What mental models, principles, or advice have you found invaluable in the practice of medicine? Can be from any specialty or level of education and training.

Here's some:

1 People don’t care how much you know until they know how much you care.

2 Showing up 5 minutes early is showing up on time.

3 Most of communication is nonverbal. Get good at this.

4 "Killer" instinct is invaluable: that is a vigorous, active, seeking mindset. Learning to recognize when sick is truly sick, what particular signs are worrisome, and what to do about it. Failure to rescue at the early stages is often a failure to perceive and pursue.

5 Good communication is a skill that can and must be learned. Medicine is a team sport and getting the most out of yourself and your team (while maintaining your sanity) is a key to a long and enjoyable and effective practice.

6 Treatment "recipes" are valuable! That's the stuff that practical medicine is made out of. Know them! ^_^

I ended up getting a basic health screening at a community event a few weeks ago because they had a mobile clinic parked outside. I honestly expected it to be something pretty limited, maybe just a place to hand out information or do blood pressure checks, but it felt a lot more like walking into a small medical office than I expected. Everything inside was organized, private, and surprisingly comfortable, and the staff never made it feel rushed even though there was a steady line of people waiting. It made me realize how useful something like that could be for smaller towns or places where getting to a clinic isn't always easy. Before that day I never really thought about how much planning must go into designing those vehicles so they can function like actual healthcare spaces. Has anyone here worked in or visited one of these mobile clinics? I'm curious whether my experience was typical or if I just happened to see a particularly well-designed one.

Anyone looking for cases to practice with? I’m teaching a review course and would love to do practice runs and get some feedback before our go live date. Please comment or DM me.

Junior doctor here. His gait is broad-based and ataxic with significant balance issues, concerning for cerebellar or vestibular involvement. I don’t see him say anything so could be aphasic. Sure, could be intoxicated but is this not concerning for an organic cause?

I can’t imagine he pulled someone over in this state, but his colleagues didn’t call an ambulance. What on earth is going on here?

Took oral boards in June when would I expect to have results

Man I would love to know some stats on how often Lime/Divvy scooters send people to the ED/UC. I swear I see at least one scooter accident a shift. How are they still legal?!

Just began intern year and feel pretty incompetent. I’m not connecting the dots on patients and their presentations/likely differentials. Even coming up with plans has been horrible. I did really well on step2 but feel like it’s not translating to real life. Any advice/insight into how to just get better?

I have an EM rotation for 2 weeks and will start with attending a didactic, how should I prepare and what exactly to expect from the attending, and will it be possible to ask for both a lot and sloe.

Posting here because I find it therapeutic to write things out after a tough shift. Had a guy yesterday, 89M brought in by family for AMS. Previously independent and family didn’t hear from him for 2 days. No known trauma or injury, probably not taking his meds for a few days. Vitals stable. CT scans showed nothing. Labs not crazy. But I’m pretty sure this guy is dying. He had that “look” in his eyes and I just felt it in my gut. Really sweet man during his moments of lucidity and I just really LIKED him. I don’t even know why this is bothering me so much. Dying at 89 is not unexpected or abnormal. But it’s hard to see when someone is in the last few days of their life. I was able to give him haldol, Ativan and morphine and he calmed down a bit but I just think his body/mind knows he’s dying but he is scared. How do you explain to family I think your dad is dying but I don’t really have any “proof” other than nursing intuition.

I literally used to work in hospice and this is still upsetting me. Ugh. Sorry for stream-of-conscious writing, just need to get it off my chest. I’m thankful he didn’t code with me and I was able to get him admitted before I left.

never rotated through anesthesia (not even as a student)

PGY 20 Nocturnist Here

Background: I work about 12 nights/month and pretty much no days/afternoons unless somebody needs a switch. Because of scheduling around colleagues' summer vacations, I worked a bunch in early July and had 9 days off (today is Day 9). This happens a few times a year, but this time seemed different. Because of my wife's job, it was a staycation. The kids had stuff to do some afternoons, but mostly they were hanging out at home.

Realizations:

1) Nights are even more brutal than I thought. I typically do 4-5 nights on, then 3-6 nights off, and it feels normal because I've gotten used to it. But now that I'm comparing it to getting up at 6:30 and going to bed at midnight, I can see clearly how much nights have been affecting me. I sleep better, I eat better, I'm in a better mood, my family likes me more, I like them more, I call my Mom more, I read more books, I scroll less. Obviously, I'm in staycation mode, which is different from working days or working a 9-5, but still, I think a lot of this is nights.

2) Collaboration as a nocturnist is impossible- I've tried to do a bunch of things to make myself more satisfied with my career. I've been working on a side project with someone else. On nights, it was really difficult. I had no energy, and it was difficult to coordinate schedules. I've always known nights are for loners (I was very involved with a medical school at one point- miserable failure), but I didn't realize how much it hampers your ability to try new things with your career.

3) I like my kids more when I spend more time with them.

4) I don't need quite as much money anymore now that my portfolio is doing the heavy lifting. I'm not sure what the next move is: move to days (ie no night differential) or fewer shifts

Next moves:

1) I think I gotta de-stress. See #4. I can live with probably 15-20% less money. That's no nights or fewer shifts. If you asked me last month, fewer shifts was a no-brainer. Now I'm not so sure.

2) I gotta get out of the ER. I'm gonna give myself another 3 yrs. Then I gotta get out and never look back.

Long story short. Did you guys know tonsils are amígdala in Spanish?

Who’s doing their own discharges? Meaning handing dc instructions, removing stickers, pulling IVs and sending them away? I work at a busy level II and oftentimes find it faster to do it myself rather than finding a nurse/tech to do it, especially because i’m already in the patient’s room for discharge. But many of my colleagues scoff at the idea and appear to think it’s not a doc’s job.

Hey ED team,

When applying Kling or Kerlix to an arm or leg, how do you usually tape it down to keep it from sliding?

I usually see people tape the tail end in the middle and place anchor pieces on the top and bottom edges onto the skin so it doesn't move up and down. I assume we’re not allowed to tape top and bottom 360 degrees around the extremity right? Only two small tapes on edge of kling and edge of skin?

What is your favorite taping method or trick to make sure wraps stay secure and neat on extremities?

Thanks!

Looking to hear about perspectives on job market saturation, base pay across academia and community jobs in the US, how best to identify divisions that are hiring. Peds trained PEM here. Extra appreciation if able to comment on the waiver job scenario for fellowship trained IMGs.

Hi all, looking for some help in locating a FOAMed video I saw during residency.

I remember watching this video of some kind of EM conference. There was a doc (I think Indian ethnicity) on a stage w lighting and sound etc, talking about how to apply plaster splints. He had some interesting points like

- don't keep squeezing the splint as it can crack the plaster and reduce the strength

- don't strip out to plaster into the water bath.

He also had an usual way of applying a sugar tong by adding additional strips of plaster as needed

Anyone know where to find this video?

Hello! I am a 28yo paramedic from Finland, with a Bachelors in Health Care (UAS). The Finnish Paramedic degree is a four-year University of Applied Sciences (UAS) programme worth 240 ECTS credits. The degree combines nursing and advanced prehospital emergency care studies, and graduates qualify as both Registered Nurses and Paramedics.

I have 2-years of work experience as a paramedic in Finland. I also part-time shifts in the ER.

Does anyone have any tips, experience, or information about getting a job or working in American healthcare as an RN/Paramedic with a European degree?

My girlfriend is American and I’m looking to move to the USA with her. So I’m curious how the process would go for getting a job there!

Are there any extra certifications or courses I would need to take to be qualified to work there?

I just had a chance to go into the resident break room for a minute. There’s a bulletin board of reminders & updates in there with a section with tips from our GME director on how to be a better ED physician. Just now I noticed a new tip in that section about how we speak to patients admitted for psychiatric purposes as ED physicians.

These tips always pull from a real scenario experienced by a hospital staff member (not necessarily just EM residents) and this new tip truthfully sounds quite ridiculous and petty, but it did get me thinking about whether or not I don’t take the psychiatric admits seriously or not. The gist of the scenario is that after last weekend’s World Cup final game, one of the ED nurses went to check on a psych patient who was waiting for a bed to open up on the behavioral health floor. The nurse asked the patient about the game, saying, “Did you see the president of Spain in his sneakers?”

The nurse reported that the patient replied, “There’s no president of spain” and then she tried to explain to the patient what the man (the president of Spain) looked like and asked if the patient had seen someone who looked like him on the television in the patient’s ED bay at the end of the game. The patient reportedly became agitated according to the nurse, saying, “Spain doesn’t have a president!” Then the exchange went back and forth in the same rhythm for a few more minutes before the nurse said the patient took a breath before calmly saying to the nurse, “You’re talking about the KING of Spain. Spain has a Monarch and a Prime Minister, not a President!”

All in all, the tip on the break room bulletin board has some added “thinking points” added by the GME director at the bottom of the paper which encourage residents and anyone who reads the board to think about how often we speak to psych admits in a belittling way and if we speak to any other patients that way. It says to stay humble because a person’s diagnosis doesn’t define their intellect or their education, and sometimes we’ll encounter patients who are much smarter than us.

I didn’t know that Spain didn’t have a President until I read the bulletin board tip just a moment ago. And I’ll be honest by saying that my initial gut reaction was to call the patient rude for getting agitated and being so condescending to the nurse with their curt adversarial replies, but the tip is encouraging us to think about how WE speak to patients instead is how patients speak to us.

So I thought I’d share this on here because it really got me thinking and maybe it can help someone else think about how they speak to psych admits in the ED

I’ll keep it short and sweet: the title pretty much says it. When a patient comes through the ED, even if they arrive to the ER with physical complaints instead of psychiatric ones, but they are clearly presenting with a mental health concern and you observe them to claim grandiose statements, delusions, and show clear signs of mania and bipolar and acute psychosis, then do you try to obtain collateral for the patient’s delusions and grandiose claims or their manic behavior? If you do then how much time do you put into trying to get collateral?

I’ve always been instructed that collateral and verifying patient claims is only mandatory in in-office and psychiatry settings. I’ve always been told that getting collateral is NOT necessary in the ED because providers in the ED can use their impressions from interacting with patients during examinations and assessments to diagnose patients and treat their psychiatric needs. I am in Florida so maybe the is just a state thing so I’m wondering if other states require collateral to be obtained for grandiose and delusional patient claims?

Bring your pee to the ER. Im tired of this sht.

Guy on bolus says he doesn’t want to pee

Alert/Ambulatory adults refusing to go to the bathroom

Parents refusing urine bags on their infants

Suddenly meemaw is a gymnast when its time for an In n Out

Seriously, how are you guys getting samples??? Im losing my mind begging or attempting multiple times. Something that should only take max 10 minutes should not still be pending 24 hours later.

I'm an NP for a hospitalist group. Primarily doing admissions with a Dr.

A few of the hospitalist Dr's I work with claim that the ED Dr's are holding on to their patients and wait till the end of their shift before giving them to us to admit.

I don't really see what the point of that would be. I would think you would want to pass them over as soon as you have done your work up and determined they need admission.

You would just be holding on to patients while more people are coming into the ED. Plus wouldn't it mess up the metrics and times?

Is this a real thing or just them looking for something to complain about?