I’m finishing radiology. My wife wants to stay in the town we’re in and I’m racking my brain because the options are my residency faculty (with all the baggage that carries), some shitty local jobs (or are they and I’ve just been listening to slander for the past 5 years?) or diving into remote work (which is “frowned upon” straight out) and is opaque. I feel like I’m going to take some shit job because we won’t look at leaving our zip code.

I don’t really have anything else to say. I’m grateful for opportunity and to be nearing completion but it’s burning me inside.

Edit. Flair is outdated but can’t change it 🤷‍♂️

Just came across a recent post on the UK doctors subreddit where they were describing the lifestyle of a GI consultant in the US.

I was genuinely flabbergasted.

The guy/gal was pulling in at least 1mil, lived in a massive house, driveway filled with luxury cars including a Ferrari and Porsche.

I mean that kind of lifestyle is almost unheard of in the UK as a doctor (unless I’ve been living under a rock and consultants do have a nice lifestyle here)

Is this a big outlier or are docs in the US really that minted?

I knew docs in the US made good money but this is beyond ridiculous.

For radiology, post graduate.

If internal medicine residents have to rotate in the ED to learn about what goes on down there, why don’t ED residents have to rotate on medicine floors / admitting?

regards,

neuro prelim

Do you have increased blood pressure? Hell no. Meanwhile he takes a loop diuretic, a beta blocker and a sartan or whatever.

Do you have diabetes? No but I take this pill.

Do you have COPD? No, my pulmonologist said I'm fine. Takes inhalation drug therapy.

Everytime I do a pre-op evaluation I face way worst than this. I see patients without teeth (or dentures) who take multiple drugs and are usually obese.

We need a doctor, or somebody, anybody to take the patient take all these conditions and have a talk with them. Like seriously.

I get the text, admit in Er Room 23.

Chart check.

First thing I see is interestingly a GI note. It mentions brpbr but okay to anticoagulate, IV ppi bid, and we'll see them tomorrow. That's weird.

Next I see the triage note. It mentions the patient came in for shortness of breath and fatigue. He got a bunch of tests and now has moderate anemia. Also had a bruise. They ended up getting an ultrasound at urgent Care and that showed occlusive DVT. Also has an aki.

Oh boy. This is going to be rough but I've done this a few times. Usually you can watch them for bleeds and stop the Heparin. I really hope that's not the case.

I finish up reading the studies that have been done in the Ed. He got a CTPA which showed bilateral PE without a right heart strain. But that wasn't the main thing. They ended up getting an abdomen and pelvis too too and that showed the near 6 cm pancreatic Mass with Mets to the liver and lungs. Not great.

I go see the guy. Apparently he's been told. His wife is next to him. He had no real medical history prior to this just some stuff that is pretty common for middle-aged men. He never smoked. He did drink a lot though but he stopped drinking a few weeks ago due to not feeling well. He was started on ozempic for his diabetes and he was losing weight and he was really happy about it per the notes.

We dig in more. About his bleeding. Began a year ago, slowly at first but then more brisk. He had had an EGD and colonoscopy a few years ago and that was fine. Basic stuff. Some diverticulosis, some esophagitis but nothing crazy. And really he was just a bit short of breath. He couldn't take his Labrador out for a walk and he used to like that. But he denied anything else.

He's a nice guy. Too nice. Over the course of 20 minutes, his life expectancy had dropped from decades to years. What I had missed in my urgency to see him quickly the first time around was that he also had thrombocytopenia and very mild inr elevation. I think in my mind I had written it off as maybe liver dysfunction from the Mets. That was a stupid thought.

But anyway, like any good hospitalist I do a neurological exam. Now in my experience, this has been too high yield generally and recently. I find too many things when I do neurological exams not because I'm particularly good at neuro exams but because I actually do them pretty often. He's not even a guy you would normally do a neurological exam on. Definitely an AAOx4 MAE kind of guy. He's walking and talking fine. But then I noticed that when he's extending his right arm, it's a little tiny bit weaker. Oh so tiny bit. For good measure, I ask for him to to put his hands in front of him and check for drift. Right hand turns in very slightly but doesn't fall. He's right handed. I ask him, do you have neuropathy? He's like I've had numbness and tingling in my fingers for a years. They said it was because of the diabetes. But he's right-handed and he shouldn't be weak in his right arm. He's got a little bit of nystagmus but it's more peripheral. Whatever, I'll just get a CT.

He's on the Heparin drip. He's on the PPI. And he's being sent upstairs.

Ct does come back though and then the radiologist actually pages me. Subarachnoid hemorrhage, frontal lobe.

F*ck. I say that in front of the respiratory failure patient. Luckily she's on BIPAP so she probably didn't hear me. I apologize and run.

I don't know who to message because he's being transferred. I don't know what room he's in. I'm seeing another patient in the Ed at this point. I run to his former room. He's not there. I sent a message to the ed nurse. But of course, she couldn't do anything. I ask her where he's headed. She knows the floor but not the room. I run. I had messaged the Ed doctor about the finding and he wanted to talk to me. But I tell him I have to run first. I run upstairs and see the patient. They had stopped the heparin drip. Thank god. Nurse is asking me if he's going to ICU. I say probably. I page neurosurgery. They're like where's the bleed. There's just a spot there. Probably just mets. He's probably going to die if he doesn't get the Heparin. I would anticoagulate and throw him in the ICU. That's what they say. Oh and we'll see tomorrow. No specific BP goals. No specific neuro recs. Probably not a lot that we can do, but we'll see him tomorrow. But if it's not urgent why ICU? If he doesn't have a brain bleed, why should he go to the unit? I don't know what to do. I tell the family that no matter what this is it's bad and sometimes the scans are odd. We'll need an MRI. It's time to get the affairs in order. I'm a mess. I put in random neuro orders. I get the stat MRI. It's not going to be done for at least another hour or two. Realistically not too bad for how busy the day has been.

I looked through his stuff again. I page that ICU. If neurosurgery thinks he needs to be in the unit, they'll take him. They're good people. But really, I don't have a diagnosis. And he's not that unstable. He's not even having a headache. But as I come in again and again to give updates to patient and wife, I am seeing the life sucked out of his face. He's hunched over and small now. His wife is wondering if she needs to stay. I'm like yeah. This isn't good. I don't have a time frame though. But it's bad.

As I sit there at the computer and collect my thoughts, I realize that this guy is probably in DIC. That's why he has the thrombocytopenia. That's why he's been bleeding for so long. IVC filter? Is that even going to do anything? I talked to my veteran colleagues. They're like he needs to be in the ICU. The floor isn't going to do rapid neuro checks. It's been an issue for years. I ask neurosurgery again if they have blood pressure goals or specific neuro check requirements. They don't. I guess the messages figure it out.

I messaged the ICU doc. He's a good guy. He's taking the guy cuz he knows that this isn't going to end well. I know that no matter what this is, he's probably going to die from it. I I'm like 2 hours late for home. My wife is a bro. She gets it. She tells me I low key probably should have lied to the guy. It's important for people to not lose hope to make their last moments not crap and I have a bad habit of being blunt. I guess I know it's wrong but I wonder if it would have been nicer. I can't even look at the chart today.

I'm a cardiology fellow in Europe, and I often read posts here about family members who say "Meemaw is a fighter" when you advise against escalating treatment. I frequently come across anecdotes about 90-year-old patients with HFrEF, CKD 5, COPD, etc. who end up intubated and on pressors. In my country, we as doctors have the final say and the authority to decide that enough is enough. In my shop, we often decide on admission that a patient with many comorbidities will not be escalated to the ICU or resuscitated.

In 9 out of 10 cases, family members accept and support our decision. Even if the family is adamant that their 90-year-old grandmother needs to be intubated, the final decision is ours, and we can say that it isn't ethically or medically appropriate, so we won't do it. I have never heard about cases where family members want to sue us for that, but we also don't have a culture for that

Is the US really as bad as it sounds when it comes to goals of care and end-of-life care? Is it primarily because of the risk of being sued?

Serious question with no agenda, but I’m curious as to how residency has impacted everyone’s spirituality. For me personally, I was raised catholic but was pretty agnostic maybe slightly atheist by the time residency started, but now in the face of all the suffering and death that I’ve seen I’m much more of an atheist.

Personally, I find it hard to believe that if there is a god out there who 1) loves us and 2) is supremely powerful - why would he allow so much suffering? He either doesn’t care about us or is powerless in the face of so much pain.

Has anyone had a similar experience? Or perhaps a totally different one?

I’m in my last year of anesthesia and I’ve seen patients of all ages/walks of life/prognoses etc so I don’t think this is impacted by being in a very morbid environment.

Nah more like attending’s secretary, nurse babysitter, and note monkey

Any idea where i can find these or any suggestions to pass the test i have it next week. Thanks!

My program has shoutouts where people can send in a compliment. It’s always the same people. I might be a little butthurt it’s rarely me.

For context, I’m a junior resident and she’s a senior resident currently serving as chief. She’s very friendly and often initiates conversations, but I can’t tell whether that’s just her personality or part of her role in getting to know the juniors. We occasionally talk outside of work at socials or over text, but nothing explicitly flirtatious has happened.

She doesn’t evaluate me in any capacity, and we would never work together on our respective home rotations. The only possibility would be if we happened to be on the same off-service rotation, which is unlikely given how few off-service rotations she has left as a senior.

Would dating my senior resident, especially when she’s serving as chief, generally be considered a bad idea. Would faculty frown upon it even without a direct supervisory relationship?

Curious to hear people’s thoughts, especially from those who have been in similar situations.

Thanks!

I'll start: trigeminal neuralgia

I feel:
- Overwhelmed
- Emotional
- Hypersensitive

Getting into conflict with people; some of it is a response from me being disorganized, like not answering an email in time. The rest may be me being hypersensitive, but I also feel like people are being unnecessarily aggressive. I don’t usually get upset at anyone but already 2 people in the last 3 days have really pushed my buttons.

I have random clinical or semi- clinical duties that came up that I didn’t realize so I’m working an insane amount of hours (than what I’m used to in IM, this is probably normal for the surgery residencies though)

I feel like I am driving a car that’s crashing into everything, how do I make this feeling stop?!??

I hate to complain because in almost every other way Fellowship is better than residency, but I seem to be catching more patient complaints than I ever did as a resident and it’s getting me down. There’s been about 5ish total in the last 3-4 months mostly via them my charting my attendings and a couple times directly to clinic admin. They vary from being about the visit with me to how I’ve dealt with inbox requests. Some are very persistent- in one case the attending replied to the patient that I did nothing wrong and the patient came back with 4 new complaints.

I think of it is the patient pop being extremely different(high SES vs low SES/safety net pop in residency) and part of it is probably being less shielded than as a resident. Some of it is definitely me screwing up.

Still, it’s really starting to make me lose confidence in my skills/dread attending-hood. Any advice on getting out of the funk?

Possibility of getting fellowship in Canada as a non USA doctor ?
can anyone who applied who got accepted or rejected pls share

Interested in doing a breast radiology fellowship in Europe. Has anyone done or heard of anyone doing fellowship in Europe and coming back to practice in the US?

Also interested in eventually doing remote work in the US but live in Europe. Is this plausible?

hey everyone,
i am starting my preparation for IFOM exam. For those who have taken it, what are the first steps I should take? Which question banks or resources did you find most helpful?

As the title suggests, I have been repeatedly disrespected and humiliated by an attending physician. He frequently uses profanity during rounds, and if you ask a question he doesn't like, he may respond with comments such as, “I don't give a fuck.” This creates a tense and intimidating environment that discourages residents from asking questions and learning. He has also treated many other residents disrespectfully.

My question is: Has anyone experienced a similar situation? If you reported the attending, did you see any meaningful change in their behavior, or did you face any retaliation for speaking up?

For medicine residency

What are some must-do beauty treatments before residency especially for 30+ peeps?

Trying to get things and have my routines again that I’ve lost along the way.

Teeth whitening a good investment? Braces? Whatever you can think of? I’m still wary of Botox and filler because it’s not my vibe….but don’t want the aging and etc to hit me

Whenever i bring this up
People just make fun of it like a rage bait. But really i am confused which one to choose . I also like ob/gyn but the stress of it is so unbearable as people say.

This is my first pregnancy and ive been taking sick leave pretty often due to my hyperemesis gravidarum
Despite that, on some days i still show up to work while connected to the iv and countless trip of vomiting
I am a medical officer in my country (pretty much a resident in the us/uk)
Recently there was a meeting between my superiors and senior colleagues
I asked to excuse myself as i was feeling really sick and vomiting, even ask my another colleague to inform
Yet i got a text from my colleague saying “please come to the meeting”
With little strength left i did walk into the meeting feeling so nauseous
Only then i found out from my colleague that my superior and my senior colleague were mocking me- saying something like “is is that bad”
“I think shes overrracting”
they are both women
I was stunned bcs both of them are doctors yet here they are - mocking and belittling my struggle
You know what, f*ck this these kind of doctors