The Official Anti-Clinical Medicine Thread

[deschutes]

Nice job on the zero admissions....(lucky bastard) j/k j/k

As with most things in clinical medicine, I had absolutely nothing to do with it. Just riding the wave, man.

Tho' karma is going to come around and bite me in the behind this Saturday, I just know it.

I'd much rather be called a bastard than a bitch. Carries different connotations, methinks.

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[b&ierstiefel]

As with most things in clinical medicine, I had absolutely nothing to do with it. Just riding the wave, man.

Tho' karma is going to come around and bite me in the behind this Saturday, I just know it.

I'd much rather be called a bastard than a bitch. Carries different connotations, methinks.

You should take full credit for the zero admissions. It means you're a white cloud...which is a legitimate reason why you should get honors in medicine.

Keep up the negative attitude regarding the next call...it keeps the white cloud above your head. If you start thinking that you're gonna have an easy call, that's when you get screwed with admissions...and your honors grade flies out the window.

I was gonna call you a bitch but I couldn't find a way to say it in a lighthearted, unoffensive fashion. I figured everyone's heard the expression "lucky bastard" and sees it as more benign than being called a "lucky bitch".

First one to call deschutes a bitch gets $5!!!!!!

 

[yaah]

RRR stands for regular rate and rhythm...it's kind of a misnomer because "regular rate" doesn't make much sense whereas "regular rhythm" does make sense. How can a rate be regular. A rate is a rate. One of the interns I worked with several months ago commented on this and requested that I write NRRR for normal rate (as opposed to bradycardic or tachycardic) regular rhythm. Semantics semantics...it's all BS anyways.

You seem to get more days off than I do.

And now, my "I hate clinical medicine but I hate even more when people do a half assed job and pretend they aren't doing a half assed job." Now, if you are doing a half assed job and readily admit it, well then, we can do business!

I told people once about the whole RRR crap when I did medicine. I argued that RRR was pointless and showed that you were either 1) trying to fill space or 2) were ignorant. Because almost every note will have the vital signs, and as everyone knows, heart rate is a vital sign. Thus, you do not need to say it again. And especially if your vital signs say 110/60 50 16 98degrees 98% RA. You can't then say RRR. 50 is not a regular rate. It is bradycardia, fools. And no one knows what the hell a gallop is anyway. When you say gallop, are you referring to the presence of an S3? Or an S4? Or both? Or something else? Thus, Yaah's cardiac exams:

Vital signs.
Regular rhythm
Normal S1, S2 physiologically split (if necessary).
No S3, No S4.
No murmurs. No rubs.

See, now I didn't really do anything different, but it looks like I spent ten minutes listening to the patient.

Same thing with murmurs. ****ing clinical people don't know how to describe a murmur. What does "II/VI SEM" mean? Do you know what a systolic ejection murmur sounds like? Do you know the difference between a regurgitant murmur, a stenotic murmur, and/or a flow murmur? Where does it radiate? Where is it heard the best? How does it relate to S1 and S2? Why did you call it II/VI? Could you feel it?

This is why I could never be a cardiologist. I would spend an hour every day yelling at residents and students for ****ing up the cardiac exam. The other reason why I could never be a cardiologist was that none of this really matters. If you are suspicious, you get the echo. If the person has aortic stenosis bad enough to be symptomatic, the cardiac exam isn't going to tell you much you don't know. You get the echo.

The lung exam, now that's a different story. Nobody knows what the hell they're listening to anyway. Crackles, rales, decreased breath sounds, whatever. Everything can mimic everything else. Waste of time. Listen at the bases, once on each side. Then get a chest xray.

 

[b&ierstiefel]

And now, my "I hate clinical medicine but I hate even more when people do a half assed job and pretend they aren't doing a half assed job." Now, if you are doing a half assed job and readily admit it, well then, we can do business!

Yeah I guess I'm a half-assed kind of person.

Vital signs.
Regular rhythm
Normal S1, S2 physiologically split (if necessary).
No S3, No S4.
No murmurs. No rubs.

Hey yaaah, I like this! It takes up more space making it look like you did more work. Too bad I can only use this convention for one more day (wtf...too bad? i mean...this is awesome!)

Same thing with murmurs. ****ing clinical people don't know how to describe a murmur. What does "II/VI SEM" mean? Do you know what a systolic ejection murmur sounds like? Do you know the difference between a regurgitant murmur, a stenotic murmur, and/or a flow murmur? Where does it radiate? Where is it heard the best? How does it relate to S1 and S2? Why did you call it II/VI? Could you feel it?

At least I realize the difference between an SEM and an HSM. One of my last patients had a I/VI SEM at the 2nd RICS (right intercostal space), a displaced PMI, and a II/VI HSM at the PMI/apex. My attending was like, "Oooh...gooooood job" (he's Indian). My understanding is that an SEM is a mid or late-peaking murmur depending on the extent of the stenotic valve whereas HSM is a monotonous, non-peaking murmur. Anyways, I'm not claiming to be a cardiologist but when I did my cardiology rotation, my attending made clear on day 1 that we should spend around 2-3 minutes doing a very careful cardiac exam. And whenever we hear a murmur, we must describe intensity, radiation, location, presence/absence of a palpable thrill (which relates to intensity) and changes with inspiration/expiration.

This is why I could never be a cardiologist. I would spend an hour every day yelling at residents and students for ****ing up the cardiac exam. The other reason why I could never be a cardiologist was that none of this really matters. If you are suspicious, you get the echo. If the person has aortic stenosis bad enough to be symptomatic, the cardiac exam isn't going to tell you much you don't know. You get the echo.

Nope...but now you're gonna be the pathologist who yells at students for not using the low-power objective first before using going to high-power. Have fun!

The lung exam, now that's a different story. Nobody knows what the hell they're listening to anyway. Crackles, rales, decreased breath sounds, whatever. Everything can mimic everything else. Waste of time. Listen at the bases, once on each side. Then get a chest xray.

I wholeheartedly agree. Every patient should get a CXR...outpatient or inpatient! Stethoscope = getting obsolete. The stethoscope is only useful for 2 reasons: cardiac exam and listening for testicular bruits.

 

[deschutes]

I argued that RRR was pointless and showed that you were either 1) trying to fill space or 2) were ignorant.

What did they say in response?

I'm a total half-ass when it comes to floor medicine. I just don't see why I should look enthusiastic or pretend to know what I'm doing when the tedium and redundancy is killing me.

Having said that, there are days when I hear myself saying "I'll be glad to (do a transfer note/call radiology/talk to OT about a testicular sling)". In those moments my eternal soul takes a beating.

I like pathology.

Pathologists are observant and down-to-earth.
Therefore your interest and talent (or lack thereof) is obvious and you don't have to impress anyone by quoting obscure Scandinavian studies.
You don't have to write something on a report just to "take up space".
You can use Post-it notes and photocopy a slice of liver to get your point across.

Best of all, pathologists know that you have better things to do at 11pm than sit in Emerg waiting for your senior to stop running around and do that tap that he wanted you to see.

~
Andy, deschutes is a bitch!! Where's my $5??

 

[b&ierstiefel]

Andy, deschutes is a bitch!! Where's my $5??

A sack of 20 quarters american (which amounts to about $593.27 canadian) is in the mail.

 

[deschutes]

20 quarters do not require a sack - only a film roll.
20 quarters would cost more than $5 to mail.
20 US quarters do not add up to C$593.27 - but I could sure use the laundry money

 

[b&ierstiefel]

20 quarters do not require a sack - only a film roll.
20 quarters would cost more than $5 to mail.
20 US quarters do not add up to C$593.27 - but I could sure use the laundry money

Yes...but I used a sack.
Yes...$5 canadian to mail
Yes...thumbs up to me...go me.

 

[b&ierstiefel]

In 2 hours and 47 minutes, my last moments on clinical medicine will pass. I'll miss posting on this thread.

Please let me get no admits today...please let me get no admits today...Please let me get no admits today...please let me get no admits today...Please let me get no admits today...please let me get no admits today...Please let me get no admits today...please let me get no admits today...

 

[deschutes]

In honour of Andy's last day of floor medicine (damned lucky bastard!!!), all the alcohol you can take in by all routes is on me. I'm glad someone's going to be having fun this Saturday!

You earned it man. You and cookypuss and any other MS4's out there streaking through the streets tearing off their steths and white coats!

I think I failed my neuro OSCE station. The examiner (an intensivist) seemed pretty interested in my ability (or lack thereof) to differentiate brainstem vs. internal capsule vs. cortical strokes on the basis of motor, speech and language function.

Which confirms my impression that halfway through this IM rotation I still know nothing about the kidneys, the biliary tree, the heart - and now the brain. eyuk.

It's a twenty-degree Friday. I need to get out of here.

 

[b&ierstiefel]

2 Large Bore IVs
D5Warsteiner drip.

As I sit here, I'm giving away my pocket books and supplies away to random people including:

Pocket Medicine
Pharmacopoiea Deluxe version
Sanford Guide
Maxwell Card
4 packets of surgilube
1 packet of ketchup
5 guaiac cards

Closure is a beautiful thing!

 

[yaah]

Funny, I would have thought you would keep the guaiac cards. And possibly the surgilube.

Warsteiner is a good choice. I have that here in my condo.

 

[Doctor B.]

A surgery resident once taught me the concept of the "triple point." Put your stethoscope in the xiphoid area (or subxiphoid depending on body habitus). You can listen to breath sounds, heart sounds, and bowel sounds all in the matter of seconds.

Also known as the orthopedic triangle

 

[deschutes]

...including:

4 packets of surgilube
1 packet of ketchup

The man knows no fear.
I would hesitate to carry surgilube and ketchup around in the same pocket.
I don't really like the taste of surgilube on my fries, whatever time of day.
But I guess if you can do an LP on a delirious septuagenarian at 4am, you can do anything.

 

[b&ierstiefel]

Warsteiner is a good choice. I have that here in my condo.

Oh! So you're the jerk who took that last 12 pack of Warsteiner from the local Kroger's!

 

[b&ierstiefel]

The man knows no fear.
I would hesitate to carry surgilube and ketchup around in the same pocket.
I don't really like the taste of surgilube on my fries, whatever time of day.
But I guess if you can do an LP on a delirious septuagenarian at 4am, you can do anything.

The fact that I had a ketchup packet in my pocket was pure accident. I bought a burger from the cafeteria and I was so hungry (I was on call and this was my first meal of the day...it was about 8 pm) that I just wolfed down the burger and forgot to use the ketchup.

I've never done an LP. And now I don't I'll ever get the chance to do so. Poor me. I'm soooooo sad about this.

Surgilube on fries is quite disgusting I must agree. It's kinda salty and the fries are salty enough. And surgilube has that weird aftertaste.

 

[Stinger86]

I've heard before that some surgeons will see their patient in the morning and make a note in their chart that says simply "LGFD".

or "looks good from door"

 

[b&ierstiefel]

I've heard before that some surgeons will see their patient in the morning and make a note in their chart that says simply "LGFD".

or "looks good from door"

And when you do surgery before Christmas, you'll have the pleasure to write these really short notes too.

S - no c/o
O - AF VSS
RRR S1 S2 no m/r/g
LCTAB
S/NT/ND hypoBSx4
Ext WWP
A/P - ?? yo M/F POD #X s/p butt surgery. LGFD.
c/t post-op care
increase ambulation/OOB

Of course, you'll hear all the medicine docs moan and groan about how short and useless surgery notes are.

 

[deschutes]

...And surgilube has that weird aftertaste.

You're not supposed to lick your fingers after a DRE yanno.

 

[b&ierstiefel]

You're not supposed to lick your fingers after a DRE yanno.

Uh...my post said surgilube on fries...not on my finger after shoving it up an old dude's bunghole.
What a horrible and sick thought deschutes...shame on you.
Your mind is still in the gutter...come back toward the light!

Just pray that you don't have to do a rectal exam or even worse, a rectal disimpaction during your general teams month. When that issue comes up, that is the best time to hide and be less visible.

 

[deschutes]

Uh...my post said surgilube on fries...not on my finger after shoving it up an old dude's bunghole.
What a horrible and sick thought deschutes...shame on you.
Your mind is still in the gutter...come back toward the light!

Just pray that you don't have to do a rectal exam or even worse, a rectal disimpaction during your general teams month. When that issue comes up, that is the best time to hide and be less visible.

It is rather sick and horrible. I am rather proud of myself on that account.
Why are you eating surgilube on fries? More to the point: how do you know the taste of surgilube?

Actually, the thought occurs to me - I'm not sure I want to know.

There was a DRE done last night. I said I was catching up on my patient since this junior conveniently forgets to update me on this particular patient's current issues/plans - but volunteered to get her the hemoccult/developer.
Score one to me!!

 

[b&ierstiefel]

There was a DRE done last night. I said I was catching up on my patient since this junior conveniently forgets to update me on this particular patient's current issues/plans - but volunteered to get her the hemoccult/developer.
Score one to me!!

Hmm...you remind me of the 3rd year student who was on teams with me last month. She would always say "Score..." during rounds. Are you sure you don't go to WSU?

Anyways, did you get to do the DRE? And BTW, don't take it personally when the junior forgets you to update you on "your" patient. It happens all the time and it's usually because the junior is pretty busy. As a subintern (not to say that I truly functioned at the capacity of a intern), I felt like I was running around like a headless chicken. I can see how juniors can forget to update you on things. And that's what sucks about being a 3rd year med student. You are expected to know EVERYTHING about "your" patient yet nobody tells you what's going on. Nurses will not page YOU when sh1t hits the fan. Your junior will often not keep you completely up to date on the patient's issues. And your senior...well seniors don't talk to 3rd year students.

How many weeks of medicine teams do you have left? I know you have other team months but my opinion is that the medicine months are the most grueling, depressing, frustrating months of a 3rd year med student's life.

 

[deschutes]

The 3rd year student who was on teams with me last month. She would always say "Score..." during rounds. Are you sure you don't go to WSU?

See, I don't always say "Score..." during rounds. I'm sure it's a WSU thing.

No I got out of doing the DRE. Which was why I said "Score!" in the first place. I don't take it personally when the junior doesn't update me - but when I ask and they don't update me, that is a little far-out.

2 more weeks of Teams, baby! With a new attending on, so I can start to impress afresh. I like cookypuss's strategy - start out crappy like you don't know what you're doing (which of course you don't), and if you even begin to perform middlingly by the end of the 4th week, you're guaranteed a pass.

Do I have other Teams months? I don't think so. Surgery doesn't do Teams, does it. And I am done with Peds, thank god. If I had to do Peds Teams again and chase those clipboards again, I would jump off a cliff.

 

[b&ierstiefel]

Do I have other Teams months? I don't think so. Surgery doesn't do Teams, does it.

Surgery is different...they typically have services and weird call schedules but I don't think they operate as teams. At least at my school surgery didn't have "teams". We had an GI surgery, Trauma/Burn, Endocrine, Transplant, Peds Surg, Vascular, and Onc Surg. Within each service, there were no teams.

Surgery is much better though. It's more brainless than the medicine clerkship. Rounds are usually quick where you read off a bunch of numbers. Progress notes are a joke too. We wrote the notes during rounds...we had one guy reading off the vitals, one guy doing physical exam/dressing changes, and one guy scribing the progress notes. Unlike medicine notes, surgery notes required very little thought...it's not like anybody read them anyway.

So...after these 2 weeks, you're done! Keep up the hate and the weeks will go by quickly

 

[deschutes]

So...after these 2 weeks, you're done! Keep up the hate and the weeks will go by quickly

AAAAAAAAAAARRRRRRRRRGHHHHHHHHHHHHHHHH!!!!!!!!!



New attending qMonday x3. New way of doing things.
Plus, new patient.

Finished at 1915 hours today - and I was not on call.

And holy crap I know I'm not interested in IM when the other clerks keep yapping about trying to get a representative from both teams each call night and I yawn.

 

[b&ierstiefel]

AAAAAAAAAAARRRRRRRRRGHHHHHHHHHHHHHHHH!!!!!!!!!



New attending qMonday x3. New way of doing things.
Plus, new patient.

Finished at 1915 hours today - and I was not on call.

And holy crap I know I'm not interested in IM when the other clerks keep yapping about trying to get a representative from both teams each call night and I yawn.

That blows chunks...just when things were going smoothly. Welcome to internal medicine...100 different ways IM can end up f'ing you over...

 

[yaah]

That blows chunks...just when things were going smoothly. Welcome to internal medicine...100 different ways IM can end up f'ing you over...

I finished at 7pm today. Started at 6:30 am.

My day:

6:30-7:30 - finished an autopsy report and delivered it to the appropriate individuals
7:30-8 autopsy conference I had to present
8-10 signed out placentas
10-10:30 met with CP director for a progress report
10:30-12 more placenta signout
12-1 Brain cutting with neuropathologist
1-4 Lunch followed by Medical examiner case (autopsy).
4-6 Grossed in placentas and two awful ischemic leg amputations
6-7 Finished paperwork.

A busy day! Unlike a 12 hour IM day though, 50% of the time wasn't spent picking my nose and waiting for things to happen all at once. And I learned a lot, even if today was a particularly placenta-heavy day. Plus path is fun, man. 12 hour days are a breeze.

 

[deschutes]

Unlike a 12 hour IM day though, 50% of the time wasn't spent picking my nose and waiting for things to happen all at once.

I put in roughly the same hours as you. The difference is that 4 hours were spent on rounds... *bangs head against wall*

Classic Teams moment: One of my patients has a mild fine intermittent resting tremor NYD and is on like 20 meds. Attending wants me to go through the CPS (a Canadian drug compendium) and figure out which drug might be causing it.

Bearing in mind of course that the CPS lists every side effect known to man including the ever-present triad of nausea, vomiting and diarrhea.

And even if I did find a tremor-inducing drug (did you know that amitriptyline causes tremor? How about ramipril?) what are the chances that we are going to take her off the drug?

Just another reason why I hate Teams.

 

[deschutes]

Another classic Teams moment: 21-year-old comes in with DKA, partially-resolved by the time we pick him up.

Attending says, "I think we should drop his Humulin down to 3 units per hour, since we've already given him 5 units Novolin sub-cu. But he's getting snacks so maybe we'll keep him at 4 units per hour. What do you think?"

I throw a quick glance at her (another one of those read-my-mind questions, huh?), but she looks back at me perfectly earnestly. I make like I'm thinking for 2 seconds, and say "Let's go with 3 per hour".

Without the slightest trace of irony she goes, "Yeah that sounds like a good idea."

 

[b&ierstiefel]

I finished at 7pm today. Started at 6:30 am.

My day:
1-4 Lunch followed by Medical examiner case (autopsy).

Hey yaah, I heard about that decomp case...how was it? Did you have your wintergreen?

Oh well, I don't do autopsies until the 3rd week of the rotation. Hopefully I'll get some cool cases. Our course adviser told us that the number of autopsies have slowly fallen over the years.

 

[yaah]

Hey yaah, I heard about that decomp case...how was it? Did you have your wintergreen?

Oh well, I don't do autopsies until the 3rd week of the rotation. Hopefully I'll get some cool cases. Our course adviser told us that the number of autopsies have slowly fallen over the years.

Ah yes. While the # of deaths is not falling, the number of autopsied deaths is. There is a logbook here from the 40s and 50s, and interestingly enough, there are similar numbers of deaths. But there is a column listing "date autopsy completed" and it is filled in for about 90% of the listings. Now it's like 5-10% at most. We usually have a few a week though.

Yes that case was pretty. Critters everywhere. We autopsied the Incredible Hulk (he was green). But it was brain only because the rest of it was going to be unrevealing because he had a lot of comorbid conditions. I DID have my wintergreen. No vics.

 

[b&ierstiefel]

Ah yes. While the # of deaths is not falling, the number of autopsied deaths is. There is a logbook here from the 40s and 50s, and interestingly enough, there are similar numbers of deaths. But there is a column listing "date autopsy completed" and it is filled in for about 90% of the listings. Now it's like 5-10% at most. We usually have a few a week though.

Yes that case was pretty. Critters everywhere. We autopsied the Incredible Hulk (he was green). But it was brain only because the rest of it was going to be unrevealing because he had a lot of comorbid conditions. I DID have my wintergreen. No vics.

Wintergreen is the bomb! I'm glad you had some of dat sh1t!

 

[b&ierstiefel]

OK deschutes,

This thread is all yours now

We want daily reports and daily reaffirmation of your disgust for clinical medicine. Maybe you'll have plenty of downtime when you're Q2 this weekend (god I still can't get past this....that really sux!)

 

[deschutes]

OK deschutes,

This thread is all yours now

We want daily reports and daily reaffirmation of your disgust for clinical medicine.

Yesterday I had a good day. I had seen and had a note written on one patient by noon, had a free lunch, saw and wrote up my other patient by 2, finished a transfer-of-care dictation and actually gave sensible answers to my attending's questions.

As opposed to the day before, when out of a 9-hour day, 6 hours were given to work rounds, teaching rounds, and clerk mandatory teaching.
Now THAT was hell.

Today has not been bad so far. One of the nurses fed me dinner.

 

[b&ierstiefel]

One of the nurses fed me dinner.

Literally? Did she handcuff you first?

 

[deschutes]

Literally? Did she handcuff you first?

Would you prefer that it were so?

 

[Homunculus]

it was brain only

most of the decomps i was involved with the brain was green stinky putty. what were you looking for and what would your yield be on a decomp brain?

--your friendly neighbothood hope you get viewers only this weekend caveman

 

[yaah]

most of the decomps i was involved with the brain was green stinky putty. what were you looking for and what would your yield be on a decomp brain?

--your friendly neighbothood hope you get viewers only this weekend caveman

Yeah this decomp brain was silly putty. As soon as it got out of the skull and into the tray it completely melted and turned into mush. Basically, he was looking for either evidence of trauma (skull fracture) or bleed. Because the guy was found in a compromising position (actually, found next to the couch with his pants around his ankles, but I guess that's another story). He wanted to make sure it wasn't a head bleed.

Otherwise, you're right, the yield is low. You might see an old stroke if it was apparent grossly. You might see a big tumor. You wouldn't see much of anything else though.

 

[b&ierstiefel]

It pains me to see all the 3rd year med students...just met a few today some of whom are doing surgery and some of whom are doing medicine .

Ahh...the days of fake enthusiasm just to get a decent frickin grade...

 

[deschutes]

It pains me to see all the 3rd year med students...just met a few today some of whom are doing surgery and some of whom are doing medicine

I saw a couple of 2nd-years today, shadowing in Teams as part of their Applied-EBM Clinical Encounter.

Who on earth would want to shadow in Teams? For 4 months?? I would have no idea what was going on (aside from the fact that there seemed to be a lot of headless chickens running around and as many infernal beeping IV pumps) - I would be bored stiff!

But in their defence, they probably had no idea what they were getting into. I had considered doing a week's elective in GIM Teams in the summer of 2nd year - thank God it never came true.

I was tempted to tell them, "you guys need to go and shadow in Path! They'll let you do a lot more than stand around computers listening to people yap."

Maybe I will tomorrow, after I get my evaluation and when my preceptor is gone.

 

[b&ierstiefel]

hey do you have the attending fill out the form in front of you and then have YOU deliver it to the clerkship director?

if true...anything is fair game after you get that evaluation form. then you can be like brandi chastain, rip off your shirt, and pump your fists in the air!

 

[deschutes]

hey do you have the attending fill out the form in front of you and then have YOU deliver it to the clerkship director?

if true...anything is fair game after you get that evaluation form. then you can be like brandi chastain, rip off your shirt, and pump your fists in the air!

I had thought about that. But her handwriting is illegible and therefore unforgeable.

Truth is, I don't know. Every attending is different. Some are more anal than others. This one is anal.

Nonetheless! SIXTEEN HOURS!! and THEN I will rip off my shirt and whirl it around my head as I dance around the nursing station

 

[b&ierstiefel]

Nonetheless! SIXTEEN HOURS!! and THEN I will rip off my shirt and whirl it around my head as I dance around the nursing station

Which hospital are you at?

 

[deschutes]

Which hospital are you at?

The one farthest away from you

 

[b&ierstiefel]

The one farthest away from you

Man I just got served! Ai-ya!

 

[yaah]

Nonetheless! SIXTEEN HOURS!! and THEN I will rip off my shirt and whirl it around my head as I dance around the nursing station

So did this actually happen? I had dreams of bringing in a portable CD player filled with an ABBA CD, then hitting play and recreating Eisenstadt's photo of the GI and the nurse in Times Square after WWII ended - I wanted to recreate it with this really cute nurse who was on the floor I was primarily assigned to. I also felt a confluence of such dramatically different ideals as the Eisenstadt photo and ABBA would be interesting.

Alas, I not only forgot the CD player but she was out sick the last day. And my photographer backed out because the hospital didn't give him permission to come in with the camera and he didn't want to run afoul of the CEO.

 

[deschutes]

So did this actually happen? ... Alas, I not only forgot the CD player but she was out sick the last day. And my photographer backed out because the hospital didn't give him permission to come in with the camera and he didn't want to run afoul of the CEO.

thanks for asking! The best-laid plans, eh? As it happens, my sense of anticipation overcame me - I celebrated too early and got burnt.

I was just telling Andy that I had gotten a "Below Expected Level" for my Teams month. It didn't help that this 21st straight day that I had been in the hospital I had been up 28 hours with an hour's sleep, and two of my three new and complicated patients decided to crump the last morning. But those are all excuses. And maybe I really do suck at something as vast as Internal.

I wish she hadn't said "I know you're going into Pathology, but..."
As if that was any excuse for it; as if I had used that as an excuse. In some surreal way, I almost feel like I let Path down. I always told myself I didn't want to be a blinkered doctor who couldn't see beyond their own chosen field.

Right now they can't tell me if this means I have to remediate Teams till the whole IM rotation is over. I did "At" & "Above Expected" my first month, and still have a month of Nephro to go, so that will be key - that is my understanding. And I will darn kill myself aceing Nephro - if only somebody could tell me that aceing my last month will mean I don't have to do Teams anymore. Heck, I would dance on the roof of my house and sing "I don't miss you at all" at the top of my lungs RIGHT NOW if I knew I would never have to do Teams again.

And then there is the question of how this will affect my Dean's Letter. And how I will explain it.

Thus looms the spectre.

Sorry for adding to the general gloom and doom! You couldn't have possibly expected a squirming can of worms when you asked

 

[yaah]

Did they tell you why they gave you below expected? Below expected, to me, is consistently showing up late, not completing tasks, etc. If they really gave it to you for simply not liking IM they have serious problems.

 

[b&ierstiefel]

I wish she hadn't said "I know you're going into Pathology, but..."
As if that was any excuse for it; as if I had used that as an excuse. In some surreal way, I almost feel like I let Path down. I always told myself I didn't want to be a blinkered doctor who couldn't see beyond their own chosen field.

What??? She brought your career choice into the discussion? That's just not cool. You need to show her the hand! Either that or give her the finger!

Right now they can't tell me if this means I have to remediate Teams till the whole IM rotation is over. I did "At" & "Above Expected" my first month, and still have a month of Nephro to go, so that will be key - that is my understanding. And I will darn kill myself aceing Nephro - if only somebody could tell me that aceing my last month will mean I don't have to do Teams anymore. Heck, I would dance on the roof of my house and sing "I don't miss you at all" at the top of my lungs RIGHT NOW if I knew I would never have to do Teams again.

Wait...if your overall evaluation from infernal medicine is "Below expected" that means you fail? Don't they make a distinction between "Below expected" and "Fail"? My impression is that not many attendings typically give the "below expected" mark. Perhaps this evaluation will represent an outlier and you wil do just fine on your last and final infernal month. And remember...P = MD

Like I told you before...forget this and enjoy the weekend! I'm so seriously right nyah!

 

[deschutes]

What a photograph!

Wait...if your overall evaluation from infernal medicine is "Below expected" that means you fail? Don't they make a distinction between "Below expected" and "Fail"? My impression is that not many attendings typically give the "below expected" mark. Perhaps this evaluation will represent an outlier and you wil do just fine on your last and final infernal month. And remember...P = MD

The way I understand it is that ONE "Below Satisfactory" out of four possible evaluations is UNLIKELY to bring on Teams remediation. I know someone who got a Below Expected for both Teams and a selective, which did mean remediation.

So what does the big bold "UNLIKELY" mean for me? Time only will tell.

I've never been anal about reading these student evaluation criteria before, so I might be mistaken. I usually prefer to do well enough that I don't have to bother reading evaluation criteria too closely!