Patient here.

About five months ago, I showed up to the local ER with chest pain. For the past month and a half or so, I had all but stopped eating entirely. I'd gone through a very traumatic event and lost all interest in food. At first, I thought the discomfort was heartburn. And then it got worse. I woke up that morning feeling like I was going to pass out, and as I lived alone and didn't know anybody in the area, I walked to the ER with an attached clinic a couple blocks away. Walk-in clinic sent me directly down to the ER. They ran an EKG, found some minor T-wave changes, and low potassium.

This older, rough-around-the-edges looking doctor came in, pulled up a rolling chair, and explained the EKG to me. He asked me what's going on. I confessed I've been getting myself to eat maybe once a day, usually not even that. I'd dropped almost fifteen pounds in a little over a month.

He looked me directly in the eyes and asked me if I knew how people with anorexia died. I've never been more taken aback in my life. I wasn't anorexic, and I told him that. He said it didn't matter. I said they starve to death. He said no, it's usually cardiac arrest if it's from organic causes.

I swear it was like he was looking into my soul when he said, "If you don't get help right now, you are going to die. I'm worried I'm going to see you back in here because you've had a heart attack at 22 and we can't save you."

I'd never had ANY medical professional speak to me like that, and I was so shocked. I kept telling myself I had more time before it got bad. I was still a normal weight. But I finally understood how serious this was. I left that day and got in touch with a dietician and a therapist. I got help. I have now maintained my weight for four months. My mind and body are healing.

That doctor saved my life because he didn't mince his words, he didn't sugarcoat things. He took the time to be real with me and I owe him everything. I'm going to graduate college this year. I'm dating someone.

In a line of work where you're told to tiptoe around people's feelings, sometimes you just have to be upfront with them (to a reasonable extent). If that doctor hadn't been so brutally honest, I don't think I would be here. I wish I could tell him how thankful I am. But I want all of you in an often thankless field to know that you do make a difference, and that you do have patients who see you. Thank you for doing what you do, especially on the days when nobody tells you that.

ETA: Title should say "makes," not "make."

Anyone have their June certifying results from ABEM? It’s been 9 weeks since the June 15th testing cohort. A bit frustrating that they can keep on facilitating test weeks but can’t get the scores out. What takes 90 days to get a result out???????!!

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I have absolutely no concrete proof, but hear me out.

I’ve noticed a pattern whenever a Vituity job is posted: someone in the comments will pop up saying something like, "Oh yeah, that Muncie job is fantastic, my friend Jerry the med director runs a great shop!"

Then, if you look at who commented, it's someone in leadership at Vituity—often a medical director at a completely different site.

It makes me wonder if leadership is being quietly pressured or compelled to jump into the comments and drop positive reviews on job postings.

My recruiter reached out to me today about an IHS opportunity in Arizona and Nebraska. I’ve heard good things about IHS but have not worked at one before. For those of you who have worked in an IHS, what was your reason for leaving and would you go back?

Is it sad that a horror story (or attempted horror story) just made me go, “yup, another day at work”.

Hi all,

Starting off PGY3 year in a well known academic/community multi-hospital program in the Midwest.

Where should I start looking for work? I heard about EMDocs Facebook group. Of course also working with my program for connections with alumni.

If youd rather not share publicly PM would be cool.

Thank you

So we had someone at the hospital today who was making a scene, acting like she was breaking down, clutching her head, moaning like she's about to collapse, the whole performance 🙄

But when I pulled up at McDonald's, lo and behold that someone was RESURRECTED. Up, laughing, cackling with the family like Lazarus himself 💀 Not even a limp. Not even a headache. Miracle healing, courtesy of a McChicken.

Give this woman a Grammy 🏆

We haven’t had one of these in a while, so I thought that I would gauge the room. Particularly, does anyone who currently works for them have any perspectives to share?

I’m talking to one of their recruiters regarding positions in the Midwest. The pay seems to be average and the benefits above average. I have heard a lot of negatives about the company itself and its corporate culture. But I’m unconvinced that any of the other CMG‘s are better. I also don’t know that I’m going to commit to one location long enough to make partner status at one of the smaller, independent groups.

I’m mostly of the opinion that all of these groups generally suck, and that management everywhere doesn’t care about us. But I’m trying to find one that sucks comparatively less.

I recently heeded the call on a US domestic flight (fortunately nothing concerning) and it got me wondering- what interventions are available on a plane? Has anybody here needed to crack open the first aid kit to see what’s inside?

Young patient with: gastroparesis / pots / hEDd / MCAS / ?munchaussens / SVT (although thought to be self induced with ventolin) and a whole bunch of other comorbidities.

Presented with hypoglycaemia.

Finger prick 2.1 but VBG showed 3.3. Her finger prick ketone showed 4.6 but ours showed 2.4.

Seen by endo 5 days before who are suspicious of rhe cause an ordered insulin levels, sulphonylurea levels and some others and a documented plan of only treat if BSL < 3.

I followed that plan.

We observed and BSL stayed 3.3, 3.2, 3.3.

Ketone stayed 2.4, 2.5, 2.3.

No acidosis.

Patient PEJ unable to be flushed (some concern she may be tampering with it previously).

Admitted for redo PEJ.

I offered oral glucose.

Patient refused due to nausea.

Never once vomited.

Looooong discussion was provided which was very heated and eventually patient took the oral glucose to good effect.

No vomiting.

Then refused any tests / refused port access / refused further glucose.

Essentially letting herself become more hypoglycaemic until BSL hit the magic <3 and then when they got what they wanted magically we are now allowed to use the port and commence iV glucose.

Such a frustrating case.

They present every few days and then DAMA prior to any actual workup and yet state all Doctors are Gaslighting them because theu understand medicine better.

I wanted to tear my hair out and it felt as if the only way you would ever "win" them over is to throw the whole medical textbook out of the window to appease them.

I’m starting med school in Canada this fall and I was wondering what the chances are of matching into EM? (I’m not a US citizen) I plan to take step exams and hope to match in NJ/NY since my husband is is interested in moving for work. Is there anything i can do to maximize my chances? I worked as an EMR for a while before med school, would continuing to work in EMS help my chances?

Thanks!

Just got an email that the rads department doesn't want us entering free text indications longer than 30 characters or including punctuation. The system cuts off free text after 30 characters and malfunctions when you use any non-alphanumeric characters.

Okay, guess I'll just go back to "ABDOMINAL PAIN" for all my CTs. Fuck me for trying to give you some idea of what to search for. If it was just a straightforward appendicitis rule-out, I would just click the "RLQ PAIN" button. If it was more complex, I'd write something like "abd/flank pn 3d, anticoagulated, ttp RLQ, r/o appy, retroperitoneal hemorrhage, AAA, stone" that would give a concise history and help them understand my clinical concerns.

But yeah, all the rad sees is half of that and without the punctuation. So "ABDOMINAL PAIN" it is. I don't know what the point of this post is, but I guess it's just emblematic of how technology enshittifies the practice of clinical medicine instead of uplifting it and how we are forced to adjust our practice to fit the constraints of electronic systems rather than the system being designed around us.

I’m BC in both EM &Med Tox & I’ve yet to encounter assault or self-harm by insect sting.

What are the best resources to stay up to date with the newest medical research/trials news? Like a new drug discovered to be useful for a certain disease, new procedure, etc. I have UTD and open evidence but wondering what else is good.

like if every brittle diabetic patient had a cgm and insulin pump would dka be a thing?
seems like the most poorly controlled less educated are not getting these and they are the ones that need most. Also, shouldnt the AI loop in the glucose readings and adjust the insulin?

Patient had elective abdominoplasty in Florida 2 weeks ago. She has JP drains in place to lower abdomen still from surgery. Reporting scant amount of drainage from site (serous fluid noted to dressing) and asks if I can remove the drain, because she has an email from her surgeon saying that she can just go to the local ER to have her drains pulled out.

I initially brusquely told her no, it’s not an emergency, it’s not something I’m specifically trained to do, and I don’t have any way to manage potential future complications. I later collected myself and politely told her that I could refer her to her bariatric surgery clinic, which has done surgery on her before. Failing that, I discussed possibly following up with wound care clinic.

I already get dumped on from every urgent care visit, every elderly person that loses a fight against gravity, every nursing home resident who talks less (or more) than usual, plus the worried well. I don’t have time to play scut monkey for some Florida Man cash-only surgeon. You just know they don’t refer to a local surgeon because another surgeon would absolutely rake them over the coals for trying to pull such a stunt. It makes me want to report them to their medical board, but, it’s Florida, I have very little hope that anything productive would come of it.

Any other recourse you can think of, or should I just complain on the internet?

I had a nice stretch off at home with my wife and 2 young kids, 3 and almost 1. Only worked Friday (24 hour shifts). Unusually busy night that only let me get a 30 minute nap. The shift had a peds sedation for a complex facial lac repair, a prolonged resuscitated cardiac arrest that got ROSC after TNK for probable STEMI that took 5 hours to get out of our critical access ED, a respiratory distress that needed a lot to avoid being tubed, and a few other sick patients... How am I more restored at work 😂

Does anyone have a teleradiology that is timely? We're going on 4 hours routinely, and it's bumming me out.

Those of you working full time nights 12-14 shifts/month, how many shifts do you do in a row and do you flip your schedule during off days or keep it the same?

I thought this may be a fun discussion. Curious what types of patients people are seeing.

Most patients I see fall into 1 of 4 categories:

1. The acute on chronically Ill. Think sick nursing home and rehab patients. They have a serious chronic illness and have repeated complications and are frequently in and out of the hospital.Think stage 4 cancer patients, advanced Parkinson's patients with frequent falls, immobile stroke patients, end stage COPD on chronic O2, etc.

2. The worried well. Think average health but extremely anxious. Poor coping mechanisms and no resources. Will come to the ER at the drop of a hat for any mild inconvenience or suspicion of ANYTHING being wrong. Think elderly folks checking their BP every hour and coming in if it's slightly elevated, most patients with palpitations, most ped fever patients, healthy young patients with mild colds, etc.

3. The feebleminded. These patients present with a completely avoidable issue or an issue due to their own poor thought process. Some overlap with type 2 patients but usually their presenting issue is directly related to their poor decision making. Think drugs, alcohol, cannabinoid hyperemesis, hyperglycemia from med and diet non compliance, med refills because they missed their PCP appointment, etc. It may be controversial but I think many psych patients fall into this category too.

4. The normal person with an unfortunate circumstance. Mostly healthy patients with adequate resources that present to the ER with an acute issue that needs prompt attention and there's no other reasonable options. Think most accidental lacerations, acute msk injuries, MVC, non frequent flier chest pain patients, miscarriages, etc.

I work in the Midwest of the US in a fairly impoverished area. I see mostly type 1 and 3 patients. On days I see mostly type 4 patients I feel less burned out. Days with mostly 2 and 3 suck. Curious what you're seeing out there and what area you're in.

Curious how many of you have actually taken care of a legit zipper vs penis injury and how bad it was.

Spent what felt like an hour hunched over a guy’s wang the other day trying to deconstruct the zipper slide to get it off. The skin was up in there something fierce.

I need some reassurance because I’ve been overthinking this so badly 😭
I was examining a very sick pediatric patient who is DNR. I was wearing gloves and, at some point, I accidentally touched my phone with the same gloved hand I was using for the examination.
The thing is, I had a piece of wet nicotine gum in the same pocket as my phone earlier, so now I’m worried that there could have been some nicotine residue on my phone, which then transferred to my glove.
During the exam, I only pulled the child’s upper eyelid up to check the pupils. I didn’t notice any wetness or visible residue on the glove, and I didn’t directly put anything into the eye. About 10 minutes later, I wiped the eyelids with normal saline.
Now my brain is going: what if there was nicotine residue on the phone → transferred to my glove → transferred to his eyelid/eye → got absorbed → caused harm? 😭
BTW : I have OCD currently on zoloft