This is the weekly careers thread for December 13, 2018.
Questions about medicine as a career, about which specialty to go into, or from practicing physicians wondering about changing specialty or location of practice are welcome here.
Posts of this sort that are posted outside of the weekly careers thread will continue to be removed.
Hey Reddit: Want to write better? Eliminate grammatical mistakes, wipe out wordiness, and let your ideas shine. See for yourself why over 15 million users are hooked on Grammarly's free writing app.
I'm a third year surgical resident.
My intern does the following:
He confabulates when he isn't sure. Doesn't say I don't know and ends up giving false or altered facts.
He's distracted most of the time. Doesn't pay attention to what other people are saying.
He doesn't confirm what is told to him and ends up doing something else then he gets defensive when he's questioned about it.
He's unreliable and I can't trust him as a source of information from patients, attendings and other ancillary staff members due to the above.
He's very slow and inefficient time manager.
He discontinues orders on his own without reviewing with senior doctors and with no evidence to support what he did or clear thought process.
He doesn't seem to know how to apply his medical knowledge or translate it into a plan.
He's very passive about patients' care.
He focuses on small stuff and forgets the main problem.
I tried to give him feedback and tips on how to improve but I think I reached a wall.
Maybe it's just me, but nothing seems to derail a patient interview faster than "Who's the current president?" Does anyone have an easy replacement for that question when evaluating mental status?
https://i.redd.it/4ghz4n86yo421.jpg
What essential apps are you using regularly in clinical practice? List your speciality so we can build a list of killer apps.
I am trying to find a study that I read a few years ago. It was a follow-up to that famous one where children were asked to delay a reward (one candy) to receive a greater reward (two candies). This original study found that children able to delay the reward were more academically successful. This was touted as "grit," and described as an intrinsic characteristic of the children.
I am looking for the follow-up study where the examiner was unreliable (broke promises), and the children with "grit" suddenly didn't have grit. They found that the rational behavior of taking a bird-in-the-hand won out. The conclusion was that the ability to delay gratification is a learned ability, and it is learned best in environments where outcomes can be reliable predicted (i.e. delaying one candy guarantees two in the future).
My description of the methodology in the second study may be off, but I'm pretty sure that I remember the conclusion correctly. I think it was out of Rochester or something?
Good day to my fellow reddit medical community. With the permission of mods, I ran into a situation this week that I’ve never encountered before and I would love to have your input/thoughts on the matter.
A little back story: Patient X is in their late 30’s. PMH consists of well controlled HTN, well controlled type 2 DM, history of opioid/benzo addiction (in recovery for about 10 years), bipolar type I, current state depressed, though well controlled with meds. 1 PPD smoker x 20 years. History of surgery to right foot earlier this year. Though day 4 post-op, X suffers a dislocated right great toe on the same foot.
Patient X was scheduled this coming Monday for an elective procedure on their foot. Right great toe joint to be reconstructed, as well as have hardware put in place to regain alignment of great toe. X had their pre-op exam earlier this week and was given the “all clear” by their primary doc. PMD says “low risk procedure, patient is medically optimized for procedure.” Pre-op labs were all WNL. Monday’s procedure was to take place at an outpatient surgical center, here in the US.
I received a call that “anesthesia (presumably an MDA)” had reviewed the X’s H&P and made the decision to pull the plug on the procedure based on the following: “mental health concerns, patient’s hx of opioid addiction, and BMI (38).” It’s worth mentioning that X had their foot surgery earlier this year at the same facility and with the same surgeon. At that time, X’s BMI was 42. Understandably, the surgeon is frustrated and pushing back on anesthesia, but anesthesia is not bending. Both X’s PMD and surgeon have been treating X for 10 years or more, and both are highly aware of X’s history of addiction, as well as their current medical status.
Now, a patient’s BMI, I can see being a risk factor, but not considering their BMI is lower now than it was earlier this year for the first surgery. What I’m having a difficult time wrapping my head around is mental health and history of addiction meeting exclusion criteria for anesthesia, especially being that the MDA that made the call never bothered to contact X, nor had they even laid eyes upon X, so what this doc doesn’t know is that X has been sober for the better part of 10 years, and their mental health has been stable for the better part of a year. Is it common for an MDA to call off a procedure without ever examining or even interviewing a patient?
In my opinion, it almost seems like an issue of discrimination in that X’s BMI is currently less than it was for the previous procedure, but also, their addiction issues are currently in remission, and their mental health is stable. But also, I completely understand that we’re in the middle of an opioid epidemic in the US, but I can’t help but feel we’re not going to solve that by denying one procedure to someone that’s been sober for 10 years. Furthermore, shouldn’t the addiction issue be of more concern to the surgeon, since he’s going to be the one that’s responsible for X’s post-op pain control.
I’d love it if someone out there could help shed some light onto the situation and let me know if there’s something more that I might not be considering. Thanks in advance!
All the MS4s are currently interviewing and thinking about their rank lists - I (and I'm sure others) would love to hear input from established physicians about what really made or break their residency experiences. What are some things we might think are important at this stage in our careers that actually turn out to not be important at all?
Approaching the end of residency, and was thinking of going to another state afterwards. Anyone know how to approach this? Need to transfer medical license? Cold call vs recruiters?
Medicare for all doesn't seem palatable for most, and will probably end up gridlocked in Washington. However, what about proposing a hybrid system? Maintain a system of insurance for inpatient and specialist coverage, but provide primary care to all (moderate-high complexity and below). Thoughts?
My background is in Biomedical Informatics and I plan to pursue a PhD in the field soon. As such, I've been wondering about a probably naive question recently, but why don't we have better EHR systems? Ideally, we would have one that focused on patients and allowed for easy configuration of clinician workflows leading to a comprehensive and easily searchable medical record.
Some reasons I know of:
- EHRs come from claims software systems, which have been adapted to hold patient information with a generally business goal in mind.
- Clinicians at different hospital systems have very distinct workflows and companies like Epic go for a One-size-fits-all approach (generally).
- There is little reason for interoperability since most large software companies increase profits by creating patient data silos.
- It is difficult to get clinicians, patients, management, other stakeholders to buy-in to a new system.
However, all of these still don't seem like insurmountable barriers. So why?
From what I've gathered working in these setting, the midlevel or doctor will order urine culture if a patient has positive leukocytes or nitrites in their urine.
What is the point if the patient is going to get a script for antibiotics days before the results of the urine culture comes back? When they do get the results of the culture back, does this ever alter the treatment course?
I'm also confused because I believe I read somewhere that UTI is a clinical diagnosis; if history and physical exam point towards UTI, then the patient likely has a UTI regardless of what the urinalysis or urine culture says.
Hi, I have a background in M&A working with larger corporations. However, I may be involved in selling my father's medical practice. It is a small practice. He is basically the only guy, and sometimes my sister. How would someone position it for sale? What are the assets besides the patient?, the equipment, the rental lease etc? How would you even start to value such an entity? How are sales of such entities usually done? thank you
203k
Subscribers
396
Online
**A community for medical professionals.** Please read the rules before posting.