Are anesthesia residents too stressed out these days?

[Mman]

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Put a good applicant from today back into 1995 and they'd absolutely wreck the cohort from then.

Conversely take an applicant from 1995 and give them all kinds of specific prep for the MCAT and their application and they'd be an insanely awesome candidate today.

The world definitely seems dumber today compared to 30 years ago.

 

[circleK]

Tell that GI doc that their add-on EGD will have to go at the end of the OR add-on list and suddenly the case doesn’t really need to be done or they remember that they are allowed to do conscious sedation.

The newer docs don’t want to work for free and also want some work/life balance. I would argue this has helped us as employees now; the hospital havs to acquiesce to the demands somewhat or they won’t be able to fully staff. So I no longer have to work like a dog, sometimes for free, like the PP days.

 

[pgg]

Here is another unpopular opinion for all of you: Medicine is not for geniuses.
You don't need to be genius to be a good doctor, you just need to be hardworking, empathetic, dedicated, and resilient.
Geniuses should do things that require being a genius like designing the next CPU or the next spacecraft.
The problem is that this society has increasingly steered smart kids with high test scores to medicine because of the social glamour and the money. This is why we end up with these kids who are very smart but in general tend to be emotionally immature and think that medicine practice is about reading many books and having high scores. These kids are the ones who are shocked when they realize that it is more about working long hours, doing repetitive tasks that require little mental processing, and about dealing with human beings who don't always operate as a binary system where there are only two possible answers to all questions. They also cannot accept being underestimated and feel depressed if the world is not always the ideal place they need to thrive.

I hear you, but I see people doing "our job" who have less formal education and less clinical training, who on the whole would plot out on an intelligence bell curve that's somewhat left of the curve that doctors fall upon.

They're called CRNAs. It's not just classroom hours and clinical training that separate us. There's a measure of self-selection that led them down their path and is down ours.

No, of course you don't need to be Turing level genius to be a doctor. And 10 people will define "intelligence" 10 different ways. It's trendy to talk about emotional IQ these days, as a placeholding fancy word for what we used to call "being able to normally interact with other human beings" and I'll agree that the internet generation has new struggles there.

But there is a threshold level of ability to process, retain, and understand new information, to apply it to novel situations, that is essential to being a good doctor. Yeah this is factory work 95% of the time and a zero-thought recipe plus some motor memory will get you through them OK. (This is where most CRNAs function.)

The essence of being good at this job is being able to handle the outlier situations, or better yet anticipate and avoid them.

And I'm going to assert that MOST people in society aren't there, in a raw information processing and decision making sense, and couldn't do this. We take it for granted because we're all smart and we're surrounded by other smart people in this profession. But we're not normal and people who are left of us on that bell curve would struggle to get here and function well here.

Maybe that makes me a little narcissistic but it's my opinion.


Welcome back to the forum, BTW. 🙂

 

[aneftp]

Conversely take an applicant from 1995 and give them all kinds of specific prep for the MCAT and their application and they'd be an insanely awesome candidate today.

The world definitely seems dumber today compared to 30 years ago.

Correct. People think these nba players are “better today” than the great players of 30 years ago.

Different rules. Different methodology.

Image prime 24-27 year old playing in today’s nba touch fouls. Even if he couldn’t shoot free throws. He’s foul out all 3 undersized nba centers. The nba literally changed the zone defense to hurt Shaq.

Think of Michael Jordan deciding to shoot 3 pointers. He did make 8 in one half in an nba finals games. The one year they move the 3 point line closer. Jordan shot a lot more 3 points shots. Jordan would be great in 2025 as he was great in 1992.

That’s what these young students these days think. They think they are better. And the older folks can’t hang. They are wrong.

It’s all recency bias. That’s why the new ones these days would die if they did 120 hr icu weeks q2 and call their mommy or call HR they are being abused.

 

[pgg]

Correct. People think these nba players are “better today” than the great players of 30 years ago.

Oh my god I'm going to have to strenuously disagree with you there.

Today's top pro athletes are MASSIVELY better than they were 30 years ago. Stronger, faster. The training that starts in earnest in childhood now is worlds better. It's not even a contest.

The NBA is maybe a liiiitle bit of an outlier because the refs play such a huge part in the game. It's one reason I can't stand to watch the NBA.

Nobody could seriously think even the worst NFL team today couldn't run the table undefeated if transported back in time to the 70s. Have you watched some of those old games and old teams?

Look at Babe Ruth swing a bat at the anemic pitches being thrown and then watch him "run" the bases. Great for his time, sure.

 

[aneftp]

Oh my god I'm going to have to strenuously disagree with you there.

Today's top pro athletes are MASSIVELY better than they were 30 years ago. Stronger, faster. The training that starts in earnest in childhood now is worlds better. It's not even a contest.

The NBA is maybe a liiiitle bit of an outlier because the refs play such a huge part in the game. It's one reason I can't stand to watch the NBA.

Nobody could seriously think even the worst NFL team today couldn't run the table undefeated if transported back in time to the 70s. Have you watched some of those old games and old teams?

Look at Babe Ruth swing a bat at the anemic pitches being thrown and then watch him "run" the bases. Great for his time, sure.

1. MLB starting pitches don’t throw more than 6 innings these days. So they can afford to throw hard 100% of the time. No one throws 150 pitches a game like even curt schilling did for the Phillies in the 1993 World Series complete game. Complete games are being so rare in mlb these days.

2. Tennis balls and courts are slower. Yes training is way better than the past. But no way baseliners like nadal/novak and compete with Pete Sampras at Wimbledon.

3. NFL wide receivers definitely better than old receivers. But running backs suck these days. The game has changed. Wide receivers can’t get mugged at the line is scrimmage anymore. Quarterbacks can’t throw these quick de facto “handoffs short passes to wide receivers if they aren’t allowed to even get off the line of scrimmage getting mugged by the Lester Hayes

To answer your general statement. Yes. I agree todays modern athletes is “better” trained than yesterdays athletes. I won’t disagree.

But talent is talent. And Pete Sampras will still destroy nadal and Novak on grass 30 years ago using the same fast courts and lighter balls. Great players are great in any era.

It’s the border line good players/all stars where the real arguments starts. Someone like klay Thompson nba player. Excellent player before his injuries. Great shooter. No doubt about it. Is klay Thompson any better than their splash brother’s dad. Dell curry? Dell curry would be mutiple times nba all stars if he played in today’s nba rules. An incredible shooter in his era. And his son obviously is an all time great. I don’t know how his son would survive in late 1980s/1990s Detroit pistons bad boys mugging rules.

 

[NSB2288]

One of the hospitals I operate out of has a family medicine residency and an OB fellowship.

The fellows initially assisted in my c sections.

They were woefully unprepared. I would ask basic questions about the patient (things I had written in the H and P) that they had no idea. I wasn't even asking them to do my H and P, just review what I had written.

I'd pimp them on routine medications used for OB hemorrhage. Very basic stuff. Crickets...

Then they would have the gall to ask to do critical portions of the case. GTFO.

They then stopped assisting. Lol

One recently did several months later and fumbled. Couldn't tie a knot adequately without a huge air knot. Had to re do it.

Obviously was not practicing outside of the OR.

Good luck to the next generation

What hospital?

 

[Mman]

Today's top pro athletes are MASSIVELY better than they were 30 years ago. Stronger, faster. The training that starts in earnest in childhood now is worlds better. It's not even a contest.

they aren't better because of some inherent increase in talent. They are better because they have had access to superior training and nutrition and analytics. The talent level hasn't increased, just that modern methods are able to get them closer to their maximum potential.

 

[deleted87051]

Here is another unpopular opinion for all of you: Medicine is not for geniuses.
You don't need to be genius to be a good doctor, you just need to be hardworking, empathetic, dedicated, and resilient.
Geniuses should do things that require being a genius like designing the next CPU or the next spacecraft.
The problem is that this society has increasingly steered smart kids with high test scores to medicine because of the social glamour and the money. This is why we end up with these kids who are very smart but in general tend to be emotionally immature and think that medicine practice is about reading many books and having high scores. These kids are the ones who are shocked when they realize that it is more about working long hours, doing repetitive tasks that require little mental processing, and about dealing with human beings who don't always operate as a binary system where there are only two possible answers to all questions. They also cannot accept being underestimated and feel depressed if the world is not always the ideal place they need to thrive.

We have a wordle group with surgeons, nurses, and anesthesiologists. Some of the nurses are definitely better at wordle than some of the doctors. 😂

 

[sloh]

Correct. People think these nba players are “better today” than the great players of 30 years ago.

Different rules. Different methodology.

Image prime 24-27 year old playing in today’s nba touch fouls. Even if he couldn’t shoot free throws. He’s foul out all 3 undersized nba centers. The nba literally changed the zone defense to hurt Shaq.

Think of Michael Jordan deciding to shoot 3 pointers. He did make 8 in one half in an nba finals games. The one year they move the 3 point line closer. Jordan shot a lot more 3 points shots. Jordan would be great in 2025 as he was great in 1992.

That’s what these young students these days think. They think they are better. And the older folks can’t hang. They are wrong.

It’s all recency bias. That’s why the new ones these days would die if they did 120 hr icu weeks q2 and call their mommy or call HR they are being abused.

I don’t think you can really compare NBA players today to those in the past. It’s not really an apples to apples comparison bc the game itself has changed wrt heavy emphasis on 3’s. Even so, it can be argued in some ways the players today are better than the past.

“
In 1991, the year Michael Jordan won his first title with the Chicago Bulls, 3-pointers accounted for 8.2% of field-goal attempts leaguewide. By 2000, the year Kobe Bryant won his first with the Lakers, that number had grown to 16.7%.

But in the decade since Curry won his first championship, the numbers have soared. Teams understand the straightforward math—three points is worth more than two—and young players of every size began emulating the skinny point guard who was revolutionizing the game.

Though shots in the paint have occurred at largely the same rate, midrange jumpers stretched out past the arc. In 2015, 3-pointers made up 26.8% of shots. This season, that number has climbed to 42%, the highest mark in history.

“Steph changed what players looked at as possible,” said former Orlando Magic coach Stan Van Gundy, who now works as an analyst for TNT. “He changed what coaches considered good shots.”

During his time with the Magic in the 2000s and 2010s, Van Gundy stuffed the floor with shooters and instructed them to fire away far more than was common back then. “We were right near the top of the league in 3-pointers attempted,” he said. “Now, take those same numbers, we’d be at the bottom.”

Fans have taken to social media to gripe about what they see as the relentless pattern of today’s basketball. A 3 on one end and a 3 on the other, over and over again.”

 

[aneftp]

I don’t think you can really compare NBA players today to those in the past. It’s not really an apples to apples comparison bc the game itself has changed wrt heavy emphasis on 3’s. Even so, it can be argued in some ways the players today are better than the past.

“
In 1991, the year Michael Jordan won his first title with the Chicago Bulls, 3-pointers accounted for 8.2% of field-goal attempts leaguewide. By 2000, the year Kobe Bryant won his first with the Lakers, that number had grown to 16.7%.

But in the decade since Curry won his first championship, the numbers have soared. Teams understand the straightforward math—three points is worth more than two—and young players of every size began emulating the skinny point guard who was revolutionizing the game.

Though shots in the paint have occurred at largely the same rate, midrange jumpers stretched out past the arc. In 2015, 3-pointers made up 26.8% of shots. This season, that number has climbed to 42%, the highest mark in history.

“Steph changed what players looked at as possible,” said former Orlando Magic coach Stan Van Gundy, who now works as an analyst for TNT. “He changed what coaches considered good shots.”

During his time with the Magic in the 2000s and 2010s, Van Gundy stuffed the floor with shooters and instructed them to fire away far more than was common back then. “We were right near the top of the league in 3-pointers attempted,” he said. “Now, take those same numbers, we’d be at the bottom.”

Fans have taken to social media to gripe about what they see as the relentless pattern of today’s basketball. A 3 on one end and a 3 on the other, over and over again.”

But guess what happened in 2001. NBA changed the illegal defense rules.

It’s not just the 3 points is worth more than 2 points.

The loosening of the illegal defense devalued post plays as players can “hedge” in and “help” out post play. A Shaq dunk has. 99% probably of going in vs a Steph curry 3 point shot having a 40% chance of going in.

A dominant post player under old rules is highly efficient. Look at Charles Barkley. He’s the darling of nba analytics because he was so efficient drawing fouls plus his inside game got him easy points at a very high efficiency.

So

1. Hand checking ban
2. Loosening of illegal defense

Help contribute to today’s 3 point barrage.

A dominant center like Shaq would cause teams to commit two defenders to cover Shaq in the paint. None of this secondary defenders sneaking in to help out. Once a defender hedges in. They must commit to the double team or its illegal defense.

The nba changed that rule cause they didn’t want dominant post play.

 

[MirrorTodd]

Had newer attending refuse to do a GI case at a satellite hospital after 5pm. Like she just walked out and said she’s leaving because no elective cases after 5pm at satellite hospital. A 5 min egd

She’s employed by the hospital.

That attitude carries over from residency to attending.

lol meanwhile I just did a CABG POD4 ERCP GI add on yesterday. I mean I respect the hustle but I would've got that case done.

 

[rowsdower88]

1. MLB starting pitches don’t throw more than 6 innings these days. So they can afford to throw hard 100% of the time. No one throws 150 pitches a game like even curt schilling did for the Phillies in the 1993 World Series complete game. Complete games are being so rare in mlb these days.

There are other trends that complicate this picture. For example, the knuckleball has generally gone out of fashion which as a pitch reduced wear on pitchers arms significantly. If the knuckleball was fashionable (or if coaches/players were more confident in it?) maybe we would be seeing more complete games.

 

[pgg]

they aren't better because of some inherent increase in talent. They are better because they have had access to superior training and nutrition and analytics. The talent level hasn't increased, just that modern methods are able to get them closer to their maximum potential.

They're more talented too.

Talent isn't just an inborn "inherent" trait, it's developed and honed. And nothing squeezes the last bit of potential out of someone like a high level of competition and pressure.

Leagues are larger, benches are deeper. Raw talent may still wither in obscurity, but it's a lot more likely to be found and nurtured. The top 1% these days would wipe the floor of the top 1% of the 1970s. Any sport. No question.

Great athletes of 50-100 years ago did impressive things, and even more credit is due them because they did it essentially on their own. It's fun to think about how much better they could've been with modern nutrition, personal trainers, coaching, analytics, and the crucible of a much higher level of competition around them.


Seriously. Watch some video of the kind of pitchers who were lobbing balls toward Babe Ruth, and him swinging a bat and waddling around the bases. And tell me with a straight face that he'd make the roster of a current MLB team, much less be an all star.

 

[Mman]

Talent isn't just an inborn "inherent" trait

When I talk about talent, I'm solely talking about the inherent inborn skill. Not the development of that skill. Enhanced training has gotten athletes to perform at a higher level, but they are probably not any more talented than their predecessors.

1920s Babe Ruth would not play in MLB today. But Babe Ruth born 100 years later would absolutely be a star in MLB.

 

[ucladoc2b]

Not to mention international recruitment in all leagues (outside of the NFL).

 

[Account1]

They're more talented too.

Talent isn't just an inborn "inherent" trait, it's developed and honed. And nothing squeezes the last bit of potential out of someone like a high level of competition and pressure.

Leagues are larger, benches are deeper. Raw talent may still wither in obscurity, but it's a lot more likely to be found and nurtured. The top 1% these days would wipe the floor of the top 1% of the 1970s. Any sport. No question.

Great athletes of 50-100 years ago did impressive things, and even more credit is due them because they did it essentially on their own. It's fun to think about how much better they could've been with modern nutrition, personal trainers, coaching, analytics, and the crucible of a much higher level of competition around them.


Seriously. Watch some video of the kind of pitchers lobbying balls toward Babe Ruth, and him swinging a bat and waddling around the bases. And tell me with a straight face that he'd make the roster of a current MLB team, much less be an all star.

Nah, the movie Invincible or Rudy could totally happen today lol

 

[ace_inhibitor111]

My opinion is that back in the 80s and 90s, you were able to get real on-the-job experience earlier and with a lot less financial and time commitment. So you could start working, decide if being an XXX doctor was worth it for you, and safely switch/quit and do something else if not. Meanwhile, those who were able to cope with it continued, and there is survivorship bias in terms of the current older batch of doctors today.

Nowadays, if you decide in your 2nd year of residency you don't like it, tough luck. Your essentially forced to do something you don't want to do, and might not even be best suited for. Those who can't really take it try to force themselves anyway. Can you quit or change jobs? Not really, at least not in a way that would result in a happy ending. Loans have become insurmountable without a physician income, and current medicals students have already endured probably multiple years of applications, research years, gap years etc etc. Sometimes multiple match years even. So aside from the stress which was always there, you have more people who are on a path they can't really escape from.

 

[pgg]

When I talk about talent, I'm solely talking about the inherent inborn skill. Not the development of that skill. Enhanced training has gotten athletes to perform at a higher level, but they are probably not any more talented than their predecessors.

Agreed, for that definition of talent.

1920s Babe Ruth would not play in MLB today. But Babe Ruth born 100 years later would absolutely be a star in MLB.

Maybe ... assuming modern trainers could get him to lay off the booze and the calories. Even then. I think there's not enough appreciation of just how amazingly good even average pro players are today.

Lot of big-fish-small-pond going on back then. And baseball was a really, really small pond in his days. I mean, his career was over a solid decade before Jackie Robinson was allowed on the field.

 

[rowsdower88]

Maybe ... assuming modern trainers could get him to lay off the booze and the calories. Even then. I think there's not enough appreciation of just how amazingly good even average pro players are today.

The data on this is mixed according to this guy. Obesity in baseball has been increasing, and some players arguably play better when they're bigger. *

Heavy hitters: Obesity rate soars among professional baseball players | Penn State University

Major League Baseball players have become overwhelmingly overweight and obese during the last quarter century, say health researchers.

www.psu.edu

*Hard data is lacking, BMI is a terrible indicator, yada yada... but just look at some of these players. Some are ridiculously fat.

 

[deleted87051]

lol meanwhile I just did a CABG POD4 ERCP GI add on yesterday. I mean I respect the hustle but I would've got that case done.

At least he had the CABG first. Now that stone needs to come out stat!

 

[DoctwoB]

The data on this is mixed according to this guy. Obesity in baseball has been increasing, and some players arguably play better when they're bigger. *

Heavy hitters: Obesity rate soars among professional baseball players | Penn State University

Major League Baseball players have become overwhelmingly overweight and obese during the last quarter century, say health researchers.

www.psu.edu

*Hard data is lacking, BMI is a terribly indicator, yada yada... but just look at some of these players. Some are ridiculously fat.

As they say in powerlifting, "Mass moves mass."

There is a reason you don't see many shredded power-lifters, Olineman, Strongmen, sumo wrestlers, etc. It's not that fat is helpful. it's that mass if helpful and you can only put on so much muscle.

More mass = more leverage/momentum. This can apply to a baseball swing as well, though not quite as directly due to how much technique and speed is involved.

 

[anonperson]

What hospital?

Community hospital in Southern California

 

[Greenbayslacker]

All kids talk about these days mental health. They can’t handle real residency. Being yelled at. Criticized. It’s all part of the learning process. Now the residents may report the attendings to HR.

We need to send these kids to Alaska wildness for survival with just toilet paper and enough water supply just for 3 days. Toughness will teach them something’s.

And yeah. My kids can’t even handle Disney fort wildness fake camping. The campsite rental for the fake camps is like $200-250/night plus for xmas season plus the luxury rv rental is $350/night so $550/night with access to shower and usual Disney stuff like heated swimming pool. We ended up at four seasons hotel 2 miles away after 1 day cause they prefer luxury living at $700/night. That was a couple of years ago. Im sure those rooms are $1000/night with inflation now.

That’s how my kids will end up like these new generation residents (if one of them wants to go into medicine). The other one definitely doesn’t want medicine

This is more of a reflection on your own parenting than the kids themselves. Not sure why you’re stating it so “matter-of-fact” rather than doing some introspection

 

[Greenbayslacker]

Spoiler alert: There is no fuss. Precedex is probably the most pointless medication ever. The way people use it nowadays leads to tons of delayed emergences and pacu discharges. There is nothing that Precedex does that I can’t do better with propofol.

Couldn’t have said it better myself. Would love to show this to our SRNAs using Precedex on every case

 

[aneftp]

This is more of a reflection on your own parenting than the kids themselves. Not sure why you’re stating it so “matter-of-fact” rather than doing some introspection

Because I’m with other parents from difference schools across different counties. It’s not just my own observation. These are very similar traits. Not just my own parenting skills. Others parenting skills as well.

Thus the reason for the post about residents these days not being able to toughen it out.

 

[pgg]

Because I’m with other parents from difference schools across different counties. It’s not just my own observation. These are very similar traits. Not just my own parenting skills. Others parenting skills as well.

Thus the reason for the post about residents these days not being able to toughen it out.

And yeah. My kids can’t even handle Disney fort wildness fake camping. The campsite rental for the fake camps is like $200-250/night plus for xmas season plus the luxury rv rental is $350/night so $550/night with access to shower and usual Disney stuff like heated swimming pool. We ended up at four seasons hotel 2 miles away after 1 day cause they prefer luxury living at $700/night. That was a couple of years ago. Im sure those rooms are $1000/night with inflation now.

So you vote for economic and political chaos in the hopes that it will inflict pain on people in order to toughen them up.

And when your kids whined after a single day of fake camping at Disney you immediately caved and took them to a $700/night hotel.

 

[deleted87051]

All kids talk about these days mental health. They can’t handle real residency. Being yelled at. Criticized. It’s all part of the learning process. Now the residents may report the attendings to HR.

We need to send these kids to Alaska wildness for survival with just toilet paper and enough water supply just for 3 days. Toughness will teach them something’s.

And yeah. My kids can’t even handle Disney fort wildness fake camping. The campsite rental for the fake camps is like $200-250/night plus for xmas season plus the luxury rv rental is $350/night so $550/night with access to shower and usual Disney stuff like heated swimming pool. We ended up at four seasons hotel 2 miles away after 1 day cause they prefer luxury living at $700/night. That was a couple of years ago. Im sure those rooms are $1000/night with inflation now.

That’s how my kids will end up like these new generation residents (if one of them wants to go into medicine). The other one definitely doesn’t want medicine

I don’t even know what a $700/night hotel looks like from the inside. My gen z daughter and I have camped overnight at Trail Camp on Whitney even though neither of us are big campers. Just a memorable and uncomfortable bonding experience. In my native language there’s a saying that parents say to their kids all the time, it roughly translates to “bear with it”. We talk about our mental health too.

 

[aneftp]

So you vote for economic and political chaos in the hopes that it will inflict pain on people in order to toughen them up.

And when your kids whined after a single day of fake camping at Disney you immediately caved and took them to a $700/night hotel.

Yes! My kids are like these new residents. Completely out of touch with reality! My son just asked me what we are gonna to do in New York besides watch the us open tennis this weekend. I’m like wtf. Do I know how lucky you get to attend this tournament and I’m not in the nose bleed seats either.

I don’t even know what a $700/night hotel looks like from the inside. My gen z daughter and I have camped overnight at Trail Camp on Whitney even though neither of us are big campers. Just a memorable and uncomfortable bonding experience. In my native language there’s a saying that parents say to their kids all the time, it roughly translates to “bear with it”. We talk about our mental health too.

$700/night 5 years ago is like $1000/night these days. It varies. It’s nothing in nyc in terms of hotel costs. But a lot of money to spend in Florida for a hotel.

 

[Drwine]

Spoiler alert: There is no fuss. Precedex is probably the most pointless medication ever. The way people use it nowadays leads to tons of delayed emergences and pacu discharges. There is nothing that Precedex does that I can’t do better with propofol.

I agree that residents who are members of what I describe flippantly as the "Jackson Pollock Club" and have the goal of giving some of everything in the drug tray use it unnecessarily. However, I challenge you to use propofol better on a 95-year-old with a 0.4 cm2 aortic valve area and a low EF. We have a very busy structural heart service where at least a couple of days each week have 7 TAVR cases. Precedex and remifentanil have evolved to our drugs of choice in that circumstance.

We also evolved to using it instead of propofol for sedation post-open heart surgery. There is mounting evidence that Precedex protects the kidneys and does what we hoped and gave up on renal dose dopamine and fenoldopam years ago.

My threshold to micromanage residents is very high, and I am currently telling them they aren't allowed to turn on nitrous to turn down sevo as part of waking a patient up. There is no need for 1 MAC to close the skin in a patient who has a block or the surgeon has put local.

 

[sloh]

I don’t even know what a $700/night hotel looks like from the inside. My gen z daughter and I have camped overnight at Trail Camp on Whitney even though neither of us are big campers. Just a memorable and uncomfortable bonding experience. In my native language there’s a saying that parents say to their kids all the time, it roughly translates to “bear with it”. We talk about our mental health too.

Rěnnài chīkǔ

 

[sloh]

Because I’m with other parents from difference schools across different counties. It’s not just my own observation. These are very similar traits. Not just my own parenting skills. Others parenting skills as well.

Thus the reason for the post about residents these days not being able to toughen it out.

The generational peer effect is really powerful and trumps the influence parents can have on their kids, unless you’re willing to markedly restrict their social media use and who they hang out with. When all their aged matched peers online and in person keep talking about mental health and microaggressions, resilience will not be top priority.

 

[anonperson]

The generational peer effect is really powerful and trumps the influence parents can have on their kids, unless you’re willing to markedly restrict their social media use and who they hang out with. When all their aged matched peers online and in person keep talking about mental health and microaggressions, resilience will not be top priority.

Kids are huge wieners nowadays.

I was a crybaby and overly sensitive as a kid. But today's kids, mine included, blow me out of the water.

It's a mix of messaging from the public, changing parenting techniques ( which I am guilty of but trying to change) , and general influence from peers.

I know a lot of parents my age ( 40s) who really coddle their kids etc. It's eye opening.

 

[VA Hopeful Dr]

Kids are huge wieners nowadays.

I was a crybaby and overly sensitive as a kid. But today's kids, mine included, blow me out of the water.

It's a mix of messaging from the public, changing parenting techniques ( which I am guilty of but trying to change) , and general influence from peers.

I know a lot of parents my age ( 40s) who really coddle their kids etc. It's eye opening.

Have your kids join Scouts. Sleeping in a tent in the outdoors does wonders.

 

[2buckchuck]

I never know what to think of this attitude. As I get older I do have moments where I want to shake my fist at the youngsters. But older generations have felt that way about younger generations for centuries. And each time the older generation acknowledges that, they also couch it with “but, like, it’s never been THIS bad”.

 

[anonperson]

Have your kids join Scouts. Sleeping in a tent in the outdoors does wonders.

Yeah. Son is in scouts as of last year.

Put both kids in boxing lessons. Learning some conditioning, how to throw a punch etc. Just told the instructor I don't want them getting hit to save their brain cells.

 

[narcusprince]

Yeah. Son is in scouts as of last year.

Put both kids in boxing lessons. Learning some conditioning, how to throw a punch etc. Just told the instructor I don't want them getting hit to save their brain cells.

Learn to hit, and learn how not to be hit. Valuable life lessons….

 

[VA Hopeful Dr]

Yeah. Son is in scouts as of last year.

Put both kids in boxing lessons. Learning some conditioning, how to throw a punch etc. Just told the instructor I don't want them getting hit to save their brain cells.

Put your daughter in too. One of mine is and loves it.

Also take her deer hunting, but that's a whole other thing.

 

[anonperson]

Put your daughter in too. One of mine is and loves it.

Also take her deer hunting, but that's a whole other thing.

Yeah. Daughter is in it along with son. She is older and I was doing focus mits with her. She hit surprisingly hard. I was pleased.

 

[deleted643396]

I agree that residents who are members of what I describe flippantly as the "Jackson Pollock Club" and have the goal of giving some of everything in the drug tray use it unnecessarily. However, I challenge you to use propofol better on a 95-year-old with a 0.4 cm2 aortic valve area and a low EF. We have a very busy structural heart service where at least a couple of days each week have 7 TAVR cases. Precedex and remifentanil have evolved to our drugs of choice in that circumstance.

We also evolved to using it instead of propofol for sedation post-open heart surgery. There is mounting evidence that Precedex protects the kidneys and does what we hoped and gave up on renal dose dopamine and fenoldopam years ago.

My threshold to micromanage residents is very high, and I am currently telling them they aren't allowed to turn on nitrous to turn down sevo as part of waking a patient up. There is no need for 1 MAC to close the skin in a patient who has a block or the surgeon has put local.

Sure, Precedex has uses in the ICU setting and certain niche uses in anesthesia. I admittedly use it in similar scenarios (basically in scenarios where you don’t really want to anesthetize the patient but pretend that you are…anxiolytic mild sedation type scenarios). Your 95yo would probably be just as adequately anesthetized with some IV acetaminophen and some gentle reminders to hold still. If you want your patient to be still during the TAVRs then the remi is probably doing the heavy lifting there. 5-10 years ago the cases that I am doing with Precedex now, I was doing just as safely with propofol (or versed/fentanyl).

So, I will concede that Precedex has these niche uses, but even if the hospital banned the drug tomorrow, I would be perfectly fine living without it. I was more responding to this new fangled kitchen sink approach to anesthesia where Precedex is being used as a crutch for inadequate opioid or inability to properly time an emergence. For a regular, run o’ the mill anesthetic on an ambulatory type patient, I can’t think of a single reason why Precedex has to be added to the anesthetic plan. It seems we agree there.

 

[VA Hopeful Dr]

Yeah. Daughter is in it along with son. She is older and I was doing focus mits with her. She hit surprisingly hard. I was pleased.

I meant Scouts since it allows girls now, but that's cool too.

 

[GassYous]

Have your kids join Scouts. Sleeping in a tent in the outdoors does wonders.

Until you pull them out an hour in and take them to a 700/night hotel

 

[Ashers]

Until you pull them out an hour in and take them to a 700/night hotel

That's like "Troop Beverly Hills" from 1990!

 

[arkgal]

The problem here is that as humans outsource cognitive tasks to AI, we start to lose those cognitive skills. I was thinking about this the other day because I am heavily reliant on GPS to navigate even in areas that I have familiarity. When I was in college, I didn’t have GPS and I could navigate the most congested of our eastern cities just by mental maps and a vague sense of direction. I have almost completely lost that ability nowadays.

I actually think the above concept is partially responsible for the concern outlined in the OP. As humans spend more time online, we are losing our skills required to process our emotions and present them in healthy ways.

That's so true. My 11 y/o was selling Scouts popcorn in front of a Walmart. He told me to look up a sales pitch on GPT. I lol'd and told him that he has everything inside his brain that he needed to sell.

 

[Lab Lover]

That's so true. My 11 y/o was selling Scouts popcorn in front of a Walmart. He told me to look up a sales pitch on GPT. I lol'd and told him that he has everything inside his brain that he needed to sell.

Not sure that this is the best approach... Some jobs will be lost to "AI" I suspect that more jobs will be lost to people who can use AI as opposed to those who can't. Would you find it less distasteful if your son asked "Mom, what do you think that I should do to be a better salesperson?"

Is it really all that different for his development?

 

[CopaceticOne]

As this is somewhat relevant to the discussion topic, on a personal note, the world isn't over for transgender people.

From court filing for my gender marker change to judge signing it took 3 days. The longest part was submission to the Vital Records attorney for approval to change my birth certificate. She actually approved it later the same day, but I had to wait until I had the time off to go back to get my new birth certificate
. I just did that 2 hours ago. In the last 2 hours, I walked out with a new birth certificate and driver's license with female gender markers in hand. The whole process took 2 weeks to complete. From surgery that I had August 2 to now, one and a half months. This in a red state. The lady at the DMV was asking me questions because her young cousin wants to transition. Set aside the political rhetoric, not much has changed. It would be nice if they went back to changing the law so you could change your marker without surgery, but that's Gov. Sanders for you. People are still going to transition. It's not something you can stop.

What does this have to do with anesthesia residents being stressed out?

 

[arkgal]

Not sure that this is the best approach... Some jobs will be lost to "AI" I suspect that more jobs will be lost to people who can use AI as opposed to those who can't. Would you find it less distasteful if your son asked "Mom, what do you think that I should do to be a better salesperson?"

Is it really all that different for his development?

I think the question came from lack of confidence. I think having a conversation with him about selling and then him going out and doing it on his own, was a good learning experience for him. Much preferable to him not using his brain and relying on a GPT suggestion, IMO

 

[arkgal]

What does this have to do with anesthesia residents being stressed out?

I'm in the wrong thread LOL

 

[pastafan]

Boomer here. Reading this thread of folks whining about stress and how difficult residency programs are is laughable. These were the pre Libby Zion, no limit to working hours. Base year IM internship was 120 hour weeks with q 4 call that got down to 90 hour weeks by the Spring as you got more efficient. No days off after 24 hour call during residency. Yup, we walked 3 miles through the snow to get to the hospital lol. Fortunately, no CRNA's anywhere so the experience gained was great. The motto among residents was that there were two things they had for us during residency, hard dick and bubblegum and they were fresh out of bubblegum.

We knew that we were the cheapest piece of equipment in the OR. I was making $24,000 my internship year in a high COL state. Now as was true then, you enter residency with an economic value that will be exponentially increased after you complete your training. Were the hours worked and demands made upon us crazy? They were but we survived, could handle the stress and thrived in private practice.

The 99% boredom, 1% sheer terror is real. Patients survived because I could handle the stress of the 1%. If they can't handle stress, perhaps this is the wrong field for them. End of rant.

BTW, a 1% story. Patient being induced for true cut breathing biopsy. As I'm inducing the surgeon is prepping the chest. I go to intubate the patient and I see blood welling up from the trachea. Puzzled, I tell the surgeon, looking down my laryngoscope, that I'm seeing blood here. He says that he may have hit something. I look up and he had started the biopsy and put the true cut through the pulmonary vein. I call out to him and the nurses that he will need to crack her chest now. I can't see anything as her mouth is filled with blood. She is exsanguinating. We turn her on her left side as the nurses rush to get instruments. I managed to intubate her as blood empties out of her airway onto the table and isolate her left lung. He actually happened to be a good surgeon, got her chest opened quickly, performed Pringle maneuver and she survived.

 

[Maz777]

Boomer here. Reading this thread of folks whining about stress and how difficult residency programs are is laughable. These were the pre Libby Zion, no limit to working hours. Base year IM internship was 120 hour weeks with q 4 call that got down to 90 hour weeks by the Spring as you got more efficient. No days off after 24 hour call during residency. Yup, we walked 3 miles through the snow to get to the hospital lol. Fortunately, no CRNA's anywhere so the experience gained was great. The motto among residents was that there were two things they had for us during residency, hard dick and bubblegum and they were fresh out of bubblegum.

We knew that we were the cheapest piece of equipment in the OR. I was making $24,000 my internship year in a high COL state. Now as was true then, you enter residency with an economic value that will be exponentially increased after you complete your training. Were the hours worked and demands made upon us crazy? They were but we survived, could handle the stress and thrived in private practice.

The 99% boredom, 1% sheer terror is real. Patients survived because I could handle the stress of the 1%. If they can't handle stress, perhaps this is the wrong field for them. End of rant.

BTW, a 1% story. Patient being induced for true cut breathing biopsy. As I'm inducing the surgeon is prepping the chest. I go to intubate the patient and I see blood welling up from the trachea. Puzzled, I tell the surgeon, looking down my laryngoscope, that I'm seeing blood here. He says that he may have hit something. I look up and he had started the biopsy and put the true cut through the pulmonary vein. I call out to him and the nurses that he will need to crack her chest now. I can't see anything as her mouth is filled with blood. She is exsanguinating. We turn her on her left side as the nurses rush to get instruments. I managed to intubate her as blood empties out of her airway onto the table and isolate her left lung. He actually happened to be a good surgeon, got her chest opened quickly, performed Pringle maneuver and she survived.

Your story is interesting. I once noticed a Urology PA starting to place a Foley before I had intubated once. I made her leave the room. Her response was "Well, everyone else lets me do it." I can't imagine prepping and starting the surgical procedure before I had induced. I wish more anesthesiologists were complete a**holes like myself.