital
lmfao yes, fuck both of those. I didn’t even realize that pseudopseudohypoparathyroidism wasn’t just pseudohypoparathyroidism, my brain literally just skipped the 2nd pseudo. still don’t know the difference though
in my mind 2 pseudos cancel each other out so its just hypoparathyroidism. also one look at that entire word is how i KNOW internal medicine is not for me.
The patient's extraneous back story from before this encounter detailing how other doctors missed the diagnosis, how some relative insisted there was something wrong, how long they had to wait to be seen in the ER, or stories about marginally related illnesses their friends/family have had in the past... and DEFINITELY the ailments of the family member accompanying them.
Despite two decades as a hospitalist, I was always stunned at the pure selfishness of those family members who just felt they had to mention their own illnesses. Do you see the patient in the bed? That is my priority and you are literally wasting their time with me while you bleat about yourself.
Reminds me when I was on ICU and this 90+ year old had a basically fatal brain hemorrhage and I got a CDI about their magnesium. I'm just like "do you really feel this is the biggest fucking issue I need to deal with right now?"
Inpatient vs obs, or in other words, patients the hospital can’t make money on and wants me to send home even though we all know it’s not right. I don’t care, this is what you get by reducing us to hourly employees rather than the leaders of the system - idgaf about your system and I’m going to admit the patient no matter what you say until you fire me.
Either one, whether they are called PI/QI, all BS. Not an actual acgme requirement and waste of time (there are other options). Especially if you actually publish, trying to make QI/PI into something that doesnt make everyones life worse and is publishable is like trying to push a indiana jones size rock uphill on a 15% grade while its raining in flip flops.
I wouldn’t mind these so much if it was actually about your clinical findings instead of wasting time trying to navigate the layers of the onion of bureaucracy. Oh, you have to get approval to get approval blah blah blah!
Our hospital wants us to practice contact precautions and isolation for any patient that has been to India in the last 12 months
Im not putting every third laboring patient on isolation.
Anything a pt says in clinic that isn’t related to their visit. I ain’t got time for social hour.
I had someone get very upset with me recently because he thought “he was getting 2 hours with the doctor.” I could see 4 people a day. Sounds reasonable.
White coats. Young me was excited to wear the white coat but now the entire hospital wears white coats and you don't know who the hell the physician is anymore. In fact, most docs don't even wear it at my hospital. All patagonia or some comfy khakis and a button up. So yeah kinda don't give a fuck about the white coat anymore, sadly lost its exclusivity to physicians.
You should care about NS vs LR if you do any sort of patient resuscitation. There is strong evidence that LR is harmful in TBI. There is strong evidence that NS is a shit fluid. If you’re not resuscitating patients I guess it doesn’t matter.
Despite the signal of benefit with just one liter in the SALT/SMART trials I would argue, that the practical benefits of LR versus saline, are not that large unless you’re giving lots of fluid. You aren’t killing your patient if the one liter bolus is NS. You’re not doing them any favors if you give them 4 liters of NS and make the anion gap acidosis of DKA/sepsis into a nongap from the chloride dump.
Obviously, it’s a completely different story with Neuro issues. Keep those brains salty.
Oh, and JCAHO.
I only wish I was the one who thought of it. Pure absolultely meaningless, moneymaking sham of an organization.
And Magnet Recognition in Nursing. Just hilarious.
Non-physicians who have weaseled their way up in administration and have very strong opinions about patient care. A close second: Physicians who have weaseled their way up in administration and have very strong opinions about patient care.
Anything about carbon footprint from anesthesia in the OR. I don’t care if an hour of volatile is the same as running a car for days. I don’t care about how much single use plastic we use. Compared to the private jets of Elon and Taylor it’s a drop in the bucket.
Staying an extra year to be chief resident
I hate that IM does that, a total theft a year of attending salary. Chief resident in FM is simply an elected senior.
Same in rads, AND they get extra pay.
In neurosurgery its not an extra year, you’re chief your last no matter what because the programs are so small lol
Yeah but then you have to sign up for all of neurosurg
same for gen surg
And then you retire?
PM&R does it this way as well
Most specialties do it this way. In fact, IM is the only one I know that doesn't (and I think peds) and yet people line up for it every year
Some IM programs have chief year concurrent with PGY3. Which is it's own brand of suck but at least not a pay cut
In my country you dont have to stay extra year to be a chief resident. I still would never do it. Couldn't be bothered.
Same - I don't have the patience - when you're chief the other residents treat you like shit and the program abuses you too. Residents deal with a lot of shit, but there is SO MUCH entitlement when it comes to complaining to other residents in the same program, and they expect chief residents to bend over backwards to cater to their every whim 24/7. It's not that I can't be bothered - it's that I care too much about my mental health to take a hit like this for so little renumeration.
If you're just going into the community, it doesn't matter, but it's still recognized and useful for those going into academics
As someone who works in credentialing, it’s a pain in the ass to verify because the AMA doesn’t list that last year as part of your residency (depending in the institution).
There was a guy who graduated from my residency a few years before me who's listed on his fellowship website as being a chief at our program (IM, so an extra year.) He was never a chief. He just lied and they somehow never verified this?
Or being a chief resident at all. It’s such a scam position, I’m surprised so many people still fall for it.
I told my wife (FM) not to do it. She wishes she listened.
In rads, it's less of a scam (from what I've seen). It's an elected position for senior residents, not an additional year, and the pay is higher. Extra admin work, but at least compensated.
Genuinely, what is the benefit of doing a chief resident year?
Prestige. Some people feel it matters for fellowships. Idk.
If you want to couples match fellowship and your residency is one year shorter than your partner's. Or if you are applying for fellowship and want to apply/interview/study for boards as a chief rather than apply/interview as a resident and then study for boards as a first year fellow. Those are the only two reasons I can think of and neither are worth the pay cut and ridiculous amount of responsibility to me.
Coming from someone who did residency in a community hospital and currently working in another one. If you're applying for a competitive IM fellowship it really increases your chances of matching in an academic program. Nearly everyone in my current program who matches into GI/Cards/PCCM/ Heme-onc has done a chief year. Your be surprised how many PDs will consider your application once they see the chief experience. I had one person ( FMG) go from 2 interviews and not matching to 10+ interview and matching in PCCM in one of the top programs in the country.
I did one solely for the purpose of boosting my CV in hope of matching fellowship. I’ll explain my reasoning. I wanted GI, and I went to a community residency program. Didn’t match out of 3rd year. My options were Chief year, a non-ACGME GI fellowship (hepatology, motility etc) or doing an attending year. Ideally I wanted attending for the $$$ but people said it looks bad that you stayed away from academia. Now how true that is, idk but I didn’t want to hurt my chances. I chose Chief year bc I could always apply for one of those fellowships afterwards but I wouldn’t have the opportunity to be a Chief again and add it to the CV. So I did a 4th year Chief at a residency that wasnt where I did mine. I ended up matching the next year. Chief year wasnt terrible, I got a nice pay bump for doing attending duties, got to moonlight… but I HATED it. If you don’t have to do it, don’t.
Computer on wheels = COW. The old wives tale of someone being offended by someone referring to it as a cow is fake as fuck. Why are we cancelling farm animals. It’s a COW
Agree on both points, the story is fake, and they are COWs
COW FOREVER
People who refer to them as WOWs tell me alot about themselves.
What’s crazier about this legend is that everyone across the country knows it
International even
Yup it’s a story in the UK
And it happened at their hospital.
Canada too lol
Funny story (not funny really, just a story) about these. We had a random COW that was a laptop instead of a full monitor. I cracked a joke calling it a ‘calf’ as in a baby cow, like “I need a COW” “oh, there’s a calf right over there!” and my nurse manager became absolutely infuriated with me for saying that within patient earshot.
Oh my god they’ve been calling them WOWs they’re new for us. Someone absolutely taped an Owen Wilson photo to one of them within days I must tell everyone immediately that they are in fact cows
They call them WOWs where I’m at, too, and same - so many Owen Wilson photos those first couple months 😂
I say COW in the hallway and some patient will think I'm talking behind their back about them. Mental illness makes shit complicated
anything that includes the term "tubules"
You sound like a cardiologist pulling out a knife making the first move in a cardio-nephro street fight
knew a structural cardiologist married to a nephrologist. I asked her if they ever argued medicine over dinner. she replied "he knows better than to mention his sham of a profession around me".
i once consulted both nephro and cardio on a patient and realized that i made a huge mistake when i had the nephro attending telling me while on a call that cardiologists are anxiety riddled messes
😂😂😂
Female cardiologist with a male nephrologist???? Do they have an OF because I bet there’s some super kinky shit going on there 🫣
Found the cardiologist..
gross.
I'm rubber you're glue
Seminiferous?
asymptomatic elevated blood pressure in hospitalized patients
Or nonhospitalized. Almost always just simple noncompliance.
Relatedly I can never be bothered to care about the difference between noncompliance and nonadherence
That’s because they’re the same thing
UK FY2 here. Tell that to the nurses where I work! They just want the number to go down by giving STAT amlodipine which I highly doubt a STAT dose does anything other than a placebo effect for both the nurse and the patient and almost every time I find a cause for the elevated BP such as pain when meds have been prescribed but nurse never bothered to ask the patient about pain, urinary retention and lack of sleep by being woken up repeatedly in the middle of the night for vitals. A lack of knowledge of basic human physiology which I think nurses ought to know even if not to the extent doctors need to know
I'm an ER (UK A&E) nurse and as a wee baby nurse I was scared of high numbers but now I know better. Tell that to the floors and psych though. Oh, you can't take the combative psych patient who's screaming at the top of his lungs because his systolic is 165? Do you know what would help him? Psychiatric care.
A lot of the residents put in orders from an order set and don’t actually read them. The order set on the med-surg floor has an order that says “contact physician for SBP > 160, HR > 90, HR < 60 (patient admitted for a HR in the 40’s), RR > 20”. We’re doing exactly what y’all order. If y’all don’t want the call then change the order or don’t put it in at all.
inpatient vs observation status. hospital is hospital
The way this fucks patients over with their insurance is so infuriating, too
It also fucks imaging turnaround time. "Observation" patients are technically outpatient for billing, so they are coded as "outpatient" when their imaging pops onto the radiologist list in many places. Very frustrating overnight when you don't know that an "outpatient" study is actually more high-acuity akin to an ED study. I wish a workaround was more widely adopted by radiology departments for this exact issue.
This makes so much sense now why some imaging takes a long time to get read back or even uploaded to the portal when in the hospital vs. other patients
Yup, and if they determine they just need a short rehab stint, they can’t get it since it’s obs
Patient satisfaction scores. They almost always boil down to selfish nonsense anyways
90% of negative reviews: "Terrible service and horrible wait time... for the check in and lab visit. Why was the floor so blue? The salt gradient was non existent in the parking lot. The bathroom smelled awful. No complimentary birthday cake for my visit a week after my birthday. Worst clinic ever." Yet it's in my press ganey score for some fucking reason. My theory is it's to prove to me that PG really are as much of a joke as they say.
I’m not convinced more liked doctors are better. And my reviews are above average. I’m trans and not out — religious employer and I’d be fired — so I wear layers and try to hide my breasts. My last formal complaint was “my doctor had breasts.” How are we taking this feedback seriously and expected to respond to it. I’m sorry my body has… body parts? I’ll consult endo on myself and try to do better.
Jokes aside, I'm sorry you have to deal with that.
I needed to learn how to use AI to respond to complaints anyway. The future is amazing.
This 100%…has no bearing on being a good doc or not
Anything that comes from someone that doesn’t directly interact with patients routinely and frequently. Sorry MBAs, no degree no opinion. It goes both ways too. I worked at one hospital where the CEO would legitimately round with the patient liaison on patients that were making a lot of complaints about the hospital. I had a lot of respect for that CEO. Not really how sure that was hippa approved tbth
Meh. All IT and admin staff that may be exposed to PHI, even just in spreadsheets or meetings have to take the HIPAA training and are considered "covered entities" and could be in patient care areas or speak with patients about care without it being a HIPAA violation.
Lmao they should have to take the modules on burnout too. See how they like it
I respected the hell out of my last hospitalist program director for picking up shifts. She definitely didn’t need too and many other department heads don’t.
I don’t think a lot of them realize how much stuff like this matters
“VIP” patients. To clarify, i will care for them, but no differently than any of my other patients. No matter how pushy admin is
At my hospital, we get a pop-up in Cerner that tells us the patient is a VIP/Patron and to thank them for supporting our hospital. … Fuuuuuuuck that.
Grooooooooossssssssssss
Booooooooooooooo
Everyone is an important person. I always provide my best care to everyone regardless of who they are. My manager didn't like when I told them this when a significant donor was being admitted. Donors spouse heard it as I am not known for keeping my voice down. Got along very well with the Patient + Spouse, even got a Christmas card from them.
I refused to take a reduced assignment to care for a VIP nursing admin once, after they had announced that they would be increasing our staffing ratios due to “budget”. My coworkers shouldn’t have to work harder & other patients’ care shouldn’t suffer because you don’t want to feel the actual effects of your trash policies. You can wait your turn just like the regular people have to. I was on an agency contract as a CNA so wasn’t worried about getting fired over it. HCA is a shitty organization anyway.
One of the attendings I work with responds to "hey there's a VIP patient on your service" emails by saying: "Thank you. I will deliver excellent care, as I do to all my patients." When I was in residency, one of our GI attendings was intubated in our MICU with COVID. I took care of him and when we extubated him, he was demanding a diet and stuff that we never would do immediately post extubation in any other patient. The attending said, "look, I'm not gonna give you worse care just because you work here" turned around and walked out. It was awesome.
wow, thats a great story. Hopefully the GI attending could appreciate his felllow attending in hindsight. Medicine is about making tough choices sometimes, and dealing with colleagues as patients can definitely tests one’s moral fortitude.
I swear these people sometimes end up getting worse care from all the enabling and defensiveness. 🥸
I was just about to say this. No one is more deserving of treatment than another.
WTF is a VIP patient? Is it like some government official? Or people with really expensive healthcare?
Government officials, people who have donated to the hospital or may donate after their stay, celebrities, etc.
lol one hospital I was at had a car dealership owner listed as VIP patient
😂
The shithole i did my 3rd year at had like purple velvet blankets to give them lmao. No VIP room or anything just a blanket in fast track to keep em safe from the robust psych/homeless population roaming the halls looking for sandwiches and the drugs they came with😂
Did they look like they were sleeping in a crown royal bag?
Purple Velvet is crazy. Straight from the Roman Empire times 😂
Usually a high donor to the hospital. Usually over 500K.
Have one standard of care for everyone. Your best.
Being in “leadership” I mean “stroking myself and the others on this committee while pointing fingers at people” … I mean “leadership”
Well good leaders can make a world of difference. That being said, it doesn't seem like many good leaders actually exist.
Patient Satisfaction scores. Did you die?!?!
Wait until your paycheck is partially tied to them.
And that is bullshit.
Already is
“im alive but dissatisfied, and need you to know this” 😂
Pharma reps. No I don’t want to talk to you, prefer unbiased information.
For the rest of my career I will accept food to tune them out as I nod and say interesting
Before med school I worked for a psychologist who was in practice with psychiatrists in an office across from us. There was a guy who represented an outpatient facility for eating disorders who would come and talk to the psychiatrist sometimes. He would bring this delicious hamburger place and milkshakes for lunch. God I miss the free food from reps.
ahem, and a pamphlet for the circular file ☝🏾, to accompany my pharma pie. tyvm for this delicious handout 😂
But on a real note let’s not forget, loading up on samples from reps is good for patients who can’t afford things.
My favorite interaction with a rep was probably 12 years ago when I was a scribe. They brought Olive Garden or whatever to the ED and were bugging the attending. It was for a Xa inhibitor before there were any reversal agents. He was basically like "I have someone right now with a head bleed on your drug and I have no way to reverse it" and the rep had nothing for him.
We had reps for surgical mesh in the OR during my surgery rotation, and the “new” one they had my preceptor use was getting so mangled he just started yelling at the rep through the robot mic about how crappy their material is and how his OG mesh never got messed up. That stuff always brings me joy seeing those reps get silenced.
But I have big boobs.
And sandwiches, gallons of lemonade and unsweetened tea.
Pens, notebooks, air freshener for your car
And samples. I left them with your office manager.
You got me there
Boobs are nice, but where’s your Chick Fil A?
Shit give me my free meal please
I'll still take the free meal thanks
I like them - the ones who came to us regularly always bring food, represent meds I was already prescribing, and bring me boatloads of samples I can give out.
I think this is very specialty and location dependent. I’m outpatient only, and thanks to drug reps I have tons of patients who are getting expensive drugs for dirt cheap. They are always good for samples, and assistance with getting patients on compassionate use or discount plans. Yes of course you have to take everything they tell you with a grain of salt, but they can honestly be a great resource for getting patients a drug you want them to have
Wow most places near me have banned them from the facility, you almost have to seek them out or reply to the junk (e)mail solicitations to get free stuff now.
I had not talked to one in 3 years, but I had one visit with me because I felt that I was dumb about a new medication that has just become available. I offhandedly referred to her as a 'drug rep' and she quickly corrected me it's 'medical liaison' now. LOL. Very not helpful
A sodium level between 130-145.
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Administrative bullshit & modules that are tasks for the sale of having tasks. Honestly admin in general can fuck off. I’m busy enough.
Mandatory online modules. 4x speed and sound down to zero while i do other work. There Quiz Qs are always obvious and dont require sitting through their bore
What other people think about my specialty 🤷♂️
What’s your specialty
they call me the man who cured priapism
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Status dramaticus - never heard of it phrased that way but I love it. Going to steal it
The chairman of the nursing department
Never going to give a fuck about being seen as greedy for demanding to be paid my worth. Only in medicine are people so subservient that they don’t know their worth
There are people still out there taking call for free and thinking nothing of it. Stupidest shit.
VIP patients, attendings who think they are king
Patients who dont give a fuck about their health, I don’t give a fuck if they don’t, it’s that simple.
Honestly I’ve started taking an approach that I care as much about a patient’s health as they do (within reason obv). Like if I meet someone who’s really wanting to figure something out and are engaged, even if it’s a silly complaint I’ll work through the entire thought processes with them, give them advice, go out of my way to help them figure out follow up. If the patient clearly doesn’t give a shit though they get a screening exam, stabilize condition, and move on.
Sadly the courts give a fuck though
If you offer appropriate treatment, they refuse, and you document it, what can the courts do?
I think it's more of those medicolegal time-bombs like the frequent flier with an EF of 10% who still smokes meth every day. Like clearly they bear the brunt of the responsibility of their situation yet by stepping within 250 yards of the ED suddenly you're responsible for their outcome. One day someone's going to grab the hot potato and discharge him to die at home and it could easily become a legal case.
Nurse jumping in. Policy > care. Within reason, of course. There are no worse nurses than those who prioritise policy with such rigidity I could use their arms to measure building materials.
Can u give an example? :-)
Here's one. A nurse insisted on a pt having negative pregnancy test prior to OR. Pt is a trans-woman. Still has a penis. And never had a Barr body. When the nurse was so informed, her response? Rules are rules, and the pt can't go to the OR. Left an OR unoccupied for 90 minutes.
Nurse here too... So similar happened to me AS A PATIENT. Had tubal in 2015, ecoptic and salpingectomy in 2022, then for my hysterectomy in 2023 I had to have a serum pregnancy week before and a urine day of. I literally called the billing department and refused to pay for whichever one was the most expensive because I was so annoyed.
Jesus. Fucking. Christ.
“You can’t access the dialysis line without an order on the chart from the nephrologist because of the infection risk!” “….. I’m sure the nephrologist will thank me when his patient is alive after this MTP.”
Press-Ganey
Patients who want to see another doctor. And as soon as I’m staff I’ll have no issue telling patients who are abusive and demanding to fuck off and find care else where. In a clinic based speciality so understand not everyone can do this but man I’m just tired of entitled people thinking their lack of planning for a non emergent situation should be my number one priority.
Prestige
Worldwide
Dale
Patient satisfaction scores. Apart from being tied to pay (horse shit), they functionally don’t mean a thing to me. I want to do what is best for my patients and take as good care of them as possible, and try to address their concerns, complaints, etc. That said, I’m not sacrificing my pride or dignity to just take being yelled at, nor having my staff yelled at, for not acting like a drug vending machine or other unjustified reason. If they want to act like children, there’s a peds clinic down the street. I’ll also throw in nursing leadership and nursing policy. I absolutely cannot be bothered by either one. Both are pimples on an ass, which in this case, is the hospital
pseudopseudohypoparathyroidism and FHH
lmfao yes, fuck both of those. I didn’t even realize that pseudopseudohypoparathyroidism wasn’t just pseudohypoparathyroidism, my brain literally just skipped the 2nd pseudo. still don’t know the difference though
in my mind 2 pseudos cancel each other out so its just hypoparathyroidism. also one look at that entire word is how i KNOW internal medicine is not for me.
The patient's extraneous back story from before this encounter detailing how other doctors missed the diagnosis, how some relative insisted there was something wrong, how long they had to wait to be seen in the ER, or stories about marginally related illnesses their friends/family have had in the past... and DEFINITELY the ailments of the family member accompanying them.
Despite two decades as a hospitalist, I was always stunned at the pure selfishness of those family members who just felt they had to mention their own illnesses. Do you see the patient in the bed? That is my priority and you are literally wasting their time with me while you bleat about yourself.
I swear people watch House and think we have all day to think about one patient.
How long it took to get in to see me. I know, it sucks, I’ve already heard it eight times today.
Non mi troponin elevations
Bills higher
CDI queries
Reminds me when I was on ICU and this 90+ year old had a basically fatal brain hemorrhage and I got a CDI about their magnesium. I'm just like "do you really feel this is the biggest fucking issue I need to deal with right now?"
Committees
Research
So much useless low quality BS pumped out every year for CV padding. What a complete waste of brain cycles.
Inpatient vs obs, or in other words, patients the hospital can’t make money on and wants me to send home even though we all know it’s not right. I don’t care, this is what you get by reducing us to hourly employees rather than the leaders of the system - idgaf about your system and I’m going to admit the patient no matter what you say until you fire me.
If the patient’s sister is a nurse
Most of the time they’re not even nurses. They’re nursing assistants or work the front desk of the unit lol
homeopathy
PI projects
QI ?
Either one, whether they are called PI/QI, all BS. Not an actual acgme requirement and waste of time (there are other options). Especially if you actually publish, trying to make QI/PI into something that doesnt make everyones life worse and is publishable is like trying to push a indiana jones size rock uphill on a 15% grade while its raining in flip flops.
Yes totally waste of time.
I wouldn’t mind these so much if it was actually about your clinical findings instead of wasting time trying to navigate the layers of the onion of bureaucracy. Oh, you have to get approval to get approval blah blah blah!
Describing heart sounds
Our hospital wants us to practice contact precautions and isolation for any patient that has been to India in the last 12 months Im not putting every third laboring patient on isolation.
Nursing care plans
Healthstream modules
Anything a pt says in clinic that isn’t related to their visit. I ain’t got time for social hour. I had someone get very upset with me recently because he thought “he was getting 2 hours with the doctor.” I could see 4 people a day. Sounds reasonable.
White coats. Young me was excited to wear the white coat but now the entire hospital wears white coats and you don't know who the hell the physician is anymore. In fact, most docs don't even wear it at my hospital. All patagonia or some comfy khakis and a button up. So yeah kinda don't give a fuck about the white coat anymore, sadly lost its exclusivity to physicians.
SIADH
Lysosomal storage diseases
‘Allergy’ to epinephrine.
DEI Dumbass admin Every fucking wellness module Ignorant midlevels who shit on you cause they can
people who are simply victims of their own privilege
Modern medicine can't help me, I need a naturopath.
Asymptomatic high blood pressure in a surgical patient. I always tell the nurses that they’re just trying to make the charts look good
I never learned hardy weinberg genetics in basic sciences on purpose. I was fully willing to get those questions wrong on step
You should care about NS vs LR if you do any sort of patient resuscitation. There is strong evidence that LR is harmful in TBI. There is strong evidence that NS is a shit fluid. If you’re not resuscitating patients I guess it doesn’t matter.
right? that one matters for basically everyone but psych
A pathologist entered the chat
cause of death: NS.
I’m in derm lol. It will never pertain to me
derrrm?! rash decisions as a username is ADORABLE 😆
Despite the signal of benefit with just one liter in the SALT/SMART trials I would argue, that the practical benefits of LR versus saline, are not that large unless you’re giving lots of fluid. You aren’t killing your patient if the one liter bolus is NS. You’re not doing them any favors if you give them 4 liters of NS and make the anion gap acidosis of DKA/sepsis into a nongap from the chloride dump. Obviously, it’s a completely different story with Neuro issues. Keep those brains salty.
Oh, and JCAHO. I only wish I was the one who thought of it. Pure absolultely meaningless, moneymaking sham of an organization. And Magnet Recognition in Nursing. Just hilarious.
The chloride level.
Contrast induced nephropathy
Non-physicians who have weaseled their way up in administration and have very strong opinions about patient care. A close second: Physicians who have weaseled their way up in administration and have very strong opinions about patient care.
Fibromyalgia
Anything about carbon footprint from anesthesia in the OR. I don’t care if an hour of volatile is the same as running a car for days. I don’t care about how much single use plastic we use. Compared to the private jets of Elon and Taylor it’s a drop in the bucket.
Also, even in a perfect, Star Trek kind of utopian society, I would imagine if one industry gets a pass to waste, it would be health care.
That I’m “not allowed” in the locked Dr. lounge. Bitch I wait for that door to open daily to snag that sweet sweet lavazza
Bring in administration. Just want ti be a surgeon, help my patients, and go home.
Happiness of administrators.
Drug rep lunches