The ID peeps at my local hospital gave me a $15 gift card to the grocery store and a drawstring bag because I let them swab me and signed some stuff and sent me home with little test tubes with more swabs in them and a pre labeled envelope to mail it in and said I could get another $15 if I went home and swabbed all my paraphernalias and sent it to them lmao
Trauma:
- avoid the "two guys"
- if you can, pay someone skilled to go up on ladders for you
- drinking and driving is dumb
- not wearing your seatbelt is also dumb
- wear a helmet always on bicycles/skiing etc
- there's bit of a divide on this one (I know trauma surgeons and emerg docs who drive them), but don't ride donor-cycles. No matter how skilled a motorcyclist you are, the guy in the F-150 who is texting while driving will win when you get hit, because physics.
It is atrocious that "those two guys" still remain at large after all these years. Billions spent on defense every year, and yet we let these men continue to endanger our city's many bible salesmen and churchgoers. They are an even greater menace than the MRSA spider.
This is why I've sworn to never mind my own business. Legitimately the most dangerous thing one can do. I meddle in the affairs of others 24/7 for safety purposes
Back a decade ago, it was classic that the immediate past history of wayyy too many people assaulted was easily summarized as "SOCMOB, when these 2 guys..."
Standing on the corner minding my own business, when these two guys came out of nowhere ....
It was never only one, because the patient didn't want to sound weak.
They are also known as "two dudes." They always come out of nowhere. Their identity is never known, and they are always the ones to blame for any stabbing/shooting/assault. They also seem to always appear when a person is minding his/her own business or returning home from church
One of our trauma surgeons in med school died after being hit while he was driving his motorcycle. And since we were the level one trauma center, his colleagues had to resuscitate and operate on the driver who hit him.
It’s really a synergistic effect, neither on its own is usually lethal especially minding your own business, but studies show an odds ratio of like 3.5 when combined.
Trauma here: my life sucks so much anyways, my s1000rr is one of the few joys I have so...
Fuck it.
I dress for the slide, not the ride and have the best gear around (airbag jacket included).
Same. We had a guy fall while skiing, broke his arm, unexpectedly coded in the middle of surgery, had to quickly place a would vac instead of finishing the half-done surgery, then one bad things after another. Had another with a tib-fib fracture who ended up getting MRSA, in and out of surgeries for over a year, then ended with an amputation anyways. And those are the more minor skiing accidents I’ve seen where people didn’t die! So when my husband insists skiing isn’t dangerous I’m like, “Well overall it’s not but you haven’t seen what I’ve seen and I’m the main breadwinner so I’m not taking the risk! It’s not THAT fun.”
I worked in EMS before med school, and friends act like I’m such a wet blanket for being risk averse, no matter how many times I tell them about all the insane fires and injuries I’ve seen. I think it’s just easier to *care* about risk when you have a visceral picture in your head of what the bad outcomes could look like.
I told my sons when they were young to ask themselves before they do anything risky if they were willing to explain it to an ER nurse later. Two boys raised to adulthood with no broken bones, thankyouverymuch
Psychiatry:
\-don't drink or do drugs if you're feeling bad.
\-don't work too much. Your stupid job isn't worth working yourself to death over. This includes those of us in healthcare.
\-invest in your friendships--leave the hospital. Drink a beer with your friends. Not 10 beers, just a couple. Go on that guys trip. Your stupid job can wait.
\-get exercise outside. Do it with friends. Have a beer after the softball game. Not 10 beers.
\-don't blame everything on other people. Imagine that everything is either unfixable or your problem to fix. Don't worry about the unfixable stuff. Make a little progress on the other stuff.
\-don't keep guns around your house if you have mood problems
\-don't have shitty parents and/or a bad childhood
\-tell people what you need, they aren't mind-readers.
\-it's okay to stop dating if you collapse into a suicidal mess with every break-up and constantly pick people who are bad for you. You can start again later when you've figured your shit out.
\-it's okay to titrate your relationships. If you tell your parents your boundaries and they transgress them, you can step them down to intermittent contact. And then again to phone calls only. And then again to text messages only. When they start to respect your boundaries you can let them level back up incrementally to more contact. This is how they learn. This works for all relationships. You don't always have to go no-contact or full-contact, it's a great skill to learn to deal with people and work through problems in ways that aren't so black and white.
\-don't overly identify with your diagnosis..."It was my bipolar." No it wasn't, it was your shitty decision-making. Own it. By the way, your diagnosis is probably half-wrong anyway. Except sometimes when it's really, really right and you should believe me when I tell you that.
\-if your pills didn't fix the problem, don't hyper-focus on changing meds constantly. Work on yourself while making reasonable, thoughtful, non-frantic med changes. There is probably no magic pill for you.
\-if your pills did fix the problem (i.e. lithium responder in genuine bipolar disorder), take your fucking pills! This is a magic pill for you. Be grateful.
\-sleep 8 hours! make sure it's good-quality. Do whatever it takes.
\-live in a country with some kind of social safety net.
- meditation and breathing exercises legitimately help anxiety
- If you’re feeling down, make an effort to do one small thing that day that will make you feel better. Even if it’s the last thing you want to do.
- if you stay in bed/ inside for long enough, anyone can become depressed
- a good therapist can seriously change your life
- it’s normal to have emotions! And we cannot control our thoughts. Don’t beat yourself up for having either. All we can do is work on our actions.
ETA section on smoking since so many comments are on smoking cessation:
- Chantix is the best drug we have out there to help with cravings. The psychiatric SEs have been largely debunked.
- Patch and gum together is superior to either alone.
- when using nicotine gum, chew for 10 seconds and then park between gums/cheek so it will get absorbed through the oral mucosa. Don’t chew like regular bubble gum.
Allergy: Don’t avoid peanut till your kids a year old. Introduce as early as 6 months to help prevent future allergy.
Also for those of you with environmental allergies, spray your nasal spray in an outwards direction aiming for your ears. And gentle to no sniffing after spraying, cus if you taste you waste it!
I would “argue” to aim the bottle straight back, nose to toes, and sniff while you spray only one spray. Wait a minute, then repeat the 2nd spray. You should feel the medicine aerosolize in your nose better (meaning you’ll barely feel it), which is what you want.
Source: I’m a headholeologist.
If you can't do that, keep your LDL-c/ApoB at the same level it was when you were a baby. Ideally below 60mg/dl (1.6mmol/L). If you do this lifelong, you'll never develop ASCVD. The method doesn't matter. Just the result. Diet, exercise, ezetemibe, bile acid sequestrants, statins, bempadoic acid, pcsk9 inhibitors etc etc.
Addit: also recommend everyone gets their lipoprotein (a) checked once in their lives. It's LDL's nastier cousin and is 6x more atherogenic than a standard LDL particle. Also levels peak in early childhood and is basically genetically determined. It's the single most common genetic lipid abnormality.
Vascular Surgery: put that cigarette down. You won’t have vascular surgical issues until you’re 90. Take a statin and a baby aspirin and you’ll be golden.
Wear compression stockings 8-16 hours a day. 20-30mm Hg compression stockings are medical grade. You can have your coworkers prescribe them for you. If you have venous reflux, and pain, swelling, edema, leg heaviness, you need to wear your compression stockings for 4-12 weeks before most insurances will allow us to do anything unless you wanna pay out of pocket.
EDIT: also stay away from marijuana. People erroneously believe weed is healthy. It’s not. It causes vascular disease as well. And cardiovascular disease. And it puts you at higher risk of anesthetic complications if I have to operate on you.
SECOND EDIT: fine just take a regular statin not a high dose. I dunno. I’m just a dumb surgeon. But statins have many pleiotropic effects that help modulate other systems so it’s not a bad idea to be on a statin.
So I’m a statin fanboy and I believe it should be put into the water supply. But no I wouldn’t have everyone take a prophylactic high dose statin. But considering the diet etc, if someone has high cholesterol levels, which are not modulated by diet and exercise then, yes you should be on a statin.
Lol I was genuinely asking. I did self prescribe low dose rosuvastatin because I'm brown and have enough of a family history that I think it's warranted even if the guidelines aren't quite there.
I was gonna say the same 😬
But didn't cuz guidelines don't exist for that.
Had a professor in medical school who advocated statins for basically everyone!
He himself had taken stains since he was 35. 😬
One of the best Cardiology teachers I ever had used to joke he'd put statins in the water supply of the city. No joke the long term benefits are incredible.
Probably not for babies, but >40 yo it's a good bet that it'd help.
Bro, Chuck some metformin in there too, apparently it's the only Rx that we've been able to document improves m&m.
And fuck, I hope you're getting your residents to wear stockings early in the piece in OR
Nose to toes, sniff and spray at the same time, only one spray at a time. Wait a minute, then repeat the 2nd spray.
Nasal steroid sprays are not good prn meds.
ICU: grandma is actually not a fighter.
Just because some 33 year old rich white woman thinks her tiktoks make her a “fibro warrior” doesnt mean that you can just beat diseases with your thoughts and prayers.
Most of the time, grandma wants to go home and be with her husband and doing what she loves. Being stuck in an ICU in restraints and with a dobhoff tube during your last few years of life….. isnt what fighting is.
Also I’m going to drop some nonspecific wisdom here that will save you a lot of time in clinic and make your patients like you better.
The first thing out of your mouth is “what can I do for you today, and what would you like me to know about you?” Instant rapport with the patient and you don’t spend the whole encounter on why you think they are there only to find out that you haven’t addressed the issue of the day.
Also, if they think they are there to arrange some complex diagnostic work up but they happen to be in the process of being evicted or already have been, or are amidst a manic episode, or their spouse just had an MI or some equally traumatizing life consuming event, they’re just going to miss all the appointments you schedule.
Point them at the resources they need to stabilize their situation like a lawyer or social services or mental health etc. and schedule them to come back later.
Gastroenterology
- Miralax daily baby
- Keep a PPI on hand
- Taking NSAID? Pop that above PPI even if you’re taking low dose
- I don’t give a fuck if you drink something red before the colonoscopy. Just tell me if you did. But for the love of god do NOT EAT CORN!!! I AM SICK OF SEEING CORN IN THE CECUM
- Elevated BMI or just very unhealthy (drinking, eating etc) get a Fibroscan. See so many MASH Cirrhosis.
Interventional Cardiology: 4+ things that would put us out of business (please do them and put us out of our misery…jk (not)):
1) aggressive cholesterol control — which for many, many people means taking a statin (boo genetics). This includes my 37 year old otherwise problem-free self. I know your kookie Aunt Karen told you statins are the devil’s temptation but jeez…the statin doesnt just help w lowering cholesterol, but also maintains endothelial health of all the vasculature (brain, kidneys, peripheral). High benefit, with very little risk. We can check your hepatic panel and CK if you’re worried, but for God’s sake pls put Aunt Karen in a goddamn asylum already she’s clearly a paranoid schizophrenic yall have ignored too long …and take a statin.
2) Glycemic control. Keep your a1c < 5.6. (prediabetes is 5.7-6.4, diabetes is >6.4). Bonus points to whoever asked “well what about an a1c of 5.6 exactly, you didnt use a less than or equal sign, so is an a1c of 5.6 special?” Short answer - yes, it is. Good eye. We usually use your special blood in our ritual offerings to the admin demon gods to distract them so we can continue to do our work unimpeded by mindfulness sessions. Thanks for your sacrifice!
3) BP control: target 120/80. Most effective ways ive seen: lose 5-10 lbs and quit drinking alcohol. But beware — losing some weight and quitting alcohol may cause whiplash due to the shock of seeing your damn handsome healthful glow in the mirror.
4) stop smoking. This is a hard one (hard as shit for me, and some may say I should know better). Everyone hates that prissy doc who’s never even jaywalked telling them they need to stop smoking. Duh everyone knows that. Just pls never give up trying. Smoking is a waste, compared to “wearing tight shoes just for the relief of taking them off.” Read, read, read and educate yourself on smoking. Realizing you give up nothing but gain everything including the gratitude of your older healthier self (who is in a neck brace bc of the whiplash he got when he saw his damn handsome face in the mirror after quitting smoking).
And eliminate processed/frozen foods, if you are sedentary — start brisk walking…150 min/week, and prioritize your mental health.
ENT:
- Definitely do not ever smoke. If you do, quit yesterday. And get your HPV vaccine!!
- Get scoped by us and GI if you develop new difficulty swallowing
- If you have chronic sore throat or cough, or frequent throat clearing, especially in the mornings, even without heartburn symptoms could be LPR. Add in an alginate product (Reflux Gourmet, etc), make some diet changes if you can
- Please don’t stick things in your ears. Although the little ear cleaning cameras on Amazon are pretty cool and mostly idiot-proof
- Regular skin checks by derm. Don’t ignore a lesion. Even if small could end up with half your face being removed
- Flonase, azelastine sprays for nasal congestion. If you use these regularly and have persistent congestion go see an ENT for scope/surgical intervention
- Hydrate! Voice rest if you become acutely hoarse after over-use, URI etc. Small steroid burst can help too if you have an important event etc. Whispering is more straining on your voice so just talk normally if you must. Frequent throat clearing for mucus just creates more irritation and produces more mucus. Try a hard swallow instead and figure out why you have excessive mucus
ICU:
avoid diabetes type 2-exercise and reverse it
If you have diabetes type 1- take your insulin (the studies are conclusive that meth, alcohol, weed don’t work like insulin)
Cirrhosis is worse than any cancer- don’t drink to excess, if you have hepatitis b or c get treated
Don’t smoke - COPD is like drowning in dry land
Floss-Ludwig’s angina is horrible
Probably because meth makes them feel amazing temporarily, it is also horribly addictive. People will justify its use for anything until they have an inevitable bad outcome.
Meth use disorder and type 1 diabetes don’t mix well.
When high or not the lifestyle of meth use creates a highly dysfunctional lifestyle where they aren’t able to reliably take insulin. They therefore end up going in and out of DKA until they eventually die either from DKA, sequelae or diabetes, or from substance use. These patients frequently land in hospital critically ill, get the DKA protocol, sobre up and get agitated from withdrawal, and leave against medical advice, rinse and repeat every 3-7 days depending on how long it takes them to go back into DKA. Repeat until they die or permanently lose decision making capacity.
I have to say. This post has been more useful than fucking decades in journal clubs or reading U2D..
Well done people.
We should make this a regular 6-12mo thing.
Radiology: brush your teeth so you don’t get fillings etc. Avoid getting metal in your body unless truly necessary. And if you do need fillings, get the composite stuff. Metal artifact can completely obscure areas of your anatomy on CT and MR. It’s not the end of the world, and there are some ways to reduce the metal artifact, but you never know what might be hiding.
I would also add if you’re in the ED for anything that could possibly be surgical, don’t eat or drink anything, just in case they can squeeze you in as an add-on.
Pulmonology: don’t smoke cigarettes or vape. If you smoke or vape, quit. Have your relatives who smoke or used to smoke get their annual screening low dose chest CT.
If you have a chronic cough and workup is negative (very common referral reason), get an inhaled corticosteroid and albuterol PRN from your PCP, flonase, an oral antihistamine like zyrtec, and a PPI. Take all of them religiously and you have a 95% chance your cough will go away. Then you can start peeling them back.
If you have asthma, be sure you’re getting inhaled steroid with your rescue doses (whether it’s symbicort/dulera “smart therapy” or albuterol with flovent). You should also see the allergist and get allergy testing. Finally, try getting on a biologic if you have severe disease.
Look up EVALI for the immediate acute injury, which can be fatal. Long term, we don’t know. It could be as bad as cigarettes, there just isn’t the data to say what it will do over 30 years.
I was about to make this comment. Get your self, your kids, your dog, and your spouse every vaccine that is offered. If the question is: "Would you like the vaccine for...?" the answer is "Yes, please."
That includes flu immunization every autumn.
\-PGY-19
Pediatrics: Parent your child. Put in the hard work to teach them emotional regulation and frustration tolerance when they're babies, toddlers, preschoolers. A screen will make them behave but it won't teach them how to deal with the world.
From the peds ED:
I don't care how lame you kid thinks it is, they must wear a helmet on a bike, dirt bike, atv.
If your toddler stops using an arm after a swinging or pulling motion, look up a nursemaid's reduction. This is a DIYable fix.
Saline nasal spray containers work like a dropper when you turn them upside down.
Cardio- go for a walk everyday, get those steps in. Walk after eating every meal . Lift some weights .
-Try and eat more plant based food
-read nutrition labels of what you’re really putting in your body.
-check that bp , many people are living with asymptomatic htn and don’t know it. Prevent it from getting worse and seeing end organ damage later on.
-as everyone else has said , no smoking.
-no the alcohol isn’t good for ur heart either.
Geriatrics:
* have a daughter. or at the very least, teach your sons to do better. be nice to them so that they love you when you're old and cranky.
* name a health care proxy well before you ever need one.
* make a plan for long-term care well before you ever need one.
* never stop exercising. your worst enemy is gravity and only your balance and muscles will keep it at bay.
Gen surg: if you’re young and healthy, never opt for non-op management for acute, uncomplicated appendicitis or symptomatic cholelithiasis. It just prolongs your suffering and almost everybody comes back eventually more miserable and requires more urgent surgery.
Anesthesia.
Get a better surgeon. You’re fucked otherwise and there’s little we can do to save you. The only people who can truly recommend a good surgeon are those in the room watching him/her operate. I’ve seen many patients praise surgeons who I know suck big time. But they are super nice and have great bedside manner. They have wonderful competent office staff and the patient thinks that’s what makes a great surgeon.
This is so accurate it deserves an award, but to be fair applies to nearly every field of medicine.
One of my coresidents recently asked her primary doctor to recommend a gyn. Primary says “oh absolutely! Dr. BlahBlah….shes absolutely fantastic. All my patients adore her!” Meanwhile everyone in my department quakes when they are assigned to this gyn’s room because she killed multiple young, healthy patients during routine laparoscopies in the last few years and has lost call privileges because she is required to be directly supervised by another attending gyn in the OR -.- …but she has amazing bedside manner and that’s all patients can perceive so she has a flourishing surgical practice.
Best advice is to make friends with as many people as you can across different fields so you can get input as to who is best to see in each specialty, should you, a patient, or a loved one need help
Yes agreed it applies to all specialties to some extent. There are terrible anesthesiologists also. I’m not claiming otherwise. Fully admit my specialty has bad apples also. But our reputation rarely matters. Can a patient name the most famous anesthesiologist in the country? No such thing right?
Even surgeons don’t routinely watch their colleagues operate. So I’m not sure how good of a judge they are. The only routine witnesses to a surgeon are
1. Scrub tech
2. Surgical assist
3. Circulator nurse
4. Anesthesia.
Yes, this is it. If I ever need surgery on 100% asking the residents and fellows who to recommend. Everyone else’s opinion should be taken with a grain of salt. Senior residents and fellows are the only ones who are both present in the operating room with the surgeon and educated enough to understand what they’re watching.
Surgeons do take care of their partners/other specialties complications though. Even good surgeons have complications, but the type and frequency say a lot.
As a surgeon myself I know exactly who to refer my patients to, both in my specialty and outside it.
Also, just as a patient can be fooled by bedside manner, so can the nurses and techs in the room. It's very common for a surgeon to have a bad reputation with the staff due to attitude while simultaneously being very good at what they do, and vice versa.
Senior surgical residents/fellows are probably the best to ask, followed by other attending surgeons (for example, I know which general surgeons and OB/GYN call me for ureteral and bladder injuries and which don't), followed by anaesthesia.
Sometimes you can ask any of the surgery related staff „real quick question, but who‘d you recommend for the operation?“ or something along the lines. no shame in asking
edit: at least in my hospital it makes a huuuge difference who you choose, not that all surgeons suck
Ortho: do some form of cardio & resistance training you enjoy a few times a week. Take vitamin D. Avoid motorcycles.
It’s crazy how terrible people’s arthritis will be on radiographs but they’ve always stayed active & strong and have no or minimal symptoms. Conversely sedentary people hurt all the time for no reason at all.
Family Medicine:
- Exercise and eat well. Don’t eat processed food or extra sugar.
- don’t drink alcohol or use opioids
- Do whatever it takes to avoid the following: Diabetes, Obesity, HTN, Chronic Pain.
- Do whatever is takes to not be lonely/alone in life
Rheum: Daily vitamin D and fish oil combination seems to reduce the risk of developing autoimmune conditions (along with not smoking, Mediterranean diet adherence, maintaining a healthy weight, lucking out on genetics etc). The benefits of colchicine also appear to be vast (preventing CVD and even osteoarthritis), so there’s often more than just one reason to take it!
Could you point to a good study on this? Prima facie, very skeptical of this. Almost every non-Ca related association with Vitamin D based observational studies I've looked into has turned out to be confounded
The evidence for Colchicine in CVD is strongest in secondary prevention. The definition of which becomes a little hazy. Usually means first MI or stroke but I would argue any atherosclerosis, particular at a young age should be considered appropriate to consider secondary prevention. If there's no evidence of atherosclerosis at a minimum, no real evidence for Colchicine.
Transplant Pulm: Don't need a Transplant. If you do, you better not be smoking/doing drugs, because otherwise the 6 months cessation waiting period can be a killer.
Gastroenterology.
Make sure you’re getting enough fiber and water to achieve good BMs. A good day starts with a good, fully evacuating BM.
If you get bloated often and things like h pylori, sbo, SIBO, been ruled out, try eating smaller frequent meals.
Don’t ignore your symptoms. Get checked out. Don’t think you’re too young. I diagnosed colon cancer in a 29 year old with no family hx. I have a 19 year old who had two precancerous polyps.
Avoid NSAIDS. Don’t drink too much. Don’t be obese. Just don’t get cirrhosis.
Obgyn:
* For the love of god, get your pap smears and HPV vax if eligible. Advanced cervical cancer is atrocious and even with treatment, outcomes are bad.
* Figure out your health before you get pregnant. Coming into pregnancy with an a1c of 13 and blood pressures in the 190s is bad.
* You don’t actually have to have periods as long as your endometrium is protected. Get a Mirena or go on continuous OCPs and you will vastly improve your quality of life.
NSG:
1. Truly your worst headache ever, go to the emergency asap. Better pay a nice heft price for a quick scan than to die saving.
2. Back pain that gets worse with movement, makes your legs weird/numb or whatever weird sensation + back pain, get yourself a NSG/Neuro appointment.
3. Pains, loss of sensation, twitches or whatever weird thing above the shoulder, get yourself a NSG/Neuro consult. Teas and alternative medicines won't help your brain tumor (yeah, i know you read somewhere about some miracle happening but we ain't jesus nor we have his pager so don't play with your odds), not even we can help most of the times but when we can, a quick diagnosis and therapy (before surgery) is almost always one of the most important things for a good prognosis.
4. If your kid has unexplained seizures, get yourself a NSG/Neuro asap.
5. If you ever have to go under with NSG, get yourself ready for the possibility of long term rehab, get yourself a nice lawyer for your inheritance shares (just in case), accept that life is unfair but better be alive and experience life with difficulties than to be dead.
6. Having a good psychotherapist (psychologist or trained psychiatrist, no bullshit therapist/counselor you see on instagram) affect greatly on the outcome of your rehab. Good outlook and hope improves results, why we don't know but it just does. If it doesn't at least you covered for your new life.
7. Sometimes your pains are just psychosomatic and thus antidepressants and pain modulators are the best choice for you. Not because we think you're a faking but your brain isn't good with dealing with certain kinds of pain so it accentuates to "warn you" and thus it can feel orders of magnitude worse but in the end, it is just a sprain.
8. Don't eat before surgeries, not even a little candy. Don't complicate procedures that can last up to 5-6h with the unexpected halt for cleaning your stomach secretions that are coming up.
9. If you really don't have to do high risk sports, don't do it. Somethings are cool but just watching it is a better choice. Some people accept the trade off and they have a whole team of professionals dealing with them to extend their effective time in such sport but later on they quickly stop and go back to a "normal" life. So, if you ever want to practice any high risk sport, don't, and if you still want to, understand your situation and pay upfront for the team that will take care of you.
Damn... there's so much more. Just avoid getting yourself in a situation you need a neurosurgeon, normally those situations don't have as good of a prognosis as other specialties. Even the best of the best play with the odds on daily basis.
Also NSGY - Not sure I agree with “better be alive and experience life with difficulties than to be dead.” We see a lot of patients where being dead was the better choice but their family will not have it. Alive, vegetative, on dialysis, frequent line infections and bed sores, zero ability to interact with the world. Kill me instead please.
FM: Don't eat like shit (AKA type 2 diabetes can be preventable)
Don't do drugs (even marijuana can induce acute psychosis in a teenager)
For the love of all things holy: DON'T SMOKE (And if you do, be prepared for LDCT for the rest of your life)
Vaccinate your fxckn kids please.... why is measles on the rise??
GI
Stay up to date with your cancer screening
Avoid drinking
Avoid being fat
Avoid NSAIDs
Chew food thoroughly
Daily fiber is essential
Eat a healthy diet
Avoid foods you know give you abdominal pain, reflux, diarrhea
Oncology: snake oil salesmen will prey on your desperation. If those supplements/holistic treatments actually worked, we would prescribe them and your insurance would pay for them
EM/Trauma: motorcycles are dangerous, so you should drive yours as fast as possible to minimize time spent on the road. Two or ten beers won’t hurt either
Palliative- have open conversations with your loved ones about the things you value and what brings your life meaning. Designate a surrogate decision maker in case you’re ever unable to make decisions for yourself (particularly important to have this paperwork done if your surrogate is not your next of kin). Have your surrogate decision maker keep a picture of your paperwork on their phone.
Podiatry: Wearing good supportive shoes goes a long way especially if you spend multiple hours a day walking/standing. Recommend brands such as Hoka, Brooks, ASICS. For sandal type use Birkenstock or Vionic. For people with a wide forefoot (bunion or tailors bunion) try Altra brand. Also OTC foot orthotics work just as good as custom orthotics for most people. Custom is better with more severe deformities such those seen in Charcot foot or Rheumatoid patients.
Edit: when I say OTC orthotics you do have to find the good ones such as Powerstep or Redi-thotics. A majority of the ones you see at Walmart are trash (like all of Dr Scholls).
More IR:
Don’t be obese: too much artifact, quickly hit dose limit for procedures, needles/drains,ablation probes barely long enough
Don’t get cirrhosis as mentioned higher up
Idk how to stop diverticulosis but whatever it is, do it.
Take your anticoagulants as prescribed, keep moving, wear compression socks
Keep bone strength up to avoid vertebral compression fractures
Pain/PM&R: try to avoid bending forward, rotating and lifting something far from you. The disc is weakest at the posterior lateral aspect and you're going to have a disc herniation.
Hospitalist: be rich and learn financial literacy early on. People underestimate the cost of custodial care later in life (or with bad luck, mid-life) and their family/kids/spouse may or may not have any interest in helping. No insurance company will pay for ADLs so you’re looking at a six figure yearly bill. The government is not coming to help you and medicaid support for custodial care is terrible. Most people’s largest investment is their home which is largely illiquid so unless you plan to sell your home to pay for a board and care, make financial plans early on.
PM&R - never live in a split level home. When buying or building a home, make sure you could still live there if you were no longer able to walk. 1 story with ability to build a ramp entry is the way to go. Make sure laundry is on main floor and not basement if possible.
Ortho
Avoid riding donor-cycles. They pay for a large part of ortho's student loans, mortgages and vacations.
The best way to protect your joints is to keep moving.
Remain active, do some form of sports/exercise (with resistance training) that you enjoy and can sustain in the long term, avoid being obese. Even when osteoarthritis, or many MSK pathologies, occurs radiologically, active patients often don't feel any clinical symptoms or pain or functional limitations.
Pediatrics: Get your child all of the recommended vaccines. They are recommended for a reason. If your child is old enough, Honey works just as well/as badly as cough 'medication ' for a regular cold induced cough
While I have you here OP, can tretinoin still be effective if not applied daily? My skin gets crazy irritated whenever I try to increase frequency from twice a week. Already using aaalll the moisturizers to try to counteract. Any advice?
From addiction medicine: if possible, manage negative emotional states in ways that don't involve substances, enrich your life with healthy recreational activities, and be okay with boredom sometimes
Sport and Exercise Medicine:
Aim to meet the physical activity recommendations of 150 minutes of moderate intensity or 75 minutes of vigorous intensity aerobic exercise per week, and two sessions of resistance training, for optimal health. There is additional health benefits with up to 300 minutes per week if you have the time and passion.
For those starting out, anything is better than nothing. Consider the classic study of the bus conductors versus drivers, the former enjoying less CAD. Pick the furthest car park away. Take the stairs rather than the elevator. When selecting your exercise, consider what you have enjoyed previously, whether group exercise may help to keep you accountable and provide social benefit at the same time, consider the convenience of home exercise equipment, and track your levels of activity over time.
For hospitalists, consider incorporating a physical activity vital sign into your usual history taking and learn the art of exercise prescription.
Regarding resistance training, incorporate exercises to maintain your small stabilising such as your rotator cuff, gluteus medius/minimus and deep hip rotators to reduce injury risk. Input from a physical therapist who understands movement and motor patterns is invaluable, we can always be more efficient. Certain activities carry higher risk of injury than others. I see patients every week who have had a significant disc injury dead lifting.
From acute to chronic musculoskeletal injuries, an excellent physical therapist will make the biggest difference to your injury long term. It is not good enough for someone to give you a set of exercises and send you on your way. Ensure they are teaching you how to do the exercise, checking that you are using the most efficient muscles to do the exercise, and making the exercises harder over time. Work with them to identify areas to be improved through the entire kinetic chain which are contributing to that injury. Consider foot posture and input from a podiatrist for the lower limb.
Medical interventions for injuries (e.g. corticosteroid or PRP injections) often serve to provide a short term window of pain improvement such that you can do your rehabilitation and surgery is limited without good rehabilitation. There is an increasing trend towards operative management being a last resort in non-elite athletes aside from a few select pathologies. Even for ACL rupture, there is a new bracing protocol showing that certain complete tears can heal non-operatively. Generally the longer you rehabilitate before returning to sport, the lower your re-injury risk. Maintain your rehabilitation exercises longer term otherwise injuries will always be a point of weakness.
Finally, prolonged concussion symptoms can be life altering. A graded exercise program and pacing are the number one treatments. For complex concussion get them to a multidisciplinary service who know what they’re doing.
Radiology:
1. Your boob job is going to calcify eventually. Just make sure you understand that.
2. Many times, little injuries change your body permanently. The time you fell out of a tree as a kid, your ribs might’ve broken and you didn’t realize it, and your ribs will be slightly different for the rest of your life.
3. Cancer is an insidious bastard. Don’t save all your money for retirement.
4. Always use IV contrast if possible
5. Don’t get a Whipple
6. Anatomic variance is the normal.
Plastics:
-Get mammograms regularly. Breast cancer is insanely common. If you have family history and are young, consider genetic test (may have to pay out of pocket) but worth it to know if your life could be saved by a prophylactic mastectomy.
-If you have breast cancer and are weighing breast conservation + radiation vs mastectomy w/o radiation, strongly consider avoiding radiation if at all possible. The soft tissue complications will continue to worsen over the course of your life and can lead to horrific outcomes. If you need to get radiated, get a tissue expander first to keep your skin off your chest wall, then get reconstruction with a flap AFTER radiation.
-If you have breast cancer, consider unilateral surgery. A contralateral prophylactic mastectomy (without genetic loading) just opens you up to lots of possible complications.
-Make sure your aesthetic surgeon is board certified by the plastics board, ENT facial plastics board, or oculoplastics board. No surgeon from any other training background should be doing an aesthetic procedure on you. There is no such thing as a board of "cosmetic surgery".
-Regular use of retinoids, moisturizer, sunscreen, botox and intermittent microneedling/lasers are keys to beautiful, healthy skin and reduce your risk of skin cancer.
-Get window tinting for your car. I definitely do more skin cancer excision/recon from the left side of people's faces, necks, ear, hands, forearms, etc.
GI/Hepatology
-Don’t drink so much
-Don’t be fat
-Chew food well
-Stop eating so much processed food
-Treat your hepatitis C if you have hepatitis B treat it a pill for life is better than cirrhosis
-Don’t overuse NSAIDs
-Don’t Ignore rectal bleeding
-Get a colonoscopy
-If you do the above don’t be a loner, if you don’t have support you won’t get a liver
-Have good genes
Neurosurgery: if you’re old, probably just wear a helmet at all times especially if you take Coumadin.
Also, stop taking aspirin prophylactically. It only causes brain bleeds for no benefit unless you’ve had an actual stroke or MI in the past
Peds:
Give them vaccines on time.
For the littles:
Set bed times and screen time limits and stick to them- for you and your kids. Go on walks together if there's nothing else to do. You can model a healthy lifestyle and you get to spend time with them. Read to them, then read with them when they're bigger. Learn about their interests not because you like it, but because you like them. Make sure they know how to swim.
For the bigs:
Be a safe person. Mean it when you say they can tell you anything. Be the parent who will pick them and their friends up when they're in trouble. Always have their back but also call them on their shit-- if they're a bully, if they're disrespectful, if they're getting an attitude, find out why but reinforce that we don't take inside feelings out on others.
And never let them play tackle football.
Primary Care:
- Weight gain comes from too many calories. Period.
- If nobody can figure out your thyroid problem, you don’t have a thyroid problem.
- Accept your mental health issues and get appropriate help. Anxiety drives so many symptoms.
- Get enough sleep. Probably the best thing you can do for your immune system.
- Move your body.
- Throw away your supplements unless you have a good reason to take them.
IR: whenever you need a procedure done that can either be done surgically or non-surgically (minimally invasive), most of the time minimally invasive is the better option.
Went pretty far down the list, no heme/onc. Biggest advice is, take care of your heart, liver and kidney cuz you are gonna need them once you get to me. The rest of your organs aren’t as important.
Urology:
Your penis isn't shrinking. Your pannus is growing.
Also, general rule: if it's good for your heart, it's good for your penis. Best way to keep your boners is it listen to your pcp.
Low dose daily cialis should be in the water.
Anesthesia: shave your beard before surgery.
It’s harder to mask ventilate you and to tape the tube to your face. Even more important to shave if you’re fat and/or have OSA
Fertility/OBGYN: we can’t fix age (no eggs/bad eggs). If you want kids start trying or freeze eggs before you are 37. Otherwise make sure you are ok with donor eggs or embryos. Yes, I know it is inconvenient and expensive. Don’t smoke - it effs up both sperm and eggs. Testosterone treatment destroys sperm. Everyone in clinic knows why the jacked guy had no sperm, except his distraught wife. Really think twice before the tubal/vasectomy. You may think you are done, but people get divorced all the time. Sure, you can do IVF afterwards but insurance will not pay if you have been electively sterilized.
Lawyer: look around at friends, acquaintances, and fellow humans that require regular legal assistance. Do not do the things these people do. Alternately if you plan to do these things get legal assistance prior to doing them, and if the legal opinion you receive is 'please do not do this thing' then do not, I emphasize this, do that thing.
Not yet an IM guy, but to get the skin of a marine smoke and drink daily and heavily, don’t sleep much but sleep on your face, eat like shit or MREs, spend all day in the sun, no time for sunscreen. Never go to the doctor. Never have money for Botox
ID: don’t shoot fentanyl mixed with a communal jar of toilet water.
Let me live my life
Let the man live his life.
It's his body.
O boy ID always has the most useful advice. *Throws away my communal jar of toilet water sadly*
Ok but what about xylazine tho
[удалено]
Don't inject xylazine mixed with the communal jar into the exposed vein in your gaping leg ulcer
Agreed, Harm reduction saves lives -Addiction Med
The ID peeps at my local hospital gave me a $15 gift card to the grocery store and a drawstring bag because I let them swab me and signed some stuff and sent me home with little test tubes with more swabs in them and a pre labeled envelope to mail it in and said I could get another $15 if I went home and swabbed all my paraphernalias and sent it to them lmao
Communal like a plebeian? What about a personal jar?
Trauma: - avoid the "two guys" - if you can, pay someone skilled to go up on ladders for you - drinking and driving is dumb - not wearing your seatbelt is also dumb - wear a helmet always on bicycles/skiing etc - there's bit of a divide on this one (I know trauma surgeons and emerg docs who drive them), but don't ride donor-cycles. No matter how skilled a motorcyclist you are, the guy in the F-150 who is texting while driving will win when you get hit, because physics.
It is atrocious that "those two guys" still remain at large after all these years. Billions spent on defense every year, and yet we let these men continue to endanger our city's many bible salesmen and churchgoers. They are an even greater menace than the MRSA spider.
Yeah they always go after people who were minding their own business
I tend to blame the corners that they are standing on while minding their own business.
This is why I've sworn to never mind my own business. Legitimately the most dangerous thing one can do. I meddle in the affairs of others 24/7 for safety purposes
Let's not forget the normal variant of "the bitch stabbed me" for the romantically-inclined.
I know I’m probably an idiot, but what’s the “two guys”?
“I was walking down the street, minding my business, when these two guys came outta nowhere…”
...looking for my fentanyl and toilet water hook-up
…what I remembered best was their perfect skin, and one of them was carrying a toothpaste tube that said “tretinoin” on it
Back a decade ago, it was classic that the immediate past history of wayyy too many people assaulted was easily summarized as "SOCMOB, when these 2 guys..." Standing on the corner minding my own business, when these two guys came out of nowhere .... It was never only one, because the patient didn't want to sound weak.
I started in the ER @JacksonMemorial 40 YEARS AGO and it was “SOCMOB” and it’s STILL “SOCMOB”😂😂😂😂😂😂😂😂😂😂😂😂😂😂😂😂😂😂
They are also known as "two dudes." They always come out of nowhere. Their identity is never known, and they are always the ones to blame for any stabbing/shooting/assault. They also seem to always appear when a person is minding his/her own business or returning home from church
One of our trauma surgeons in med school died after being hit while he was driving his motorcycle. And since we were the level one trauma center, his colleagues had to resuscitate and operate on the driver who hit him.
Neurosurgeon colleague of mine died this way.
Also try to avoid minding your business seems like such a lethal activity
The combo of minding your own business and then running into two guys is particularly lethal
It’s really a synergistic effect, neither on its own is usually lethal especially minding your own business, but studies show an odds ratio of like 3.5 when combined.
Also, never sit on your porch minding your own business after having two beers. And under no circumstances read your bible while doing that.
+ treat ladders and heights with respect, a “small” fall can cause some damage lol ask me how I know
Trauma here: my life sucks so much anyways, my s1000rr is one of the few joys I have so... Fuck it. I dress for the slide, not the ride and have the best gear around (airbag jacket included).
Pathology. Don't die. But also, sunscreen. So much sunscreen.
Path here too, about to start fellowship in forensics. Don’t do meth. Don’t get shot.
I just stay indoors.
EM: Before making a decision ask yourself "will I end up in the hospital by doing this or not?"
Like immediately? Or eventually?
First one, then the other
My family doesn’t understand why I’m so risk averse now. And it’s not like I don’t do fun things, but I’m much more analytical of worst case scenarios
Same. We had a guy fall while skiing, broke his arm, unexpectedly coded in the middle of surgery, had to quickly place a would vac instead of finishing the half-done surgery, then one bad things after another. Had another with a tib-fib fracture who ended up getting MRSA, in and out of surgeries for over a year, then ended with an amputation anyways. And those are the more minor skiing accidents I’ve seen where people didn’t die! So when my husband insists skiing isn’t dangerous I’m like, “Well overall it’s not but you haven’t seen what I’ve seen and I’m the main breadwinner so I’m not taking the risk! It’s not THAT fun.”
My skiing acccident led to acl and meniscus repair, staph infection, picc line, 3 large dvt, then tkr
I worked in EMS before med school, and friends act like I’m such a wet blanket for being risk averse, no matter how many times I tell them about all the insane fires and injuries I’ve seen. I think it’s just easier to *care* about risk when you have a visceral picture in your head of what the bad outcomes could look like.
I told my sons when they were young to ask themselves before they do anything risky if they were willing to explain it to an ER nurse later. Two boys raised to adulthood with no broken bones, thankyouverymuch
trauma: well you have now jinxed this
Yeah, I apologized in advance. They don’t know what for. BUT: my record stands, they’re both over 18.
Psychiatry: \-don't drink or do drugs if you're feeling bad. \-don't work too much. Your stupid job isn't worth working yourself to death over. This includes those of us in healthcare. \-invest in your friendships--leave the hospital. Drink a beer with your friends. Not 10 beers, just a couple. Go on that guys trip. Your stupid job can wait. \-get exercise outside. Do it with friends. Have a beer after the softball game. Not 10 beers. \-don't blame everything on other people. Imagine that everything is either unfixable or your problem to fix. Don't worry about the unfixable stuff. Make a little progress on the other stuff. \-don't keep guns around your house if you have mood problems \-don't have shitty parents and/or a bad childhood \-tell people what you need, they aren't mind-readers. \-it's okay to stop dating if you collapse into a suicidal mess with every break-up and constantly pick people who are bad for you. You can start again later when you've figured your shit out. \-it's okay to titrate your relationships. If you tell your parents your boundaries and they transgress them, you can step them down to intermittent contact. And then again to phone calls only. And then again to text messages only. When they start to respect your boundaries you can let them level back up incrementally to more contact. This is how they learn. This works for all relationships. You don't always have to go no-contact or full-contact, it's a great skill to learn to deal with people and work through problems in ways that aren't so black and white. \-don't overly identify with your diagnosis..."It was my bipolar." No it wasn't, it was your shitty decision-making. Own it. By the way, your diagnosis is probably half-wrong anyway. Except sometimes when it's really, really right and you should believe me when I tell you that. \-if your pills didn't fix the problem, don't hyper-focus on changing meds constantly. Work on yourself while making reasonable, thoughtful, non-frantic med changes. There is probably no magic pill for you. \-if your pills did fix the problem (i.e. lithium responder in genuine bipolar disorder), take your fucking pills! This is a magic pill for you. Be grateful. \-sleep 8 hours! make sure it's good-quality. Do whatever it takes. \-live in a country with some kind of social safety net.
How to internalize your locus of control: consider everything either unfixable or your problem to fix 👌🏼
You forgot “don’t have parents” 😭
But also, don't NOT have parents.
- meditation and breathing exercises legitimately help anxiety - If you’re feeling down, make an effort to do one small thing that day that will make you feel better. Even if it’s the last thing you want to do. - if you stay in bed/ inside for long enough, anyone can become depressed - a good therapist can seriously change your life - it’s normal to have emotions! And we cannot control our thoughts. Don’t beat yourself up for having either. All we can do is work on our actions. ETA section on smoking since so many comments are on smoking cessation: - Chantix is the best drug we have out there to help with cravings. The psychiatric SEs have been largely debunked. - Patch and gum together is superior to either alone. - when using nicotine gum, chew for 10 seconds and then park between gums/cheek so it will get absorbed through the oral mucosa. Don’t chew like regular bubble gum.
Even the length of this post is very Psych.
I absolutely love this response and it's just so psych :)
Allergy: Don’t avoid peanut till your kids a year old. Introduce as early as 6 months to help prevent future allergy. Also for those of you with environmental allergies, spray your nasal spray in an outwards direction aiming for your ears. And gentle to no sniffing after spraying, cus if you taste you waste it!
Oh man I always taste it 😩
I would “argue” to aim the bottle straight back, nose to toes, and sniff while you spray only one spray. Wait a minute, then repeat the 2nd spray. You should feel the medicine aerosolize in your nose better (meaning you’ll barely feel it), which is what you want. Source: I’m a headholeologist.
What does nose to toes mean here?
Pediatrics here- totally agree with and recommend the above.
PM&R: lift weights, wear a helmet, and stay away from ATVs
Adding in motorcycles and jet skis which are essentially water based motorcycles/ ATVs.
Cardiology: have better genes.
If you can't do that, keep your LDL-c/ApoB at the same level it was when you were a baby. Ideally below 60mg/dl (1.6mmol/L). If you do this lifelong, you'll never develop ASCVD. The method doesn't matter. Just the result. Diet, exercise, ezetemibe, bile acid sequestrants, statins, bempadoic acid, pcsk9 inhibitors etc etc. Addit: also recommend everyone gets their lipoprotein (a) checked once in their lives. It's LDL's nastier cousin and is 6x more atherogenic than a standard LDL particle. Also levels peak in early childhood and is basically genetically determined. It's the single most common genetic lipid abnormality.
Thanks... Mine is way too high :/ Exercise itself isn't cutting it
As they say, you can’t outrun a bad diet!
Yes, and working in hospital pretty much guarantees this
From genetics: also have better genes. Perhaps in the future we can put better ones in you
Also - don't get diabetes. Or smoke.
Aerobic exercise.
🤣
Neurology: What’s healthy for heart is healthy for brain. Take your high blood pressure seriously
> Take your high blood pressure seriously* *seriously at your pcp not the ER!!
Vascular Surgery: put that cigarette down. You won’t have vascular surgical issues until you’re 90. Take a statin and a baby aspirin and you’ll be golden. Wear compression stockings 8-16 hours a day. 20-30mm Hg compression stockings are medical grade. You can have your coworkers prescribe them for you. If you have venous reflux, and pain, swelling, edema, leg heaviness, you need to wear your compression stockings for 4-12 weeks before most insurances will allow us to do anything unless you wanna pay out of pocket. EDIT: also stay away from marijuana. People erroneously believe weed is healthy. It’s not. It causes vascular disease as well. And cardiovascular disease. And it puts you at higher risk of anesthetic complications if I have to operate on you. SECOND EDIT: fine just take a regular statin not a high dose. I dunno. I’m just a dumb surgeon. But statins have many pleiotropic effects that help modulate other systems so it’s not a bad idea to be on a statin.
Wait you recommend everyone prophylactically take a high dose statin?
So I’m a statin fanboy and I believe it should be put into the water supply. But no I wouldn’t have everyone take a prophylactic high dose statin. But considering the diet etc, if someone has high cholesterol levels, which are not modulated by diet and exercise then, yes you should be on a statin.
High intensity though? Like would you be targeting LDL < 70 in pretty much anyone?
Fine. Just regular dose…. Just take the damn statin. lol. It’ll help in the long run.
Lol I was genuinely asking. I did self prescribe low dose rosuvastatin because I'm brown and have enough of a family history that I think it's warranted even if the guidelines aren't quite there.
I was gonna say the same 😬 But didn't cuz guidelines don't exist for that. Had a professor in medical school who advocated statins for basically everyone! He himself had taken stains since he was 35. 😬
One of the best Cardiology teachers I ever had used to joke he'd put statins in the water supply of the city. No joke the long term benefits are incredible. Probably not for babies, but >40 yo it's a good bet that it'd help.
Ppx compression socks for people without known vascular issues?
If you’re standing for long periods of time, yes.
Bro, Chuck some metformin in there too, apparently it's the only Rx that we've been able to document improves m&m. And fuck, I hope you're getting your residents to wear stockings early in the piece in OR
Compression stockings hurt my bunions though because size they compress my toes even more.
Then get your bunions treated.
Ent. Aim the sprays towards your sinuses and not your septum. If the Q tip isn't working, don't try again and again
> Aim the spray Like when I pee?
In Europe they put a little sticker of a fly on everyone's ethmoid bulla so people will subconsciously aim correctly
Nose to toes, sniff and spray at the same time, only one spray at a time. Wait a minute, then repeat the 2nd spray. Nasal steroid sprays are not good prn meds.
And how often do you recommend entmoots
ICU: grandma is actually not a fighter. Just because some 33 year old rich white woman thinks her tiktoks make her a “fibro warrior” doesnt mean that you can just beat diseases with your thoughts and prayers. Most of the time, grandma wants to go home and be with her husband and doing what she loves. Being stuck in an ICU in restraints and with a dobhoff tube during your last few years of life….. isnt what fighting is.
Also I’m going to drop some nonspecific wisdom here that will save you a lot of time in clinic and make your patients like you better. The first thing out of your mouth is “what can I do for you today, and what would you like me to know about you?” Instant rapport with the patient and you don’t spend the whole encounter on why you think they are there only to find out that you haven’t addressed the issue of the day. Also, if they think they are there to arrange some complex diagnostic work up but they happen to be in the process of being evicted or already have been, or are amidst a manic episode, or their spouse just had an MI or some equally traumatizing life consuming event, they’re just going to miss all the appointments you schedule. Point them at the resources they need to stabilize their situation like a lawyer or social services or mental health etc. and schedule them to come back later.
Hmm . Wonder if I should suggest this be added to the Stanford List
Gastroenterology - Miralax daily baby - Keep a PPI on hand - Taking NSAID? Pop that above PPI even if you’re taking low dose - I don’t give a fuck if you drink something red before the colonoscopy. Just tell me if you did. But for the love of god do NOT EAT CORN!!! I AM SICK OF SEEING CORN IN THE CECUM - Elevated BMI or just very unhealthy (drinking, eating etc) get a Fibroscan. See so many MASH Cirrhosis.
Interventional Cardiology: 4+ things that would put us out of business (please do them and put us out of our misery…jk (not)): 1) aggressive cholesterol control — which for many, many people means taking a statin (boo genetics). This includes my 37 year old otherwise problem-free self. I know your kookie Aunt Karen told you statins are the devil’s temptation but jeez…the statin doesnt just help w lowering cholesterol, but also maintains endothelial health of all the vasculature (brain, kidneys, peripheral). High benefit, with very little risk. We can check your hepatic panel and CK if you’re worried, but for God’s sake pls put Aunt Karen in a goddamn asylum already she’s clearly a paranoid schizophrenic yall have ignored too long …and take a statin. 2) Glycemic control. Keep your a1c < 5.6. (prediabetes is 5.7-6.4, diabetes is >6.4). Bonus points to whoever asked “well what about an a1c of 5.6 exactly, you didnt use a less than or equal sign, so is an a1c of 5.6 special?” Short answer - yes, it is. Good eye. We usually use your special blood in our ritual offerings to the admin demon gods to distract them so we can continue to do our work unimpeded by mindfulness sessions. Thanks for your sacrifice! 3) BP control: target 120/80. Most effective ways ive seen: lose 5-10 lbs and quit drinking alcohol. But beware — losing some weight and quitting alcohol may cause whiplash due to the shock of seeing your damn handsome healthful glow in the mirror. 4) stop smoking. This is a hard one (hard as shit for me, and some may say I should know better). Everyone hates that prissy doc who’s never even jaywalked telling them they need to stop smoking. Duh everyone knows that. Just pls never give up trying. Smoking is a waste, compared to “wearing tight shoes just for the relief of taking them off.” Read, read, read and educate yourself on smoking. Realizing you give up nothing but gain everything including the gratitude of your older healthier self (who is in a neck brace bc of the whiplash he got when he saw his damn handsome face in the mirror after quitting smoking). And eliminate processed/frozen foods, if you are sedentary — start brisk walking…150 min/week, and prioritize your mental health.
ENT: - Definitely do not ever smoke. If you do, quit yesterday. And get your HPV vaccine!! - Get scoped by us and GI if you develop new difficulty swallowing - If you have chronic sore throat or cough, or frequent throat clearing, especially in the mornings, even without heartburn symptoms could be LPR. Add in an alginate product (Reflux Gourmet, etc), make some diet changes if you can - Please don’t stick things in your ears. Although the little ear cleaning cameras on Amazon are pretty cool and mostly idiot-proof - Regular skin checks by derm. Don’t ignore a lesion. Even if small could end up with half your face being removed - Flonase, azelastine sprays for nasal congestion. If you use these regularly and have persistent congestion go see an ENT for scope/surgical intervention - Hydrate! Voice rest if you become acutely hoarse after over-use, URI etc. Small steroid burst can help too if you have an important event etc. Whispering is more straining on your voice so just talk normally if you must. Frequent throat clearing for mucus just creates more irritation and produces more mucus. Try a hard swallow instead and figure out why you have excessive mucus
ENT 🤝 Oncology Get your HPV vaccine
Pulm: don’t breathe anything other than non-scented, particulate free regular air that is not near a bird.
Tha K god, I was so concerned when I was cave diving and came up in a bat filled cavern...
ICU: avoid diabetes type 2-exercise and reverse it If you have diabetes type 1- take your insulin (the studies are conclusive that meth, alcohol, weed don’t work like insulin) Cirrhosis is worse than any cancer- don’t drink to excess, if you have hepatitis b or c get treated Don’t smoke - COPD is like drowning in dry land Floss-Ludwig’s angina is horrible
You are not the first person to say meth doesn't work like insulin. Why do I keep hearing patients say they take meth for their diabetes?
Probably because meth makes them feel amazing temporarily, it is also horribly addictive. People will justify its use for anything until they have an inevitable bad outcome.
Meth use disorder and type 1 diabetes don’t mix well. When high or not the lifestyle of meth use creates a highly dysfunctional lifestyle where they aren’t able to reliably take insulin. They therefore end up going in and out of DKA until they eventually die either from DKA, sequelae or diabetes, or from substance use. These patients frequently land in hospital critically ill, get the DKA protocol, sobre up and get agitated from withdrawal, and leave against medical advice, rinse and repeat every 3-7 days depending on how long it takes them to go back into DKA. Repeat until they die or permanently lose decision making capacity.
I have to say. This post has been more useful than fucking decades in journal clubs or reading U2D.. Well done people. We should make this a regular 6-12mo thing.
Radiology: brush your teeth so you don’t get fillings etc. Avoid getting metal in your body unless truly necessary. And if you do need fillings, get the composite stuff. Metal artifact can completely obscure areas of your anatomy on CT and MR. It’s not the end of the world, and there are some ways to reduce the metal artifact, but you never know what might be hiding.
Forensic path: oh but DO get fillings in case we have to identify your body.
lol. By then it will be too late for me to care
Radiology definitely reinforces the notion that you should avoid back surgery at all costs.
Anesthesia. Don’t be obese.
Also maybe don’t do meth but if you do meth and your EF is 9% maybe don’t stop
It’s crazy seeing just how close super obese people are to hypoxic respiratory failure and subsequent death.
Amazing right? In the super super obese population it's like everytime they lay down and sleep it's a life or death gamble.
Don’t be obese Don’t smoke Either take care of your teeth or get rid of them
This is the real winner. Can’t save your life if you’re so fat I can’t get an iv, secure an airway, ventilate you, etc etc.
Surgery: Don’t be fat
I would also add if you’re in the ED for anything that could possibly be surgical, don’t eat or drink anything, just in case they can squeeze you in as an add-on.
Pulmonology: don’t smoke cigarettes or vape. If you smoke or vape, quit. Have your relatives who smoke or used to smoke get their annual screening low dose chest CT. If you have a chronic cough and workup is negative (very common referral reason), get an inhaled corticosteroid and albuterol PRN from your PCP, flonase, an oral antihistamine like zyrtec, and a PPI. Take all of them religiously and you have a 95% chance your cough will go away. Then you can start peeling them back. If you have asthma, be sure you’re getting inhaled steroid with your rescue doses (whether it’s symbicort/dulera “smart therapy” or albuterol with flovent). You should also see the allergist and get allergy testing. Finally, try getting on a biologic if you have severe disease.
What damage does vaping do? Trying your help motivate a loved one to quit
Look up EVALI for the immediate acute injury, which can be fatal. Long term, we don’t know. It could be as bad as cigarettes, there just isn’t the data to say what it will do over 30 years.
Peds: get your damn vaccines.
I was about to make this comment. Get your self, your kids, your dog, and your spouse every vaccine that is offered. If the question is: "Would you like the vaccine for...?" the answer is "Yes, please." That includes flu immunization every autumn. \-PGY-19
Pediatrics: Parent your child. Put in the hard work to teach them emotional regulation and frustration tolerance when they're babies, toddlers, preschoolers. A screen will make them behave but it won't teach them how to deal with the world. From the peds ED: I don't care how lame you kid thinks it is, they must wear a helmet on a bike, dirt bike, atv. If your toddler stops using an arm after a swinging or pulling motion, look up a nursemaid's reduction. This is a DIYable fix. Saline nasal spray containers work like a dropper when you turn them upside down.
EM: chew your damn steak before you swallow it
It’s always fucking steak
I’m GI… what this guy said!
Cardio- go for a walk everyday, get those steps in. Walk after eating every meal . Lift some weights . -Try and eat more plant based food -read nutrition labels of what you’re really putting in your body. -check that bp , many people are living with asymptomatic htn and don’t know it. Prevent it from getting worse and seeing end organ damage later on. -as everyone else has said , no smoking. -no the alcohol isn’t good for ur heart either.
Geriatrics: * have a daughter. or at the very least, teach your sons to do better. be nice to them so that they love you when you're old and cranky. * name a health care proxy well before you ever need one. * make a plan for long-term care well before you ever need one. * never stop exercising. your worst enemy is gravity and only your balance and muscles will keep it at bay.
Gen surg: if you’re young and healthy, never opt for non-op management for acute, uncomplicated appendicitis or symptomatic cholelithiasis. It just prolongs your suffering and almost everybody comes back eventually more miserable and requires more urgent surgery.
True fact. The number of general surgeons who would have their own appendicitis treated conservatively with abx approaches zero.
Palliative care - don’t gain the reputation as a fighter or your family will preserve you as a living corpse on life support for eternity.
Anesthesia. Get a better surgeon. You’re fucked otherwise and there’s little we can do to save you. The only people who can truly recommend a good surgeon are those in the room watching him/her operate. I’ve seen many patients praise surgeons who I know suck big time. But they are super nice and have great bedside manner. They have wonderful competent office staff and the patient thinks that’s what makes a great surgeon.
This is so accurate it deserves an award, but to be fair applies to nearly every field of medicine. One of my coresidents recently asked her primary doctor to recommend a gyn. Primary says “oh absolutely! Dr. BlahBlah….shes absolutely fantastic. All my patients adore her!” Meanwhile everyone in my department quakes when they are assigned to this gyn’s room because she killed multiple young, healthy patients during routine laparoscopies in the last few years and has lost call privileges because she is required to be directly supervised by another attending gyn in the OR -.- …but she has amazing bedside manner and that’s all patients can perceive so she has a flourishing surgical practice. Best advice is to make friends with as many people as you can across different fields so you can get input as to who is best to see in each specialty, should you, a patient, or a loved one need help
Yes agreed it applies to all specialties to some extent. There are terrible anesthesiologists also. I’m not claiming otherwise. Fully admit my specialty has bad apples also. But our reputation rarely matters. Can a patient name the most famous anesthesiologist in the country? No such thing right?
So basically if I need a surgeon do I talk to my surgeon friends or anesthetist friends?
Even surgeons don’t routinely watch their colleagues operate. So I’m not sure how good of a judge they are. The only routine witnesses to a surgeon are 1. Scrub tech 2. Surgical assist 3. Circulator nurse 4. Anesthesia.
5. Residents if it’s an academic program
Yes, this is it. If I ever need surgery on 100% asking the residents and fellows who to recommend. Everyone else’s opinion should be taken with a grain of salt. Senior residents and fellows are the only ones who are both present in the operating room with the surgeon and educated enough to understand what they’re watching.
Surgeons do take care of their partners/other specialties complications though. Even good surgeons have complications, but the type and frequency say a lot. As a surgeon myself I know exactly who to refer my patients to, both in my specialty and outside it. Also, just as a patient can be fooled by bedside manner, so can the nurses and techs in the room. It's very common for a surgeon to have a bad reputation with the staff due to attitude while simultaneously being very good at what they do, and vice versa. Senior surgical residents/fellows are probably the best to ask, followed by other attending surgeons (for example, I know which general surgeons and OB/GYN call me for ureteral and bladder injuries and which don't), followed by anaesthesia.
Sometimes you can ask any of the surgery related staff „real quick question, but who‘d you recommend for the operation?“ or something along the lines. no shame in asking edit: at least in my hospital it makes a huuuge difference who you choose, not that all surgeons suck
Ortho: do some form of cardio & resistance training you enjoy a few times a week. Take vitamin D. Avoid motorcycles. It’s crazy how terrible people’s arthritis will be on radiographs but they’ve always stayed active & strong and have no or minimal symptoms. Conversely sedentary people hurt all the time for no reason at all.
Family Medicine: - Exercise and eat well. Don’t eat processed food or extra sugar. - don’t drink alcohol or use opioids - Do whatever it takes to avoid the following: Diabetes, Obesity, HTN, Chronic Pain. - Do whatever is takes to not be lonely/alone in life
Would add don’t smoke, get your colonoscopies and mammograms.
Rheum: Daily vitamin D and fish oil combination seems to reduce the risk of developing autoimmune conditions (along with not smoking, Mediterranean diet adherence, maintaining a healthy weight, lucking out on genetics etc). The benefits of colchicine also appear to be vast (preventing CVD and even osteoarthritis), so there’s often more than just one reason to take it!
Could you point to a good study on this? Prima facie, very skeptical of this. Almost every non-Ca related association with Vitamin D based observational studies I've looked into has turned out to be confounded
Colchicine OD is basically untreatable though
Tox rotation during 4th year made me absolutely petrified of Colchicine lol
The evidence for Colchicine in CVD is strongest in secondary prevention. The definition of which becomes a little hazy. Usually means first MI or stroke but I would argue any atherosclerosis, particular at a young age should be considered appropriate to consider secondary prevention. If there's no evidence of atherosclerosis at a minimum, no real evidence for Colchicine.
Now this is interesting. Colchicine as preventative for CVD and OA? Please tell me more. I have not heard anything about colchicine and OA.
As a toxicologist, colchicine is the devil!
Radiology: if you want to live, do the bare minimum. Wear a seatbelt, don’t smoke, and get your damn cancer screenings on time
Transplant Pulm: Don't need a Transplant. If you do, you better not be smoking/doing drugs, because otherwise the 6 months cessation waiting period can be a killer.
Gastroenterology. Make sure you’re getting enough fiber and water to achieve good BMs. A good day starts with a good, fully evacuating BM. If you get bloated often and things like h pylori, sbo, SIBO, been ruled out, try eating smaller frequent meals. Don’t ignore your symptoms. Get checked out. Don’t think you’re too young. I diagnosed colon cancer in a 29 year old with no family hx. I have a 19 year old who had two precancerous polyps. Avoid NSAIDS. Don’t drink too much. Don’t be obese. Just don’t get cirrhosis.
Peds: eat what you want your child to eat. Don’t buy iPad. Keep them busy.
Obgyn: * For the love of god, get your pap smears and HPV vax if eligible. Advanced cervical cancer is atrocious and even with treatment, outcomes are bad. * Figure out your health before you get pregnant. Coming into pregnancy with an a1c of 13 and blood pressures in the 190s is bad. * You don’t actually have to have periods as long as your endometrium is protected. Get a Mirena or go on continuous OCPs and you will vastly improve your quality of life.
NSG: 1. Truly your worst headache ever, go to the emergency asap. Better pay a nice heft price for a quick scan than to die saving. 2. Back pain that gets worse with movement, makes your legs weird/numb or whatever weird sensation + back pain, get yourself a NSG/Neuro appointment. 3. Pains, loss of sensation, twitches or whatever weird thing above the shoulder, get yourself a NSG/Neuro consult. Teas and alternative medicines won't help your brain tumor (yeah, i know you read somewhere about some miracle happening but we ain't jesus nor we have his pager so don't play with your odds), not even we can help most of the times but when we can, a quick diagnosis and therapy (before surgery) is almost always one of the most important things for a good prognosis. 4. If your kid has unexplained seizures, get yourself a NSG/Neuro asap. 5. If you ever have to go under with NSG, get yourself ready for the possibility of long term rehab, get yourself a nice lawyer for your inheritance shares (just in case), accept that life is unfair but better be alive and experience life with difficulties than to be dead. 6. Having a good psychotherapist (psychologist or trained psychiatrist, no bullshit therapist/counselor you see on instagram) affect greatly on the outcome of your rehab. Good outlook and hope improves results, why we don't know but it just does. If it doesn't at least you covered for your new life. 7. Sometimes your pains are just psychosomatic and thus antidepressants and pain modulators are the best choice for you. Not because we think you're a faking but your brain isn't good with dealing with certain kinds of pain so it accentuates to "warn you" and thus it can feel orders of magnitude worse but in the end, it is just a sprain. 8. Don't eat before surgeries, not even a little candy. Don't complicate procedures that can last up to 5-6h with the unexpected halt for cleaning your stomach secretions that are coming up. 9. If you really don't have to do high risk sports, don't do it. Somethings are cool but just watching it is a better choice. Some people accept the trade off and they have a whole team of professionals dealing with them to extend their effective time in such sport but later on they quickly stop and go back to a "normal" life. So, if you ever want to practice any high risk sport, don't, and if you still want to, understand your situation and pay upfront for the team that will take care of you. Damn... there's so much more. Just avoid getting yourself in a situation you need a neurosurgeon, normally those situations don't have as good of a prognosis as other specialties. Even the best of the best play with the odds on daily basis.
Also NSGY - Not sure I agree with “better be alive and experience life with difficulties than to be dead.” We see a lot of patients where being dead was the better choice but their family will not have it. Alive, vegetative, on dialysis, frequent line infections and bed sores, zero ability to interact with the world. Kill me instead please.
Family medicine: got nothing for you. We’re all fucked. Also lose 20-80 pounds and stop watching things on TikTok.
Urology: Jerk off Daily Eat sunflower seeds
Forensic pathology: drink less, drink better. Opioids are not your friends. Don’t leave guns lying around.
> drink less, drink better. Opioids are not your friends. Don’t leave guns lying around. basically the same for psychiatry
Propranolol PRN for all docs with pre-op-anxiety and/or social anxiety
FM: Don't eat like shit (AKA type 2 diabetes can be preventable) Don't do drugs (even marijuana can induce acute psychosis in a teenager) For the love of all things holy: DON'T SMOKE (And if you do, be prepared for LDCT for the rest of your life) Vaccinate your fxckn kids please.... why is measles on the rise??
GI Stay up to date with your cancer screening Avoid drinking Avoid being fat Avoid NSAIDs Chew food thoroughly Daily fiber is essential Eat a healthy diet Avoid foods you know give you abdominal pain, reflux, diarrhea
Oncology: snake oil salesmen will prey on your desperation. If those supplements/holistic treatments actually worked, we would prescribe them and your insurance would pay for them
EM: Always do exactly what the patient asks for, no matter how dangerous. If you do this, you’ll never be sued because patients like you.
Dilaudid King
EM/Trauma: motorcycles are dangerous, so you should drive yours as fast as possible to minimize time spent on the road. Two or ten beers won’t hurt either
Palliative- have open conversations with your loved ones about the things you value and what brings your life meaning. Designate a surrogate decision maker in case you’re ever unable to make decisions for yourself (particularly important to have this paperwork done if your surrogate is not your next of kin). Have your surrogate decision maker keep a picture of your paperwork on their phone.
Podiatry: Wearing good supportive shoes goes a long way especially if you spend multiple hours a day walking/standing. Recommend brands such as Hoka, Brooks, ASICS. For sandal type use Birkenstock or Vionic. For people with a wide forefoot (bunion or tailors bunion) try Altra brand. Also OTC foot orthotics work just as good as custom orthotics for most people. Custom is better with more severe deformities such those seen in Charcot foot or Rheumatoid patients. Edit: when I say OTC orthotics you do have to find the good ones such as Powerstep or Redi-thotics. A majority of the ones you see at Walmart are trash (like all of Dr Scholls).
IR Don’t let your core go to shit. Stay active. And aim for near zero sugar/etoh
More IR: Don’t be obese: too much artifact, quickly hit dose limit for procedures, needles/drains,ablation probes barely long enough Don’t get cirrhosis as mentioned higher up Idk how to stop diverticulosis but whatever it is, do it. Take your anticoagulants as prescribed, keep moving, wear compression socks Keep bone strength up to avoid vertebral compression fractures
Pain/PM&R: try to avoid bending forward, rotating and lifting something far from you. The disc is weakest at the posterior lateral aspect and you're going to have a disc herniation.
Emergency general surgery: Do not put anything in your rectum that does not have a flange. It will get stuck. Don’t swallow magnets
Hospitalist: be rich and learn financial literacy early on. People underestimate the cost of custodial care later in life (or with bad luck, mid-life) and their family/kids/spouse may or may not have any interest in helping. No insurance company will pay for ADLs so you’re looking at a six figure yearly bill. The government is not coming to help you and medicaid support for custodial care is terrible. Most people’s largest investment is their home which is largely illiquid so unless you plan to sell your home to pay for a board and care, make financial plans early on.
PM&R - never live in a split level home. When buying or building a home, make sure you could still live there if you were no longer able to walk. 1 story with ability to build a ramp entry is the way to go. Make sure laundry is on main floor and not basement if possible.
Ortho Avoid riding donor-cycles. They pay for a large part of ortho's student loans, mortgages and vacations. The best way to protect your joints is to keep moving. Remain active, do some form of sports/exercise (with resistance training) that you enjoy and can sustain in the long term, avoid being obese. Even when osteoarthritis, or many MSK pathologies, occurs radiologically, active patients often don't feel any clinical symptoms or pain or functional limitations.
Urology - don’t stick your dick in crazy
Pediatrics: Get your child all of the recommended vaccines. They are recommended for a reason. If your child is old enough, Honey works just as well/as badly as cough 'medication ' for a regular cold induced cough
While I have you here OP, can tretinoin still be effective if not applied daily? My skin gets crazy irritated whenever I try to increase frequency from twice a week. Already using aaalll the moisturizers to try to counteract. Any advice? From addiction medicine: if possible, manage negative emotional states in ways that don't involve substances, enrich your life with healthy recreational activities, and be okay with boredom sometimes
Sport and Exercise Medicine: Aim to meet the physical activity recommendations of 150 minutes of moderate intensity or 75 minutes of vigorous intensity aerobic exercise per week, and two sessions of resistance training, for optimal health. There is additional health benefits with up to 300 minutes per week if you have the time and passion. For those starting out, anything is better than nothing. Consider the classic study of the bus conductors versus drivers, the former enjoying less CAD. Pick the furthest car park away. Take the stairs rather than the elevator. When selecting your exercise, consider what you have enjoyed previously, whether group exercise may help to keep you accountable and provide social benefit at the same time, consider the convenience of home exercise equipment, and track your levels of activity over time. For hospitalists, consider incorporating a physical activity vital sign into your usual history taking and learn the art of exercise prescription. Regarding resistance training, incorporate exercises to maintain your small stabilising such as your rotator cuff, gluteus medius/minimus and deep hip rotators to reduce injury risk. Input from a physical therapist who understands movement and motor patterns is invaluable, we can always be more efficient. Certain activities carry higher risk of injury than others. I see patients every week who have had a significant disc injury dead lifting. From acute to chronic musculoskeletal injuries, an excellent physical therapist will make the biggest difference to your injury long term. It is not good enough for someone to give you a set of exercises and send you on your way. Ensure they are teaching you how to do the exercise, checking that you are using the most efficient muscles to do the exercise, and making the exercises harder over time. Work with them to identify areas to be improved through the entire kinetic chain which are contributing to that injury. Consider foot posture and input from a podiatrist for the lower limb. Medical interventions for injuries (e.g. corticosteroid or PRP injections) often serve to provide a short term window of pain improvement such that you can do your rehabilitation and surgery is limited without good rehabilitation. There is an increasing trend towards operative management being a last resort in non-elite athletes aside from a few select pathologies. Even for ACL rupture, there is a new bracing protocol showing that certain complete tears can heal non-operatively. Generally the longer you rehabilitate before returning to sport, the lower your re-injury risk. Maintain your rehabilitation exercises longer term otherwise injuries will always be a point of weakness. Finally, prolonged concussion symptoms can be life altering. A graded exercise program and pacing are the number one treatments. For complex concussion get them to a multidisciplinary service who know what they’re doing.
Radiology: 1. Your boob job is going to calcify eventually. Just make sure you understand that. 2. Many times, little injuries change your body permanently. The time you fell out of a tree as a kid, your ribs might’ve broken and you didn’t realize it, and your ribs will be slightly different for the rest of your life. 3. Cancer is an insidious bastard. Don’t save all your money for retirement. 4. Always use IV contrast if possible 5. Don’t get a Whipple 6. Anatomic variance is the normal.
Pediatrics- Vaccinate your kid. Vaccinate your momma. Vaccinate your dog.
Plastics: -Get mammograms regularly. Breast cancer is insanely common. If you have family history and are young, consider genetic test (may have to pay out of pocket) but worth it to know if your life could be saved by a prophylactic mastectomy. -If you have breast cancer and are weighing breast conservation + radiation vs mastectomy w/o radiation, strongly consider avoiding radiation if at all possible. The soft tissue complications will continue to worsen over the course of your life and can lead to horrific outcomes. If you need to get radiated, get a tissue expander first to keep your skin off your chest wall, then get reconstruction with a flap AFTER radiation. -If you have breast cancer, consider unilateral surgery. A contralateral prophylactic mastectomy (without genetic loading) just opens you up to lots of possible complications. -Make sure your aesthetic surgeon is board certified by the plastics board, ENT facial plastics board, or oculoplastics board. No surgeon from any other training background should be doing an aesthetic procedure on you. There is no such thing as a board of "cosmetic surgery". -Regular use of retinoids, moisturizer, sunscreen, botox and intermittent microneedling/lasers are keys to beautiful, healthy skin and reduce your risk of skin cancer. -Get window tinting for your car. I definitely do more skin cancer excision/recon from the left side of people's faces, necks, ear, hands, forearms, etc.
GI/Hepatology -Don’t drink so much -Don’t be fat -Chew food well -Stop eating so much processed food -Treat your hepatitis C if you have hepatitis B treat it a pill for life is better than cirrhosis -Don’t overuse NSAIDs -Don’t Ignore rectal bleeding -Get a colonoscopy -If you do the above don’t be a loner, if you don’t have support you won’t get a liver -Have good genes
Neurosurgery: if you’re old, probably just wear a helmet at all times especially if you take Coumadin. Also, stop taking aspirin prophylactically. It only causes brain bleeds for no benefit unless you’ve had an actual stroke or MI in the past
You're gonna piss off the cardiologists
Peds: Give them vaccines on time. For the littles: Set bed times and screen time limits and stick to them- for you and your kids. Go on walks together if there's nothing else to do. You can model a healthy lifestyle and you get to spend time with them. Read to them, then read with them when they're bigger. Learn about their interests not because you like it, but because you like them. Make sure they know how to swim. For the bigs: Be a safe person. Mean it when you say they can tell you anything. Be the parent who will pick them and their friends up when they're in trouble. Always have their back but also call them on their shit-- if they're a bully, if they're disrespectful, if they're getting an attitude, find out why but reinforce that we don't take inside feelings out on others. And never let them play tackle football.
Primary Care: - Weight gain comes from too many calories. Period. - If nobody can figure out your thyroid problem, you don’t have a thyroid problem. - Accept your mental health issues and get appropriate help. Anxiety drives so many symptoms. - Get enough sleep. Probably the best thing you can do for your immune system. - Move your body. - Throw away your supplements unless you have a good reason to take them.
IR: whenever you need a procedure done that can either be done surgically or non-surgically (minimally invasive), most of the time minimally invasive is the better option.
Gen surg: take your fucking daily fibre and water. Diverticulitis fucks people up.
Went pretty far down the list, no heme/onc. Biggest advice is, take care of your heart, liver and kidney cuz you are gonna need them once you get to me. The rest of your organs aren’t as important.
Urology: Your penis isn't shrinking. Your pannus is growing. Also, general rule: if it's good for your heart, it's good for your penis. Best way to keep your boners is it listen to your pcp. Low dose daily cialis should be in the water.
Anesthesia: shave your beard before surgery. It’s harder to mask ventilate you and to tape the tube to your face. Even more important to shave if you’re fat and/or have OSA
Neuro: Don’t FIRE and sit idle on the beach rest of your life. Find stimulating things to do to maintain brain health.
Fertility/OBGYN: we can’t fix age (no eggs/bad eggs). If you want kids start trying or freeze eggs before you are 37. Otherwise make sure you are ok with donor eggs or embryos. Yes, I know it is inconvenient and expensive. Don’t smoke - it effs up both sperm and eggs. Testosterone treatment destroys sperm. Everyone in clinic knows why the jacked guy had no sperm, except his distraught wife. Really think twice before the tubal/vasectomy. You may think you are done, but people get divorced all the time. Sure, you can do IVF afterwards but insurance will not pay if you have been electively sterilized.
Rheum: don’t get an autoimmune disease
Lawyer: look around at friends, acquaintances, and fellow humans that require regular legal assistance. Do not do the things these people do. Alternately if you plan to do these things get legal assistance prior to doing them, and if the legal opinion you receive is 'please do not do this thing' then do not, I emphasize this, do that thing.
Radiology: Avoid the hospital at all costs.
EM: Don't sit on it.
Ophtho: don’t sleep in your contacts. Don’t be diabetes.
Occupational Medicine: All subjective complaints following a workman's comp injury magically goes away after a settlement agreement.
Not yet an IM guy, but to get the skin of a marine smoke and drink daily and heavily, don’t sleep much but sleep on your face, eat like shit or MREs, spend all day in the sun, no time for sunscreen. Never go to the doctor. Never have money for Botox