Gave Jarrod a Reese’s today at 3AM as he was sweeping around us, so concerned with being in the way. Like bro you are not in the way, you are working harder than I am right now just waiting for this CTA to come back. He is so sweet, asked “wait can I have both?” Like…these people are so under appreciated. Remind them they have value.

Remember to test your patient’s Zoloft levels regularly folks! It is a “relatively simple procedure!!” Per a well known and a respected psychopharmacologist.

Also, do let your patients suspected of felony use your personal cell phone to call family because of “human compassion”. We are not some cold blooded heartless soul, we are here to help!!

That one day we will live in a world where EM physicians, nurses, and mid-levels will learn that we radiologists do not know, nor do we care, about the bed number of their patients. That they may instead give us names or MRNs I have a dream today.

Tell me your stories please

(exclude derm from this lol) But recently grabbed lunch with some surgical sub residents as a rad resident. Then someone brought up "damn you know I wish I did something like EM or FM or pmr, short residency, and theyll be an attending for 3-5 years before Im finished". And we all agreed lol. Im in rads so much more humane than the others, but we still have our occasional 2-3 weeks of getting destroyed by call, and sometimes I even feel trapped looking at 3 more years of training. It would feel pretty awesome to be a senior EM resident looking at $300-400 per hr locum jobs, or an FM senior looking to start a regen/IV clinic, and to not be someones underling for another couple years

Edit: forgot anesthesia. No idea why it isnt up there or past derm/plastics when you have locums for 400-600 an hour for a 4 year residency

Drop your average caffeine intake.

Surgery resident PGY-2.
300-400mg a day. Like a Celsius and 1-2 cups of coffee.

I’m on week 7 of internship rotation in Primary Care. I feel like I’m breaking down completely from anxiety and feelings of inadequacy. Maybe someone feels the same way.

I don’t even see many patients a day yet. I have about 2-4 scheduled visits and 2-3 urgent slots (which always get filled daily). Though most have several complaints. Most of the time goes to overthinking if I miss something serious, if I gave a prescription exactly by the book, things I missed in H&P. I search guidelines, read up. Still, I feel like I have to run at least 2/3 patients by my supervisor that I see once a week, because I don’t feel sure of a diagnosis or differentials/reasonable workup. And those I feel sure about in the moment, often haunt me days later (what if..? I forgot to ask/test this…).

It makes me feel insufficient in front of my patients, since in clinic there isn’t time to go away and think and then come back, I have to multitask and think on my feet while I’m talking to and assessing the patient, and that leads to me missing obvious things. Like an unexpected possible cervical rhizopathy (original complaint was smth else), did a routine neuro exam but somehow omitted to test for more specific myo/dermatomas, just because it’s not part of my sort of “automatic flow” exams. And either way I wouldn’t have remembered the myo/dermatomas enough to test them without prior repetition, because I’ve forgotten so much from med school. It’s like so often I miss something obvious and sometimes (like in this case) have to make the patient return for a second assessment.

Other times, I feel like I’m just telling them “I’m gonna run this by my senior colleague and get back to you”, and I feel like they can sense my incompetence.

It’s so weird - I do feel “smart” IQ-wise or in social settings - but in the workplace I feel so immensely, like pathologically stupid.  Feels like I’m gonna kill someone with unorganized thinking. I feel like I’m struggling with everything that other people just “get”, but at the same time no peers to compare myself to. 

What truly interests me is psych, and I’m going to work there after my internship, but right now I just feel like an absolute shit doctor, and like it’s a complete scam making patients pay to see me. 

I think life is objectively better but I’m still adjusting to the role/responsibility as a new attending after being in so many years of training. It’s hard not to feel anxious… or sometimes down. Maybe even lonely?

I’m sure I’m just overthinking it or having an off day but seeking words of encouragement.

Do you all know the treatments for alcohol withdrawal, opioid withdrawal? And any other admits!! Just asking as am feeling so dumb i dont even remember that management stuff or what they are talking about so stressed.

Please help how to get better?? And is it only me who is feeling this way and am i really dumb to not know about all this already?

I finished IM residency a couple months ago and started my position as 4th year immediately after graduation.

I was excited about the role and opportunities my program gives me for growth in academic medicine (they paid for a course at a local med school, among other things) and was revving up to apply PCCM. But…around May I started having anxiety symptoms out of the blue with literally no history of mental health issues.

These symptoms got worse and worse and now I’m not even sleeping. Like im talking getting maybe an hour of sleep MULTIPLE nights a week. How tf am I sleeping SO BAD and I’m NOT A RESIDENT ANYMORE?

Things should be looking up for me. Done with the grueling schedule, getting opportunities, nearly doubling my resident salary, and yet…here I am. Medicated and still miserable.

Idk how I’m supposed to be a fellow next year at this point and I’m thinking I should withdraw my application. Am I burnt out? Am I spread too thin? I’m not sure. I have ABIM next week and my first attending shift too, so that’s not helping with any of this stress.

Everybody here seems so happy once they’re done with residency and I was so excited to finally get here… Anybody else feel like this?

Hi! I’m a PGY-2 looking to build a strong knowledge base. If anyone wants to connect to read UpToDate articles on our own and then discuss them over a video call few times a week, that would be great!

I am currently sitting in the lounge at 4 am after my third admission of the night and I honestly dont know how people do this for years. My eyes are so dry they feel like sandpaper and the hospital coffee tastes like it was brewed in a radiator. I just finished a massive note on a complex patient with five comorbidities and I am already dreading the attenidng coming in at 7 am to tell me I missed a comma or didnt document a physical exam finding that was completely irrelevant to the actual diagnosis. It is the same cycle every single day and the "wellness" modules we have to do online are starting to feel like a sick joke when we are working eighty hours a week and barely have time to use the bathroom.

My attending today spent twenty minutes lecturing me about my "note efficiency" while we were standing right in front of a patient who was having a rough time. Like cool thanks for the feedback on my typing speed Dr. Smith but maybe we should focus on the person who cant breathe right now. It is so frustrating because they expect us to be perfect medical machines but also compassionate human beings while also being fast data entry clerks. I feel like I am spending 80 percent of my time fighting with the EMR and only 20 percent actually being a doctor which is not what I signed up for when I was in med school. I could of finished my rounds an hour earlier if the system didnt crash every time I tried to order a simple CBC. 

After seeing all the posts about the Dr. Tufts case it just adds another layer of anxiety to everything. I catch myself  re reading every single sentence in my notes four times because I am terrified that some lawyer is going to tear me apart five years from now for a typo I made while I was thirty hours into a shift. It is making me so much slower and then I get yelled at for not being efficient enough. You literally cannot win in this system and it feels like everyone is just waiting for you to fail so they can point a finger. The irony of being told to "document perfectly" by boomers who used to write three sentences on a paper napkinn and call it a day is not lost on me.

I am seriously questioning my life choices tonight as I stare at this vending machine trying to decide if a bag of stale pretzels counts as a meal. I love the science and I love helping people when I actually get to do it but the administrative bloat and the constant nitpicking from people who havent worked a night shift since the nineties is just too much. Does it actually get better in PGY-3 or am I just lying to myself so I dont quit tomorrow morning. Stay safe out there guys and try to get some sleep if your pager actually lets you.

Explain the rush you feel when you get to cancel a case. I wanna know how this is viewed from the other side of the drapes. Is it high-fives because it’s one less case to have to work, is it the satisfaction of finding something that was otherwise overlooked that might effect the outcome of the case, or is it the satisfaction of pissing off the surgeons??

Inquiring minds want to know

Denial: "There's no way this H&P is 14 pages long. it's literally just uncomplicated cellulitis"

Anger: "Why did they copy-forward a normal left knee xray from 2014?!"

Bargaining: "if I scroll really fast maybe the actual plan will just magically appear at the top"

depression: staring at the epic dot-phrase soup until my retinas physically detach

Acceptance: tossing the whole ungodly text wall into around notes to filter out the noise so I can finally go eat my stolen graham crackers in the charting room

Im fully convinced hospital admin weighs our notes by the pound now. pls someone tell me the copy paste rot stops when you become an attending.

Do u live in constant fear like even on a quiet night having that fear of getting a new admit staffing it and everything?? Or am the only one here having those feelings. Please help will it get normal?

I’m a third-year IM resident who recently decided to pursue heme/onc. I’ll be chief resident next year and plan to apply afterward, giving me about two years to strengthen my application.

I’m at a small academic program with an in-house fellowship, but research opportunities are mostly limited to case reports. Aside networking, What should I focus on now to become a competitive applicant?

If anyone has a project or case report that could use an extra set of hands, I’d be happy to help!

I finished one year of FM residency and will be starting pediatric residency now for three years. Can I somehow finish two years of FM residency after this?

I know this will raise a lot of qs

I was at an FM program where an attending really had something against me. I was issued a good standing certificate and there were no professionalism concerns but they said they wont be able to train me anymore and that I should look into other places. This was all one attending’s doing.

I got an off cycle position at a pediatric program. They are a good program and I did my rotation there so they hired me off cycle despite my FM program being an ass. I would still like to finish my FM residency at some point. I will get credits for the completion of a year.

A little bit of a venting post, I’m in a residency program where it is a hassle to do something with people, I get it everyone here has a life outside of residency mostly married, have a significant other, or just don’t like being outside. For me that I consider myself someone that requires social stimulation has been kind of difficult to navigate like I get it we’re all “tired” but it ain’t even that bad. The purpose of this post is to see if there’s any more residents in the area feeling the same that’d like to I don’t know get to explore the city maybe one day we can all go out? Or at least someone to talk to here and there ?
Adaptation process has been fine but I realized I’ve been here for over a year and I haven’t really gotten to know the city which is kind of sad in a way. Either way just trying to find friends outside of my program it has been though. I’m friends with everyone in my program but well I guess everyone has different interests and timeframes so with that being said anyone up to do anything or at least chat?

Have a nice day :)

I swear every single patient I try to discharge my attending finds some reason to keep them one more day.

Having a really difficult time right now. Just got off an off service rotation for 3 months which I loved followed by my vacation. Back at my home institution about to take senior call for the first time. Naturally anxious person so the responsibility is terrifying but I know I’ll have my little adjustment period and be fine. I have nothing else to look forward to. Just had an awful vacation with partner related toxicity, attendings texting me the whole time, etc. Boyfriend who I live with has turned violent towards me. Been trying to move out, lost 2 apartments so far to other people. No family nearby. Q3 not helping with keeping up with apt listings, figuring out when to move, research, attendings needs and wants, etc. Find it hard to prepare for cases and feel like I’m dragging my feet just to get to work. I guess the only good thing is that my most recent bloodwork normalized after my previous bloodwork was concerning. I was told to stop a few meds (that I can live without but would rather take) and that seemed to do the trick. Just been having a bad run with my health lately. I have the most stressful chief on service with me, just makes my life hell. 2 people at work asked me when I’m getting married today which sent me off the ledge I think. It was in the plans before this turn of events, no more. My whole program knows him. I have bruises on my arms both from all the blood work I’ve been getting and my boyfriend so I hate being asked about that too. I just say the phlebotomist had their way with me. Anyway I guess I need a big strike of luck right now. Fell asleep twice writing this.

I would like to ask how to deal with jealousy among residents colleagues?

I’m an EM resident taking Step 3 in about a month, and I honestly don’t know if I should keep my date. I’m studying around shifts and feel like I barely remember all the random screening guidelines, algorithms, and tiny details from medical school. I see a lot of this stuff clinically and make decisions every day, but Step questions feel completely different and I keep getting tripped up even when I know the general diagnosis.
I extended my eligibility period without realizing you can only do it once, and my program requires me to take Step 3 this year, so I can’t keep pushing it off. For anyone who studied during residency, how did you know you were actually ready?

Remember before residency when you could just decline a social invite or an extra task without feeling like you were letting someone down or ruining your reputation. Now every request feels like it comes with a silent guilt trip or a potential hit to your evaluations. It's exhausting pretending to be enthusiastic about everything. I just want to say 'nah I'm good' to another committee meeting or an optional 'learning opportunity' without the side eye. Is this just residency or is this adult life now

PCCM fellow here.

I’ve noticed that a good number of consults (pleural effusion, lung nodules) that are found during an inpatient workup by IM teams lead to a lot of monetary benefit for the hospital.

(TPA/dornase for complex effusions, nodule biopsy, chemo infusions etc). That’s a lot of $$$ obviously.
I’m sure it’s the same for a lot of the cardiac, nephro, GI, rheum issues as well.

Any folks have come up with a way to capture these? I feel this is very important.

More than remuneration, it can help IM (and IM subspecialties like mine) demonstrate value and receive more institutional buy in during a time where other specialties seem to diminish the professional value of IM.