medical school

Any situation where patient is dry with BP like 80/40 = give IV NS before doing anything. Even if their sodium is like 120 or 150. That is my primary lesson from studying for the Medicibe shelf with USMLE World.

yeah i feel like 'push fluids' is kind of a safe go-to intervention

btw by 'shelf' i mean all the shelfs

OK so how much of this can I remember:

Medicine shelf: U-World + MKSAP + everything you did to an actual patient (seriously this is the stuff you do not have to study, you're just like "Oh of course it is to begin HAART therapy, because we had that guy who had Cryptosporidium and all we did was give him HAART and some Immodium.")

Peds shelf: Pretest

Surgery shelf: there are really only maybe 15-20 sorts of scenarios where surgery is testable (appys, cholecystitis vs cholangitis vs choledocholithiasis, perforations, etc.). It is less daunting than it appears. Also it is generally best to select the most conservative option (although watchful waiting is not always actually the most conservative therapy).

Psych shelf: I forget.

OB shelf: I felt like this one sucked because the OB you are supposed to know as a 3rd year is a relatively finite batch of common issues, and thus pretty manageably knowable (preeclampsia and gestational diabetes and chorioamnionitis and such), but the actual exam tests almost none of this in favor of the things you may see like once a year.

Step 2 CK: Take after medicine if possible. Also there is some OB and a little Peds but medicine is where the action is.
Step 2 CS: is stupid, and expensive. Do not fail it because my God it would suck to have to do it again.

Awwww yeah, it is officially official today.

ahhhh congrats!!!

Hell yeah. Congratulations.

bigtime!!!!

soooooo i think i'm going into psych

(you win, horseshoe)

tell me more in a possibly emo fashion!

feel free to use all caps!

also yay!

wow dude that's boss

the brainsick of the world thank u gbx (though I've still never seen a proper psychiatrist)

that's because psychiatrists just rx the drugs and leave the therapy to clinical psychologists, counselors, social workers, etc.

um, hi...I'm here for the gbx livejournal? :)

(xp I have drugs, got them from my PCP though)

PSYCHIATRY

CONS FIRST, ALWAYS START WITH THE CONS:
- BASICALLY YOU JUST WASTED A FEW YEARS LEARNING SHIT YOU WILL NEVER EVER DO OR NEED AGAIN, EVEN IF YOU LIKED IT, LOL TOO BAD
- CAN'T DELIVER BABIES
- USELESS ON AN AIRPLANE
- EVERYONE AND THEIR FUCKING PROBLEMS, GAWD
- LOTS OF THINKING, NOT A LOT OF DOING
- WILL ASSUME EVERYONE PUTS IN THEIR OWN AIRQUOTES WHEN YOU TELL THEM YOU'RE A PHYSICIAN
- YOU'RE JUST A DRUG-DEALER, LET'S FACE IT

XP KATE78 GETS IT
- WHILE WE'RE FACING IT: YOUR COLLEAGUES DO NOT RESPECT YOU AND YOUR FLIM-FLAMMERY
- FRIENDS RELATIVES AND PPL AT PARTIES WILL ASSUME YOU'RE EVALUATING THEIR PSYCHE ALL THE TIME, AND WILL CERTAINLY BRING IT UP IN TIMES OF CONFLICT
- YOUR KIDS ARE GOING TO BE FUCKED UP (SEE PRECEDING)

you've just described... every job

HEY MAN I'M JUST DOING WHAT THE LADY ASKED

haha my parents are doctors and have said some asshole shit about psychiatrists in their time but i would have really appreciated it if one/both of them had seen a pscyhiatrist at some point in their lives if you catch my drift.

why do you want to do it then? i read a book that convinced me drugs are bad

also thank you evan!!!

let us just be real that lots of thinking in a job sounds awesome. or is that the caricature of psychiatrists? either way, it sounds awesome.

bring on the PROS

A delightful choice! I was working with a 4th year student who is going into Psych and we discussed our mutual interest in chattin' with dudes and not doing procedures and wanting to give sad people hugs sometimes.

So how is your ERAS going?

FAMILY MEDICINE

CONS:
- EVERYONE IS SICK ALL THE TIME, JUST CUT IT OUT
- ALL DIABETES ALL DAY
- NOTHING IS WRONG WITH YOUR KID
- DID I SAY 'DIABETES'? I MEANT PAPERWORK
- HOW AM I SUPPOSED TO AFFORD A BMW ON 150K A YEAR, THAT SHIT IS WHACK, I WENT TO MEDICAL SCHOOL, I AM A DOCTOR
- PICK ONE: A) IT'S A VIRUS OR B) SEE A SPECIALIST
- NO I DO NOT WANT TO SEE YOUR RASH, WE'RE ~SOCIALIZING~ FOR CHRIST'S SAKE

my dad is a pediatrician and i think he is excellent at it and he loves kids but he has some *regrets* about not using the full range of his diagnostic skills. a lot of his day is: your kid has strep throat, here's a prescription, rinse repeat.

i would never do family medicine! i hate families!

interest in chattin' with dudes and not doing procedures and wanting to give sad people hugs sometimes.

C-L gets it. plus, behavior ("behavior") sits at an intersection of actual, real science-y science (BRANES!), sociocultural stuff, and hugging that i find v appealing

plus unlike neurologists, psychiatrists can prescribe stuff that at least ~seems~ like it makes people better

(i love procedures, though)

sorry that was very first world problems of me, i guess. family medicine is amazing, but it burns you out, too.

(i kid, obv)

man now I wanna become a doctor

this is so exciting!

ERAS goes, it goes

need to gently prod at least one letter writer, tho

personal statement is....not complete

i think you just wrote your personal statement

behavior ("behavior") sits at an intersection of actual, real science-y science (BRANES!), sociocultural stuff, and hugging that i find v appealing

me too kinda but i think that's only because I've got no idea what I'm doing with my life right now. I'd probably get all As in a postbacc premed thing but I'd likely faint 30 minutes into med school due to weak constitution (7)

xp to dayo

xpost
It's all paperwork. Soooooo maaaaaaany people go to med school an no one tells them that they are primarily going to be administrators, and they have no aptitude for it.

haha my friend is straight killing a post bacc premed thingy right now, hopefully that translates into med school success

let us just be real that lots of thinking in a job sounds awesome. or is that the caricature of psychiatrists? either way, it sounds awesome.

― horseshoe, Tuesday, September 4, 2012 5:38 PM (7 minutes ago) Bookmark Flag Post Permalink

honestly, this is sorta what i had to face up and admit to -- psych seems like the 'easy way out' for someone with my, uh, personal sensibilities? like ok i will talk to people with problems all day, ok, fine, why are you paying me so much? i mean, ultimately, choosing psych sorta means choosing what plays to my strengths (and interests, obv) over what i think i ~should~ do with all this crazy training. i got honors in psych (BRAGGING) and was not even intending to (like, for real, i barely studied). but i know that some other students really struggled with it and/or hated HATED psych patients (sorry folks, but it's true). ...and i'm guessing the reason a lot of them didn't really like psych was because it was just a little ~too~ squishy; accurate diagnoses are hard and their criteria change all the time (that can't possibly be science!), treatment is rarely definitive (anti-depressants don't work basically half the time), and ewwww gross i don't want to hear about your icky relationship with food/sex/your dad/cutting/self-image/etc, just gimme something to TREAT, LIKE A BOSS.

english-lit-major-instincts die hard

yeah, but the psych rotation is, I think, the most important one for MDs, RNs, etc, because crazy people are everywhere. They're having babies and heart attacks and getting diabetes. Ya gotta know how to deal with them when they eventually make their way to you.

i was also just recently working with a 4th year med student who wants to go into psych. it takes a certain kind of person to want to do that kind of work. mental health is so criminally neglected as a part of health are and public health, i'm glad a good guy like you is going into it. plus, think of all the looooong notes you are gonna get to write :) congrats!

when in my next life i'm a doctor i'd probably choose to be an internist but psych seems like a great field with some great people

gbx you are a 4th year right?

yeah, but the psych rotation is, I think, the most important one for MDs, RNs, etc, because crazy people are everywhere. They're having babies and heart attacks and getting diabetes. Ya gotta know how to deal with them when they eventually make their way to you.

― kate78, Tuesday, September 4, 2012 5:58 PM (2 minutes ago) Bookmark Flag Post Permalink

this is otm imo. it's crazy how neglected it is by most students---right in the frontmatter of First Aid for Psychiatry (FA is a series of med student textbooks) it says something to the effect "hey we know all of you gunners are going to blow of your psych rotation because i mean c'mon, but fyi for most of you these six weeks are going to be the ONLY psychiatric/psychological training you get in your ENTIRE CAREERS and there is just no way to avoid people with mental health issues because a) they're everywhere (YOU'RE ONE OF THEM) and b) they look just like people, so at least pretend to give a shit ok"

xp 5th year, but yeah: residency app season opened up a few days ago

now I imagine a psych rotation as staring into the abyss and the abyss staring right back

english-lit-major-instincts die hard

― horseshoe, Tuesday, September 4, 2012 5:58 PM (7 minutes ago) Bookmark Flag Post Permalink

p much. some of my favorite classmates went into psych last year, and they were almost all "non-traditional" students: older, degrees in the humanities, not v gunnery, med school was more like a job than College Part II (ie - didn't socialize with the 'class' much, had more friends outside med school than within it, etc).

Here are the 2 questions I ask any new patient to determine if they are crazy or not. It is sure-fire:

1. Do you have any allergies? (if they report they are allergic to more than 3 things or "every antibiotic", they are crazy)

2. Is there a history of mental illness in your family? (if no, IT'S THEM)

now I imagine a psych rotation as staring into the abyss and the abyss staring right back

― USADA Bin Dopen (dayo), Tuesday, September 4, 2012 6:06 PM (1 minute ago) Bookmark Flag Post Permalink

well it could be if you're on the psychosis ward

BOOM

(just a bit of fun, etc)

xp ha, i like that kate78, and am totally stealing it, my EM attending will eat it up.

what's the earning potential like in psychiatry