Second residency in Emergency Medicine (Part 2)

[dadaddadaBATMAN]

1. S-tier post for both humor and accuracy.
2. Blood pressure should read "over 9000!" (meme)
3. Everything that I bolded is absolutely 100% gold.
4. Pots-Danlos-Lyme ! Perfectly stated. Per-fect.

At one point in time, we had a running list on here of all the "imaginary diagnoses" that exist in America alone.

Irritable bowel syndrome.
POTS
Fibromyalgia.
Mitral valve prolapse (somehow symptomatic)
Chronic Lyme.
"Heavy Metal Poisoning"

We need to do that again.

Edited for accuracy. Never experienced dbz in real time but I always felt that captured the sentiment of Htn “emergency” well.

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[RustedFox]

Is this the one? Things I hate to hear patients say:

Yep. THAT'S IT.

This is mandatory reading for the OP.

 

[elanmorin]

1. S-tier post for both humor and accuracy.
2. Blood pressure should read "over 9000!" (meme)
3. Everything that I bolded is absolutely 100% gold.
4. Pots-Danlos-Lyme ! Perfectly stated. Per-fect.

At one point in time, we had a running list on here of all the "imaginary diagnoses" that exist in America alone.

Irritable bowel syndrome.
POTS
Fibromyalgia.
Mitral valve prolapse (somehow symptomatic)
Chronic Lyme.
"Heavy Metal Poisoning"

We need to do that again.

Chronic Fatigue
Interstitial cystitis
Seizures (when actually they mean pseudoseizures)

I spend about half my time in the ED when on call and still remember rotating through the ED as an intern (very different experience compared to as a med student). The struggle is real and I sympathize. Not sure if/when OP last spent time working in the ED, but they should probably get some more recent experience in it before committing to residency in it.

 

[Siggy]

Seizures (when actually they mean pseudoseizures)

Are we suggesting that psychogenic non-epileptic seizures are not a thing, or are we conflating malingering with pseudoseizures?

 

[Mount Asclepius]

Are we suggesting that psychogenic non-epileptic seizures are not a thing, or are we conflating malingering with pseudoseizures?

I think folks are equating PNES, amongst other conditions that tend to frequent the ED, with being not an emergency (inappropriate use of the ED). Doesn’t matter if it’s a ‘thing.’ Still not an emergency.

As an aside, somewhat similar to >90% of epileptic seizures that present to the ED. Very rarely an emergency. Granted there is always the off chance of status, but it’s incredibly uncommon.

 

[Siggy]

I think folks are equating PNES, amongst other conditions that tend to frequent the ED, with being not an emergency (inappropriate use of the ED). Doesn’t matter if it’s a ‘thing.’ Still not an emergency.

As an aside, somewhat similar to >90% of epileptic seizures that present to the ED. Very rarely an emergency. Granted there is always the off chance of status, but it’s incredibly uncommon.

I agree that known PNES is hardly an emergency, however it seems to be more emergent than a lot of other things that presents to the ED. It's just a pet peeve of mine that people tend to equate PNES with faking/malingering, when they're significantly different entities.

Based on American Epilepsy Society guidelines, status is actually pretty common, but that's because status technically starts at 5 minutes. So anyone getting benzos is technically in status.

 

[elanmorin]

Are we suggesting that psychogenic non-epileptic seizures are not a thing, or are we conflating malingering with pseudoseizures?

All of those things listed are diagnoses, but PNES patients sometimes simply say they have "seizures" without specifying anything more. Also seems to be more of a "first world" diagnosis (which I think was what RF's post was getting at).

 

[BoardingDoc]

It's just a pet peeve of mine that people tend to equate PNES with faking/malingering, when they're significantly different entities.

Differentiating the two can be challenging sometimes as there is frequently a subset of patients who likely have PNES who also tend to have convulsions in the ED at the most convenient of times (e.g. when asking the patient pointed questions that they don't want to answer, if they are looking for attention etc). You can make the argument that in those cases, that still falls under the category of PNES and not malingering, however, I suspect many would disagree with this.

 

[Rekt]

That's laughable. Psychogenic seizures are the exact same spectrum as fibromyalgia, gastroparesis, POTS, chronic Lyme, mastocytosis, fake Ehlers/Marfan's, this new "alpha gal" syndrome, etc.

The unfortunate 1% that have actual real pathology based on the above are washed out by the 99% that self diagnose those conditions and it's really just malingering and somatization of mental illness.

 

[RustedFox]

That's laughable. Psychogenic seizures are the exact same spectrum as fibromyalgia, gastroparesis, POTS, chronic Lyme, mastocytosis, fake Ehlers/Marfan's, this new "alpha gal" syndrome, etc.

The unfortunate 1% that have actual real pathology based on the above are washed out by the 99% that self diagnose those conditions and it's really just malingering and somatization of mental illness.

The number one cause of burnout is...

 

[dadaddadaBATMAN]

Are we suggesting that psychogenic non-epileptic seizures are not a thing, or are we conflating malingering with pseudoseizures?

They aren’t the same thing but they’re not exactly mutually exclusive.

 

[Old_Mil]

Hi everyone,

As I have previously posted, I'm interested in pursuing a second residency in Emergency Medicine. I completed an Internal Medicine residency in 2017 and I have been working as a hospitalist since then. I'm ABIM board certified. Although the hospitalist gig has been good to me financially, making $400K yearly with bonus + extra shifts, I would like to be a more versatile doc - peds, ortho, OB, performing lifesaving procedures, working up undifferentiated patients, etc. I'm planning to apply to many of the 270 EM residencies next month.
I would appreciate it if any of you, good folks, can give me some insight into which programs are willing to accept applicants who have completed another residency?
Thanks!

No I won't. I'm not going to help you ruin your professional life.

 

[Crisistraining1200]

This has 100% been my shift so far tonight. My two best patients both happened to be Irish. One had abd pain and wound up having epiploic appendagitis. Going home. Nice guy and was thankful for the care. Other one had vague URI with HTN that his nurse daughter told him needed to be checked. I explained that it didn't. "Aww man, that's great. Thanks a bunch!" DC.

Two very reasonable patients saying thank you with an Irish brogue was nice.

Rest of the evening so far:
Kidney stone
Migraine/Personality disorder (treated with Droperidol minus the benadryl with the hope that akathisia would set in. It did and she almost ran out of the ED. Win.)
Old person with mild cellulitis and can't walk because old.
Alcoholic who feels crappy
Alcoholic with mild pancreatitis
Abd pain x1 year who has had a CT, MR and EGD for the same.
Drippy dick s/p "I went to Vegas and picked something up"
Foot hurts. Foot is fine.
Dehydrated. Sorta.
Neurotic hypertension.
Baby with mild illness and utterly normal vitals and unvaccinated parents
Fat and constipated
"BL LE Edema per PCP. Sent in for DVT study." Has no LE edema on exam. Has no DVT on US ordered in triage.
Chest pain

Literally the best part of my night has been inducing akathisia in a patient and seeing two reasonable dudes with uninteresting medical problems.

This post about inducing akathisia on a patient is liked by others and no one has the guts to do the right thing for which an oath was taken? Inducing akathisia on a patient then not informing them what is happening to them watching them run out of the Emergency Department is how to treat patients? Time to reconsider a new career because this is not just wrong but probably illegal!!

 

[RustedFox]

This post about inducing akathisia on a patient is liked by others and no one has the guts to do the right thing for which an oath was taken? Inducing akathisia on a patient then not informing them what is happening to them watching them run out of the Emergency Department is how to treat patients? Time to reconsider a new career because this is not just wrong but probably illegal!!

I love it when we get these guys in here.

 

[gyngyn]

Someone who appears to be a patient/non-physician has been excused from this forum.

 

[RustedFox]

Someone who appears to be a patient has been excused from this forum.

Homeboy was all up in my PMs with all of his victim complex nonsense.

 

[gyngyn]

Homeboy was all up in my PMs with all of his victim complex nonsense.

If they manage to get past the ban, let me know.

 

[RustedFox]

If they manage to get past the ban, let me know.

Hehehe... Maybe.

He thought that BoardingDoc's post was mine and was "I'm going to report you to "the medical boards" so it's not my trauma anymore" and all the typical triggeredphrase nonsense.

It was fun.

 

[NITRAS]

Someone who appears to be a patient has been excused from this forum.

That didn’t take long.

I wonder what the record for shortest time to ban is.

 

[Apollyon]

That didn’t take long.

I wonder what the record for shortest time to ban is.

In the whole hx of SDN, it's been less than a minute, but it was really obvious - like, if you got banned, and you immediately sign up with "NITRAS1". That obvious.

 

[RustedFox]

Judging by the way he/she used the English language, I'm pretty sure it was a 10th grader with a behavioral health problem who was between 4th period geometry and 5th period study hall.

I love it when people say that their a "survivor" of (some benign condition).

I told them to enjoy their tantrum and their victim complex.

Keep supporting the current thing, NPCs.

 

[turkeyjerky]

Judging by the way he/she used the English language, I'm pretty sure it was a 10th grader with a behavioral health problem who was between 4th period geometry and 5th period study hall.

I love it when people say that their a "survivor" of (some benign condition).

I told them to enjoy their tantrum and their victim complex.

Keep supporting the current thing, NPCs.

Would definitely appreciate it if you posted their PMs. These rings crack me up. I always wonder how they find their way to some random post that’s months or years old.

 

[Tenk]

I’m really sad that person got instantly banned.

 

[wook]

I would concur with the other posters on the challenges with EM right now and foreseeable future.

Another thing I would make you aware of is that the EM residency program may have to pay for your training. Since it appears you have already completed a residency, the EM residency would have to pay the 3 or 4 years of training you are doing. This might detract their interest in training you. I will let the other posters explain more on how that works, since I've not looked at this in 7 years (when I was more involved with the EM residency and EMS fellowship programs).


Thanks.


Wook

 

[RustedFox]

Would definitely appreciate it if you posted their PMs. These rings crack me up. I always wonder how they find their way to some random post that’s months or years old.

So, I did - but it got removed and I got a message saying "you can't do that".

 

[turkeyjerky]

So, I did - but it got removed and I got a message saying "you can't do that".

No worries, I saw them last night. F-ing hilarious. “Akathisia survivor” LMAO

 

[Old_Mil]

Are we suggesting that psychogenic non-epileptic seizures are not a thing, or are we conflating malingering with pseudoseizures?

We are suggesting that a seizure that miraculously stops when a person drops a hand or weight from two feet above a seizing patients face because they suddenly regain the ability to fend it off is voluntary behavior, not epilepsy. This is particularly true if one upper extremity suddenly regains the ability to fend it off while the rest of the patient continues to "seize".

 

[Siggy]

We are suggesting that a seizure that miraculously stops when a person drops a hand or weight from two feet above a seizing patients face because they suddenly regain the ability to fend it off is voluntary behavior, not epilepsy. This is particularly true if one upper extremity suddenly regains the ability to fend it off while the rest of the patient continues to "seize".

Ah, not pseudoseizures but malingering.

 

[IM.MD]

Thank you all for the replies! I applied broadly to EM but did not match. Now I'm applying to GI fellowship 😀

 

[BoardingDoc]

Thank you all for the replies! I applied broadly to EM but did not match. Now I'm applying to GI fellowship 😀

Congratulations on your good fortune.

 

[wook]

Good luck! I hope you match where you would like to go!

 

[Amazingmuzmo]

Thank you all for the replies! I applied broadly to EM but did not match. Now I'm applying to GI fellowship 😀

Nice, good luck!

 

[solitarius]

Thank you all for the replies! I applied broadly to EM but did not match. Now I'm applying to GI fellowship 😀

The EM peeps saw through your rose-tinted glasses.

 

[Prehealth1011]

Thank you all for the replies! I applied broadly to EM but did not match. Now I'm applying to GI fellowship 😀

That’s one hell of a 0 to 100! Good luck