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How To Get Ivermectin? Buy Online! One of the biggest mistakes I made in residency was not to ask basic questions. It’s precisely the issue implied in the prompt - I felt bad, and as though I should already know the answer. Which is absurd, when you think about it. Medicine is fractally complex, and the knowledge is constantly being updated.

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  • Gravity13

    Gravity13

    March 10, 2015, 6:35 pm

    I didn’t buy a sick car after residency, and our house is fairly normal*. But one of the luxuries I promised myself was that I was going to ask anybody whatever I wanted, until I was satisfied with the answer. I’ve been happily surprised, actually - when you get into it, even basic questions wind up having complex and interesting answers.

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  • Tlide

    Tlide

    March 11, 2015, 8:33 am

    Now serious: I 100% regret not asking basic questions. I would find every excuse to run and grab my phone to look up something because I was embarrassed to ask. I regret it now because I know if I did I would have retained that information much better and have a better understanding of the disease process / surgical application / ect. I mean asking Infectious disease/pathology a question was always a long answer but I was able to take away so much more. It's also a sure fire way to show you that there is a ton of information below the superficial bit you may know.

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  • chromacolor

    chromacolor

    March 10, 2015, 7:19 pm

    I think the important thing in medicine to remember that you're truly a frog in a well until you ask and learn from others who are a much more vast knowledge base/experience than you do. You don't know what you don't know.

    Reply

  • UnificationDotCom

    UnificationDotCom

    March 11, 2015, 3:51 am

    The thing to remember is that the attending might not know either, and then telling you to look it up is because they don’t have an answer for you. But they might have the exact same thoughts you do… I SHOULD be able to explain this well. But I can’t.

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  • EmpiresCrumble

    EmpiresCrumble

    March 10, 2015, 6:47 pm

    One day I sat in the residents lounge questioning the difference between a traumatic brain injury, stroke, and a brain bleed. Thinking these were obviously different, but then realizing that they share many more similarities than I had originally thought. I ended up having to dive into the subtlety and complexity more than I ever would have previously…. And even today I still find the delineation sort of grey.

    Medicine is immensely complex, I’ve tried to take the same approach as you and approach my learning with complete humility at risk of looking like a fool in front of my attending. I doubt this will ever end, and I love it.

    Reply

  • Gedrah

    Gedrah

    March 11, 2015, 12:00 am

    I was absolutely amazed how much I learned in the first few years out of residency. I've always worked in academia so I have easy access to experts in subject areas, but to this day if I have a particularly difficult patient or a need advice regarding a treatment approach I will reach out to someone in my department who is an expert in the subject. Likewise if folks have questions regarding the management of schizophrenia or bipolar disorder (my areas of expertise) they reach out to me. Curbside consults happen all the time and I've learned a lot from them.

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  • marblelion

    marblelion

    March 10, 2015, 11:07 am

    One of the most frustrating parts of medicine is the mindset that any question is totally acceptable answered with “that’s a great question, why don’t you look it up and present on it tomorrow”

    I have so many problems with this tradition in medicine. High among them is it's even less than should be expected of a teacher, even though it's understandable if they don't know the answer. One of the most important roles of a teacher is to be a guide to the best sources of information, not be the textbook themselves. Look it up where? Ask whom? What depth of knowledge is necessary for clinical application ("as much as possible" is a response that should be a capital offence, just saying)?

    Reply

  • Snorple

    Snorple

    March 10, 2015, 8:13 pm

    Yeah I get MAs telling me the state vaccine registry won’t accept a vaccine within four weeks of a live vaccine, and I go back on some in depth search looking for any evidence and find nothing. No live after live but I’m gonna give them their catch up dtap next week rather than give them a chance to escape

    Reply

  • megatom0

    megatom0

    March 10, 2015, 6:47 am

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  • mredd

    mredd

    March 11, 2015, 1:58 am

    I actually called my companies clinical pharmacist medication question service and they told me that recommendation has even been dropped. Felt like an idiot calling and asking about a much more mundane situation of an inactive 3 weeks after a live (I give maybe 2 live vaccine a year so I didn’t bother looking further into it)

    Reply

  • corby10

    corby10

    March 11, 2015, 5:50 am

    We had a fellow that had the students convinced it was a chair where the patient would sit and tilt their head back to actually have their face plunged by a toilet plunger. He also convinced and intern that a patient with a cuff leak on the vent had been bitten by a bat overnight and the frothing secretions was due to rabies. Neither time could I keep a straight face for more than 30 seconds.

    Reply

  • backpackwayne

    backpackwayne

    March 10, 2015, 10:51 pm

    Airway clearance encompasses therapies we use to mobilize lower airway mucus. These include inhaled medications like bronchodilators and mucolytics as well as mechanical therapies like manual chest physiotherapy, HFCWO vest, IPV, etc. Cough assist (insufflator/exsufflator) is another method of airway clearance. These specific therapies have different indications based on the patient’s respiratory pathophysiology.

    Reply

  • Gravity13

    Gravity13

    March 10, 2015, 6:48 am

    I am actually a cofounder of something similar. More of a drug information app, but we get a decent amount of non-pharmacy questions that can have evidence-based answers (not saying the name to avoid self-promotion). But we get a decent amount of questions from doctors or pharmacists that make us facepalm... I usually try to assume it is just a resident who is lacking confidence or needs some reassurance or something.

    Reply

  • sonicon

    sonicon

    March 11, 2015, 9:10 am

    A site of regulation for the cascade is antithrombin which breaks down factor 2 (thrombin) and factor 10. Heparin, enoxaparin, fondiparinux all basically just upregulate antithrombin to block the cascade. Factors 2 and 10 are in the common pathway so PT and PTT should rise, but heparin only rises the PTT. Why? It's an artificial value because lab tubes have antiheparin products so you only get a rise in PTT. If you have a severe heparin toxicity, the PT will eventually rise.

    Reply

  • Chaoticmass

    Chaoticmass

    March 10, 2015, 2:21 pm

    After 20 years in medicine. Vaccines that prevent cancer - HPV vaccine, treatment that cures Hepatitis C. Both to me are underrated and amazing. I had people dying of both HCV virus and Cervical cancer when I started and no one with either active issue in past 5 years now.

    Reply

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