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Discussion in 'Pathology' started by deschutes, Nov 20, 2005.
I have all kinds of theories about it. I wish they would.
Because they are afraid people will find out who they are and their careers will be destroyed.
In all seriousness that isn't far off. People have an unbelievable amount of paranoia these days. I agree people should post more.
Yes, people are afraid of not just controversy, but the potential for controversy. It's the whole "Better to not understand than misunderstand" thing.
I think there is also that lack of necessity.
Residency program selection can be like life-or-death (or at least somewhat concerning to the most even-keeled of us), and once that point is past and you're actually in a residency program then you have most of the career support you need without having to go looking for it.
It's funny how every year people come looking for the straight dope while going through residency program selection, and then when that's over they just occasionally check in to see what the Match gossip is and to see if anyone is crapping on their - well, I mean, giving uninformed opinions on their home program etc.
Not a criticism, just an observation.
As for lack of time - I think we can dispose of that one. If one has time to read SDN threads during clerkships, one obviously has time to post.
It's path residency, for heaven's sake. There are lot more miserable people in the world than us.
Yeah, it may seem like I am on here all the time because of the # of posts I have, etc. But in truth I am not on here that much.
I would love for more people to post about what residency is like, what challenges they face, etc, instead of innumerable posts about whether dermpath is competitive or what the salary you can expect is.
Hi Old SDN Pals:
I miss posting, I still check-in and read the posts on occasion, but as a real old-timer to this forum (i.e. check back, believe it or not, for risk of sounding like Al Gore, I actually requested that there be a "pathology" forum added on to SDN when the idea of subspecialty forums was a new concept to the site!!!), I miss the focus we used to have. Now, I feel that the forum is so diluted into silliness, it doesn't have the pathology-specific zest that I used to love.
For myself, everyone who wants to knows who I am can, since I use both my real first name, and have told everyone that I am a MGH resident. No surprises, or paranoia for me.
Just a sense of nostalgia for on-topic posting...
Yes, I do remember that famous post
And yes, the amount of non-pathology randomness/silliness has certainly increased (I think we have been here before) but if I may play devil's advocate for a moment, I think part of it is precisely because we don't have many residents posting - and therefore any real pathology knowledge is quite limited.
There is some silliness, yes, but at the same time 2 years ago there were maybe 1 or 2 posts per day, and they were not always on topic either. These days we get some silly topics but we still get much more than 1 or 2 on topic posts per day. It's all in how you look at it. You have to strike a balance between info and community. I actually got kind of annoyed when I started visiting this site because all that would be posted would be occasional questions (the same questions we get now, BTW) with occasionally someone answering it. Numerically, there are far more pathology related topics and posts now than in the past (if not percentage wise). I mean, right now, 8 of the first 10 threads are directly related to path - as a resident I find it interesting to hear about other on call stories, interesting cases, and of course interview experiences and all that.
I agree that the randomness can get out of control at times and get distracting. I have been guilty too of course, but I think we have been better lately at confining it to threads where the subject kind of gives it away.
Wow! Brings back memories, Deschutes!
Yaah: I am not criticizing the SDN community in the least. It is like your old childhood neighborhood--you play in it, you grow up, you leave, you come back, and it is no longer the way you left it (or at least remember it.) And you are no longer the same, either. I am glad we lasted this long! But I do remember the days of Kim Cox & the Great Pumpkin. I saw that Crepitus still posted on occasion.
See my thread about a meeting at USCAP this year! We are the next group of leaders in pathology!
I personally enjoy all the silliness/distracting stuff around here, but definitely agree that it should be confined to a few threads. I feel like I have gotten to virtually know some people, and I may get to meet them in real life as I go on the interview trail!
The other thing I can see that would be annoying to residents is that so much of the conversation right now is from M4s (like me) who are talking about applying, interviewing, the match, etc. Once you are in residency, this probably doesn't hold much interest. But I have really found it to be very useful in terms of finding out what other people think about programs, what I should look for in programs, and what to expect on interviews.
Yeah- I think everyone should go back to the beginning of the path forum and read some of the stuff posted then. It isn't hard to do - on the bottom of the page under "Display options" you can just sort in ascending order, starting from the beginning, and see. It may not work now with the search disabled (unless you are a donor). But then again it might!
Why don't more residents post more often?
I'm busy, overworked, and tired.
As for anonymity...I don't care.
I do miss the days of Mindy and Great Pumpkin. Reading their advice was helpful and what attracted me to the forum back when I was starting the process of applying.
For some reason I find that when I am on call my posting amount skyrockets. I guess I kind of feel like I can't really do anything productive since I could get interrupted at any second. I guess also that I am still getting used to being on call because that's kind of lame rationale.
Actually, I don't find this annoying at all. In fact, I have bets and wagers with classmates as to who will end up where. I have $20 riding on bets so far right now. That's precious cash.
If everyone did that we would never have anything to talk about, evah.
I try to check in at least a couple of times a month. Now that the obsession of the Match is behind me, I feel less of that frenzied urge to post. Life in residency is good...not really much more to say.
I don't post more because, now that med school is over, and now that I've moved and transitioned into residency, I've begun actively pursuing various extracurricular activities. At the top of the hobby list, to be a triathlete!!! While it's off-season now, I find I'm so pooped between working 50-60 hours a week and running, biking and swimming that I go to bed by 8:30 or 9, then get up the next day and start all over again. Add on all the autopsy paperwork I'm behind on, and there's not much time for posting. I still check in occasionally, however.
I post more often than not, but I've been very busy with work (I'm on autopsy) plus I'm on a diet so I spend a great deal of time avoiding food and doing pilates.
did go back..real good stuff there.however, there are themes which keep recurring in cycles every year:
how is path to get in/$$/"life-style"(by MS-I/HighSchoolGunner/FMG underachiever)-where/how to apply-*biting nails*interviews...-*biting remaining finger-stubs* match...- yippie- step3- path is cooler than rest and so on..
i guess we could just keep reading those old posts..and they still are relevant.
however, i think we are of a generation where the net is also a place to socialise as much as a club/workplace.i look at SDN as more than just a place to get info.i find myself cheering others like me on their interview trails,listening to those already residing with attention and respect, jeering the "i-like-Path's-easy-lifestyle" types..in short, having a regular community here.. like everyone, i agree the extras should be kept away from the core issues (seperation-of-Work&Home-ish). however, i like coming here as much for the silliness and distractions as for the "interview experiences"/"on call stories"/ "histopath images"/case threads.pathologists and wanna(/gonna)-be's are among the most multi-dimensional people in medicine, something i am more convinced of each day..
and, to ressurect an old thread's topic..
Is being the one who makes the Final Diagnosis on a case an attraction/reason for taking up path, or is the responsibility daunting?
i,personally, feel that it is one of the things i like about the field..i am the one who KNOWS.the rest make (educated)guesses and are more concerned with management.this cerebral aspect of Pathology was a HUGE attraction for me.what do the rest of you feel?
I totally agree with you. I actually find it both very attractive yet daunting at the same time. It is amazing how much impact you really have on a patient's life in making a diagnosis.
In a way, I am sort of looking forward to the responsibility (after learning the craft, of course!) I think my work will feel so much more important than it does now as an M4 when nothing we do really matters.
Or even by mis-managing a case
seriously,in my country after MS4, we have to do 1 year of externship,where we are basically the lowest rung on the totem pole at the hospital.the first night on call in IM,a patient went into arrest, and I forgot to begin CPR!!luckily the Staff Nurse had her wits about her..with doctors like me, better eat lots of apples!!
seriously, i don't know how prepared 4 years of Residency will make us to become able diagnostitians(with all the powers and responsibilities therein). medicine is all practice, and the more you see,the better you get.some may argue the 1 year wouldn't add much..but i feel it would, because you are still theoretically are under supervision, and can continue to learn under that umberella.. 1 more year of seeing cases at a teaching hospital is sure to be beneficial. i wanted to go into Heme fellowship,but now feel i should plan on a year's Surg Path fellowship straight out of residency, no matter which fellowship i want to do later on.i will always need be practicing surg path in addition to whatever else..
I for one don't post more for couple reasons:
1. Don't feel I have much to add and I'm not one to repeat something just to be heard (or read).
2. Related to #1, I am somewhat intimidated by other posters. It seems everyone knows a lot more than I do and they are doing things in their program we don't do in ours (though I think we see plenty of variety, maybe not the volume, and we don't do much that won't apply to practice when we get out), so somewhat fearful of displaying my ignorance (despite the anonymity of the forum), I shall probably continue to be one of the Knothole Gang.
Oh wow, so much fodder!
Thanks gungho. I actually love that someone came right out and said it. I went as far as thinking it but I thought saying it would have sounded terribly terribly arrogant. Plus, you've been posting here a lot longer than I have!
I don't know if it makes any difference, but the reason I come here is to hear how people at other places do things differently, be it community or quaternary-care, whatever. I've already said it's too bad that we don't hear more from the community-based folks.
I don't think we necessarily have to define a method of practice as necessarily "better" or "worse", just different. Look at Mayo - they do things differently from everyone else, and no one's arguing that they're doing their patients wrong.
Also, (and this relates somewhat to what uhoh! was saying about community) - senior residents and fellows and faculty are always saying during residency, "Go to meetings! Shake hands! Talk to other residents and see how they're doing. Network! You never know when you will need that contact to get you that job."
Conferences are great, but isn't SDN like, one big permanent conference in your backyard? And it can be as short a visit as 5 or 10 minutes every other day, or every day if you're inspired. Why wait for conferences (which you get to go to maybe 2 or 3 times a year max) when you can have this, at home, every day, practically real-time?
Which is the reason I started the original post - certainly not to fault people like AngryTesticle in his previous guise with 10,000+ posts for "not posting often enough".
(Resist just this once the urge to segue into "My-post-count-doesn't-matter-to-me"... we've been there before )
As for ignorance
It seemed like at the end of 4 years of med school we were supposed to know (or make like we knew) everything - and I knew that under the surface this just wasn't the case with a lot of people, whether they admitted fallibility or not.
Another major reason I chose path was because it was like starting over again, and people didn't mind if you asked stupid questions. I think being able to laugh at oneself in some form or another is really quite disarming for everyone in the room...
I had a prof who asked me a difficult question once to make me sweat, and when I did he twinkled at me and said "When you're a student, 'I don't know' is an admission of ignorance. When you get your degree, it becomes a consultant's opinion."
Back in med school I did hear from an attending who had trained in the US that Dr. Rosai was quite vocal about opposing the shrinking of Path residency training from 5 years to 4.
The upshot of this is that more and more people are going to be doing a fellowship, and more and more are going to be doing two.
As for hemepath/surgpath - are there really people who read out both flow and GI biopsies?? I mean, I'm sure there are, but that can't be common...
"I see you're drinking 1%. Is that 'cause you think you're fat? 'Cause you're not. You could be drinking whole if you wanted to."
'Tis a wonderful time of year to be on bloodbank. I fill my pockets with Hersheys Almond Nuggets and Ghirardelli Filled Chocolate Squares every day.
*moves Minnesota up list for free Ghiardelli*
You mean we weren't at the top?
Seriously though, you're on clinical rotations, unlike me. I thought nursing stations have chocolate year-round. I pocket the chocolate in exchange for the pain of actually having to be on the unit.
I have never seen this.
Must be an institution-culture type thing.
I feel ignorant every day. But generally things also come up where I just find that they make sense, and start to become second nature. Counting aspirate smears was frustrating at first - it was hard to tell a monocyte precursor from a lymph precursor from a neutrophil precursor, etc. Residency is all about learning how stupid you are (and don't you forget it!) but at the same time how to use your talents and abilities. Today we had a case that made the seasoned attending throw up his hands and say "I don't know," even after talking it over with others.
Today for instance I felt extremely stupid.
A patient with a HgB of 4 and possible warm auto-Aby turned up to be coded in Emerg first thing in the morning. This is the first time I've been in the Emerg at this hospital.
The scene was relatively serene by the time I met up with the BB attending and fellow, which was good. I mean, I might be studying for Step 3 but I sure as hell don't know in which order D50 insulin bicarb and methylpred go into a code patient.
Have you done Ob/Gyn? They get tons of chocolate around this time of year. In my experience.
Nope. It is my last rotation in med school.
So I basically have to teach it to myself before Step 2, which I have in a month.
Did someone place a call for the old timers.
I don't post as much as I used to just because I am so much busier than before. Studying for boards right now, looking for a job, etc...
I will post my job hunt experiences in a couple of weeks when a few things are finalized.
That happened to me on call too sort of. A patient came in with Hgb of 3 and they gave him about 10 units of red cells as well as fluids, and SURPRISE, he got a coagulopathy and all of a sudden I had to approve products. I wanted to take the time to lecture the resident on the importance of transfusing other components besides just the one you are trying to treat when you are in a massive transfusion type of situation, but it was late.
My massive transfusion hits are coming up in December (trauma ctr rotation). I'm both looking forward to and dreading it. The teaching is going to be awesome.
We don't get the best teaching about massive transfusion situations. The only time we really hear about them is usually after the fact, often the attending is the one around and is the one involved at the critical times, and they don't have time to page us. If we are around, we can learn, but people don't always hang around the blood bank waiting for things to happen. Kind of a shame, because the few days I hung around there I learned a lot.
I've not exactly been getting fantastic massive transfusion teaching at the U either - different patient population, probably. Plus the attendings cross-cover the Red Cross, Cell Therapy Lab etc.
At the county hosp/trauma ctr it's a different set of staff. Slightly more community-oriented. Should be interesting.
What the heck did you end up doing with yourself!!!???
Mindy! We could ask the same of you!! Hope MGH is treating you well.
Just studying hard and job hunting. I am not going to do a fellowship, so I am planning on taking the boards in June and going to work.
Hope things are good up in Yankee country
So it's December already, and I now have 3 out of my 4 possible site ID cards.
Hennepin County MC is proving to be interesting because it is massive, well-organized and in downtown Minneapolis (next to the Metrodome). Day 1 there and I thought - I bet this is what other programs are like, and what we would be more like, if we didn't already have the quaternary-referral U-hosp - which can sometimes feel a little fragmented because of the degree of sub-specialization (HLA lab in the research building, acute care lab/BB in the hospital wing, CP residents' room on a different floor from the residency coordinator etc.)
I think HCMC used to have one path residency spot per year until they were combined with the U.
Funny how the physical properties of a place affect the work atmosphere.
I even have a small meal allotment on my swipecard for my 2 weeks, which is kinda nice. Paella for lunch!
Collecting ID cards sounds fun. We use the same ID for all our sites.
The physical environment makes a big difference. At our VA we have an ocean view from the residents' and gross rooms that is the envy of every other department. We can gaze out at the sea lions playing in the sun while staining frozens. (Well, to actually see a seal from the window would require hawk-like vision.) The look on the clinicians' faces when they stop by is priceless.
So a patient with a Dx of ?ITP was given platelets last weekend with a plt count of 10k and they wanted me to follow up on it, since these patients don't usually get platelets unless they're bleeding.
The resident I talk to is all over the "Path-has-no-patient-contact" issue, though fairly good-naturedly.
I give my usual spiel.
"But you won't go in and see the patient, right?"
"No, I trust your clinical judgement."
I was to repeat this statement again when they excitedly said that he had presumed melena, "do you want to see the stool?"
That's when you call their bluff.
The part I don't get is why they would want a pathologist standing by their (dare I say it?) "unopened" patient. I mean, is there some unwritten quota as to how many people have to stand by a patient's bed and nod gravely and attempt to look both serious and encouraging at the same time?
How the heck have you been?!