God, ORTHO...

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prettypea

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Just.... yeah. 👎
 
why? u don't have to be an orthopedist to take in some of their knowledge for other specialties....primary care, er, trauma, etc. i think its fun🙂
 
What's wrong with Ortho?

They don't think. They're paid for their procedures, don't care much about documentation...I mean have you read a Ortho's H&P, if you can call it that. I just don't understand while all docs, regardless of being a surgeon or not, aren't all held to the same standard of patient care.
 
They don't think. They're paid for their procedures, don't care much about documentation...I mean have you read a Ortho's H&P, if you can call it that. I just don't understand while all docs, regardless of being a surgeon or not, aren't all held to the same standard of patient care.
case-of-the-mondays.jpg
 
They're paid for their procedures, don't care much about documentation...I mean have you read a Ortho's H&P, if you can call it that.
Uh, they're surgeons... they get paid to do procedures.

Only in Medicine do you see huge, long notes. Surgeons keep it simple and to the point.
 
They don't think. They're paid for their procedures, don't care much about documentation...I mean have you read a Ortho's H&P, if you can call it that. I just don't understand while all docs, regardless of being a surgeon or not, aren't all held to the same standard of patient care.



Can anyone find the IM cantidate?
 
They don't think. They're paid for their procedures, don't care much about documentation...I mean have you read a Ortho's H&P, if you can call it that. I just don't understand while all docs, regardless of being a surgeon or not, aren't all held to the same standard of patient care.

Really? IMHO, most surgeons' H&Ps (regardless of G Surg vs. Ortho vs. ENT vs. GU vs. NSGY, etc.) are as complete as they need to be.

I mean, we won't document the fundoscopic or deep tendon reflex exam or anything...but everything that's pertinent is in there.

Plus we don't take an hour (or more! 😱 ) to write them. 🙂
 
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Really? IMHO, most surgeons' H&Ps (regardless of G Surg vs. Ortho vs. ENT vs. GU vs. NSGY, etc.) are as complete as they need to be.

I mean, we won't document the fundoscopic or deep tendon reflex exam or anything...but everything that's pertinent is in there.

Plus we don't take an hour (or more! 😱 ) to write them. 🙂

Maybe it's just our program. I'm not trying to jump anyone here, just think that the guys I've interacted with feel like after they're prelim year of general surgery they hang up the stethoscopes, forget how to document basic things and also somehow forget how to manage diabetes or HTN. I just think the other specialties cater to them and I don't totally understand it. Yes, I know they are surgeons and that's what they're paid to do...that doesn't mean they don't have to write complete H&P's or actually communicate plans in their notes. Hey, it is what it is...I know it's not like this everywhere, just seems to be a trend with Ortho docs.
 
Maybe it's just our program. I'm not trying to jump anyone here, just think that the guys I've interacted with feel like after they're prelim year of general surgery they hang up the stethoscopes, forget how to document basic things and also somehow forget how to manage diabetes or HTN.

Ortho hasn't done prelim surgery for internship in several years, our internships are now categorical.
 
Ortho hasn't done prelim surgery for internship in several years, our internships are now categorical.

Well I guess technically it's not prelim surgery, but they work the entire year under the general surgery department right? That's what ours do at least. They spend first year as general surgery residents and start PGY-2 as Ortho
 
haha, one of our clinical practicum professors made fun of orthopod's H&p's. He wrote:

B B M F


X



Translation: Bone broke, Me fixed. The X is the sig.
 
The thing about the ortho guys (they are all dudes) at my school is that they actually pride themselves on their lack of non-ortho related medical knowledge. I've probably interacted with 50% of the residents and virtually every time EKGs are mentioned they make jokes about how they are meaningless or "they're no bones on that there paper" or something else. This specific example is ridiculous b/c anyone doing surgery or trauma should really know how to read an EKG. They are pretty much the same when talking about stethoscopes or the whole field of psychiatry (when actually the apprehension test is based on conditioning - but oh well) and other stuff as well. I think what orthopedic surgeons do is very interesting, it just seems that a lot of the guys in our program are total a--holes who don't really care about patient care. I don't know if this is the norm, but I hope not.
 
The thing about the ortho guys (they are all dudes) at my school is that they actually pride themselves on their lack of non-ortho related medical knowledge. I've probably interacted with 50% of the residents and virtually every time EKGs are mentioned they make jokes about how they are meaningless or "they're no bones on that there paper" or something else. This specific example is ridiculous b/c anyone doing surgery or trauma should really know how to read an EKG.

Not to worry - since Dr. Dubin was gracious enough to write an EKG interpretation book at the level even an orthopod could understand, they have nothing to worry about.

In a completely unrelated digression, exactly how do Pediatricians hear murmurs in hearts that are scooting along like a drumroll in an 80s hair band hit?
 
The thing about the ortho guys (they are all dudes) at my school is that they actually pride themselves on their lack of non-ortho related medical knowledge. I've probably interacted with 50% of the residents and virtually every time EKGs are mentioned they make jokes about how they are meaningless or "they're no bones on that there paper" or something else. This specific example is ridiculous b/c anyone doing surgery or trauma should really know how to read an EKG. They are pretty much the same when talking about stethoscopes or the whole field of psychiatry (when actually the apprehension test is based on conditioning - but oh well) and other stuff as well.

Isn't this true of any other doctor who is in a very specialized field? I've heard people in ophtho, neuro, neurosurg, psych, path, and anesthesia make similar comments about equally basic medical conditions (diabetes, HTN, etc.)
 
Isn't this true of any other doctor who is in a very specialized field? I've heard people in ophtho, neuro, neurosurg, psych, path, and anesthesia make similar comments about equally basic medical conditions (diabetes, HTN, etc.)

Actually, I think an anesthesiologist would be very concerned with diabetes or HTN. Often, an anesthesiologist wants to make sure that, in a patient with HTN, blood pressure is well-controlled prior to the patient undergoing surgery. Also, many times in a diabetic patient, an anesthesiologist may have to manage blood sugars intraoperatively. They may order a specific insulin regimen while the patient is undergoing surgery.
 
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Well I guess technically it's not prelim surgery, but they work the entire year under the general surgery department right? That's what ours do at least. They spend first year as general surgery residents and start PGY-2 as Ortho

Never heard of such a thing. Even General Surgery interns don't do the majority of their time on the Gen Surg service, so I'd be amazed if Ortho interns spent a year on Gen Surg rotations.

I do:
Ortho (3 months)
Trauma (1 month)
Ped Surg (1 month)
Internal Medicine (1 month)
ER (1 month)
Plastics (1 month)
Vascular (1 month)
ICU (1 month)
Anesthesia (1 month)
Radiology (1 month)
 
Isn't this true of any other doctor who is in a very specialized field? I've heard people in ophtho, neuro, neurosurg, psych, path, and anesthesia make similar comments about equally basic medical conditions (diabetes, HTN, etc.)

Absolutely. If you consider how little of the med school curriculum covers ortho, an actually pay attention during your ortho rotation, you will see how much more orthopods know about things we've never heard of. The orthos I worked with know how to manage basic stuff and many conduct sophisticated research. Hardly cavemen.

It's just ridiculous how those pursuing one of the most educated career paths in the world can be so infantile as to put down other specialties. We all are good at our own thing, whether it be a particular organ system or "jack of all trades" knowledge, and that should be enough.
 
Ortho is one of the more competitive specialties...much more so than IM or FM. It's folly to think that orthopods aren't capable of handling or are somehow too stupid to handle basic medicine problems.

The next time you IM-type folks get a consult from ortho to handle a creatinine of 1.7 or a blood pressure of 150/90 and you think "what a bunch of meatheads", just consider who is getting the best of whom.
 
Ortho is one of the more competitive specialties...much more so than IM or FM. It's folly to think that orthopods aren't capable of handling or are somehow too stupid to handle basic medicine problems.

The next time you IM-type folks get a consult from ortho to handle a creatinine of 1.7 or a blood pressure of 150/90 and you think "what a bunch of meatheads", just consider who is getting the best of whom.

weird statement. Kind of like saying, "next time you consult ortho for some joint issue and they're thinking what a bunch of a--holes, consider who is getting the best of whom." IM people love creatinine bumps and peri-operative HTN, just like ortho folks liking bones and joints. I guess I don't see how IM people are getting taken advantage of.

Of course orthopedic surgeons can do well - the interesting thing was how they often (clearly not always, there are some pretty solid guys/gals out there I'm sure) choose to disregard the rest of medicine. Apparently, per previous poster, that is what specialized physicians do. Maybe medicine is too complex these days to expect people to manage problems that used to be second nature.
 
weird statement.

Please to explain...

All of my IM buddies whine and complain when ortho (or surgery, or urology, or psychiatry, or even family medicine) consults them for a bump in creatinine, a borderline high blood pressure, or which ABX to choose for a simple infection.

They're complaining because these are pretty weak consults. These problems are either very basic or the right answer is simple to find without a consult. (Notice that this theory falls apart in the face of legitimate medical issues)

Yet, the IM folks never tell them to take their consult and shove it. Why? Because they believe that the orthopods are honestly not capable of handling the situation, and unless the internists come in to save the day the patient could suffer.

In reality, I think the orthopod is playing dumb. He/she doesn't want to deal with this medicine crap. After all, they didn't go into IM for a reason, and this stuff takes away from OR time.

So, I always find it kind of amusing when people make fun of orthopods for being dumb since they're the ones getting other people to do their scut work.
 
Please to explain...

All of my IM buddies whine and complain when ortho (or surgery, or urology, or psychiatry, or even family medicine) consults them for a bump in creatinine, a borderline high blood pressure, or which ABX to choose for a simple infection.

They're complaining because these are pretty weak consults. These problems are either very basic or the right answer is simple to find without a consult. (Notice that this theory falls apart in the face of legitimate medical issues)

Yet, the IM folks never tell them to take their consult and shove it. Why? Because they believe that the orthopods are honestly not capable of handling the situation, and unless the internists come in to save the day the patient could suffer.

In reality, I think the orthopod is playing dumb. He/she doesn't want to deal with this medicine crap. After all, they didn't go into IM for a reason, and this stuff takes away from OR time.

So, I always find it kind of amusing when people make fun of orthopods for being dumb since they're the ones getting other people to do their scut work.

I've also had it explained to me that sure they could prescribe meds for elevated BP or other problems, but IF something should go wrong, and if the patient or family would decide to sue and then the chart was gone over thoroughly, and if it was found that the orthopod managed the medical issues instead of the internist, that could be a point for a lawyer to grab, even if the orthopod would've done the exact same thing as the internist.
 
I've also had it explained to me that sure they could prescribe meds for elevated BP or other problems, but IF something should go wrong, and if the patient or family would decide to sue and then the chart was gone over thoroughly, and if it was found that the orthopod managed the medical issues instead of the internist, that could be a point for a lawyer to grab, even if the orthopod would've done the exact same thing as the internist.

I call BS on this.

It's one thing to get in over your head, but I've already stipulated that my point falls apart in the face of serious conditions that require sub-specialty care.

Does diabetes only get treated by endocrinologists? Does hypertension only get treated by cardiologists?

What about family doctors that take care pediatric or OB patients? Or OB/GYNs that serve as primary care physicians? Or the general surgeon that does a varicose vein surgery?

The point is, for pretty much every condition there is probably a specialty or sub-specialty that is better prepared to treat that condition. But when little Johnny gets his hand caught in the car door, he can't always be treated by a pediatriac hand surgeon. Most likely, he'll have to "settle" for a general orthopaedist.

Similarly, if you're admitted to an ortho service, there are certain baseline problems that can and should be handled. The system is designed around this concept - e.g. the same medical school training, the same licensure requirements, almost everyone (save pathologists) having to at least complete an internship.

To win in a lawsuit, you have to demonstrate that the standard of care was not met - not that the best care available wasn't met.
 
IM doesn't like seeing "weak" consults? So what, go eat a ****. The guy in the ER with the Weber B didn't need me and my R2 to see him, look at the films, order a splint, and tell him to followup in clinic. The IM clinic didn't need me to look at the cellulitis on their patient's knee and say, "Yup, it's cellulitis, start antibiotics."

We get called for all cellulitis or abscesses over joints, to rule out septic joints. Wow, IM can't say, "Hey, he can bend that knee without pain, so it's not septic!" We get called for sprains, simple fractures, and "rule out muscle tear". In one week I saw four patients from the IM clinic, all with consults that said "rule out labral tear" and all were trochanteric bursitis. IM can't tell the difference between hip joint pain (groin) and bursitis (greater troch)?

We all complain about the consults we think are dumb. The point is, just shut up and do your job. IM wants to complain, go ahead and complain. Just don't do it to me on the phone, because I don't really care how you feel, I just want you to see the f-ing patient.
 
I agree with Tired. It annoys me when generalists think that every doctor should know what they know. I don't know much about orthopedic surgery, but I'd imagine that it's a challenging specialty like all others and requires years of specialized dedication to the field. The fact of the matter is that an orthopod's time is best used becoming a better orthopod, not brushing up on general medicine.

The janitor can bust out harrison's and start learning to manage diabetes too, but I don't expect her to because it's not her damn job! In fact, I demand that orthopods completely neglect diabetes because my knees are starting to ache after long runs, and I want my future joint replacements done right!
 
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There are two issues here that are completely separate. The first is whether or not Orthopods know medical care. Or, more precisely, do they need to? Because I don't care if an Orthopod knows how to write an H&P. They're there to deal with orthopedic issues, not anything else. If you expect an orthopod to be dealing with an MI or an obstructing bowel carcinoma, your patient will likely die and it won't be because of Ortho. And it won't be Ortho that is being stupid.

HOWEVER, the problem comes into play that everyone knows Ortho does their thing and then immediately throws the person onto another service (usually either IM or General Surgery). This could be even if the patient is ONLY hospitalized for an orthopedic procedure. It is this behavior that everyone finds distasteful (including me) because they're like "this controlled HTN scares me! I have bad dreams at night about it!!" And next thing you know, you have an Ortho patient on your service and they come by and tell you to arrange social work for their 80 y/o hip replacement and PT and then sign off. It's total B.S.

One thing you have to understand is that Ortho has a LOT of patients. It's ridiculous how crammed their clinics are. And at least in residency, they are VERY busy. On the other hand, you can (and I do) argue that's their problem because it's still their patient.

And the thing is, everyone rags on Ortho when a lot of subspecialty surgery is like that. ENT loves to do radical necks and then throw them into the SICU on Fridays for General Surgey to take care of. Then, on Monday, they discharge the patient. Essentially, they didn't have to take care of the patient at all post-op.

All I know is that this is residency. When I'm done training, I'm going somewhere where I take care of my patients, other people can eff off, and I don't need to deal with this B.S. Maybe that's going to be in the middle of Montana. I don't know.
 
One thing you have to understand is that Ortho has a LOT of patients. It's ridiculous how crammed their clinics are. And at least in residency, they are VERY busy. On the other hand, you can (and I do) argue that's their problem because it's still their patient.

And the thing is, everyone rags on Ortho when a lot of subspecialty surgery is like that. ENT loves to do radical necks and then throw them into the SICU on Fridays for General Surgey to take care of. Then, on Monday, they discharge the patient. Essentially, they didn't have to take care of the patient at all post-op.

I'm going to jump in here for a second and defend my Ortho brethren...

Now while G Surg and Ortho sometimes have a difficult, tense relationship (especially during trauma cases, when neither service wants the patient with an isolated extremity fracture, +/- other issues), I've worked closely with the many of the Ortho residents throughout residency. We see them all the time on Trauma, Peds Surg, Plastics, SICU, etc. As an intern I also did an Ortho month. And let me tell you, they are BUSY. They operate a ton, often late into the night. They get consulted for almost every patient in the ER who's fallen, sprained/strained something, or tripped - not to mention the actual traumas. Many ortho procedures actually have a relatively small window for taking the patient to the OR, so they can easily get slammed. And their services tend to be HUGE - true, you may argue that a tib-fib is a tib-fib, or a distal radius is a distal radius - but each patient comes with his/her own comorbidities that have to be managed.

So give them a break. You know the orthopods are all damn smart because they matched into Ortho! Sometimes if they ask for help with HTN/DM/AFib/infection/whatever it's because they need help - as we all do sometimes. Of course we all learned the same material in med school.

But hell, IM often consults ID for ABX choice, or Cards for AFib, etc. - and these guys all did the exact same residency!

Edit: BTW, yes, General Surgery is often the dumping ground for all surgical patients. Kind of like how the General Medicine/Hospitalist service is for medicine patients.
 
They get consulted for almost every patient in the ER who's fallen, sprained/strained something, or tripped - not to mention the actual traumas.
I know, I feel for the guys, but let's put it all in persepective. We all get consulted by those lose -- uh, I mean, our "special" colleagues in that manner. Medicine has to clear chest pain, Surgery has to clear abdominal pain, Surgery and its subspecialties have to clear minor traumas, etc, etc. Everyone knows the torture of the ER.

You know the orthopods are all damn smart because they matched into Ortho!

I know the orthopods know their field inside and out. But the Match is B.S. All it proves is that people can cram a certain amount of trivia into their skulls for two days and then release it. I mean, Dematologists by that standard would be the smartest people you've ever met, but I'm pretty sure that if you talk to a Dermatologist five years after medical school you'll think you're talking to the Avon sales lady, not someone who completely hammered you on Step 1-2 like a rusty nail.
 
They get consulted for almost every patient in the ER who's fallen, sprained/strained something, or tripped - not to mention the actual traumas.

Surely you exaggerate, or have never actually rotated in the ED. I have a really hard time imagining Emory's EM program doing that. The residents/attendings are known for being quite strong. 👎
 
Surely you exaggerate, or have never actually rotated in the ED. I have a really hard time imagining Emory's EM program doing that. The residents/attendings are known for being quite strong. 👎

Uh, no. I did a month of ER as an intern, in August 2005.

I may be exaggerating 2%...but that's it.

Hell, I used to get consulted for "trauma" in the VA ER (which doesn't have trauma). Trips and ground-level falls, 1-cm lacerations on the hand/forearm, etc. Pain.

The ER residents I've worked with (they rotate with us on our Trauma and SICU services) have been pretty strong, for the most part. Of course there are always exceptions.
 
Uh, no. I did a month of ER as an intern, in August 2005.

I may be exaggerating 2%...but that's it.

Hell, I used to get consulted for "trauma" in the VA ER (which doesn't have trauma). Trips and ground-level falls, 1-cm lacerations on the hand/forearm, etc. Pain.

The ER residents I've worked with (they rotate with us on our Trauma and SICU services) have been pretty strong, for the most part. Of course there are always exceptions.

So are these "cover my a$$ consults?" Why would they consult for that crap? Did the attending make you do it when you rotated? 😕
 
So are these "cover my a$$ consults?" Why would they consult for that crap? Did the attending make you do it when you rotated? 😕

Perhaps CYA. Perhaps they were lazy. Perhaps they were overworked. Who knows?

When I rotated through the ER, the vast majority of my shifts were of the 7 pm - 7 am or 5 pm - 3 am variety. So they tended to stick me with the prisoners, ashmatics, foreign-body-in-rectum patients or the vaginal bleeders.

🙁
 
I'm going to jump in here for a second and defend my Ortho brethren...

Now while G Surg and Ortho sometimes have a difficult, tense relationship (especially during trauma cases, when neither service wants the patient with an isolated extremity fracture, +/- other issues), I've worked closely with the many of the Ortho residents throughout residency. We see them all the time on Trauma, Peds Surg, Plastics, SICU, etc. As an intern I also did an Ortho month. And let me tell you, they are BUSY. They operate a ton, often late into the night. They get consulted for almost every patient in the ER who's fallen, sprained/strained something, or tripped - not to mention the actual traumas. Many ortho procedures actually have a relatively small window for taking the patient to the OR, so they can easily get slammed. And their services tend to be HUGE - true, you may argue that a tib-fib is a tib-fib, or a distal radius is a distal radius - but each patient comes with his/her own comorbidities that have to be managed.

So give them a break. You know the orthopods are all damn smart because they matched into Ortho! Sometimes if they ask for help with HTN/DM/AFib/infection/whatever it's because they need help - as we all do sometimes. Of course we all learned the same material in med school.

But hell, IM often consults ID for ABX choice, or Cards for AFib, etc. - and these guys all did the exact same residency!

Edit: BTW, yes, General Surgery is often the dumping ground for all surgical patients. Kind of like how the General Medicine/Hospitalist service is for medicine patients.

It's not so much the consult, I don't mind that. In fact I get pissed off when medicine/surgery/insert specialty here, gets mad when consulted, even if its somewhat questionable...it's your job. It's the fact that it seems like often times their notes/H&P's/medical information is incredibly lacking. I hope that when I order consults I can have the medical record as complete as possible so other services aren't having to page me all the time requesting information.
 
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Absolutely. If you consider how little of the med school curriculum covers ortho, an actually pay attention during your ortho rotation, you will see how much more orthopods know about things we've never heard of. The orthos I worked with know how to manage basic stuff and many conduct sophisticated research. Hardly cavemen.

It's just ridiculous how those pursuing one of the most educated career paths in the world can be so infantile as to put down other specialties. We all are good at our own thing, whether it be a particular organ system or "jack of all trades" knowledge, and that should be enough.

Exactly. I mean after all, we spend two entire days learning about worms and parasites but then the first time someoen comes in with a hurt knee....

These posts complaining about specific rotations are always so funny. Ortho does not suck, your experience, your residents, your attending may have sucked but every field in medicine is interesting and is the perfect for for someone.


P.S. I hated my Ortho rotation.
 
In fact I get pissed off when medicine/surgery/insert specialty here, gets mad when consulted, even if its somewhat questionable...it's your job.

You must be preparing for a career in EM because that's a shockingly ignorant statement to make unless you're a specialty that only lives to consult. Making a consult without thinking is totally inappropriate and shows a lack of intelligence or at the very least sheer laziness. If your attitude is "I called you, so you come here," then you deserve to require a trauma consult called on you.
 
In a completely unrelated digression, exactly how do Pediatricians hear murmurs in hearts that are scooting along like a drumroll in an 80s hair band hit?
You think that's tough, try hearing one in a kitten!

I pride myself on my H&Ps, and I'm with a vet orthopod. Not too much longer until it's Orthonut DVM and an ortho surg residency. I suppose I'll forget all the medicine stuff after graduation?
 
You must be preparing for a career in EM because that's a shockingly ignorant statement to make unless you're a specialty that only lives to consult. Making a consult without thinking is totally inappropriate and shows a lack of intelligence or at the very least sheer laziness. If your attitude is "I called you, so you come here," then you deserve to require a trauma consult called on you.

Making a consult without thinking is generally frowned upon within all fields, even *gasp!* within EM (which does not just live to consult). However, many individual docs (some EM docs included) practice as though they live to consult. Just clarifying. 🙄
 
As usual, I will believe it when I see it. I mean, if a bunch of Ortho guys come on here and say they never consult other services and they manage all of their own patients and anyone who says otherwise is uninformed, I'll say the same.
 
As usual, I will believe it when I see it. I mean, if a bunch of Ortho guys come on here and say they never consult other services and they manage all of their own patients and anyone who says otherwise is uninformed, I'll say the same.

Well, I never claimed anything so ridiculous. It is just as silly to say "always" as to say "never". While the EDs I have worked in don't consult often, I can't deny the occurence of CYA and dump consults. I am just asking that each doc be judged on his or her own merit rather than generalizing statements to entire groups of people. Despite distasteful practices and people I have experienced (many in the same field), I try to be fair to individual professionals by not summarily condemning the group as a whole. That is all.
 
You think that's tough, try hearing one in a kitten!

I pride myself on my H&Ps, and I'm with a vet orthopod. Not too much longer until it's Orthonut DVM and an ortho surg residency. I suppose I'll forget all the medicine stuff after graduation?

H&P's on kittens with heart defects. Vet orthopods. What's going on here?
 
Well, I never claimed anything so ridiculous. It is just as silly to say "always" as to say "never".

OK, in the future I will use "usually" instead of "always." How's that?
 
As usual, I will believe it when I see it. I mean, if a bunch of Ortho guys come on here and say they never consult other services and they manage all of their own patients and anyone who says otherwise is uninformed, I'll say the same.

We don't really consult all that often, but we do transfer patients to medicine on a regular basis (almost never to Gen Surg, usually because Trauma is primary on any . . . you guessed it . . . trauma). I don't really care if medicine gets mad about that, I just want them to shut up and quit complaining at me, when we both know they don't have the cojones to actually block the transfer.

Shut up Medicine Residents! You'll take it and you'll like it!
 
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