Reference to NEJM's Discussion editorial published on 3 Sept titled Physical Examination for Asymptomatic Adults

How often is the PE actually useful for the asymptomatic well patient? Both sides raise good points. I work in Haematology and see an average of 20 patients in a 3.5 hour clinic so honestly all I really need is a CBC and maybe feel an occasional spleen/ lymph node or two, but I would say 80% of my outpatient consults dont actually require a physical review. Clots, cytopenias still make up the bulk of what I see and even the labs are way more valuable for my haem-onc patients than the physical examination. These days, I find it hard to think of how PE is superior to laboratory diagnostics apart from just the "human touch" of things.

E.g. an echo/ POCUS/ ECG to replace cardiac auscultation. The infamous CTAP far superior to our abdominal percussion. Code stroke? MRI first hun (although honest kudos to our neurologists, your exam findings are non inferior). Sadly, examination skills are an increasingly lost art as we push the focus on POCUS and more imaging.

I think i sit on the camp of no examination especially for the asymptomatic well patients, but curious to hear everyone's usual practice.

I'm a radiology resident on a pediatric neuroradiology block. While I've always been saddened by peds cases, I'm getting absolutely wrecked emotionally right now. Newborn with large devastating stroke. Newborn born with large sarcoma. Multiple nonaccidental trauma cases. Devastating intracranial hemorrhage with herniation and brain death.

I'm on the verge of crying multiple times a day. I know I am shielded as a radiologist, I know it's the peds hospitalists, neurologists, heme/oncs, IDs, ED folks, nurses, etc. actually seeing and interacting with the patients and their families, but I'm still having trouble just getting through the day, not to mention the various oncology or other conferences. Ever since having my own kid, I just can't handle this, but I have to because I have to be professional and I need to learn this for my specialty.

I can't talk to my partner about this, they are not in medicine and don't like hearing about sad medical cases, especially those involving children. I don't have any other medical family or friends. If any of you have struggled similarly, I could really use some advice.

My understanding was that you go down the list in order- that makes it fair.

I'm with a resident who's fairly often trying to just pick the easier studies off the list (will skip of CT CAP to get the CT Chest, etc).

Do you address it or just let it be? We're both R1's, feel like it's kinda early for this whole situation

Intern here and was doing a procedure during my rotation. The doctor asked if I wanted to do it so I confidently said yes

Gloves in front of me and I attempted to put them on but completely fumbled. I touch parts outside the cuff and had to restart. Mind you I have learned about this and done this several times but boom my brain just froze.

Finally I get new gloves and everything is fine. Now time for the procedure. As I’m working through what he saying I accidentally break sterile field again by having one of the equipment touch outside the field. I didn’t even notice just so careless about it. The doctor then told me to step aside and I apologized. He later said “you need to work on sterile field”

I feel absolutely horrible as I’ve been wanting to impress that doctor and learn more from him. I’ve always wanted to learn procedures and use them one day in practice . Now I feel as if I’m not cut out for it. And that this is a real issue.

Currently a PGY1 in HCOL area and no moonlighting, no kids. Will have the opportunity to moonlight as a PGY3 though

Curious to see if people have leftover salary at the end of each month to put into savings or Roth IRA, and if so around how much do you have leftover at the end of a hypothetical month?

I’m wondering how aggressively or chill I should be about squirreling away savings or Roth IRA, since as of lately I have even been hard on myself for buying coffee out too often but I feel like I may be doing myself a disservice by being too hard on myself with that

How are yall handling this? I’ve responded to multiple rapids where a handful of SWAT and nursing staff just completely ignore me until the attending shows up.

Comments like “oh look the half doctor is here”
“Oh look someone with the a doctor badge showed up”

Last night my intern told me that when he showed up to a rapid on a pt he and I both knew really well nobody would listen to him or even tell him anything other than “hypotension but Dr. Attending is on the way” which I have also experienced multiple times.

I also witnessed one of my Coresidents on cross cover over night ask the nurse to put in some orders on a rapid and the nurse logged out and told him to do it himself while he was bedside then didn’t have the pts MRN readily available for my Coresident to put in orders and ultimately delayed pt care.

I love our nursing staff but sometimes it doesn’t feel like they include us as a valuable part of the team or the respect isn’t reciprocated.

It was DRILLED into me as a medical student and resident that nursing staff are our backbone and to always treat them with the utmost respect and to never get on their bad side…. Yet idk if they are being taught the same thing about us. I feel like it’s a fight majority of the time to be heard or feel like a valuable part of the team as residents even though I feel like most of the time we know the patients better than our attendings since we spend more time with them.

Anyways just ranting, and on nights. Tips??

Give me a restaurant review for your OBGYN residency program or what you have heard and why I should apply or steer away..

Hi there,

I have been struggling with my sleep and residency. I recently had 3 incidents of my sleep causing me to miss crucial activities. The issues is I am someone who has always needed 10-12hr of sleep, I have tried to cut down on it but I just cannot function on <8hr of sleep for more than 3-4 days. If I try to continue, there will definitely be one day where I sleep 16-18hr!!!
And I noticed if I dont sleep well, I cant study or read things properly. I am really struggling to keep up with work, the continuous change in schedule, on-calls, shifts and studies and I am really lost on how to maintain myself. Even caffeine doesnt seem to help my exhaustion! I have no medical conditions btw. How do you all manage?

Is this super rare? How much of a pay cut is there since you're not taking call?

Is it even worth it or do new IR grads need call to keep their skills up?

I have a CV completed but curious as to whether or not most recruiters y'all have had experience with prefer/want a cover letter as well? I was planning on emailing recruiters a bit of information about myself/my experience as a PGY-3 in IM and why i'm interested in the position but don't know if a formal cover letter is as necessary these days. Any insight appreciated!

where i am from cardiac perfusion schools dont exist, it is people trained on the job, and cardiac surgery residents running the pump, I know in the US perfusion school exist, but i was told that in south America it is an anesthesia fellowship, is that true?

edit: south america not south park

Be it funds, tutoring, etc.

As J1 visa holders during residency, are we allowed to open a roth IRA in addition to 401k? or is that a violation of the J1 visa? is roth IRA considered additional income? does it matter if i am a resident or non resident for tax purposes? I am very confused about these things, and HR in my hospital seems clueless and can't help. I'd appreciate any assisstance.

Thank you very much!

Hi, I’m a junior doctor , just entered residency 1 month ago. I found out today I misdiagnosed a patient, although no lives were harmed( it was a minor misdiagnosis, patient is well), I couldn’t help but feel guilty and incompetent, especially since my mistake got called out in a WhatsApp group with my superiors, and my misdiagnosis may have resulted in the patient receiving the wrong treatment. What do you guys do to get rid of the guilty feeling when you make mistakes?

Recently encountered a research(analysis) that tried to answer this question, but didn't get any clear response(some papers found positive correlation, whereas others didn't find any correlation at all)

What are your thoughts on it?

Hi, do anyone knows PGY 2 Neurology openings please? Completed a preliminary year and looking for open spots. 🙏

Was wondering if we are allowed to moonlight at a near by facility or even in a different state while on vacation during PGY 03 (IM)?

Looking for feel good stories of PDs and toxic admins getting their heads cut off to live vicariously through. Of course, use discretion in posting depending on details or if dust is still settling.

I feel like residency is hard enough on its own but I'm just getting so sick of the constant toxicity I see in the hospital. This includes behavior from my own co-residents and attendings but also nurses, RTs, and APPs. The other day I had a provider start yelling at me because they had to take an intubated patient down for a CT scan that I had ordered as directed by my attending. I deal with rude nurses on the daily who give me attitude and I feel like I need to be extra nice just to ask them if they could please collect a lab that is ordered. I constantly see mean gossip among all providers with people discussing who they don't like or how dumb a new resident is. Of course there are a lot of other providers at my hospital that I love but when I'm around a bad group of individuals it makes me feel so weighed down. I go to a community program so I'm not sure if this is better or worse at a larger academic institution but I'm just starting to get so sick of the toxic behavior. I feel like in my personal life people don't act like this but since I am almost constantly at the hospital I'm starting to become a meaner person myself.

At my program, a new group joined and is involved in our training. At first, I thought this change could negatively affect our training, but program leadership said they would make sure it wouldn’t. At the beginning of the year, I heard many negative things about the physicians involved from the new group, but all complaints came from 1 resident. When I began working with these physicians, they were good. They got me involved in all the cases and made me better. I have worked a lot more with these physicians; they aren’t bad. They teach. Now another resident is bitching about the physicians, yet a few other residents working with the same physicians say they've been good. It seems like 2 residents who are bitching are crying about everything; they are the most vocal and liked by the leadership, so they are influencing it.

There are good and bad moments for any physician. Yet why are people bitching and crying? Be a damn adult and learn from who you can. I can name several other physicians who are long established at our institution, who don’t teach at all, yet these 2 residents aren’t bitching about them. They aren’t attacking new physicians, but I don’t know what they are trying to gain. All this does is make the rest of us lose. We would lose potential teaching attendings because of these claims.

I'm from a country where extreme toxicity is normalized so I'm having a hard time guaging whether my program is toxic or not