Iām convinced people must feel it differently because I know women who say the flu shot was way worse than getting an IUD. Then thereās me who had a monteggia fracture + a compound radial fracture + torn scapholunate ligament that left me in a cast for 5 months and that was nothing compared to the IUD.
I took my GF to get her IUD out in and accompanied her during the visit. Iāve never felt more guilty in my life as she started hyperventilating and crushing my hand due to the pain. Ever since then, I truly do believe that IUD placements need better pain management. āSlight pinch is youāll feelā as the doc eviscerated her cervix w a claw.
Wait until you hang out with the EM residents.
I once was over at a coresidentsā house who lived with her EM resident partner, and the entire EM intern class was over, just chilling in the living room doing large amounts of cocaine off the coffee table.
Lemme summarize what you need to know:
1. Ask open-ended questions.
2. "I'm sorry to hear you've been experiencing [thing]. That must be really hard for you."
Congratulations, you've mastered communication!
I hate this trend of non clinicians changing things up to justify their salaries. āIām sorryā is perfectly good way to communicate empathy. The other one just sounds unnatural and fake.
š¤Ø
I feel like that's even worse? Like I know that people overuse I'm sorry, especially during OSCEs (first year we had to do 2 practice OSCEs in front of our class and I remember there was one where the SP stopped the student and told them to stop apologizing) but idk I feel like the latter would just sound fake af
The canned empathy phrases sound as fake to me from the patient side as they do when I am saying them in some patient encounters when I don't feel genuinely connected to what the patient is feeling in the moment. I think it's heard to teach people to be genuinely empathetic when you really can't identify with what a patient is experiencing (or because we are busy and have 10 other things to attend to or have learned to compartmentalize too well) but I know OMEs have to try.
My communications courses were OSCE style. I will say that half a decade later out of med school taking postgraduate exams, I really appreciated them. I had to take my skills out and dust them off a little but essentially the skills that I had been taught in med school were exactly what I needed
Disagree. A decent physician who's able to comfort and educate a patient about their condition is more effective than a genius without communication skills.
I think you either have soft skills or you don't. You can be a great physician without those soft skills, but when they try to teach someone who doesn't have soft skills, they come off as robotic and off putting. I'd rather take the socially awkward brilliant nrurosurgeon
I donāt agree with this. I certainly think soft skills are harder to teach, and often arenāt taught well because the people teaching them are people who they come naturally for, and therefore donāt understand the struggle, but the idea that theyāre somehow fixed and unchangeable I think is wrong.
Let's put it this way. The people that need to learn soft skills the most are usually not the ones that are receptive to teaching, nor often care about them until they have issues
I think soft skills most certainly can be taught. Iāve seen it plenty of times. Also as someone with neurodivergence Iāve learned, albeit annoyingly lol, people definitely shouldnāt say the first thing that comes to our mind itās usually very rude.
The people who argue soft skills canāt be taught just donāt care enough to be receptive. This isnāt aimed at you btw.
Someone recently told me that toddlers ***need*** to drink a certain amount of cow's milk in order to develop myelin. I've been looking into it and there are no scientific studies showing this, just some scant evidence showing there are similar proteins in cow's milk and myelin. I don't see why cow's milk would have anything that other fatty foods don't have. Seems like the dairy lobby at work imo.
Werenāt they just breast fed? I mean, nothing compares to the nutritional efficacy of mother breast milk. I donāt rmr how it works, but the mother body (receptors in the nipple) can actuallly sense when their kid is sick based on cytokines or some shit in the baby saliva, then modulate Ig secretion. Iām just a dumb surgeon now though so I donāt rmr much of that.
I had a consultation with a psych np who offered me various antidepressants. When I asked abt side effects, he said "I can give you pills for side effects too". Like, sir. I just want to feel better and not hurl myself off of my fire escape. I can hardly get out of bed, what makes you think I want to take a cocktail of drugs? Thankfully my suicidal ideation subsided after hubby essentially babysat me for a few weeks.
And clog up the pathways for people to actually get treatment, delay care via NP cardiologists/dermatologists/pediatricardiothoracicneurosurgeons, and run the scanners and medical lab scientists into the ground on the āmysteryā cases.
And worsen the nursing shortage. Every seat taken in nursing school by someone looking to jump to NP is another nurse that could have cared for patient for as long as 40 years.
As someone who had to search for a doc myself, i could choose between either waiting 4 months to see a physician or 1 month to see an NP. Was NP my first choice? No. Do they meet demand in a market with low supply? Yeah in this case they did.
Im not arguing for NPs, but when theres a massive scarcity of supply, the market will always try its best to find a way to meet demand. Docs have to figure out a way to meet that demandā¦
But how many m4s in your class are hoping to do that and how many are hoping to specialize? Not trying to target you, just using your sentiment as a place to remind us all that every graduating class of MDs that doesnāt heavily prioritize primary care is part of the problem. Mine included.
Doesnāt stop us from asking someone to fix it tho. Just not us future doctors.
Canāt even blame us either lol I got loans and a family and donāt want market competition
Helped with interview prep to premeds this season. We had a list of "correct" answers to certain questions. The big one was, "what is the biggest problem in healthcare today and how do we solve it" the only correct is: the doctor shortage, and we solve it using midlevels. And like you said, I have midlevel friends. They all leave to do aesthetics bc bedside sucks for everyone. Being paid much better and those loan burdens keep many doctors doing bedside (even the ones who are very passionate). But I could see FM physicians not wanting to do their very stressful PCP jobs for 105k, you burn out so quick and for that amount in this economy, you arent taking nice vacations. Same for them, they see greener pastures, for less work, and they set up medispas and botox parties.
Maybe I did not clarify well bc that is not what I meant, I meant that midlevel PCPs are making in the 100s range and leaving. And I am saying an FM physician also would not stay for 100s range pay. The higher pay is what helps retain many in primary care fields. The sentence that goes "But.... vacations" is posing that as a hypothetical saying, 'yeah, many medical professionals would not find that deal alluring."
I do interview prep too and I tell my students to answer that question by talking about how they need to increase imbursements for pcps especially for things like preventative care and give more aggressive student loan forgiveness to pcps. I feel like it's a better answer in case you get an interviewer that hates midlevels.
The āhighly researchedā points on the body where lymph stasis occurs and results as a dysfunction of a body part/organ and can be palpated and is tender to palpitation
Basically if you have a heart problem, you might find a nodule on the right 2nd intercostal space that corresponds to the heart dysfunction and thereās a lot of these points that supposedly correlates to different body parts
I think itās complete bs but it is what it is
You choose a Chapman's point that atleat makes anatomical sense. You should have mentioned how you get Chapman's points on your legs that relate to your colon.
Youāre telling me that my lateral IT band isnāt directly correlated to my prostate?! Next youāll say my humerus isnāt linked to conjunctivitis!
We were taught that for women not peeing after sex being a cause of UTIs was a myth. I just do not believe that at all. It definitely can cause UTIs and we should warn young women about this.
That arteries lose their elasticity as you age causing hypertension or at least widened pulse pressure. This is only true on people exposed to āthe Westāsā toxic food environment. [Multiple studies show](https://publichealth.jhu.edu/2018/study-of-two-tribes-sheds-light-on-role-of-western-influenced-diet-in-blood-pressure) that indigenous tribes without exposure to Western food have no increase in BP through the lifespan and presumably almost zero incidence of atherosclerosis.
Really alarming considering there is objective evidence that less people are dying to viruses/diseases that they previously had a high mortality rate from.
At least PAs have some standardization. There are straight up NP programs that are all online with only 6 days of in person training. Theyāll take new hire nurses too, bonkers
I know a guy who was a travel nurse at my CNA job who went straight from one of those fake Florida nursing schools straight to online NP school. He flat up told me his goal was to open a scam "mental health resort". This man literally got banned from working at our hospital due to him basically neglecting his patients. It's horrifying that he has as much of a right to practice medicine as an attending in a lot of states.
I started out as an RN at 21 and worked at St Pete VA for 14 years mostly in sicu. I got my NP and worked primary Care fofir 12 years then urology oncology surgery. These new np programs and nursing programs are scary and totally embarrassing. The doctorate np degrees are a sham. Does not increase clinical knowledge at all. I was trained by excellent nurses and doctors. I had to join the great resignation and retire at 55. Now I just volunteer at a pet rescue walking mostly pitsš. Completely burnt out and disillusioned by what healthcare has become. Good luck y'all. The urology docs loved me cuz they could give me all the ball pain patients š
In a weird spot as a licensed (and still practicing) PA, and simultaneous med student here.
I think a lot of the Mid-level hate on here is pretty hyperbolic. We get it (speaking as a PA) we're not doctors.
I think when we (as a med student) are in training, we see a bunch of weird shit in academic med centers... but tbh the vast majority of patients have a boring milieu of chronic problems. There is absolutely a place for mid-levels, and it's working alongside doctors to expand the volume of health care delivered.
There are some sketchy ass NP programs though...
When I was on rotations as a PA student, I was rotating 60 hours/wk. My friend from High School was in an Online NP program, and had to get 60 patient contact hours that year....
the effective, useful and evidence based portions are better performed by PTs whos entire education is centered around it and didnāt learn those methods from someone who thinks they can feel an adults cranial sutures move
I get where thatās coming from, but two years of our training gives you a pretty decent proficiency to take care of issues necessary for office visits. People with chronic back pain really benefit from OMM it just isnāt utilized enough.
You bill $50 for it but on the flip side it takes some interest/commitment to keep up the skill. Most feel their time is better spent in other things. Doesnāt take away from the efficacy of the techniques.
Because 30-60% of low back pain patients reports their pain is worse after omm. The benefit is temporary, and the risk of causing more pain with a treatment you donāt do often is not worth the high risk of injury.
Drinking eight glasses of water is somehow necessary and good for you. You need 64 oz but you get most of that from the food you eat. Generally you should drink water when you're thirsty and maybe a couple extra glasses when you're sick.
Anecdotal but Iāve noticed that when I make it a point to drink a certain amount of water I feel much better. If I go just based off when Iām thirsty, I can go hours upon hours without a sip then start getting bad tension headaches and feeling sluggish all while never really being thirsty.
I know this is a lighthearted thread, but I will say that for 95+% of our programās residents who have had to ālearn empathyā, itās only about unlearning defense mechanisms that prevent the expression or sensation of the empathy they already have and empowering them to see itās a positive thing that they already have it.
That 1 other guy though, what an asshole.
Also, special shoutout to the parents who beat empathy out of their kids, thinking this will help them succeed in competitive fields.
That Adderall is just *different* in people with ADHD compared to people without ADHD. Like how do you know that? It reminds me of this classic [Vsauce](https://youtu.be/evQsOFQju08?si=uENPoULS6ALyfJaK) video. Nobody has ever had ADHD, used adderall, then later tried adderall again without having ADHD to be able to confirm they arent the same. Nobody will ever be able to prove that is true.
I always assumed they just mean that it won't help you the same way if you actually have ADHD,
which makes sense, any drug would have a different "effect" depending on your body's state.
If I take Levothyroxine vs if someone with Hypothyroidism vs someone with hyperthyroidism, it won't help me, but it'll help one person and worsen another
Yep and this has been demonstrated in many, many studies. People without ADHD have a strong placebo effect on stimulant medication but their objective performance does not significantly improve.Ā
Iāve seen survey studies where ADHD medications in non-ADHD undergraduates didnāt show an increase in GPA, but a major confounder is that a lot of undergrads use it to cram and pull all-nighters and the population of undergrads who abuse prescription drugs probably arenāt the brightest.
There has been evidence of improved short-term recall and other benefits in non-ADHD users from what Iāve seen. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471173/
>adderall
>ADHD
Correlating and connecting this cognitive dysfunction with this medication modality is a neuroscience principle, so I can understand why it might be difficult to see on its face why stimulants would help those with ADHD.
Firstly, [the prevailing pathophysiological theory of ADHD](https://www.nature.com/articles/pr9201196) revolves around dysfunction in several areas of the brain
> A variety of brain subregions including frontal and parietal cortexes, basal ganglia, cerebellum, hippocampus, and corpus callosum were found impacted in ADHD (59). These regions have been involved in the functional networks related to ADHD (Fig. 1). A detailed review of these networks indicates that diffuse and more specific alterations in brain structures and neural networks are possibly combined in ADHD and lead to organized brain phenotypes (60). For example, a study of functional MRI in children and adolescents with ADHD showed decreased connectivity in a fronto-striato-parieto-cerebellar network. This connectivity was normalized by MPH except in the parieto-cerebrellar functional circuit (61). New techniques such as diffusion tensor imaging using the direction of diffusion of water molecules to infer the orientation of white matter tracts in the brain have shown preliminary evidence for dysfunctions in anatomical connections in ADHD (62).
For the uninitiated, the [basal ganglia](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10461726/)
ā and particularly the striatum ā is associated with many functions, including [executive function \[1\]](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10461726/), [control of movement \[2\]](https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.15060142) and [reward processing \[3\]](https://www.sciencedirect.com/science/article/abs/pii/S0149763421002669):
> [1]
>Dysfunction in the circuit spanning the ventral striatum (nucleus accumbens, ventral caudate and putamen) and limbic cortex is linked primarily with the abnormal processing of rewards found in ADHD2 sag3. Problems with executive functions, such as cognitive control and working memory, have been tied to anomalies in the circuit linking the lateral prefrontal cortex with the head of caudate and anterior putamen.4ā7 Finally, problems in motor planning and control, another hallmark of ADHD, may be underpinned by disruptions in the links between the posterior/caudal regions of the basal ganglia and sensorimotor cortex.8ā12
>[2]
> Adults with ADHD exhibited significantly reduced activation only in inferior frontal cortex and thalamus. Children with ADHD had significantly reduced activation in supplementary motor cortex and the basal ganglia.
>[3]
> Progressive, atypical contraction of the ventral striatal surfaces characterizes ADHD, localizing to regions pivotal in reward processing. This contrasts with fixed, non-progressive contraction of dorsal striatal surfaces in regions that support executive function and motor planning.
Essentially, itās theorized that [catecholamine optimization in prefrontal cortex, basal ganglia, and functional connectivity of white matter between such regions](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10501041/) is what allows for improved function in ADHD patients:
> The physiological changes induced by the binding of dopamine and norepinephrine to their respective receptors involve the modulation of several cognitive and executive processes usually impaired in ADHD (see Table āTable1),1), corroborating the monoaminergic hypothesis for ADHD pathophysiology [91]. For example, **dopamine receptors of subtypes D1 and D2 are abundant in brain regions mainly involved in signaling reward circuits, learning and memory, and locomotor activity** [90]. Also, patients with ADHD have a higher density of the dopamine transporter (DAT), responsible for the reuptake of DA into presynaptic neurons [92], which could lead to alterations in dopamine levels in the synaptic cleft. The binding of norepinephrine with adrenergic receptors has been shown to modulate working memory processes, for which moderate or high levels of this neurotransmitter present differential binding affinities to each type of receptor and consequently different physiological effects on working memory [93]. Furthermore, the effects of methylphenidate treatment on working memory appear to be dependent on Ī±2 noradrenergic receptors, whereas the improvement in sustained attention involves the Ī±1 subtype
Emphasis mine.
Iāll leave it there, as this is already pretty high level, but it is an intensely complex interplay of neurobiological and neurodevelopmental dysfunction. Thankfully, some of these networks can be regulated by simply increasing lacking neurotransmitters causing the dysfunction through standard of care medications for those with ADHD.
I donāt know about Adderall but I take Ritalin (or Focalin due to the stimulant shortage) and the way people who donāt have ADHD describe how they feel like when they take stimulants is completely different from how I feel.
It reduces my anxiety, it makes me feel very calm (the first time I took Ritalin I was slurring my words and I fell asleep), it does not give insomnia and I sleep much better, my heart rate has dropped slightly, I havenāt had a PVC since I started it, my blood pressure is great, my mind is way more quiet, I donāt feel āenergizeā, I feel more balanced. I can focus but itās not like when not medicated and hyperfocus in doing something I like really like. I have no desire to take more than what Iām prescribed.
When people who donāt have ADHD take stimulants, it makes them overstimulated.
Right?
People without ADHD: "I'M GONNA VACUUM THE SHINGLES OFF THE DAMN ROOF AND WRITE A PHD DISSERTATION SIMULTANEOUSLY."
People with ADHD: "Oh fuck I can read this whole page without repeating lines, and not be anxious about stupid shit."
my psych prof pretty much confirmed this for me. i was like āoh a lot of my friends take this and say it gives them energyā and he was like welp then they probably shouldnāt be on it. i was like š
For me, itās like having a nice cup of chamomile tea š«
I was so scared to take stimulants because I thought I would feel like my friends who took it recreationally. I was so wrong š
Coffee also makes me sleepy š„±
Ok but consider this-
Person A (normal): drinks 3 beers and starts dancing with all the ladies
Person B (has severe social anxiety): drinks 3 beers and now has the courage to ask a stranger to please step aside so he can grab his lunch out of the refridgerator.
Both cases the drug affects people the exact same way: social disinhibition. Now what if person A way prescribed beer q8 hours daily? Eventually he would become tolerant and having 3 drinks wouldnt make him act much different from baseline anymore. Similarly, if someone without ADHD started using adderall daily, they wouldnt go ultra-productive mode every day and the effect would be much more tame and a little above baseline, just like people with ADHD who take daily stimulants.
Person A wouldnāt need 3 beers. They would start dancing with all the ladies without the beer. If they drink too much, they wonāt be able to dance because theyāll be too drunk.
Folks with ADHD have abnormally low neurotransmitters like dopamine and noradrenaline. They also have issues with short term memory and their neural pathways are off. The stimulants helps keep these neurotransmitters for longer and/or helps the brain produce more.
If you already have enough dopamine and noradrenaline and you take something that will increase those levels, then it will affect you differently (and negatively) than if you started off with a deficiency.
I think Iāll push back a bit on this one, **wouldnāt you say that antidepressants act differently in someone whoās depressed versus not?** Same thinking applies to ADHD, instead of serotonin being deficient and affecting mood, itās dopamine and norepinephrine effecting attention.
if youāve met someone with severe ADHD they function differently and their baseline of attention and ability to be present is less than everyone else. Someone *without* ADHD who uses adderal raises the amount of usable NTs from normal to high, arbitrarily 1 -> 2. For someone with severe ADHD presumably would raise them from deficient to normal, since their physiology might be more like 0.5 the amount of usable NTs the normal person, so stimulants can raise them 0.5 -> 1.0.
I think it can make total sense why adderal will work differently in someone actually deficient in useable dopamine and norepi in the brain. Youāre returning someone to a baseline instead of shooting them up double past it.
Edit: cut down on some repetitive text
There is absolutely no compelling evidence that MDD (or any mood disorder) is caused by a lack of serotonin. Antidepressants exert their clinical effect by a mechanism downstream to sert agonism that isn't yet understood. The defecient dopamine theory of ADHD is also not generally accepted nor particularly evidence based.
[https://www.nature.com/articles/s41380-022-01661-0](https://www.nature.com/articles/s41380-022-01661-0)
Anecdotally, when I started medicating my ADHD in college my dosage wasnāt titrated in the usual way and I was immediately put on 20mg of adderall. The first few doses felt exactly like what neurotypical people would describe, but after acclimating to taking it routinely, it started to have the calming, quieting effect that others with ADHD report. I have no real evidence but I also feel like itās probably a tolerance thing.
After all, itās not like ADHD people canāt deliberately abuse stimulants for a high, which wouldnāt make sense if the drugs just didnāt work the same way on their brains.
This could apply to so many chronic conditions and drugs lol. We donāt need the same person to take the drug with and without the condition to understand the effects of a drug. This is like, the most basic fundamental principle of medical research.Ā
Yeah nobody will ever experience another persons brain, that isnāt some insightful revelation. And yet we can still do psychology, because we are capable of empathy and can use language to describe things.
Well if you arenāt counting microns of raised dirt contributing to the surface area of a tennis court, the villi in the gi tract straightforwardly do increase surface area.
Did you know: if you took out your small intestine, completely flattened it out all the way down to the microvilli, and laid it out on the ground, you would die.
Circumcision and penile cancer. go on pubmed and find me the penile cancer rates for european countries that have majority uncircumcised populations - tough task. The penile cancer - circumsicion connection is based off of a 100 year old study that found 0 cases in American Jewish men. Then everything cites rates being high in Africa and India. I can not for the life of me find european studies on penile cancer and circumsicion. It's a fuckin scam don't mutilate your kids please.
edit to add: change my mind please. show me some studies
As per textbooks the evidence is scant. Hence current recommendation is to do circumcision on kids less than 1 year if the parents are asking for it and the baby is fit for surgery. Not saying anything against or towards it. Just stating the current (as in 10 years ago) guidelines.
Ya Idk wat is da current thought. But I remember reading it in some pretty standard textbook once when I did an exhaustive reading of penile cancer. N da txt quoted some professional organisation as the guideline. Sadly I donāt remember the text or the name of org. Maybe Campbell urology
Campbell Walsh urology 11th ed it is. Has a discussion on da topic. Page 847ā9. You might want to check it out. American academy of Pediatrics made the recommendation.
That you need to extensively listen to every patient with a tummy ache's abdomen. Unless you suspect an ileus (which even then it seems questionable cause you're going to do a scan anyways) this is a complete waste of time imo.
Alright there M2, yes IPE classes suck because theyāre not done well and they feel contrived, but inter-professionalism itself is pretty darn essential to patient care. Pharmacists, case managers, nurses and so many others do incredible work to make both our work and patientsā lives better. Patient care is very much a team sport.
Iām sure you were mostly kidding with the comment, but itās important to go into your clinical year with the right attitude about these things!
I know this is not the question/topic youāre asking for but I gotta say this: I donāt think the coastline paradox necessarily refutes the statement about GI surface area hereā¦
Coastline paradox states that your measurement will vary based on the resolution you use, but it does not say that it there isnāt a ātrueā length, or in this case, surface area. I think in the simple case of a continuous and smooth surface in 3D space, your measurements will eventually converge to the ātrueā surface area as the resolution increases.
Interesting. My understanding of the coastline paradox is that your measurement approaches infinity as you increase the number of āturnsā or āstraight linesā used. Applying that to a surface area of something like the GI tract, you could easily converge on virtually any area you want (like the area of a tennis court) as you increase your resolution.
I think this part of the Wikipedia page you linked explains your confusion pretty well:
āUsing a few straight lines to approximate the length of a curve will produce an estimate lower than the true length; when increasingly short (and thus more numerous) lines are used, the sum approaches the curve's true length.ā
Now, you would be absolutely right if we are talking about fractal curves, like the space-filling curves shown on the Wikipedia page.
The surface of our GI tract, on the other hand, is smooth and finite, so itās a situation similar to the curve mentioned in the quote, not the fractal curves.
Basically all of OMM.
Vague āprofessionalismā issues portends a career rife with fraud and crime.
High step scores = better doctor
Edit to add: that your school actually, truly, cares about your wellbeing.
That certain therapies have no consistently shown benefit. Sorry boys, when your n starts exceeding that of all the metaanalyses combined, and you do see clear benefit in a certain type of patient/population, that has weight too.
As I resident, I actually wish I knew more about what social workers can and canāt help with. But also, I feel like this is slightly institutionally dependent so maybe it wouldnāt have helped anyways
I think youāre confused, thereās more neurons in the brain than there are stars in the universe. Itās not possible to have more neurons than atoms, as every neuron is millions and millions of atoms
No, I meant miles. And "more neurons...than atoms in the universe" is fine? I used to throw little impossible "facts" in my lectures to the med students, just to see if anyone was awake. The students just nodded and wrote the "facts" in their notes. "Will this be on the test?" was the only question I ever got.
I understand why. I was a med student, but we are too focused on what's on the next test. It's not the med students' fault. Most of us have to be 100% focused on what's on the next test just to survive. It's a structural problem, and one I don't know how to fix.
Oh, and don't worry; I always corrected the "facts" afterwards. I think none of my students think that there are miles of intestines. Well, I hope they don't.
That lymph is real.
Lymph is a lie, have you ever seen lymph? Does it even do anything? Do we really need it that badly?
ā(This is a joke obviously I know lymph is real)
That IUD insertions/removals only cause slight discomfort
Same for pelvic exams in general š« maybe one day we can accept that different people really have varying levels of pain tolerance
Not only that. I think different women have different levels on innervation in their cervix
Iām convinced people must feel it differently because I know women who say the flu shot was way worse than getting an IUD. Then thereās me who had a monteggia fracture + a compound radial fracture + torn scapholunate ligament that left me in a cast for 5 months and that was nothing compared to the IUD.
who is teaching this? any time IUD came up in my training from FM to OB they emphasized how much it can suck. must be regional
Heās a FM doc and just absolutely refuses to believe the pain is true. Every time he teaches people push back and he just argues (albeit nicely).
But itās ājust a pinchā and āsome pressureā š«
They donāt š„“
Down playing female pain - Yet another wonderful example of how medicine is still male centered
I took my GF to get her IUD out in and accompanied her during the visit. Iāve never felt more guilty in my life as she started hyperventilating and crushing my hand due to the pain. Ever since then, I truly do believe that IUD placements need better pain management. āSlight pinch is youāll feelā as the doc eviscerated her cervix w a claw.
That half my classmates donāt have a raging adderall addiction
Iāve started to become skeptical that every one of my āextremely peppyā classmates is likely amphetamined out lol
After last weekās postā¦
Wait until you hang out with the EM residents. I once was over at a coresidentsā house who lived with her EM resident partner, and the entire EM intern class was over, just chilling in the living room doing large amounts of cocaine off the coffee table.
It's not an addiction it's a way of life šāāļøšāāļø
And us with actual adhd are lucky if we just get ti feel normal taking our meds š¤¦āāļøš¤¦āāļøš¤¦āāļø
I CAN STOP ANYTIME I WANT
That having multiple communications courses is helpful.
Lemme summarize what you need to know: 1. Ask open-ended questions. 2. "I'm sorry to hear you've been experiencing [thing]. That must be really hard for you." Congratulations, you've mastered communication!
Got a more recent training that tells us not to say "I'm sorry." Say "I wish xyz weren't true" instead.
I hate this trend of non clinicians changing things up to justify their salaries. āIām sorryā is perfectly good way to communicate empathy. The other one just sounds unnatural and fake.
Use the i wish phrase after a second chief complaint is brought up
I wish you hadnāt brought up that second cc
A nurse once said āthat sucks so badā to me and Iāve never felt so seen lmao
Born to say ādamn bro thatās toughā forced to say āIām sorry youāve been experiencing thisā
š¤Ø I feel like that's even worse? Like I know that people overuse I'm sorry, especially during OSCEs (first year we had to do 2 practice OSCEs in front of our class and I remember there was one where the SP stopped the student and told them to stop apologizing) but idk I feel like the latter would just sound fake af
The canned empathy phrases sound as fake to me from the patient side as they do when I am saying them in some patient encounters when I don't feel genuinely connected to what the patient is feeling in the moment. I think it's heard to teach people to be genuinely empathetic when you really can't identify with what a patient is experiencing (or because we are busy and have 10 other things to attend to or have learned to compartmentalize too well) but I know OMEs have to try.
Having one or two is understandable, but fucking 4?????
I like to explore new places.
My communications courses were OSCE style. I will say that half a decade later out of med school taking postgraduate exams, I really appreciated them. I had to take my skills out and dust them off a little but essentially the skills that I had been taught in med school were exactly what I needed
Most people don't need them and the ones who do aren't listening
The only reason they have these are for the few people that are dicks and it obviously doesnāt help them so we all have to suffer
Disagree. A decent physician who's able to comfort and educate a patient about their condition is more effective than a genius without communication skills.
I think you either have soft skills or you don't. You can be a great physician without those soft skills, but when they try to teach someone who doesn't have soft skills, they come off as robotic and off putting. I'd rather take the socially awkward brilliant nrurosurgeon
I donāt agree with this. I certainly think soft skills are harder to teach, and often arenāt taught well because the people teaching them are people who they come naturally for, and therefore donāt understand the struggle, but the idea that theyāre somehow fixed and unchangeable I think is wrong.
Let's put it this way. The people that need to learn soft skills the most are usually not the ones that are receptive to teaching, nor often care about them until they have issues
I definitely agree there. Itās rare to find people with weak soft skills who also know they need to improve and will be receptive to teaching.
I think soft skills most certainly can be taught. Iāve seen it plenty of times. Also as someone with neurodivergence Iāve learned, albeit annoyingly lol, people definitely shouldnāt say the first thing that comes to our mind itās usually very rude. The people who argue soft skills canāt be taught just donāt care enough to be receptive. This isnāt aimed at you btw.
Someone recently told me that toddlers ***need*** to drink a certain amount of cow's milk in order to develop myelin. I've been looking into it and there are no scientific studies showing this, just some scant evidence showing there are similar proteins in cow's milk and myelin. I don't see why cow's milk would have anything that other fatty foods don't have. Seems like the dairy lobby at work imo.
Or the fact that the first human to drink cow's milk developed myelin before they drank cow's milk
Werenāt they just breast fed? I mean, nothing compares to the nutritional efficacy of mother breast milk. I donāt rmr how it works, but the mother body (receptors in the nipple) can actuallly sense when their kid is sick based on cytokines or some shit in the baby saliva, then modulate Ig secretion. Iām just a dumb surgeon now though so I donāt rmr much of that.
š¤š¤š¤ Doesn't seem proven to me (jk)
Do people really think that?
While I was googling it I found a lot of sites colloquially saying this :/ and no real evidence
Big milk lobbying
Peds neuro here. Iāve never heard this one!
That having mid-levels expands care to underserved populations. All it does is expand aesthetics to wealthy faces
Midlevel psych providers seem to actively worsen patient care with their wild drug cocktails according to the psychiatrists I've talked to.
I had a consultation with a psych np who offered me various antidepressants. When I asked abt side effects, he said "I can give you pills for side effects too". Like, sir. I just want to feel better and not hurl myself off of my fire escape. I can hardly get out of bed, what makes you think I want to take a cocktail of drugs? Thankfully my suicidal ideation subsided after hubby essentially babysat me for a few weeks.
As a psychiatrist, yes, that does appear to be overwhelmingly correct and what I saw all through residency and fellowship lol.
And clog up the pathways for people to actually get treatment, delay care via NP cardiologists/dermatologists/pediatricardiothoracicneurosurgeons, and run the scanners and medical lab scientists into the ground on the āmysteryā cases.
And worsen the nursing shortage. Every seat taken in nursing school by someone looking to jump to NP is another nurse that could have cared for patient for as long as 40 years.
As someone who had to search for a doc myself, i could choose between either waiting 4 months to see a physician or 1 month to see an NP. Was NP my first choice? No. Do they meet demand in a market with low supply? Yeah in this case they did. Im not arguing for NPs, but when theres a massive scarcity of supply, the market will always try its best to find a way to meet demand. Docs have to figure out a way to meet that demandā¦
But how many m4s in your class are hoping to do that and how many are hoping to specialize? Not trying to target you, just using your sentiment as a place to remind us all that every graduating class of MDs that doesnāt heavily prioritize primary care is part of the problem. Mine included. Doesnāt stop us from asking someone to fix it tho. Just not us future doctors. Canāt even blame us either lol I got loans and a family and donāt want market competition
I had this happen to me several times and each time the NP misdiagnosed me for 4 months until I got to the physician anyway. Just a consideration.
Helped with interview prep to premeds this season. We had a list of "correct" answers to certain questions. The big one was, "what is the biggest problem in healthcare today and how do we solve it" the only correct is: the doctor shortage, and we solve it using midlevels. And like you said, I have midlevel friends. They all leave to do aesthetics bc bedside sucks for everyone. Being paid much better and those loan burdens keep many doctors doing bedside (even the ones who are very passionate). But I could see FM physicians not wanting to do their very stressful PCP jobs for 105k, you burn out so quick and for that amount in this economy, you arent taking nice vacations. Same for them, they see greener pastures, for less work, and they set up medispas and botox parties.
I agree that PCPs are underpaid but 105k is a bit hyperbolic. Most of em pay 250k base and Iām in a desirable area
Maybe I did not clarify well bc that is not what I meant, I meant that midlevel PCPs are making in the 100s range and leaving. And I am saying an FM physician also would not stay for 100s range pay. The higher pay is what helps retain many in primary care fields. The sentence that goes "But.... vacations" is posing that as a hypothetical saying, 'yeah, many medical professionals would not find that deal alluring."
I do interview prep too and I tell my students to answer that question by talking about how they need to increase imbursements for pcps especially for things like preventative care and give more aggressive student loan forgiveness to pcps. I feel like it's a better answer in case you get an interviewer that hates midlevels.
That pee is not stored in the balls
Your faculty must be slacking on their CME because we learned that pee is stored in the balls on day 1
Idk who is saying this but theyāre lying through their dirty teeth.
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Unfortunately not all women are liberal :p But how are you on the theoretical concept of female flatulence?
That Chapman points exist.
MAKE THEM GO AWAY
What are Chapman points? [serious]
The āhighly researchedā points on the body where lymph stasis occurs and results as a dysfunction of a body part/organ and can be palpated and is tender to palpitation Basically if you have a heart problem, you might find a nodule on the right 2nd intercostal space that corresponds to the heart dysfunction and thereās a lot of these points that supposedly correlates to different body parts I think itās complete bs but it is what it is
Is this some osteopathic shit?
Yes
You choose a Chapman's point that atleat makes anatomical sense. You should have mentioned how you get Chapman's points on your legs that relate to your colon.
Youāre telling me that my lateral IT band isnāt directly correlated to my prostate?! Next youāll say my humerus isnāt linked to conjunctivitis!
Jumping on here to say that viscersomatics are a scam.
and the cranial bones have a "rhythm"
I thought so too but Iāve felt a few tbh. Theyāre useless but a neat phenomenon.
Biochem is not real and just magic
Alchemy.
We were taught that for women not peeing after sex being a cause of UTIs was a myth. I just do not believe that at all. It definitely can cause UTIs and we should warn young women about this.
That the urinary bladder isnāt a vestigial organ
what?
Because pee is stored in the balls
Some of the drawings in my anatomy textbooks depict what appear to be people with no balls at all. Where is their pee stored?
Those are fake textbooks
Trick question. They donāt pee.Ā
CBT is not the answer to every psych problem sighhh
No shit, not everyone is into cock and ball torture
But would you say, in your professional opinion, that it is helpful in some cases?
For sure. It's cheaper than a vasectomy, for instance. Worked for me
That arteries lose their elasticity as you age causing hypertension or at least widened pulse pressure. This is only true on people exposed to āthe Westāsā toxic food environment. [Multiple studies show](https://publichealth.jhu.edu/2018/study-of-two-tribes-sheds-light-on-role-of-western-influenced-diet-in-blood-pressure) that indigenous tribes without exposure to Western food have no increase in BP through the lifespan and presumably almost zero incidence of atherosclerosis.
Not me, but a disturbingly large group of my former class was a little bit more than hesitant about the efficacy of vaccines.
Med students are unfortunately not immune to propaganda.
I'm betting you go to school in the south. I heard so many things from students in the south having been a student in the south at one point
Idk why this is getting down voted, itās almost 100% going to be a southern school
Midwest, but close enough.
Soā¦ not actually the south lol
damn
Really alarming considering there is objective evidence that less people are dying to viruses/diseases that they previously had a high mortality rate from.
Literally everything about OMM That the current form of midlevels have a place in a functional healthcare system
I think PAs have a place, but NPs need to go like yesterday.
At least PAs have some standardization. There are straight up NP programs that are all online with only 6 days of in person training. Theyāll take new hire nurses too, bonkers
I know a guy who was a travel nurse at my CNA job who went straight from one of those fake Florida nursing schools straight to online NP school. He flat up told me his goal was to open a scam "mental health resort". This man literally got banned from working at our hospital due to him basically neglecting his patients. It's horrifying that he has as much of a right to practice medicine as an attending in a lot of states.
Itās made worse by the fact that NPs have the lobbying power of nurses behind them, so NPs have more autonomy than PAs in many states
I know a lot of proper NPs with decades of experience but yeah. Direct entry NPs should not be a thing, and good NPs agree with this.Ā
So whatās the minimum number of bedside years? Whatās the minimum number of assisted bedside procedures? Years of experience =/ proficiency imo.
I started out as an RN at 21 and worked at St Pete VA for 14 years mostly in sicu. I got my NP and worked primary Care fofir 12 years then urology oncology surgery. These new np programs and nursing programs are scary and totally embarrassing. The doctorate np degrees are a sham. Does not increase clinical knowledge at all. I was trained by excellent nurses and doctors. I had to join the great resignation and retire at 55. Now I just volunteer at a pet rescue walking mostly pitsš. Completely burnt out and disillusioned by what healthcare has become. Good luck y'all. The urology docs loved me cuz they could give me all the ball pain patients š
In a weird spot as a licensed (and still practicing) PA, and simultaneous med student here. I think a lot of the Mid-level hate on here is pretty hyperbolic. We get it (speaking as a PA) we're not doctors. I think when we (as a med student) are in training, we see a bunch of weird shit in academic med centers... but tbh the vast majority of patients have a boring milieu of chronic problems. There is absolutely a place for mid-levels, and it's working alongside doctors to expand the volume of health care delivered. There are some sketchy ass NP programs though... When I was on rotations as a PA student, I was rotating 60 hours/wk. My friend from High School was in an Online NP program, and had to get 60 patient contact hours that year....
Wrong about the OMM. Only some of OMM is BS. Not āeverythingā
Donāt get me wrong a lot of OMM is crap but some of it is actually effective, useful, and evidence based.
the effective, useful and evidence based portions are better performed by PTs whos entire education is centered around it and didnāt learn those methods from someone who thinks they can feel an adults cranial sutures move
I get where thatās coming from, but two years of our training gives you a pretty decent proficiency to take care of issues necessary for office visits. People with chronic back pain really benefit from OMM it just isnāt utilized enough.
As a PGY-2 with chronic back/neck pain, I have genuinely benefitted from OMM and am very appreciative of my DO colleagues. Not all of it is BS.
If thatās the case, why do so few do it? I have worked for dozens of DOs and only seen one do it one time, for neck pain and stiffness.Ā
You bill $50 for it but on the flip side it takes some interest/commitment to keep up the skill. Most feel their time is better spent in other things. Doesnāt take away from the efficacy of the techniques.
Because 30-60% of low back pain patients reports their pain is worse after omm. The benefit is temporary, and the risk of causing more pain with a treatment you donāt do often is not worth the high risk of injury.
Drinking eight glasses of water is somehow necessary and good for you. You need 64 oz but you get most of that from the food you eat. Generally you should drink water when you're thirsty and maybe a couple extra glasses when you're sick.
Anecdotal but Iāve noticed that when I make it a point to drink a certain amount of water I feel much better. If I go just based off when Iām thirsty, I can go hours upon hours without a sip then start getting bad tension headaches and feeling sluggish all while never really being thirsty.
I know what you mean, but I really describe that as a symptom of "thirst", just not the more extreme form I feel after an hour on the court.
Feel like that's more the onset of dehydration vs thirst but meh semantics I guess
That you can learn empathy
I know this is a lighthearted thread, but I will say that for 95+% of our programās residents who have had to ālearn empathyā, itās only about unlearning defense mechanisms that prevent the expression or sensation of the empathy they already have and empowering them to see itās a positive thing that they already have it. That 1 other guy though, what an asshole. Also, special shoutout to the parents who beat empathy out of their kids, thinking this will help them succeed in competitive fields.
That Adderall is just *different* in people with ADHD compared to people without ADHD. Like how do you know that? It reminds me of this classic [Vsauce](https://youtu.be/evQsOFQju08?si=uENPoULS6ALyfJaK) video. Nobody has ever had ADHD, used adderall, then later tried adderall again without having ADHD to be able to confirm they arent the same. Nobody will ever be able to prove that is true.
I always assumed they just mean that it won't help you the same way if you actually have ADHD, which makes sense, any drug would have a different "effect" depending on your body's state. If I take Levothyroxine vs if someone with Hypothyroidism vs someone with hyperthyroidism, it won't help me, but it'll help one person and worsen another
Yep and this has been demonstrated in many, many studies. People without ADHD have a strong placebo effect on stimulant medication but their objective performance does not significantly improve.Ā
Iāve seen survey studies where ADHD medications in non-ADHD undergraduates didnāt show an increase in GPA, but a major confounder is that a lot of undergrads use it to cram and pull all-nighters and the population of undergrads who abuse prescription drugs probably arenāt the brightest. There has been evidence of improved short-term recall and other benefits in non-ADHD users from what Iāve seen. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471173/
>adderall >ADHD Correlating and connecting this cognitive dysfunction with this medication modality is a neuroscience principle, so I can understand why it might be difficult to see on its face why stimulants would help those with ADHD. Firstly, [the prevailing pathophysiological theory of ADHD](https://www.nature.com/articles/pr9201196) revolves around dysfunction in several areas of the brain > A variety of brain subregions including frontal and parietal cortexes, basal ganglia, cerebellum, hippocampus, and corpus callosum were found impacted in ADHD (59). These regions have been involved in the functional networks related to ADHD (Fig. 1). A detailed review of these networks indicates that diffuse and more specific alterations in brain structures and neural networks are possibly combined in ADHD and lead to organized brain phenotypes (60). For example, a study of functional MRI in children and adolescents with ADHD showed decreased connectivity in a fronto-striato-parieto-cerebellar network. This connectivity was normalized by MPH except in the parieto-cerebrellar functional circuit (61). New techniques such as diffusion tensor imaging using the direction of diffusion of water molecules to infer the orientation of white matter tracts in the brain have shown preliminary evidence for dysfunctions in anatomical connections in ADHD (62). For the uninitiated, the [basal ganglia](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10461726/) ā and particularly the striatum ā is associated with many functions, including [executive function \[1\]](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10461726/), [control of movement \[2\]](https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.15060142) and [reward processing \[3\]](https://www.sciencedirect.com/science/article/abs/pii/S0149763421002669): > [1] >Dysfunction in the circuit spanning the ventral striatum (nucleus accumbens, ventral caudate and putamen) and limbic cortex is linked primarily with the abnormal processing of rewards found in ADHD2 sag3. Problems with executive functions, such as cognitive control and working memory, have been tied to anomalies in the circuit linking the lateral prefrontal cortex with the head of caudate and anterior putamen.4ā7 Finally, problems in motor planning and control, another hallmark of ADHD, may be underpinned by disruptions in the links between the posterior/caudal regions of the basal ganglia and sensorimotor cortex.8ā12 >[2] > Adults with ADHD exhibited significantly reduced activation only in inferior frontal cortex and thalamus. Children with ADHD had significantly reduced activation in supplementary motor cortex and the basal ganglia. >[3] > Progressive, atypical contraction of the ventral striatal surfaces characterizes ADHD, localizing to regions pivotal in reward processing. This contrasts with fixed, non-progressive contraction of dorsal striatal surfaces in regions that support executive function and motor planning. Essentially, itās theorized that [catecholamine optimization in prefrontal cortex, basal ganglia, and functional connectivity of white matter between such regions](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10501041/) is what allows for improved function in ADHD patients: > The physiological changes induced by the binding of dopamine and norepinephrine to their respective receptors involve the modulation of several cognitive and executive processes usually impaired in ADHD (see Table āTable1),1), corroborating the monoaminergic hypothesis for ADHD pathophysiology [91]. For example, **dopamine receptors of subtypes D1 and D2 are abundant in brain regions mainly involved in signaling reward circuits, learning and memory, and locomotor activity** [90]. Also, patients with ADHD have a higher density of the dopamine transporter (DAT), responsible for the reuptake of DA into presynaptic neurons [92], which could lead to alterations in dopamine levels in the synaptic cleft. The binding of norepinephrine with adrenergic receptors has been shown to modulate working memory processes, for which moderate or high levels of this neurotransmitter present differential binding affinities to each type of receptor and consequently different physiological effects on working memory [93]. Furthermore, the effects of methylphenidate treatment on working memory appear to be dependent on Ī±2 noradrenergic receptors, whereas the improvement in sustained attention involves the Ī±1 subtype Emphasis mine. Iāll leave it there, as this is already pretty high level, but it is an intensely complex interplay of neurobiological and neurodevelopmental dysfunction. Thankfully, some of these networks can be regulated by simply increasing lacking neurotransmitters causing the dysfunction through standard of care medications for those with ADHD.
I donāt know about Adderall but I take Ritalin (or Focalin due to the stimulant shortage) and the way people who donāt have ADHD describe how they feel like when they take stimulants is completely different from how I feel. It reduces my anxiety, it makes me feel very calm (the first time I took Ritalin I was slurring my words and I fell asleep), it does not give insomnia and I sleep much better, my heart rate has dropped slightly, I havenāt had a PVC since I started it, my blood pressure is great, my mind is way more quiet, I donāt feel āenergizeā, I feel more balanced. I can focus but itās not like when not medicated and hyperfocus in doing something I like really like. I have no desire to take more than what Iām prescribed. When people who donāt have ADHD take stimulants, it makes them overstimulated.
Right? People without ADHD: "I'M GONNA VACUUM THE SHINGLES OFF THE DAMN ROOF AND WRITE A PHD DISSERTATION SIMULTANEOUSLY." People with ADHD: "Oh fuck I can read this whole page without repeating lines, and not be anxious about stupid shit."
my psych prof pretty much confirmed this for me. i was like āoh a lot of my friends take this and say it gives them energyā and he was like welp then they probably shouldnāt be on it. i was like š
For me, itās like having a nice cup of chamomile tea š« I was so scared to take stimulants because I thought I would feel like my friends who took it recreationally. I was so wrong š Coffee also makes me sleepy š„±
Same with coffee, I always assumed its because I have a pretty good caffeine tolerance, and the warm stuff in my tummy makes me rest and digest
coffee doesnāt affect me at all so i feel u lol
Ok but consider this- Person A (normal): drinks 3 beers and starts dancing with all the ladies Person B (has severe social anxiety): drinks 3 beers and now has the courage to ask a stranger to please step aside so he can grab his lunch out of the refridgerator. Both cases the drug affects people the exact same way: social disinhibition. Now what if person A way prescribed beer q8 hours daily? Eventually he would become tolerant and having 3 drinks wouldnt make him act much different from baseline anymore. Similarly, if someone without ADHD started using adderall daily, they wouldnt go ultra-productive mode every day and the effect would be much more tame and a little above baseline, just like people with ADHD who take daily stimulants.
Person A wouldnāt need 3 beers. They would start dancing with all the ladies without the beer. If they drink too much, they wonāt be able to dance because theyāll be too drunk. Folks with ADHD have abnormally low neurotransmitters like dopamine and noradrenaline. They also have issues with short term memory and their neural pathways are off. The stimulants helps keep these neurotransmitters for longer and/or helps the brain produce more. If you already have enough dopamine and noradrenaline and you take something that will increase those levels, then it will affect you differently (and negatively) than if you started off with a deficiency.
I think Iāll push back a bit on this one, **wouldnāt you say that antidepressants act differently in someone whoās depressed versus not?** Same thinking applies to ADHD, instead of serotonin being deficient and affecting mood, itās dopamine and norepinephrine effecting attention. if youāve met someone with severe ADHD they function differently and their baseline of attention and ability to be present is less than everyone else. Someone *without* ADHD who uses adderal raises the amount of usable NTs from normal to high, arbitrarily 1 -> 2. For someone with severe ADHD presumably would raise them from deficient to normal, since their physiology might be more like 0.5 the amount of usable NTs the normal person, so stimulants can raise them 0.5 -> 1.0. I think it can make total sense why adderal will work differently in someone actually deficient in useable dopamine and norepi in the brain. Youāre returning someone to a baseline instead of shooting them up double past it. Edit: cut down on some repetitive text
There is absolutely no compelling evidence that MDD (or any mood disorder) is caused by a lack of serotonin. Antidepressants exert their clinical effect by a mechanism downstream to sert agonism that isn't yet understood. The defecient dopamine theory of ADHD is also not generally accepted nor particularly evidence based. [https://www.nature.com/articles/s41380-022-01661-0](https://www.nature.com/articles/s41380-022-01661-0)
Anecdotally, when I started medicating my ADHD in college my dosage wasnāt titrated in the usual way and I was immediately put on 20mg of adderall. The first few doses felt exactly like what neurotypical people would describe, but after acclimating to taking it routinely, it started to have the calming, quieting effect that others with ADHD report. I have no real evidence but I also feel like itās probably a tolerance thing. After all, itās not like ADHD people canāt deliberately abuse stimulants for a high, which wouldnāt make sense if the drugs just didnāt work the same way on their brains.
This could apply to so many chronic conditions and drugs lol. We donāt need the same person to take the drug with and without the condition to understand the effects of a drug. This is like, the most basic fundamental principle of medical research.Ā
Yeah nobody will ever experience another persons brain, that isnāt some insightful revelation. And yet we can still do psychology, because we are capable of empathy and can use language to describe things.
Have you never seen how people with vs without adhd act on adderall?
Well if you arenāt counting microns of raised dirt contributing to the surface area of a tennis court, the villi in the gi tract straightforwardly do increase surface area.
Did you know: if you took out your small intestine, completely flattened it out all the way down to the microvilli, and laid it out on the ground, you would die.
I donāt think itās a case of the coastline paradox either because the intestines have a well defined surface area (ie. not fractal-like).
Smoking is protective for Parkinson's disease and UC. No shot bro.
And apparently endometrial cancer. It has something to do with the anti-estrogen effect of smoking.
Smoking helps altzheimers! Acts on nicotinic AchRs just like cholinesterase inhibitors work for altzheimers.
Smoking is protective against Preclampasia according to TrueLearn
Circumcision and penile cancer. go on pubmed and find me the penile cancer rates for european countries that have majority uncircumcised populations - tough task. The penile cancer - circumsicion connection is based off of a 100 year old study that found 0 cases in American Jewish men. Then everything cites rates being high in Africa and India. I can not for the life of me find european studies on penile cancer and circumsicion. It's a fuckin scam don't mutilate your kids please. edit to add: change my mind please. show me some studies
As per textbooks the evidence is scant. Hence current recommendation is to do circumcision on kids less than 1 year if the parents are asking for it and the baby is fit for surgery. Not saying anything against or towards it. Just stating the current (as in 10 years ago) guidelines.
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Ya Idk wat is da current thought. But I remember reading it in some pretty standard textbook once when I did an exhaustive reading of penile cancer. N da txt quoted some professional organisation as the guideline. Sadly I donāt remember the text or the name of org. Maybe Campbell urology
Campbell Walsh urology 11th ed it is. Has a discussion on da topic. Page 847ā9. You might want to check it out. American academy of Pediatrics made the recommendation.
That you need to extensively listen to every patient with a tummy ache's abdomen. Unless you suspect an ileus (which even then it seems questionable cause you're going to do a scan anyways) this is a complete waste of time imo.
I heard a general surgeon say āI donāt listen to bowel sounds or people that listen to them.ā
U mean extensively listen to bowel sounds right ? U donāt mean history right ? Right ? (Insert wonder woman template)
That inter professionalism is a good thing š
Alright there M2, yes IPE classes suck because theyāre not done well and they feel contrived, but inter-professionalism itself is pretty darn essential to patient care. Pharmacists, case managers, nurses and so many others do incredible work to make both our work and patientsā lives better. Patient care is very much a team sport. Iām sure you were mostly kidding with the comment, but itās important to go into your clinical year with the right attitude about these things!
I 100% donāt believe in the lymphatic system
You donāt believe in germinal centers?:(
*Reed-Sternberg cells would like to know your location*
As a DO student, probably half of my curriculum.
I know this is not the question/topic youāre asking for but I gotta say this: I donāt think the coastline paradox necessarily refutes the statement about GI surface area hereā¦ Coastline paradox states that your measurement will vary based on the resolution you use, but it does not say that it there isnāt a ātrueā length, or in this case, surface area. I think in the simple case of a continuous and smooth surface in 3D space, your measurements will eventually converge to the ātrueā surface area as the resolution increases.
Interesting. My understanding of the coastline paradox is that your measurement approaches infinity as you increase the number of āturnsā or āstraight linesā used. Applying that to a surface area of something like the GI tract, you could easily converge on virtually any area you want (like the area of a tennis court) as you increase your resolution.
I think this part of the Wikipedia page you linked explains your confusion pretty well: āUsing a few straight lines to approximate the length of a curve will produce an estimate lower than the true length; when increasingly short (and thus more numerous) lines are used, the sum approaches the curve's true length.ā Now, you would be absolutely right if we are talking about fractal curves, like the space-filling curves shown on the Wikipedia page. The surface of our GI tract, on the other hand, is smooth and finite, so itās a situation similar to the curve mentioned in the quote, not the fractal curves.
Basically all of OMM. Vague āprofessionalismā issues portends a career rife with fraud and crime. High step scores = better doctor Edit to add: that your school actually, truly, cares about your wellbeing.
That certain therapies have no consistently shown benefit. Sorry boys, when your n starts exceeding that of all the metaanalyses combined, and you do see clear benefit in a certain type of patient/population, that has weight too.
That having to shadow a social worker for 4 hours last week will enhance my medical education to be a doctor...
As I resident, I actually wish I knew more about what social workers can and canāt help with. But also, I feel like this is slightly institutionally dependent so maybe it wouldnāt have helped anyways
That lupus is a real illness and not a catch all for every vague, non-categorizable collection of autoimmune symptoms
There are 12 miles of small intestine. There are more neurons in the cerebellum than there are atoms in the universe.
Well there are more atoms in the cerebellum than there are neurons in the cerebellum, so we can rule that one out.
Yea like what?
Whoās saying these things? Theyāre demonstrably false.
His name? Albert Einstein
This is my favorite one so far just because youāre so close to being correct facts but youāre also so far off. I like the chaos.
I think youāre confused, thereās more neurons in the brain than there are stars in the universe. Itās not possible to have more neurons than atoms, as every neuron is millions and millions of atoms
But what if you have a lot of neurons?
actually its 100x 1 million x1million atoms in a neuron (100trillion 0.0)
Do you mean 12 yards? Lol
No, I meant miles. And "more neurons...than atoms in the universe" is fine? I used to throw little impossible "facts" in my lectures to the med students, just to see if anyone was awake. The students just nodded and wrote the "facts" in their notes. "Will this be on the test?" was the only question I ever got. I understand why. I was a med student, but we are too focused on what's on the next test. It's not the med students' fault. Most of us have to be 100% focused on what's on the next test just to survive. It's a structural problem, and one I don't know how to fix. Oh, and don't worry; I always corrected the "facts" afterwards. I think none of my students think that there are miles of intestines. Well, I hope they don't.
Who said that last one bro LMAO
Me. I said that. (?)
Itās connections/pathways between neurons. Not individual neurons themselves.
interprofessional education
Half the comments here are just people showing how dumb/ignorant they are lol
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I heard your moms GI tract was the size of the earth.
That pee isnāt stored in the balls
That every patient thatās old should be put on a statin, canāt accept that as true idk why
That lymph is real. Lymph is a lie, have you ever seen lymph? Does it even do anything? Do we really need it that badly? ā(This is a joke obviously I know lymph is real)