@jfitzgeraldMD
Seems like I spend half my time as an OB anes on L&D helping pts through the childbirth process and the other half in the main OR helping to fix the uro-gyn ravages of childbirth. I know many happy couples my age w/o children and there is nothing wrong w/ not having children
@londyloo
Apparently one has to be a North Carolina or South Carolina resident to qualify so this wouldn’t help the out of state students who dream about going to Duke but can’t afford it
@fuzzymittens
It has been my observation that there is an inverse relationship between airway management skill and ego about said skill. The day I stop fearing airways is the day I will need to retire from anesthesia
@dig_deeper1
Couples that started off poor and become rich together tend to have bank accounts together.
Couples that were rich before they became a couple tend to have separate bank accounts.
I don’t see a problem with either 🤷🏻♂️
@TheBlondeRN
Yup!
Its:
-8h for fatty meals (cheeseburger)
-6h for light meals (toast, cereal)
-2h for clears (water, black coffee)
Some places make pt NPO after midnight so they can call them in early if there is a cancellation (again, convenient for everyone but pt)
@dansolomon
Friend of a friend has a huge commercial real estate empire. During pandemic, he said “mom and pop” types worked out deals when couldn’t pay rent. Big corporations? It was their “business strategy” to avoid paying rent but they would end up paying once he threatened legal action
@studentdrdemon
There is a uro-GYN at my hospital who is about to retire and he insisted upon being there at induction so he could hold his pts hand as she fell off to sleep. Surgeons who are present for induction tend to have smoother running rooms too
@WFJimMulligan
@londyloo
I believe what she is saying is that 200 students from NC & SC who were accepted to Duke come from families who make less than $150K and will benefit from this new financial aid. Observation: the family one is born into has an outsized influence on college admissions
@dremilyportermd
We were homeschooling in TX before pandemic and go 9-3 every day w/ a rigorous curriculum taught by my wife who is a PhD level psychologist (no longer practices). There’s homeschooling and then there’s homeschooling
@lealuo
Completely agree. I don’t have a problem w/ Elon Musk making billions dreaming up new inventions but I do have a problem with healthcare CEO’s extracting millions of dollars of salary (often from non-profits) on the backs of nurses and physicians
@blondemedSJW
Some of the scariest anesthetics I have ever done have been on pts w/ infected teeth who present at midnight w/ trismus w/ no mouth opening. Most often due to lack of access to a dentist
@kathryniveyy
As an anesthesiologist, I would have ZERO expectation of vecuronium being stocked in a drug dispensing machine located in MRI. When we do anesthesia for MRI’s, we bring our own drugs. Crazy that the system that put vecuronium there in the first place not held accountable here
When LIV adds a slate of new golfers, someone needs to interview the ones they are displacing. Ask them if they regret signing w/ LIV, what they are going to do now w/ their career, etc. I’m looking at you
@AlanShipnuck
(although I’m sure LIV has this stuff wrapped up with NDA’s)
@MamaDoctorJones
Risk of aspiration for any laboring pt: 30% cesarean rate*5.6% GA rate*0.15% aspiration rate reported by Mendelson = 1:38K
That’s a lot of starving pts to prevent one aspiration
Imminent cesarean is one thing, but many are NPO w/o benefit
I’ve done the anesthesia for pts who choose to deliver fetuses w/ lethal anomalies at term and for those who end those pregnancies early on. Neither choice is easy for the pts. Compelling Ms. Fox to carry her Trisomy 18 fetus to term is a special kind of state sponsored cruelty.
BREAKING: Late tonight, the Texas Supreme Court temporarily halted a lower court ruling that would have allowed Kate Cox, our plaintiff with severe pregnancy complications, to have an abortion to protect her health and future fertility.
@GeorgeChristanz
M1 year was my hardest year in medicine. It took 5 years after residency before I felt like a “real” attending and 10 years after residency before I felt mastery of my specialty. Don’t pay attention to the pretenders…
@VipsMDMEd
Some things can be handled over the phone but if in doubt, I’ve never regretted going to the bedside but I’ve regretted NOT going to the bedside
Applicants: don’t lie like this b/c consequences can bite you later on
PD’s: maybe the term “ranked to match” should only be used when a candidate is in top 10 if you are matching 10 and NOT when candidate ranked 11-25 if you <usually> go to 25th spot to fill your class of 10
2012 match: EVERY one of my students from Texas A&M matched into anesthesia, even the ones I was really worried about. In recent years, applicants I would bet $100 to match are starting to not match. Don’t be so hard on yourself if you don’t match into anesthesia.
#Match2024
Every article that describes the fentanyl epidemic occurring in US communities should also include the sentence “When used by licensed professionals in a clinical setting, fentanyl provides excellent pain relief with a proven safety profile”
@nytimes
After the birth of our first born, my wife felt like she was “lied to” b/c ppl sugarcoated the difficulty of caring for an infant. For many, this leads to feelings of inadequacy. Yes, about 5% of the time the baby will do “cute” things you’ll love, but 95% of the time is drudgery
I’m tired of hearing the…
“You’ll never sleep again”
“Your travel life is over”
“Say goodbye to your weekends”
My first baby is joining us in the next 3 weeks and I’m excited, nervous, anxious, and grateful.
I’d love to hear your favorite parts of having a newborn/baby/kids
@ohJuliatweets
It varies. My wife has a PhD in clinical psychology and homeschools our children. We do a lot of virtual courses w/ independent teachers fed up w/ school system. Homeschooling in Texas means we can teach LGBTQ and “CRT” issues. There are certainly those who abuse it though
@MamaDoctorJones
This Twitter anesthesiologist (me) agrees w/ you that low risk pts should be able to eat easily digestible foods (toast, pasta, pancakes, lean protein) during labor. It’s an uphill battle to change society (ASA, SOAP, etc) and hospital guidelines
@sasstronomical
Sometimes we assume that healthcare workers (or those who aspire to be one) are completely stoic and at ease when receiving medical care as a patient but some of the most scared, vulnerable patients I have taken care of have been healthcare workers
I believe that reporting the use of anesthetic adjuncts adds clinical context to the general anesthesia rate for cesarean delivery. I present data from a community hospital within my system
@emilysharpe
@MariaSheikhMD
@bagchisubha
@RobertGaiser1
As an anesthesiologist, I obviously can’t work remotely from home (the patients are at the hospital 🤷🏻♂️). I fully support all efforts for remote work b/c it makes my commute easier/safer.
And besides, if we take all of those people off the road, it makes a safer and more enjoyable commute for those who can't be remote.
Moves money to small towns where otherwise nobody would live.
Lots of stuff.
ATTENTION
#Match2024
APPLICANTS: 🧵 on personal statements
There are many things you can NOT control during the application cycle
Your personal statement is something you ABSOLUTELY have control over.
@trpender
@FutureAnesRes
@Inside_TheMatch
ATTENTION
#Match2024
ANESTHESIOLOGY APPLICANTS: A 🧵 on how to pick a residency.
With tokens, WHERE you apply has become a high stakes event. In this 🧵, I’ll walk you through how to choose which programs to send your applications
@FutureAnesRes
@Inside_TheMatch
@trpender
@allisonoconn
Gross anatomy lab was one of my least enjoyable experiences of medical school. At the same time, I was grateful for the sacrifice/gift of the cadaver and the opportunity to learn. I don’t think this experience can be replicated in any other way
My advice (when asked) for my female med students:
1) don’t make rank list decisions w/ your partner w/o a ring
2) if marriage is what you want out of a relationship (and you have communicated that), move on if he hasn’t proposed after a year of dating
@thanh_neville
It has been my observation that family members who have had healthy relationships with the terminally ill pt have a much easier time letting go than family members who have had a rocky relationship
@ashtroid22
Mandates work. I know several RN’s who were on the fence but got the vaccine once it was required. I think Biden has to treat these holdout healthcare workers like Regan treated the striking air traffic controllers in the 80’s - let them resign/get fired and move on
@dig_deeper1
I stayed in a rental in Turks & Caicos in 2010 and the deal was that if we wanted AC, they would charge us for the electricity we used. The manager read the meter before and after we checked in. I gladly paid. Everybody wins 🤷🏻♂️
@alextatem
graduated from med school in 04, can count on one hand the times I have been mistaken for anything other than a physician. Also not above helping out and most frequent task is helping people to the bathroom in day surgery. Completely agree this is a huge problem for female MD’s
@MissKayeW
@jfitzgeraldMD
Pregnancy and childbirth are traumatic experiences for the body and we as a society severely sugarcoat their long term effects. Pts should absolutely have agency to decide whether to stay pregnant when they find out they are pregnant.
@LouStagner
If he played an easier course, he could have a scoring average of 72.0
Breaking 80 is fun, but an 81 from the tips at Sawgrass is a whole lot better than shooting 79 at your typical muni. Lots of players don’t get this 🤷🏻♂️
@paulaalorenaa
I’m sorry about your Step 1 result. I know several excellent physicians who failed board exams. The skills needed to pass these exams are not the same skills needed to be a great doctor
@MaxJordan_N
Yup. In 2016 (at age 38) had an exercise stress test for “heartburn” that gave me a NSTEMI. 95% occluded RCA that was subsequently stented. It absolutely happens to people in their 30’s
@WhyamIhereb
When I was a med student, my PhD prof rewrote my work.
When I was a resident, my attending rewrote my work.
As a young attending, my work I could call my own often was rejected.
As a senior attending, I now rewrite my mentees work
@anxiouscatmom
My GYN colleagues will selectively bring some pts to OR and we’ll do deep sedation for IUD placement. Someone w/ your history deserves this option
@vlamers
My 9 y/o gets her first shot today. My wife gets her booster today and my 13 y/o is fully vaxxed. I’ve spent the pandemic intubating dying COVID pt’s. It blows my mind that people have bought into the disinformation and will not get themselves/their family vaccinated
@EpiEllie
The first statement implies that there is an association just not enough statistical power to prove it. The second statement leaves the question of association open
@sheologian
I would say that it has already collapsed. Hospitals are struggling to get to prepandemic staffing levels and every wave/surge makes it worse
@SarahColando
@ASALifeline
@FutureAnesRes
I’ll be there! For residency fair, pick out 6-10 programs ahead of time. It can get really crowded. It might take 10-15 minutes of patiently waiting to talk to someone at a booth. Many residencies (including mine) document who makes contact and this can help w/ IV invites later
@thatgirl409
A few years ago there was an outbreak of chlamydia at the high school in Stephenville (TX) and the superintendent was quoted in the news as saying he had no idea how the outbreak occurred given that the school district had implemented an abstinence based sex Ed curriculum
@sarahshulist
@ZJAyres
Yup. When I got my first request to review a paper I had NO idea what I was doing. The best “training” I received for being a reviewer was reading the reviews of my own submitted manuscripts.
@georgetolisjr
I think it’s reasonable for trainees/assistants to close while the attending starts the next case in another OR. I don’t think it’s reasonable to have pts under anesthesia longer than necessary while waiting for the attending surgeon to arrive
@Eldricks_hoes
My neighbor used to be a F&B manager at a mid-tier club and they figured out it was cheaper to put free iced tea, lemonade, and snacks at the turn compared to paying someone to stand out there to sell it 🤷🏻♂️
For medical students applying to residency, objective metrics like class rank, a useful Dean’s letter, and Step 1 scores have disappeared. Presenting a project at a national meeting is a big line on the CV for ERAS.
@FutureAnesRes
@Inside_TheMatch
I encouraged my students to go to a conference to build their CV - which cost hundreds of $$ to attend - for them to present to an audience of 2 people. Why? Countless hours of work and hundreds of dollars… for a line on their CV?
@AcademicChatter
@AlanaKinrich
I don’t think anyone expects an EM doc to do a perimortem C/S. In a perfect world, OB would be at the bedside if a parturient was in cardiac arrest but this is only possible at the most resourced hospitals
@RodGerardo
I once rescinded a LOR for a med student when I found out that he was asking to go home at NOON on his fourth year elective/audition rotation!
Two observations:
1) a medical school can’t recruit a diverse class w/o a great deal of intentionality - free tuition alone won’t do it
2) free tuition won’t induce students to pick primary care - higher salaries for primary care will
“Relieving the burden of student loan repayment does nothing to address the link between wealth and medical school admissions in the United States.”
Read more from me and
@Jared_Boyce
via
@statnews
here:
@theRNbiologist
If we don’t have a circulating nurse, we can’t do the case
If we don’t have a PACU nurse, we can’t move on to the next case
If we don’t have floor/ICU nurses, we have no place to move our pt’s out of PACU
Yup, nurses are pretty essential
@PollyannaRN1
@GRGirl8
@EPNurse10
In Texas there is something called “safe harbor” and a nurse invokes it in writing when he/she feels they are given an unsafe assignment. It is a BIG deal administratively and there is not “supposed” to be relation by the employer
@Eldricks_hoes
Completely agree! Like I said in my other post, if you can’t afford to pay for your guest to play in your member-guest, you can’t afford to play in your member-guest!
For
#Match2024
, anesthesiology applicants will have 5 gold tokens and 10 silver tokens. If you apply to a program and don’t send a token, you are stating they are at best 16th preference. My advice is just to apply to 15 programs for anesthesiology and save your money
Rising M4s -
These are 2023 fees, so they may change come September.
As you prepare and estimate the number of programs you intend to apply to, you should estimate what it will cost you.
Almost 1 in 5 US MD seniors did NOT match in 2023 and 2 in 5 US DO seniors. I think it’s important to take an honest appraisal of your application if you are thinking of applying to anes this cycle. Better to get actionable feedback now vs October
#Match2024
@FutureAnesRes
Wow - look at the difference in preferred specialty match rate for ONE YEAR of
#Anesthesiology
applicants. (Pink was 2022, Fuschia was 2023)
Source: NRMP
@pedsmd2b
One of my rising M4’s going into anesthesia is a 47 year old former dentist who was an officer in the army. Even the med students who have gone “straight through” deserve not to be infantilized.
For anes, once you cross 230/240 for USMLE Step 2, you have already demonstrated a high probability of passing ABA exam. When I see a 270+ score, I look at the rest of the ERAS/CV to see what opportunities that person gave up to get that score
@FutureAnesRes
@trpender
#Match2024