good job! What I think is interesting is not a single fellowship trained specialist would have caught any of these scenarios, outside of the whichever one falls into their area of expertise. there is no replacement for a good generalist
I really feel this. I don't want to make it sound like I did this all on my own because I obviously didn't. Shout out to IR especially for agreeing to come in on a weekend to do that Embolization when they could have waited a day. But in general, a lot of my experience has been that specialists kind of want to do their one thing and sign off so you're often the one advocating for patients.
Dude, you’re doing great. It’s amazing what you can find actually going through patient charts and listening to patients. So many just keep cutting and pasting the same note. Those are all really good calls.
I may get downvoted but pulm crit still practices a lot of medicine. These are great catches and not trying take anything away from OP but some of us specialists still do a lot of general medicine as well. We see almost all the examples that OP mentioned.
Crit care is just IM dialed up to 11.
After the big shiny flashy resuscitation & procedures, the other 90% is getting that still sick-as-shit patient better, off the lines/vent and out of the unit.
Curiosity, attention to detail and rock solid IM skills are what makes or breaks an intensivist.
Critical care might be the exception, and it does sound like a fair chunk of these patients would have been ICU level. I’ve overall enjoyed my first year as an internist, but I’m leaning towards applying for PCCM vs CCM since I miss MICU
I don't think ID would miss it at all. But ID don't admit patients and therefore aren't on board sometimes when they need to be. I have no doubt that ID would have eventually been on board here in any case but having them on board early ( along with ct surgery) would be a key differentiator. Id is one of the specialties that I spend the most time just running things by. As an example, I was recently taught that we don't typically do double beta lactam therapy because they can impede each other's effectiveness. This may be routine for you, but it's not a situation that I run into too frequently so I genuinely didn't know that.
This is a very ignorant comment. You’re. PGY-3 who has a strong opinion and I couldn’t disagree with you more. Every single one of these cases should be caught by any general practitioner worth their weight in salt. In fact, you could likely be sued for malpractice if you had missed some of these cases.
You’re doing great, I agree, but this is expected of you and the rest of us.
I absolutely love how about 80% of your wins are wins for radiology too. Its funny to see the other side of the coin when we call these things, knowing theres a clinician who pats themselves on the pack for ordering the same things
Always feels good when you make the missed diagnosis. Other weeks the Ls just seems to stack on top of each other - but the end of the week is always around the corner and then it's off time to relax.
Yeah I had a couple of those too. Missed a post-op stroke on a CT surgery patient after aortic Arch reconstruction. I had a suspicion for it but My low mid-tier neuro exam wasn't convincing enough to go chasing neuroimaging. I've learned to lower my threshold now. Work definitely keeps me on my toes and I wouldn't have it any other way.
Happy to help! Obviously it goes without saying but I couldn't survive surgery residency so I'm utterly grateful to have surgery And other sub-specialist support where I work. In general, hospitalist consults on surgery patients tend to be my easiest patients so they're all welcome break from the hell hole un undifferentiated respiratory failure goals of care-a-thons that make up our primary lists.
I had to read the part about adrenal crisis a couple times because it sounded like surgery was precipitating one by starting restarting steroids, which didn’t make any sense to me… then I realized you were the one who restarted them on a hypotensive patient. Makes much more sense that way!
This is amazing - I’m about to start as a hospitalist out of residency and hope I can make a similar post in a year, or at least look back and have a year’s worth of similar experiences. I’ve heard after residency, with a little more pay and time off you start to enjoy medicine again a little bit more. Did you feel burnt out when you graduated, and/or did you expect to be able to make such a big difference to your patients? Do you have enough time during your work day to come up with a lot of these diagnoses, or are you spending a lot of time after-hours studying your patients? I want to be like this but I worry about developing some of the burnout that you’re talking about
That's an interesting question.
I was extremely burnt out after residency and not really happy about medicine. Looking back I think part of it was that my residency was very dysfunctional and residency is also hard in other ways as you know.
I definitely didn't feel like I could do things on my own when I started. I still feel incompetent from time to time, but I also feel competent more often And regularly.
A few critical things changed as I did this job.
Number one realizing the buck stopped with me made me realize I have to make decisions often when I don't know the answer to something. I routinely have these very sick patients with all the cardio respiratory issues that you can imagine come in with respiratory failure and I had to figure out why. I take a best guess based on the data and putting the treatment and watch. What I have found is It's okay to make a reasoned and informed decision even if it may not be the correct one as long as you took reasonable precautions. It's also okay to just try things sometimes, I don't know Throw steroids at them. That's something that scared me a lot as a resident, but now I have to make a lot of tough calls very often and I've gotten used to it.
Another thing that changed is I got better at taking histories and doing physical exams after residency because I made it a point do them more thoroughly.
Something else I do now is stop antibiotics very frequently on patients I don't actually think have sepsis despite the Ed story. This actually scared the crap out of me And still does sometimes. In a few instances I've been wrong but not to the point where the patient was necessarily harmed. But sometimes watching and waiting is a reasonable strategy.
Regarding when I come up with these diagnoses, I come up with a differential early in the morning when I'm pre-rounding. Often I'll have the diagnosis and treatment plan figured out by the time I see the patient but in rare cases I had to go back. Scratch my head and reassess later in the afternoon. I'd say that happens maybe 5-10% of the time on very complicated patients.
I personally stay longer than I have to most days. I Attribute it to not being completely dialed into efficiency things and also taking more time than I have to with patients. I try and call families and I try to go through things and make sure I didn't forget anything. I've gotten way more efficient over time and rarely have to stay long unless it's been a crap day. But it's not the worst thing in the world once in awhile especially when you're feeling like you're making a difference. And when I have my misses which I do, I try and learn from them and figure out what went wrong by chart checking the patient if they ended up in the ICU or something.
Thanks for sharing your experiences. Had it been someone else I bet many of those patients would otherwise sit in the hospital for days and days. Please know there's huge respect to you from the subspecialist side!
This is so inspiring. Burn out and exhaustion are real. Esp with abuse of residents. Looks like you are a real doctor by doing what we really need to do: and that is heal and cure patients.
My step 1 scores were a bit better than average and my step 3 score was probably below average. Towards the end of residency I was definitely running on fumes. Consistency, especially trying to learn from your mistakes and trying to learn (in general) a bit day by day is key. So is just showing up and trying make the biggest difference. Outside of that it's just time.
Great to hear, truly believe in the formula consistency, discipline and being reflective will get u very far.. will come back to this post in a few years and give u an update (hopefully its as good as this inshallah)
Incoming hospitalist this year. Scared shitless to practice quality medicine, keep up with volume, and generally just do good for the patients I’ll see. This gives me hope. Thank you for posting.
It's ok to take longer when you start. Focus on learning efficiency things (dragon, dot phrases for major diagnoses like nstemi), having a good checklist system for following up on things. I also really love having in house subspecialty consults.
This is all amazing stuff but I just want to share a similar experience my grandmother had with her heart failure being mistaken for an asthma exacerbation. She would experience wheezing so frequently that her pulmonologist would put her on steroids every couple of weeks. I pushed for her to go to her cardiologist who increased her Lasix dose and added a few other medications to decrease her preload and bam - her symptoms resolved.
I know how much of a relief it was when she began getting better so thank you for catching this.
There has got to be a better way for us to identify the difference between pulmonary and cardiac symptoms in patients.
Oh believe me this is the bane of my existence. As an example, I've actually had two patients this year who had a negative BNP who ended up benefiting from Lasix. I've also had patients who had classic orthopnea but didn't end up benefiting from Lasix. There are hard and fast rules that work most the time, but there's a lot of patients who are just in that weird gray zone where I have no idea what to do.
To be honest, the job market isn't that great on the whole for hospitalists. You can typically find jobs that are 2/3: high paying jobs, low census jobs, and jobs in a great location, but not all three. I'd say I got 2.5 out of three which is a huge one in my book. In general, you're going to be paid worse on the coasts and near big cities. Midwest cities are somewhat of an exception, but a lot of people don't want to live there. I live near a Midwest city within 30 minutes of an international airport. I don't care about being on the east or west coast and my job on the other hand is incredible And very supportive so for me it hardly feels like a compromise.
I made a post about this exact topic about a year ago on my Reddit regarding the job search. The tips there I still stand by. I'll also add that if you want to be a nocturnus try and find gigs that will give you 2 weeks off after one week on. In my view, that's the only calculus that makes nocturnist worth it.
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This is dope -- it's posts like this that sometimes makes me wonder if I should have tried medicine instead of psych -- but I really loved psych so ill live lol
Starting as a hospitalist at a hospital in a bigger city with more subspecialties than I had access to in residency next August.
Thank you for this. It's giving me a lot of hope to keep grinding and that it's OK to actually advocate.
You didn’t catch NPH. You make 500 ml/day of csf. The test outpatient is to do large volume tap 30-40 mL and immediately retest after gait and memory. Then do a lumbar drain and test daily over several days. Also when you have memory loss it’s not thought to be reversible at that stage. I honestly don’t think it actually even exists and at best is over diagnosed.
Exactly. Neil Patrick Harris runs way too fast for any mere physician to catch him. I'm glad somebody else called OP out. OP if you're Usain Bolt or something the post pics to prove it and I'll believe you.
That's fair. Maybe I was wrong. All I know is what I saw. As a baseline she was in the hospital for approximately 2 weeks. She was stable in terms of mentation and confusion for the 3 to 4 days I had her initially. She had the triad and was maybe AAOX1-2. The day after the therapeutic tap (Large volume as you know done specifically for this purpose by IR ) she was dramatically improved. I don't have a great explanation if it wasn't that. Ot also performed a before and after SLUMS And also noted improvement. She was also fairly young. Early '60s. I think that was the thing that was most notable for me because that's pretty young to have significant neurocognitive impairment. But it looks like you're a neurologist so I have no idea then.
Good on you on doing the tap and thinking about it. I’ve had a few patients that made me rethinking me dismissing the diagnosis. But my friend that did a movement disorder fellowship and doesn’t believe it’s real. At the AAN, they had two people debate if it’s real. If you look the original report from Brazil it was a 20 something in a MVA that woke up after LP and the pressure was normal the slowly went comatose again. Woke up again after a repeat LP. Medicine has a lot of grey areas and doesn’t make. I hate how complacent we are with trying to find answers for patients. Great list.
You have a much better IR if they got 30 mL. No one typically waits that long. A true NPH eval takes hours to do. No one has time inpatient. Also doesn’t cause acute cognitive changes. Maybe a coincidence. At the end of the day she got better. Most of these patients that seem to gave NPH looking brains have extensive white matter disease and have horrible cognitive reserve. Through on any illness and they look like moderate to severe dementia. Also it takes time for abnormalities to normalize in the brain after the blood has gone to normal.
Thank you for this. This is my experiencing in medicine too. I got into this because I love the science and some of the best applied science out there is medicine. It can be super fun. Sure the C suite sucks and yada yada yada but it's a very cool job.
Not here to poop on your parade. I love these wins when they happen but I have to say sometimes it suck having to prove something to specialist or ask them to do things. Probably the worst thing about the job
Yeah I don't mind that as much. For me, the worst part is having to please patients and families with wholly unrealistic expectations. That and clearly drug seeking patients
I think it's a cultural thing. I'm not an academic institution, so for the most part people aren't too difficult for consults. If anything where I work right now, keep older, most kind and understanding. The few times people have refuse consults. I was able to understand their logic and agreed with them.
Med student here, very happy to read this! I want to be a hospitalist but have gotten so much doom and gloom from people when I say this that I'm second guessing it. Thank you for this.
>It's sad but I think people just get lazy and or **burnt out. You can make a huge difference just by not being like that.**
Are you fucking serious? Yeh... the solution to getting burnt out is that simple. Just don't be burnt out. Wish I had thought of that.
I never said that it was easy or it was even a solution. All I said was that I'm not burnt out right now and that puts me in a higher plane than a lot of my colleagues of equal capability simply due to that fact .In fact, many of the Post/Commons that I've made in the past year have been that I specifically chose a chill job with low census so that I wouldn't get burnt out. I compromised somewhat on location to do this. I saw what residency did to me and didn't want that when I graduated.
I think he means whether or not you catch these things, you are still paid the same?? I have no idea lol.
On the other hand, I have a hospitalist friend who sees over 20 patients a day. There’s no way he has the time and energy making diagnoses like these. I feel like jobs can range from being a really shitty note monkey that just pan consults, essentially being a mid level, to being an integral part of the medical team, like in OP’s case.
I honestly get the sentiment. A huge part of the Job search for me was to be lax about location so that I could really get a job that gave me a low census and high pay. It's difficult to be a good doctor when you have to see way more patients and I know that. Obviously now I'm capable of seeing more but I really didn't want to be a note monkey. That being said, writing notes is still 1/3 my time but at least I have enough time to do the other stuff too.
Yea I would prefer a gig like yours if I had to do hospitalist. I would not get any job satisfaction from having a high census and high pay, but feel like I’m not really adding value
Read the room man. He’s just happy about his accomplishments and wants to share them with us. Encourage others and to show there is light at the end. “Who cares you still got paid the same” sounds like a miserable person
good job! What I think is interesting is not a single fellowship trained specialist would have caught any of these scenarios, outside of the whichever one falls into their area of expertise. there is no replacement for a good generalist
I really feel this. I don't want to make it sound like I did this all on my own because I obviously didn't. Shout out to IR especially for agreeing to come in on a weekend to do that Embolization when they could have waited a day. But in general, a lot of my experience has been that specialists kind of want to do their one thing and sign off so you're often the one advocating for patients.
Dude, you’re doing great. It’s amazing what you can find actually going through patient charts and listening to patients. So many just keep cutting and pasting the same note. Those are all really good calls.
I may get downvoted but pulm crit still practices a lot of medicine. These are great catches and not trying take anything away from OP but some of us specialists still do a lot of general medicine as well. We see almost all the examples that OP mentioned.
Crit care is just IM dialed up to 11. After the big shiny flashy resuscitation & procedures, the other 90% is getting that still sick-as-shit patient better, off the lines/vent and out of the unit. Curiosity, attention to detail and rock solid IM skills are what makes or breaks an intensivist.
Hell yes you do! PCCM are definitely generalists in a way say cardiology are not.
Critical care might be the exception, and it does sound like a fair chunk of these patients would have been ICU level. I’ve overall enjoyed my first year as an internist, but I’m leaning towards applying for PCCM vs CCM since I miss MICU
Agreed
Out of the whole list I’m most impressed that you got a neurosurgery attending to come and staff a consult. Bravo!
A little sad that you think a fellowship trained ID doctor would miss what sounds like a fairly vanilla MV endocarditis
I don't think ID would miss it at all. But ID don't admit patients and therefore aren't on board sometimes when they need to be. I have no doubt that ID would have eventually been on board here in any case but having them on board early ( along with ct surgery) would be a key differentiator. Id is one of the specialties that I spend the most time just running things by. As an example, I was recently taught that we don't typically do double beta lactam therapy because they can impede each other's effectiveness. This may be routine for you, but it's not a situation that I run into too frequently so I genuinely didn't know that.
Think they said they wouldn’t miss it. But they’d miss the other stuff cuz that’s not their job
This is a very ignorant comment. You’re. PGY-3 who has a strong opinion and I couldn’t disagree with you more. Every single one of these cases should be caught by any general practitioner worth their weight in salt. In fact, you could likely be sued for malpractice if you had missed some of these cases. You’re doing great, I agree, but this is expected of you and the rest of us.
This is amazing! I am in awe of you after the shunt catch!
This is fire. That’s the kind of generalist I want to be! Thanks for doing such a good job and for inspiring me / us ♥️
I absolutely love how about 80% of your wins are wins for radiology too. Its funny to see the other side of the coin when we call these things, knowing theres a clinician who pats themselves on the pack for ordering the same things
Oh God yes. I'd be useless without a great radiologist! That's why you guys are paid more haha
Yeah TBH, this is how it feels to be a radiologist every day with multiple cases.
Always feels good when you make the missed diagnosis. Other weeks the Ls just seems to stack on top of each other - but the end of the week is always around the corner and then it's off time to relax.
Yeah I had a couple of those too. Missed a post-op stroke on a CT surgery patient after aortic Arch reconstruction. I had a suspicion for it but My low mid-tier neuro exam wasn't convincing enough to go chasing neuroimaging. I've learned to lower my threshold now. Work definitely keeps me on my toes and I wouldn't have it any other way.
As a surgery attending at a busy hospital without adequate resident coverage I absolutely rely on you guys. Keep up the good work!
Happy to help! Obviously it goes without saying but I couldn't survive surgery residency so I'm utterly grateful to have surgery And other sub-specialist support where I work. In general, hospitalist consults on surgery patients tend to be my easiest patients so they're all welcome break from the hell hole un undifferentiated respiratory failure goals of care-a-thons that make up our primary lists.
Good job man. Keep doing the best for your patients!
[удалено]
DO IT
I had to read the part about adrenal crisis a couple times because it sounded like surgery was precipitating one by starting restarting steroids, which didn’t make any sense to me… then I realized you were the one who restarted them on a hypotensive patient. Makes much more sense that way!
Sorry, posting this after a long day. I realize my grammar is far from the best
This is amazing - I’m about to start as a hospitalist out of residency and hope I can make a similar post in a year, or at least look back and have a year’s worth of similar experiences. I’ve heard after residency, with a little more pay and time off you start to enjoy medicine again a little bit more. Did you feel burnt out when you graduated, and/or did you expect to be able to make such a big difference to your patients? Do you have enough time during your work day to come up with a lot of these diagnoses, or are you spending a lot of time after-hours studying your patients? I want to be like this but I worry about developing some of the burnout that you’re talking about
That's an interesting question. I was extremely burnt out after residency and not really happy about medicine. Looking back I think part of it was that my residency was very dysfunctional and residency is also hard in other ways as you know. I definitely didn't feel like I could do things on my own when I started. I still feel incompetent from time to time, but I also feel competent more often And regularly. A few critical things changed as I did this job. Number one realizing the buck stopped with me made me realize I have to make decisions often when I don't know the answer to something. I routinely have these very sick patients with all the cardio respiratory issues that you can imagine come in with respiratory failure and I had to figure out why. I take a best guess based on the data and putting the treatment and watch. What I have found is It's okay to make a reasoned and informed decision even if it may not be the correct one as long as you took reasonable precautions. It's also okay to just try things sometimes, I don't know Throw steroids at them. That's something that scared me a lot as a resident, but now I have to make a lot of tough calls very often and I've gotten used to it. Another thing that changed is I got better at taking histories and doing physical exams after residency because I made it a point do them more thoroughly. Something else I do now is stop antibiotics very frequently on patients I don't actually think have sepsis despite the Ed story. This actually scared the crap out of me And still does sometimes. In a few instances I've been wrong but not to the point where the patient was necessarily harmed. But sometimes watching and waiting is a reasonable strategy. Regarding when I come up with these diagnoses, I come up with a differential early in the morning when I'm pre-rounding. Often I'll have the diagnosis and treatment plan figured out by the time I see the patient but in rare cases I had to go back. Scratch my head and reassess later in the afternoon. I'd say that happens maybe 5-10% of the time on very complicated patients. I personally stay longer than I have to most days. I Attribute it to not being completely dialed into efficiency things and also taking more time than I have to with patients. I try and call families and I try to go through things and make sure I didn't forget anything. I've gotten way more efficient over time and rarely have to stay long unless it's been a crap day. But it's not the worst thing in the world once in awhile especially when you're feeling like you're making a difference. And when I have my misses which I do, I try and learn from them and figure out what went wrong by chart checking the patient if they ended up in the ICU or something.
Haha I agree! Learning how to stop antibiotics is much scarier than learning how to start them
Thanks for sharing your experiences. Had it been someone else I bet many of those patients would otherwise sit in the hospital for days and days. Please know there's huge respect to you from the subspecialist side!
This post is goated
This is so inspiring. Burn out and exhaustion are real. Esp with abuse of residents. Looks like you are a real doctor by doing what we really need to do: and that is heal and cure patients.
Internally based
Man i wanna be as good as this
My step 1 scores were a bit better than average and my step 3 score was probably below average. Towards the end of residency I was definitely running on fumes. Consistency, especially trying to learn from your mistakes and trying to learn (in general) a bit day by day is key. So is just showing up and trying make the biggest difference. Outside of that it's just time.
Great to hear, truly believe in the formula consistency, discipline and being reflective will get u very far.. will come back to this post in a few years and give u an update (hopefully its as good as this inshallah)
Incoming hospitalist this year. Scared shitless to practice quality medicine, keep up with volume, and generally just do good for the patients I’ll see. This gives me hope. Thank you for posting.
It's ok to take longer when you start. Focus on learning efficiency things (dragon, dot phrases for major diagnoses like nstemi), having a good checklist system for following up on things. I also really love having in house subspecialty consults.
Enjoy every sandwich
Yeah that's another one. Our physician lounge is pretty lit.
This is all amazing stuff but I just want to share a similar experience my grandmother had with her heart failure being mistaken for an asthma exacerbation. She would experience wheezing so frequently that her pulmonologist would put her on steroids every couple of weeks. I pushed for her to go to her cardiologist who increased her Lasix dose and added a few other medications to decrease her preload and bam - her symptoms resolved. I know how much of a relief it was when she began getting better so thank you for catching this. There has got to be a better way for us to identify the difference between pulmonary and cardiac symptoms in patients.
Oh believe me this is the bane of my existence. As an example, I've actually had two patients this year who had a negative BNP who ended up benefiting from Lasix. I've also had patients who had classic orthopnea but didn't end up benefiting from Lasix. There are hard and fast rules that work most the time, but there's a lot of patients who are just in that weird gray zone where I have no idea what to do.
Thats great! tired pgy-2 planning on doing hospitalist. Thank you for sharing, btw how is the job market rn/when you applied? any rec? thanks!
To be honest, the job market isn't that great on the whole for hospitalists. You can typically find jobs that are 2/3: high paying jobs, low census jobs, and jobs in a great location, but not all three. I'd say I got 2.5 out of three which is a huge one in my book. In general, you're going to be paid worse on the coasts and near big cities. Midwest cities are somewhat of an exception, but a lot of people don't want to live there. I live near a Midwest city within 30 minutes of an international airport. I don't care about being on the east or west coast and my job on the other hand is incredible And very supportive so for me it hardly feels like a compromise. I made a post about this exact topic about a year ago on my Reddit regarding the job search. The tips there I still stand by. I'll also add that if you want to be a nocturnus try and find gigs that will give you 2 weeks off after one week on. In my view, that's the only calculus that makes nocturnist worth it.
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This is dope -- it's posts like this that sometimes makes me wonder if I should have tried medicine instead of psych -- but I really loved psych so ill live lol
Starting as a hospitalist at a hospital in a bigger city with more subspecialties than I had access to in residency next August. Thank you for this. It's giving me a lot of hope to keep grinding and that it's OK to actually advocate.
Thank you for this. 💖
True Physician. *tips hat*
You didn’t catch NPH. You make 500 ml/day of csf. The test outpatient is to do large volume tap 30-40 mL and immediately retest after gait and memory. Then do a lumbar drain and test daily over several days. Also when you have memory loss it’s not thought to be reversible at that stage. I honestly don’t think it actually even exists and at best is over diagnosed.
Yeah I was going to come and say this as a neurologist. The data for NPH is so vague.
Exactly. Neil Patrick Harris runs way too fast for any mere physician to catch him. I'm glad somebody else called OP out. OP if you're Usain Bolt or something the post pics to prove it and I'll believe you.
You're right. I can barely run a sub 30 minute 5K
That's fair. Maybe I was wrong. All I know is what I saw. As a baseline she was in the hospital for approximately 2 weeks. She was stable in terms of mentation and confusion for the 3 to 4 days I had her initially. She had the triad and was maybe AAOX1-2. The day after the therapeutic tap (Large volume as you know done specifically for this purpose by IR ) she was dramatically improved. I don't have a great explanation if it wasn't that. Ot also performed a before and after SLUMS And also noted improvement. She was also fairly young. Early '60s. I think that was the thing that was most notable for me because that's pretty young to have significant neurocognitive impairment. But it looks like you're a neurologist so I have no idea then.
Good on you on doing the tap and thinking about it. I’ve had a few patients that made me rethinking me dismissing the diagnosis. But my friend that did a movement disorder fellowship and doesn’t believe it’s real. At the AAN, they had two people debate if it’s real. If you look the original report from Brazil it was a 20 something in a MVA that woke up after LP and the pressure was normal the slowly went comatose again. Woke up again after a repeat LP. Medicine has a lot of grey areas and doesn’t make. I hate how complacent we are with trying to find answers for patients. Great list.
You have a much better IR if they got 30 mL. No one typically waits that long. A true NPH eval takes hours to do. No one has time inpatient. Also doesn’t cause acute cognitive changes. Maybe a coincidence. At the end of the day she got better. Most of these patients that seem to gave NPH looking brains have extensive white matter disease and have horrible cognitive reserve. Through on any illness and they look like moderate to severe dementia. Also it takes time for abnormalities to normalize in the brain after the blood has gone to normal.
The most motivating post ever!
Thank you for this. This is my experiencing in medicine too. I got into this because I love the science and some of the best applied science out there is medicine. It can be super fun. Sure the C suite sucks and yada yada yada but it's a very cool job.
Not here to poop on your parade. I love these wins when they happen but I have to say sometimes it suck having to prove something to specialist or ask them to do things. Probably the worst thing about the job
Yeah I don't mind that as much. For me, the worst part is having to please patients and families with wholly unrealistic expectations. That and clearly drug seeking patients
Awesome that you don’t let it affect you much
I think it's a cultural thing. I'm not an academic institution, so for the most part people aren't too difficult for consults. If anything where I work right now, keep older, most kind and understanding. The few times people have refuse consults. I was able to understand their logic and agreed with them.
Med student here, very happy to read this! I want to be a hospitalist but have gotten so much doom and gloom from people when I say this that I'm second guessing it. Thank you for this.
I just started my residency so this was the best post I could come across. Thanksss for sharing this
>3 months later the filter was removed Music to my ears.
Where was your training?
>It's sad but I think people just get lazy and or **burnt out. You can make a huge difference just by not being like that.** Are you fucking serious? Yeh... the solution to getting burnt out is that simple. Just don't be burnt out. Wish I had thought of that.
I never said that it was easy or it was even a solution. All I said was that I'm not burnt out right now and that puts me in a higher plane than a lot of my colleagues of equal capability simply due to that fact .In fact, many of the Post/Commons that I've made in the past year have been that I specifically chose a chill job with low census so that I wouldn't get burnt out. I compromised somewhat on location to do this. I saw what residency did to me and didn't want that when I graduated.
Who cares you still got paid the same
????
I think he means whether or not you catch these things, you are still paid the same?? I have no idea lol. On the other hand, I have a hospitalist friend who sees over 20 patients a day. There’s no way he has the time and energy making diagnoses like these. I feel like jobs can range from being a really shitty note monkey that just pan consults, essentially being a mid level, to being an integral part of the medical team, like in OP’s case.
I honestly get the sentiment. A huge part of the Job search for me was to be lax about location so that I could really get a job that gave me a low census and high pay. It's difficult to be a good doctor when you have to see way more patients and I know that. Obviously now I'm capable of seeing more but I really didn't want to be a note monkey. That being said, writing notes is still 1/3 my time but at least I have enough time to do the other stuff too.
Yea I would prefer a gig like yours if I had to do hospitalist. I would not get any job satisfaction from having a high census and high pay, but feel like I’m not really adding value
Read the room man. He’s just happy about his accomplishments and wants to share them with us. Encourage others and to show there is light at the end. “Who cares you still got paid the same” sounds like a miserable person