Procedures

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Dunce

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Other than surgery and its various specialties/subspecialties, what fields would you suggest to a medical student who told you he really likes the idea of being able to do a bunch of procedures?

Note: I'm not looking for some holy grail answer to guide me to my chosen specialty -- just curious
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Dunce said:
Other than surgery and its various specialties/subspecialties, what fields would you suggest to a medical student who told you he really likes the idea of being able to do a bunch of procedures?

Note: I'm not looking for some holy grail answer to guide me to my chosen specialty -- just curious
Click to expand...

If you want repetition on simple procedures go for ER. If you want variety of different procedures go Radiology. They do a different procedure every day.

Here is the link.

http://forums.studentdoctor.net/showthread.php?p=4015095#post4015095


This is one of the reasons that radiology is one of the best specialty in medicine. To think that most medical students (and ER attendings) think radiologists just sit in the dark. :laugh:
 
I would also recommend anesthesiology if you enjoy sticking people a lot and intubating. And critical care which can be approached from a variety fields both surgical and non-surgical.
 
good suggestions.

I think radiology definitely gets overlooked in regard to procedures.
Anesthesia is also a sweet choice for getting your hands dirty. I just happen to abhor chemistry and only have a functional tolerance for physiology and pharm. :scared:

I created this thread because I was thinking about something I heard the other day and was wondering what other specialties have the hidden potential for being procedure heavy.
I was talking to a family medicine resident who had strongly considered general surgery but opted for family instead, based primarily on lifestye issues. Anyway, she said one of the things she liked was the ability to tailor her future practice in family med to include a pretty fair amount of procedures -- standard in-office stuff but also more atypical things like flex sigs or colonoscopy (GI beware! ;) )

keep the ideas coming
 
Taus said:
how about interventional pain or GI?
Click to expand...

nice.

I've always considered GI to be a good one.

I would say Cards is another of the IM options that could lead to a huge amount of procedures depending on what you want to focus on.
 
Wow, I had no idea general radiologists did that much stuff. That's actually really cool. Hmm...
 
Dunce said:
Other than surgery and its various specialties/subspecialties, what fields would you suggest to a medical student who told you he really likes the idea of being able to do a bunch of procedures?

Note: I'm not looking for some holy grail answer to guide me to my chosen specialty -- just curious
Click to expand...

i echo the anesthesiology suggestion. lots of intubations, a-lines, IVs in the OR. also, lots of tubes, drains, and CVLs if you do critical care/icu type stuff.
 
Billy Shears said:
Wow, I had no idea general radiologists did that much stuff. That's actually really cool. Hmm...
Click to expand...

Welcome to my world.

In fact you can do a one year fellowship in inteventional radiology and you will be able treat lung cancers with thermal ablation. Treat hepatocellular carcinoma with RF ablation. Transjugular Intrahepatic Shunts for patients with cirrosis.
 
Billy Shears said:
Wow, I had no idea general radiologists did that much stuff. That's actually really cool. Hmm...
Click to expand...

Radiology is the most intellectual specialty of them all. Plus, it offers the most procedures than any other specialty. I have such a huge passion for radiology, I can go on for days.

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In fact you can do a one year fellowship in interventional radiology and you will be able treat lung cancers with thermal ablation. Treat hepatocellular carcinoma with RF ablation. Transjugular Intrahepatic Shunts for patients with cirrosis.

They can even treat AAAs.

Interventional Repair - This minimally invasive technique is performed by an interventional radiologist using imaging to guide the catheter and graft inside the patient's artery, rather than making a large incision. For the procedure, an incision is made in the skin at the groin through which a catheter is passed into the femoral artery and directed to the aortic aneurysm. Through the catheter, the physician passes a stent graft that is compressed into a small diameter within the catheter. The stent graft is advanced to the aneurysm, then opened, creating new walls in the blood vessel through which blood flows.

Breast Cancer Treatment - Radiofrequency AblationFor cancerous tumors, radiofrequency ablation (RFA) offers a nonsurgical, localized treatment that kills the tumor cells with heat, while sparing the healthy breast tissue. Because of the localized nature of this treatment, RFA does not have any systemic side effects. Radiofrequency ablation can be performed without affecting the patient's overall health and most people can resume their usual activities in a few days.

In this procedure, interventional radiologists use imaging to guide a small needle through the skin into the tumor. From the tip of the needle, radiofrequency energy is transmitted into the target tissue, where it produces heat and kills the tumor. Most patients experienced mild to moderate discomfort during the 15 minute RFA time. Following the RFA, the dead tumor tissue shrinks and slowly forms an internal scar. Because there is no surgical incision, RFA barely affects the appearance of the breast.


Aneurysms Sections of blood vessels that bulge or balloon out abnormally (aneurysms), often may be treated without surgery by interventional radiologists. The doctor threads a thin tube (catheter) into the blood vessel and inserts a device that blocks off the supply of blood to the aneurysm.

Arteriovenous Malformations (AVM) are blood vessel abnormalities in the brain or elsewhere. If untreated, AVMs can rupture, causing life-threatening bleeding. Interventional radiologists can often treat these abnormalities without surgery by guiding thin tubes (catheters) to the site and injecting a substance that blocks the supply of blood to the affected blood vessels.

Bleeding Internally When a patient is bleeding inside the body due to injured blood vessels after an accident or other trauma, the interventional radiologist pinpoints the area of injury with angiography. The doctor injects a clotting substance, such as a gel, foam, or tiny coils, through a thin tube (catheter) to stop the bleeding.

Blood Clots that form in the deep veins of the lower legs (known as deep vein thrombosis or DVT) can cause chronic swelling and leg pain when walking. There is a risk that the clots will move to the lung (pulmonary embolism) or heart -- a potentially life-threatening complication. Interventional radiologists treat DVT by dissolving the clot with thrombolytic therapy. This treatment opens up blood flow and may prevent permanent damage to the blood vessels, a common side effect of DVT.

Blood Clot Filters Patients with certain chronic illnesses or other conditions that require prolonged periods of inactivity, are at risk of forming blood clots that can travel to the heart or lungs. The interventional radiologist can insert a small filter (called a vena cava filter) into a blood vessel to catch and break up blood clots.

Cancer Treatments Some types of cancers, such as those of the endocrine system that have spread to the liver, can be treated by delivering cancer-fighting agents directly to the site of a tumor in a procedure known as chemoembolization.

High Blood Pressure In some patients with high blood pressure, the condition is caused by a narrowing of the arteries in the kidneys. The problem, called renal hypertension, often can be treated with angioplasty.

Infection and Abscess Drainage Patients with a variety of illnesses may develop an area of persistent infection (abscess) in the body. The infection can be drained by inserting a thin tube (catheter) through a small nick in the skin< and to the site of the infection.

Urinary Tract Obstruction The ureter -- the tube that carries urine from the kidneys to the bladder -- sometimes becomes blocked by kidney stones or other obstructions. The interventional radiologist inserts a thin tube (catheter) through a small nick in the skin and into the blocked kidney to drain the urine.
 
That's not even including a Neuroradiology fellowship. They do treaments for stroke and cerebral aneurysms.

Treatment to Dissolve Blood Clots. If the stroke is due to a blood clot, a clot-busting drug, tPA (tissue plasminogen activator) can be given intravenously to break up or reduce the size of blood clots to the brain. This technique must be performed within three hours from the onset of symptoms.

When therapy cannot be initiated within three hours or when treatment with tPA during the first three hours is not sufficient to dissolve the blood clot, interventional radiologists (IR) that specialize in neurological procedures can provide intra-arterial thrombolysis treatment.


Using x-ray guidance, an IR will insert a catheter through a nick in the skin at the groin and advance it through the femoral artery in the leg all they way to the tiny arteries in the brain where they place the clot-busting drug directly on the clot or to break up the clot mechanically.

When given locally this way, the tPA can be administered up to six hours after the onset of stroke symptoms. In many cases, the ambulance drivers will take a stroke victim past the three-hour window directly to the interventional radiology suite for assessment for this direct thrombolytic therapy. Often a significantly disabled stroke patient who receives this treatment can return to normal life with minimal or no after effects from the stroke.


Carotid artery angioplasty and stenting. More recently, an interventional radiology procedure called carotid artery angioplasty and stenting that does not require open surgery has been developed. In this technique, a catheter is inserted through a nick in the skin, usually in the groin, and threaded under X-ray guidance to the carotid artery. A balloon is inflated to compress the plaque against the wall of the blood vessel and open up the artery. Usually, a tiny wire cylinder called a "stent" is inserted and acts like a scaffolding to keep the artery open. There are a number of potential advantages to carotid artery angioplasty and stenting, primarily because it is less invasive than surgery.

Treatments for Hemorrhagic Stroke Interventional neuroradiologists can also treat ruptured aneurysms inside the brain causing hemorrhage into the subarachnoid space, which can cause stroke or death. One recent study in the Lancet showed that the minimally-invasive interventional technique substantially reduced the relative and absolute risk of subsequent severe disability or death compared to surgical repair, in those patients who were candidates for both procedures.

During the embolization technique, an interventional neuroradiologists inserts a catheter through a nick in the skin of the groin and advances it to the site of the ruptured blood vessel. An embolizing agent (a substance that clots or closes off the bleeding blood vessel) is injected under X-ray guidance. Most commonly, tiny metal coils are used to embolize and block the abnormal blood vessel or aneurysm. The catheter is withdrawn and the coils remain to provide the occlusion. The same technique can be used to treat aneurysms and AVMs before they rupture. Surgery had been the primary treatment available until the platinum coil device was approved by the FDA in 1995.

Vertebroplasty Treatments
Vertebroplasty was first performed in France in 1984 to treat compression fractures caused by bone cancer or bone metastasis, and later to treat compression fractures caused by osteoporosis. Percutaneous vertebroplasty was introduced in the United States in 1994 and has become widely available since 1997 as a treatment for pain associated with compression fractures due to osteoporosis. The procedure has been shown to provide continued pain relief for osteoporotic compression fractures. A 1998 study by Dr. Deramond and colleagues reported on 80 patients with rapid and complete pain relief in more than 90 percent of osteoporotic cases. The follow-up in this patient population ranged from one month to 10 years with evidence of prolonged pain relief. Vertebroplasty is likely to become a standard of care for treating osteoporotic compression fractures as more patients and physicians become aware of the new advances in interventional radiology.

Vertebroplasty is an outpatient procedure using X-ray imaging and conscious sedation. The interventional radiologist inserts a needle through a nick in the skin in the back, directing it under fluoroscopy (continuous, moving X-ray imaging) into the fractured vertebra. The physician then injects the medical-grade bone cement into the vertebra. Vertebroplasty takes from one to two hours to perform depending on how many bones are treated. The cement hardens within 15 minutes and stabilizes the fracture, like an internal cast.

Link to Neuroradiology below

http://neurosurgery.mgh.harvard.edu/Interventional/INRgdc.HTM

--------------------------------------------------------------------------
 
There isn't a specialty that does more different procedures than the field of Radiology. If you want to subspecialize you can do some cool stuff in interventional radiology or Neuroradiology.

If you want to learn more about radiology go to RSNA this November. It is the world's largest medical meeting (60,000+ people). I was there last year and it was truly amazing.

This is why Radiology is one of the best specialty in medicine. :thumbup:
 
After all that propaganda, keep a few things in mind:

1. MOST radiologists won't do MOST of these procedures after residency (don't believe a resident - ask attending radiologists that are not in academic practice - they will support what I am saying).

2. Neurorads is divided into two camps - interventional and non (imaging only).

3. MOST radiologists are not so divisive, insulting, and juvenile as the one above - they work as team players.

4. In practice, anesthesia and EM will do a more varied list of procedures than radiology. It may be opposite in residency, but most of the procedures that residents in radiology do, they will not do (and will NOT be CREDENTIALED to do) in practice, unless fellowship-trained. It is essentially not possible to do an interventional fellowship, then a neuro/interventional fellowship, while keeping your skills up (as you do the second, you won't have time or opportunity to keep on the leading edge of the first), nor is anyone willing to. And, if you are not on top of your game, you are taking the liability RIGHT into your hands. Many attending general radiologists (not fellowship-trained) would rather just not deal with it.

And, before the individual abuse from one person ensues, I am EM. And, for me, IJ's, SC's, femorals, endotracheal intubation, nasotracheal intubation, thoracentesis, paracentesis, pericardiocentesis, joint aspiration, arterial lines, cracking chests, fracture reduction and splinting, laceration repair, epistaxis packing, peritonsillar abscess drainage, nerve blocking, LP's, and goal-directed ultrasound, among MANY other things, are the same "repetitive" things that I find enjoyable.

Likewise, epidurals, intrathecals, any and all airway manipulations known to man, nerve blocks, PCA/pain medicine, arterial lines, and a bunch of other stuff I don't know/remember are things that my anesthesia colleagues enjoy - "repetitively".

The person above will respond how he, individually, personally, rescues EM for multiple procedures. I will tell you - there is NO EM doc - anywhere - that has called radiology to put a line in emergently. By the time rads gets involved, the patient has already been admitted. If it's a PICC, I don't do them - at all. Likewise, never had rads tap a joint (unless it was for an LP). Only two things I called rads for that I couldn't do - LP on the fatties and replacing PEG tubes (and the PEGs sometimes waited 2 days, and they were NEVER done emergently). And when I say "couldn't do", I mean, "tried and was unable to complete".

So, it depends on whether you want to do it for 4 years (plus a fellowship), or 30+ years.

As for most intellectual, eh. I think radiation oncology has them beat (even though radiology takes physics boards, so do the rad oncs, and, anecdotally, the rad onc boards are tougher). Rads is certainly more intellectual than some, though - that's why I'm glad they're my colleagues, and not abusive pricks. A case in point - guy falls off his motorized scooter - brought in altered mental by EMS. CT-brain is part of the workup - has some pretty specific finding that worries the rads resident enough that HE called the MR fellow, and patient got an emergent brain MR. There was some finding on the MR that I don't recall, except that it was something the fellow had to explain to the rads resident (R2, PGY3), and part of the differential was carbon monoxide, Creutzfeldt-Jakob and Wilson's disease. First time I've ever ordered a ceruloplasmin from the ED (which I came up with all by my lonesome - wasn't recommended by the rads resident). It was a total team effort, and the right thing happened.
 
How can anyone believe that radiologists do more procedures than any other specialty? That's crap.
 
While I agree that IR is a great field for someone who likes to do procedures but doesn't want to be a surgeon, I take issue with the list p53 provides. While technically those procedures are possible, it doens't always mean that they are appropriate. In the case of thermal ablation of breast tumors, there are no RCT to show that this is effective in the vast majority of breast malignancies, or even wise given the fact that it destroys information on margins, receptor status and staging. It is currently only approved for investigational use....

A statement from the American Society of Breast Surgeons...

Ablative and minimally invasive percutaneous excisional treatments for early stage breast cancer are being investigated by various groups involved with breast cancer research. At this time, these include ablation by laser, cryotherapy, microwave, and radiofrequency. Percutaneous excision by rotational or vacuum-assisted devices is being investigated. Initial studies included traditional surgical lumpectomy with surgical pathology and axillary lymph node sampling, as appropriate.

These techniques raise a number of questions about efficacy and patient safety, staging, margin analysis, and follow-up.

Until such a time that safety and efficacy of these techniques are ascertained, ablative and percutaneous excisional treatments for breast cancer are investigational and should not be performed outside the realm of clinical research trials.
 
Maybe I'll just be a vascular surgeon. The only stuff I like is the endovascular stuff, and I'd rather be able to do the open procedures as well. I think I'd feel nervous stenting a AAA if I couldn't do an open one "just in case".
 
Man, I guess he got some people blood boiling. lol

The EGOs started running wild. lol

IR guys do lots of procedures. But not all of the above. Kimberly fox is correct as well as the other person who mentioned this.

It is a relatively new field and as the procedures and the success rates rise, more options for treatment will be possible.

Residents tend to get exposure to a little of everything so p53 has most likely seen this and believes he will be doing all of this in his practice.

Remember, you have to be good at it to do it. And you can't be good at all of these procedures. Even specialist, sub-specialize.
 
Pox in a box said:
How can anyone believe that radiologists do more procedures than any other specialty? That's crap.
Click to expand...

Name another specialty that does more different procedures than a general radiologist. Answer after you take a radiology rotation okay.
 
Apollyon is once again confused between Interventional Radiology and General Radiology. :thumbdown:
As for the comment about Rad-Onc as being more intellectual than Radiology. That's a tough one. I doubt the beautiful stephew would even make such a strong statement. It is close, but everyone knows where I stand. I'll just say that Radiology and Rad-onc are the two most intellectual specialties because you have to have a working knowledge of every specialty in the hospital. With that said 75% of radiologists do an academic fellowship for further training.

A general radiologists does ALL of the following below (without an IR fellowship). Who else in a hospital would be qualified to do procedures that I listed below? Do you think pathologists do the image guided biopsies? Nope. Do you think Ob does hystosalpingograms? Nope. Do you think GI docs do barium studies, esophograms, or swallow studies? Nope. Do you think Orthopods do arthograms? Nope.

1. Biopsies of neck, lung, breast, mediastinum, liver, kidney, adrenal glands, chest or abdominal masses, or other soft tissue masses. Majority of them CT guided or US guided.

2. Arthrograms is an invasive procedure of the knee, shoulder, and hip.

3. Angiograms, Cystograms, IVPs, Retrograde uretrograms, hystosalpingograms, swallow studies, barium swallows

4. Central lines that the ED physicans can't get are sent to the radiologists for image guided.

5. Spinal Taps that the ED physicians can't get are sent to the radiologists.

These are the ones I can think of from the top of my head. Go to any community hospital in the U.S. and you will see general radiologists do these procedures.

Interventional Radiology is not the same as general radiology. Once you do an interventional radiology fellowship. One is trained to do IVC filters, chemoembolization, stents, embolization, CT guided thermal ablation of liver, lung, kidney, etc.

Why is it so hard for the ER attendings here to figure out that interventional radiology procedures are NOT the same as General Radiology Procedures? Is this a difficult concept?
 
p53 said:
4. Central lines that the ED physicans can't get are sent to the radiologists for image guided.
Click to expand...

Once again, p53 is wrong. You will NOT find an EM-residency trained EM doc - anywhere - that sends patients to rads for central lines. By the time the patient gets on the rads schedule, the patient is either admitted or dead.

And community general rads can't/won't be bothered.

But, p53 is unswayed by other opinions. Note that no rads colleagues support him.

I think that the procedures that you think of 'off the top of your head' is because your head comes to a point.
 
KentW said:
Freudian slip? Or maybe you've met her? ;)
Click to expand...

Speaking of Hot Mods. I've never seen Kimberli Cox but I have seen Stephew. Stephew looks like a playboy model. No Joke!
 
As far as procedures go- try GI, anesthesia, or even PM&R.
 
Dunce said:
Other than surgery and its various specialties/subspecialties, what fields would you suggest to a medical student who told you he really likes the idea of being able to do a bunch of procedures?

Note: I'm not looking for some holy grail answer to guide me to my chosen specialty -- just curious
Click to expand...

Bump

I figured anyone else that would be tempted to barge in would appreciate the original criteria so they don't jump in with meaningless posts.

I know some specialties are too busy to read the whole thread. Kind of like how some specialties don't read the patient's HPI rather call the resident on call for a verbal HPI.
 
Kimberli Cox said:
KentW has met me and could comment (although its been, what, 10 years since you've seen me?), but I haven't been called a "fox" since HS (as in, "hey, you're a total fox, wanna go to the AC/DC concert with me?) :p
Click to expand...

Not that it matters, if I was a betting man, I would bet that Kimberli Cox is pretty cute. No concrete proof just a good hunch. The kind of girl that I would intellectually flirt with at a coffee shop.
 
It may have been a slip.

Maybe you know something I don't know.:love: :cool:
 
Kimberly? would you like to commet?:D
 
Take a chill pill. Do an interventional thing on yourself to relax a little or something.
 
erichaj said:
It may have been a slip.

Maybe you know something I don't know.:love: :cool:
Click to expand...

"If you think she's cute now, you should have seen her a couple years ago." - Michael Scott, "The Office" ;)

66883.jpg
 
love it.

Kimberly, the world awaits an answer. :D
 
p53 said:
That's not even including a Neuroradiology fellowship. They do treaments for stroke and cerebral aneurysms.

Treatment to Dissolve Blood Clots. If the stroke is due to a blood clot, a clot-busting drug, tPA (tissue plasminogen activator) can be given intravenously to break up or reduce the size of blood clots to the brain. This technique must be performed within three hours from the onset of symptoms.

When therapy cannot be initiated within three hours or when treatment with tPA during the first three hours is not sufficient to dissolve the blood clot, interventional radiologists (IR) that specialize in neurological procedures can provide intra-arterial thrombolysis treatment.


Using x-ray guidance, an IR will insert a catheter through a nick in the skin at the groin and advance it through the femoral artery in the leg all they way to the tiny arteries in the brain where they place the clot-busting drug directly on the clot or to break up the clot mechanically.

When given locally this way, the tPA can be administered up to six hours after the onset of stroke symptoms. In many cases, the ambulance drivers will take a stroke victim past the three-hour window directly to the interventional radiology suite for assessment for this direct thrombolytic therapy. Often a significantly disabled stroke patient who receives this treatment can return to normal life with minimal or no after effects from the stroke.


Carotid artery angioplasty and stenting. More recently, an interventional radiology procedure called carotid artery angioplasty and stenting that does not require open surgery has been developed. In this technique, a catheter is inserted through a nick in the skin, usually in the groin, and threaded under X-ray guidance to the carotid artery. A balloon is inflated to compress the plaque against the wall of the blood vessel and open up the artery. Usually, a tiny wire cylinder called a "stent" is inserted and acts like a scaffolding to keep the artery open. There are a number of potential advantages to carotid artery angioplasty and stenting, primarily because it is less invasive than surgery.

Treatments for Hemorrhagic Stroke Interventional neuroradiologists can also treat ruptured aneurysms inside the brain causing hemorrhage into the subarachnoid space, which can cause stroke or death. One recent study in the Lancet showed that the minimally-invasive interventional technique substantially reduced the relative and absolute risk of subsequent severe disability or death compared to surgical repair, in those patients who were candidates for both procedures.

During the embolization technique, an interventional neuroradiologists inserts a catheter through a nick in the skin of the groin and advances it to the site of the ruptured blood vessel. An embolizing agent (a substance that clots or closes off the bleeding blood vessel) is injected under X-ray guidance. Most commonly, tiny metal coils are used to embolize and block the abnormal blood vessel or aneurysm. The catheter is withdrawn and the coils remain to provide the occlusion. The same technique can be used to treat aneurysms and AVMs before they rupture. Surgery had been the primary treatment available until the platinum coil device was approved by the FDA in 1995.

Vertebroplasty Treatments
Vertebroplasty was first performed in France in 1984 to treat compression fractures caused by bone cancer or bone metastasis, and later to treat compression fractures caused by osteoporosis. Percutaneous vertebroplasty was introduced in the United States in 1994 and has become widely available since 1997 as a treatment for pain associated with compression fractures due to osteoporosis. The procedure has been shown to provide continued pain relief for osteoporotic compression fractures. A 1998 study by Dr. Deramond and colleagues reported on 80 patients with rapid and complete pain relief in more than 90 percent of osteoporotic cases. The follow-up in this patient population ranged from one month to 10 years with evidence of prolonged pain relief. Vertebroplasty is likely to become a standard of care for treating osteoporotic compression fractures as more patients and physicians become aware of the new advances in interventional radiology.

Vertebroplasty is an outpatient procedure using X-ray imaging and conscious sedation. The interventional radiologist inserts a needle through a nick in the skin in the back, directing it under fluoroscopy (continuous, moving X-ray imaging) into the fractured vertebra. The physician then injects the medical-grade bone cement into the vertebra. Vertebroplasty takes from one to two hours to perform depending on how many bones are treated. The cement hardens within 15 minutes and stabilizes the fracture, like an internal cast.

Link to Neuroradiology below

http://neurosurgery.mgh.harvard.edu/Interventional/INRgdc.HTM

--------------------------------------------------------------------------
Click to expand...

Interventional radiologist's tears can cure cancer.

Too bad they never cry...
 
p53 said:
Not that it matters, if I was a betting man, I would bet that Kimberli Cox is pretty cute. No concrete proof just a good hunch. The kind of girl that I would intellectually flirt with at a coffee shop.
Click to expand...

Probably not.

In looking at me, most people (especially men) do not believe I would be capable of holding an intelligent conversation.

Or as a friend of mine once remarked, "isn't interesting how the dumbest looking one of us, is also the smartest?" (referring to me).

Let's just say that having blonde hair and certain "assets" does not lead most to assume that I can discuss anything more involved than the latest Dolce & Gabbana collection or those cute shoes at Nordstroms! (which reminds me, they are having a sale this weekend and I absolutely have to get some red shoes to go with the faboolous new bag I just got. ;) )
 
See how you are, now your just teasing.

Tell me all.
 
See how you are, now your just teasing.

Tell me all.

I have time. :D ;)
 
every woman I know says they need to lose 10 pounds.

I can picture you ordering all those interns around.

They believe your bite is worse than you bark. But I know better. :D

I won't tell. ;)
 
erichaj said:
every woman I know says they need to lose 10 pounds.

I can picture you ordering all those interns around.

They believe your bite is worse than you bark. But I know better. :D

I won't tell. ;)
Click to expand...

Nah, I'm not much of an ordering around type of gal. Matter of fact, I feel guilty if I ask them to do too much. But if you like to picture me as more of a dominatrix type of gal you can, although Dr. Mom has had, in the past, the lock on that fantasy! ;)

But nowadays I'm mostly hanging with the fellows and have little contact with the interns except at M&M, conferences and my monthly teaching rounds (maybe I'll start ordering them around and making them bring me some Starbucks!).
 
How in the in the world did a topic on "Procedures" end up with posts on "foxes" and "Dominatrix(es)".:eek: :laugh:
 
Well, it went like this,

The "FOX" put a post up, then I replied and then well we got to talking about coffee and interns and starbucks and then I wanted to know it all.

Clear as mud, right? :( :confused:

By the way, Kimberly I have to say I would bring you a starbucks coffee.

Maybe even an iced carmel latte or another one of those fancy named drinks I can never pronounce. ;)
 
p53 said:
Bump

I figured anyone else that would be tempted to barge in would appreciate the original criteria so they don't jump in with meaningless posts.

I know some specialties are too busy to read the whole thread. Kind of like how some specialties don't read the patient's HPI rather call the resident on call for a verbal HPI.
Click to expand...

interventional radiology sucks.
 
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