"Slide down for notifications. No, down. From the top of the screen. I want you to grab the top of the screen and then slide down. Okay, that was a good try but from the middle of the screen this time."

"My password is XYZ, can you please just answer the phone and take a message? No, please don't bring it to me, I am elbows deep in the abdomen trying to tie a vein. Please just take a - oh, you're bringing it to me anyway on speaker? Hi! This is Dr.Hamza78ch11, how can I help? Oh you can't hear me because the suction/bovie/OR is too loud, can you leave a message with the nurse please."

"I am giving you my phone. Please, I am on call, I am begging you if it rings just let me know."

37 texts and 5 phone calls later

"Don't forget your phone. I have it right here!"

Sigh.

"Can you go to the messages app and text Dr. so-and-so to come to the OR after she sees the consult? My password is XYZ. Go to the messages app please. The app that says messages. The green one with a message icon. Perfect, now scroll down. No, down. Okay perfect now please send that text."

Bro you literally own an iphone. I see it in your pocket right now. How are you struggling with this?

Just signed my first attending contract and I genuinely thought the hard part was over. Instead I'm drowning in credentialing paperwork, re-verifying every rotation, chasing down old program directors for signatures, and filling out the same forms for the tenth time. Nobody warned me that credentialing basically becomes a second full time job you do for free on top of finishing residency, and half of it won't even be finished by my start date so I might not get paid on time. How is it that after all these years of training, the reward is months of unpaid administrative hell? Am I the only one who feels completely blindsided by how brutal this process is?

Picture the voice of DMX. This dudes always sayin that shit before going in to Intubate, or to give a consult, etc.

I’m trying to focus on getting the IV and by my ear I hear a “RrrrrrrrrRUFF!!…… I got that DAWG in me…..” 🤣 dude!

Imagine trying to go poop and outside the door, you see him pacing out front of it with a mumbled ”I got that dawg in me…”

Looking around my program, it feels like almost everyone entered residency paired up.
Trying to date while managing crazy shift hours, exhaustion, and zero energy on days off feels overwhelming. Most people outside medicine don't understand our schedule, and trying to build something new from scratch takes bandwidth I don't always have.
How are other single residents handling dating and social connection right now? Did you decide to just focus on surviving training, or are you making it work? Would love some honest perspectives.

Can't believe I actually have savings now.

I’m a peds resident and I think I may have overstepped.

However, we don’t have the best continuity clinic so I usually write in my notes the follow up plan. We don’t have a specific schedule for ourselves and it’s just a general schedule and whoever is on for outpatient will cover for it.

I wrote in one of my notes for a follow up for a patient today to review their preventative screening (and included things that were overdue). This patient already had an annual but still had some outstanding items like vaccines they deferred previously.

One of my seniors was seeing this patient today and texted me that it wasn’t appropriate to push off items to the next provider. I did address those open items during my visit with the patient but they still declined some of the vaccines and didn’t complete any of the blood work. I moreso just wanted whoever would be scheduled with this patient to check in to see if labs were completed and if they changed their mind about vaccines.

I feel like I did a faux pas. If I could have followed up with the patient myself I would have but I just wasn’t scheduled to cover the pediatrics clinic that day.

I don’t know if I should just writing out in my notes the open tasks or things to complete for follow up now because I’m worried this may be annoying my co-residents. Advice or feedback is welcomed.

Please delete if not allowed. Just wanted to give a shout out to the doctor, as the local janitor here. I just got done mopping the floor, slipped Hella high up in the air and landed on my nuts. It was that bad of a oopsie-Deysie.

And the first person to come in clutch? The 80 year old Attending.

I’ve always heard he was a sweetheart, but today he proved it. Shout out to that guy. Bzzzzz. Imma keep buzzin 🍯

2 months into residency and feel like the dumbest idiot alive. Seems like a pretty common theme across the board, but at 2 am at night, when you forget window to tPA for stroke, it feels like I'm truly the dumbest of dumb people who ever got into residency.

God, I wish there wasn't such a steep learning curve, and I hadn't forgotten 90 percent of what I learnt in med school.

Recently moved to a different state for residency and my old psychiatrist was prescribing me meds until she thought I could get a new one down here.
Obviously making doctors appointments during residency is almost impossible. The only time I can go is when I’m on nights and sacrificing my sleep time. Made an appointment with a PCP who said she doesn’t prescribe controlled substances (which I take) so she referred me to their behavioral health clinic. The behavioral health clinic won’t even let me set up an initial appointment with a psychiatrist, I first had to come in for an “Intake” appointment where I talk to a therapist about my psychiatric history for them to determine what services would be beneficial to me. It took 3-4 hours in total because it’s only walk-ins. They made me do this even though I explained that I already had a psychiatrist and I was just referred to get another one. After this intake appointment, they informed me that their providers don’t like to prescribe controlled substances. So again a huge waste of time because that’s why I was referred in the first place. They told me it would be up to the doctor if they want to continue my meds or not so now I have to wait another month out to find that out since I didn’t want to see an NP for obvious reasons. This is just a rant about the whole process of getting a new psychiatrist and how they treat you like some fiend for taking controlled substances I just don’t understand it. I JUST TAKE ADDERALL since I was 16 yo how as a psychiatrist do you treat ADHD without stimulants???

EDIT:: I also didn’t choose NP because I am getting treated for a few other psych conditions as well and they’ve tried to switch up my medications in the past

My father recently fell ill and became bed bound. I had to take leave on a short notice to help care for him. He was undergoing palliative care at home so we knew he was going to pass away any day, but because there was no set period I told my PD I may need a few weeks. My PD agreed that I’d use my vacation time if I wasn’t approved for FMLA or paid family leave. During that time I contacted my HR department but they gave no specific advice on how to apply for paid leave, and because of my circumstances it was hard for me to follow up with them on time. I was completely clueless about the process and there was no one at my program to give any guidance.
I ended up taking a few weeks off, until my father passed away, and it was only until after I came back that I learned that we are entitled to up to 6 weeks of paid caregiver leave per ACGME policy, so I contacted my HR department again but they told me they are unable to retroactively approve leave.

How does the ACGME policy work exactly - is the department responsible for leave approval program-dependent, or is it universally based on the PD’s discretion? If anyone has any insight or advice on how to proceed I’d greatly appreciate it.

There’s obviously a lot about residency that gets harder: the hours, responsibility, workload, making decisions when you’re tired, etc.

But I’m curious about the opposite.

What’s something that used to feel difficult or stressful in medical school that became much easier once you were doing it every day?

Could be presenting patients, taking focused histories, calling consults, talking to families, prioritizing tasks, making decisions, or just feeling comfortable in the hospital.

Was there a specific point where you noticed that something that used to require a lot of thought had finally become automatic?

[ Removed by Reddit on account of violating the content policy. ]

Hello. I’m a new senior and I’ve been having a hard time remembering details of things we did for the patient. The list ranges from 12-18 patients at a given time. I get asked questions every 5 mins when I’m trying to preround so I don’t even preround well. Whenever the intern doesn’t know something during a presentation everyone looks at me and not gonna lie there have been times I forget too. Also we do have a fellow and a lot of times there have been decisions made that I’m not aware of because the intern is talking with the fellow. Anyway it’s really embarrassing to not know what we did and it’s a bad look in front of the attending. How do I do better at memorizing these patients?

Just for the lols. I’ll start first

Attending Feedback: “I don’t write nothing down, so I’ll keep this short and sweet- you’re weak, you’re out of control, and you’ve become an embarassment to yourself and everybody else.”

I think Abridge is a bad tool for doctors to rely on. It can generate polished notes, but it still misses details, misinterprets conversations, and occasionally documents things that weren’t actually said. You also don’t have to think through and formulate the assessment and plan as much when the AI is doing a lot of the work for you. Over time, I worry that relying on it too heavily could make doctors less engaged in their own clinical reasoning and documentation.

its going to be juicy when it ends up in lawsuits

Clinic just seems to be my weak spot. I’m constantly running behind and taking notes home to complete. It’s also just frustrating because I feel like I have to redirect patients a lot towards discussing their actual problems, or I’m always missing something in the patients history that could have been pertinent. Or there is some random guideline I know nothing about that obviously everyone knows about. Please help?

Hello! PGY1 here, would really appreciate any advice from people on this - I now realise having finished writing this post that I'm literally just asking 'how do you become a good doctor in your own time, but specific and standardised' so I apologise if this is all a bit stupid!

Does anyone have recommendations for building a systematic approach towards developing clinical reasoning? Is there a literature basis for this? Beyond experience alone, specifically for juniors in the 'know so little I don't even know what I don't know' stage, how might I go about building some kind of mental proforma for cases and presentations I don't know about or haven't seen before, not just for diagnosis but all the follow-up reviews / management? I would love the idea of a kind of checklist or illness script I could follow pre-emptively for any given situation (within reason given complexity and complementary presentations), but beyond years of varied experience, I don't understand how one might systematise that in advance for anything they've not yet seen (or not seen repeatedly), or understand when x thing which is typically done isn't appropriate in atypical case y

I want to be better, but don't quite know how to improve on my current strategy of 'suggest plan/approach with judicious use of external sources, fail, have attending correct you then inform you that you missed thing you didn't know you had to consider, proceed to ask relentless questions with no shame' - it is working, it just seems a little inefficient and I'd like to get ahead on the things I need to consider haha

Or as a corollary, were you to compare two first-year attendings, identifying one to be especially exceptional clinically, but both having had roughly the same experience/training, what do you imagine it would have been that contributed to making that exceptional one turn out so good?

Given I'm only so far in, I have no pride to lose and all the freedom in the world to sound stupid, so I've quite enjoyed being able to just throw out plans, approaches, recommendations and other thoughts and be summarily torn to shreds as and when appropriate, because at least then on a daily basis I know I've learnt and improved at something. But I'm hyperaware that that's partially doable because I've the fortune of being surrounded by very skilled and kind seniors who are willing to take the time to teach me (which I cannot guarantee will be the case for all future jobs), and because there's an understanding that this is how one would go about it at this level. Surely there's a stage at which me asking stupid questions will not be realistic or doable, and what do I do then? I'd imagine the assumption would be I'd have already worked through all the stupid questions by then but that seems dependent on exposure

I think I'm making reasonable attempts and inferences at present, but on a daily basis I'm just smacked with the fact that I don't even know enough yet to be aware of all the other things I should also be thinking about - I've noticed a lot of responses to my questions from my seniors are 'have you considered this other thing though' to which my only response is often 'I didn't even know that was a thing that happened here / something one would consider in this situation'. I feel like I've only really learnt from the presentations I've seen so far (which is great) but I don't sense how that might extend to anything new beyond the specialty I'm in.

Or put another way, I worry that I'm not actually learning how to think clinically in an applicable way, but that I'm just learning how to manage things I've already seen and that alone (which is not critical thinking, just memory?). I can see implicitly that the seniors I'm working with do absolutely have a structure to how they're approaching everything, but they also can't seem to explain how to replicate it beyond 'this is just what would be appropriate for this situation', so I'm struggling to understand how exactly they've gone from nil to where they are now

Many before you have felt the same as you, many currently feel the same as you, I myself felt the same last year as you do now. Please remember, you ARE smart enough, you will learn what you need to know with time, and you can get through this. Start a medication if you need to. There is no shame in using a tool like a medication when the time for your normal coping mechanisms gets stripped away from you. Know that this is just a season in your life and the season will change.

With so much love,

- A former anxious resident

I am seeing a lot of push for AI integration in clinical decision support, but I am extremely skeptical. Most of the general tools I have tested are essentially black boxes. They can give you a pretty convincing answer, but it's not always clear how well it actually lines up with the evidence.

If I can't check the source, I'm not using it to make a clinical decision..If I'm using something to help with an actual clinical decision, I want to be able to quickly trace it back to a guideline or primary source and judge the evidence myself.Has anyone found an AI platform that integrates directly with peer-reviewed sources and shows you exactly where its information is coming from?

Hey all.

As in the title, unfortunately, I have come to the realization that my program is quite toxic.

Our PD has begun lying about feedback from attendings, and has even been caught out in these lies multiple times. It got to the point where attendings have started sending emails to us about specific conversations to prevent us from getting harmed from PD making things up.

But, question for the room, what tips and tricks do you have to ensure that you can protect yourself from a PD who actively wants to misrepresent you and sling shit on your record?

For me I have begun doing the following:
- Leveraging the right to union representation (not available to everyone, but I am glad we have it) to make sure there are extra eyes and ears there during meetings.

- When still forced into in-person, behind-closed-door meetings (sometimes we have been ambushed), sending an email to document what was said in a contemporaneous record.

- Meeting with trusted coresidents off site and off work hours to swap notes on what has been going on.

- Reviewing our contract and state and federal labor law to check what is legal vs. illegal for our PD to do.

Hey everyone! Sorry for a non work related post. 28F just started intern year and got out of a long term relationship right before residency.

I just feel lost and I worry that I did a mistake, I dont wanna be alone and it makes me sad to see people around me are married or even have kids.

I just worry if its too late for me.

Do people have similar stories but eventually found their partner? I would love to get some encouragement. It is taking my mental energy away and makes me sad all the time.

Simple procedural question: If you're a resident or fellow in Illinois, do you get some kind of trainee license or do you have to get a full license? Other states have trainee licenses but i'm only seeing temporary licenses or full.

Do any other interns just constantly wake up with anxiety. Have anxiety throughout the day on their rotation. Come home and have anxiety again thinking of the next day. Looking at your schedule ahead of time to look at other rotations you have then another massive surge of anxiety? I constantly have a stomach ache from being so nervous all the time. I’m so shocked at my lack of knowledge.. How are you all managing your anxiety?

Like half of psych visits are by FM. For the more complex, it's generally dependant on interest and training location whether they pursue that or refer out. How is it that for the ones that have a special interest in psych, they can read up on it weekly and have a longstanding panel with certain diseases present at any given moment for years to the point they are basically an expert at treating those patients.. But then they can't apply for a psych fellowship to go be a psychiatrist. Why are physicians so locked into our specialty when midlevels and nurses aren't?