Doctor Fingerguns

Med student about Scrub nurse to break the sterile | field | | | V V

ICU/ED Airway "Secrets": ~40% of endotracheal intubations (ETI) performed in the ICU or the ED result in hypotension, hypoxemia, or cardiac arrest Of all procedures, ETI is the one I find most intimidating & have the greatest respect for #foamed #foamcc #meded #medtwitter

Bugs in the colon are rarely encountered on colonoscopy - if you do, take good photos and pump prime it for a case report!

Counterpoint: Growing up poor and being the first person in your family to go to med school is significant to those of us that came from little and had to navigate this process by ourselves and you probably shouldn’t be mocking people who did. 🤷🏻‍♂️

MAP > 65 is a myth Lactate isn’t intrinsically bad 30 ml/kg fluid bolus was invented by a shadow government

@MySystolic It's literally the best dude!

@docfingerguns It’s wild how much I enjoy it now 🥺

Am I thinking about FM-OB again??

Take care of people in the hospital, work in ERs, do colons and EGDs, sometimes all in the same week!

The funny thing is, a complete revitalization and restoration of the autonomy of primary care docs is how we fix our healthcare system. Also it's not a mind numbing life of referrals and med refills. I get to delivery babies, see newborns, have palliative care discussions

I felt like writing a post in defense of physicians. We seem to be getting a lot of crap recently. But I don’t know really where to start or what say. There is so much cynicism and bad faith and really plain unhidden contempt these days. But why? Because we can’t fix you? And never could? Because you want us to be something we are not? A coach. A trainer. A knower of all things nutrition and all things non-pharmaceutical. A knower of every little niche thing you’re into. That isn’t how we are taught or trained. But that’s our fault somehow that the reality of us doesn’t meet with the expectation of you? You’re mad about how we don’t have long periods of time for you and this can lead to less accurate or optimal diagnosis or treatment. You’re mad the drugs cost a lot. You’re mad you pay for health insurance and it seems like it never pays for much. Yet, none of those phenomena are the fault of physicians. We’re mad about those things too. You’re mad about Covid. And vaccines. A pandemic we didn’t create. Nor other endemic viruses we had anything to do with. You blame us for the vaccines and policies put into place by politicians bureaucrats as if we are personally responsible. You get mad we make a good salary. Tell us we only make this money because we did dirty tricks to prevent there from being enough doctors. Decisions made decades ago based on predictions that seemed reasonable then but turned out wrong now that those of us working currently had nothing to do with. Our knowledge, experience and expertise downplayed. All that is needed out there is a smart teenager with an AI and access to any chemical they want. I don’t even know how you even begin going after addressing all of it. It’s rather daunting. I’m not sure I can, so I won’t try. The thing is I don’t owe anyone any explanations or apologies. I’ve showed up every gd of this job to be the best doc I could for the people the Lord put in my path. And I’ve manned the f*cking wall against the dragons and barbarians with honor for a decade. I run into the rooms of the sick when everyone else is running out. I’ve stood in the gaps between life and death and fought hard for everyone, even the ones I lost. And you never really ever forget the ones you lose. It’s been nights, weekends, holidays, birthdays, anniversaries, & kids sporting events. I’ve taken those hits to my health and to my family life for the same people who just want to sh*t all over me and my profession today and it’s so heartbreaking & disappointing. I guess maybe you were disappointed by a doctor at some point. We clearly aren’t infallible. We have bad days too. You can see the burnout in the way they make many physicians in clinic practice. I don’t know what to tell you about the guys that are really awful. They do exist. They also aren’t all or even most physicians. Most of what everyone is mad about has nothing to really do with us. It’s policies and laws made bureaucrats, politicians & corps. We simply exist in it. Try to work inside the crazy nonsense ourselves. We’ve never had a “lobby” and it might be interesting to see what things would look like if we actually did. There are people working in this now. But mostly physicians have been too busy just being docs to get all caught up in any of it. There is barely anything left after a week in clinic for my family and some working out let alone some cynical ploy or play to keep it hard for people to become physicians. I don’t know if enough people really understand that. How really taxing and exhausting the work is. I wouldn’t wish the responsibility on anyone either. Heavy is the white coat … This post probably won’t change any minds of the bad faith actors but I do hope it in some way humanizes us to you if only in some small way. I’m just one guy fighting the good fight. On tonight actually and holding down the fort. If any are in need of my expertise, and I hope not (no one meets me in a good day), I’m here.

We had one person apply from my old residency…I can’t tell you how many people told me “why work harder and for cheaper for 3 more years to lose more money when I graduate?”

@jasonryanmd Eczema, psoriasis, hypertriglyceridema, CAD, asthma, COPD, atrial fibrillation, heart failure, RA, OA, pediatric conditions, obstetrics, even more in rural communities. A good PCP should be able to manage the first 2 lines of most conditions before referring to a specialist

Serious question that was put to me by a student: outside of diabetes, HTN, high cholesterol, what are some chronic conditions that primary care docs manage without involving a specialist? Heart failure? Lupus? Parkinson’s? I don’t have a sense of what the average PCP is managing these days versus what gets referred out.

Common pitfall among residents planning a paracentesis. You consent the patient Talk to family Talk to nurse Gather all the supplies Make sure your attending knows/is available … then you ultrasound and find there’s no safely tappable pocket. Do that last thing first!

@MySystolic Strong work, if the nurses like you, you're on the right track!!

Zosyn supremacy💪🏻💪🏻

@MySystolic If yalls program is like ours it gets better as you progress and you have more clinic per week, but yeah as an intern when you're rarely there and just leaving other rotations to pop over for a half day a week it does suck!

Residency would be cooler if there wasn’t so much mandatory clinic

Having no shows in clinic>>>>

Patients who were admitted for a week with sepsis requiring abscess drainage, a fib, and a kidney injury don’t need 12 pages of “heart healthy eating tips” in their discharge paperwork. They need to be able to see their instructions, meds, and appointments simply and clearly.

POCUS should be part of physical exam in the ED/on admission for anything even remotely cardiac related.

One of our main points in MICU this week. No call/vital/output/lab should equal automatic fluids.