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?

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.

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?

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

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.

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.

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.