This post is primarily aimed at program/fellowship directors (i.e. LOR readers). Is there anything in particular I should or should not say/do in my letter that will actually inform your decision about an applicant? What is an ideal length? From some cursory searching, it seems like too short is interpreted as "I don't really give a shit" but if it's too long it will be mostly ignored since the reader probably has hundreds or thousands to go through.

For letter requesters, anything you wish your attendings would say?

Boring.

Boring.

Boring.

Ooo, this could be interesting...naw, actually boring.

Boring.

Annoying.

Boring.

Super fucking annoying.

Mildly interesting.

Boring.

HOLY FUCK, WHAT DID I JUST SEE?!....Anyway, on to the next.

Boring.

Ah, is this dude really trying to start shit right now?

Boring.

Okay, ummm...this is just confusing...this has to be fake, right? Right, guys? Guys? God damn it.

Boring.

Wooow, how does this chick keep showing up??? That's like the 4th time I've seen her today! 🤦🤦🤦

Boring.

Boring.

Boring.

Omg, I'm so fucking tired...just a little more though....

Boring.

Ah shit, probably shouldn't have said that...meh, fuck it.

Boring.

Boring.

Lol, now THAT was actually funny!

Boring.

Oh damn, is that the time for real? Shit, shit, shit, I gotta go.

there are a lot of experienced attendings on this thread and wanted to absorb some knowledge from y'all. What's your go-to headache and GI cocktail?

Recently been adding mag-ox 400mg for headaches that I learned from another attending, and sucralfate for GI cocktail if Gerd or pud?

Some attendings like viscous lido for the GI cocktail but saw mixed things in the literature about utility of it ?

I wanted to let you all know the app has again been updated to include all the feature requests from the prior Reddit thread. The update is free to all existing users.

Here is a video going over how to use everything: https://www.youtube.com/watch?v=e2wBmc7EZfE

Thanks for letting me share the project!

Any Emergency Medicine physicians have experience with joining the Army National Guard? Can you tell me what your experience and duties have been like?

I’m a resident physician and am interested in the opportunities to be involved in disaster preparedness and public service. I’m not primarily interested for the financial or loan forgiveness opportunities, but I’d be interested in hearing about those as well.

I'm under the assumption I'll get materials online to begin to learn, then the date of my course in person I'll do some simulations and then get certification. Is this true?

Hi friends, incoming MS1 and ED RN unsure about why the doc I was working with wanted to admit my patient. Any insight appreciated.

~70yo gentleman presents after passing out at home. Pmh of anxiety (never taken benzos) and HLD (on statin). Pt sts he was doing routine yard work when he felt "overheated" and "dehydrated" and passed out upon coming inside to cool down. Wife says pt unconscious for total of 2-3 seconds. Patient is well-appearing in no distress. Denies any pain. Wife and pt both deny head trauma, no wounds or abrasions. Labs unremarkable, trop negative. Head and C-spine CT negative. CXR with no acute pulm process. Vitals signs all WDL, except for HR 50-55 bpm w/ 12-lead showing sinus brady. Pt sts he has been "very active" and has regularly exercised his entire life and this HR is "normal" for him.

Doc comes in after w/u completed and says he's consulting medicine to admit him for obs due to sinus brady. Doc says he's worried pt's "heart may have stopped beating." Has me repeat 12-lead, still showing SB w/ no changes from initial EKG. Patient was confused as to the reason for observation given his "baseline" HR. Asked me a few times about it and I couldn't really give him a good answer. Ultimately, patient declined admission due to unrelated family reasons and signed out AMA.

I feel like this is normally the kind of thing most docs would discharge. Any insight or ideas are appreciated. Thanks!

Need some help with what people think this might be? Cheers

Graduating PGY3 here. Am about to sign up for disability insurance before I graduate… and I know nothing about it in terms of quotes and how much you should pay, and I don’t want to get scammed.

What’s considered a standard price vs deal on disability insurance ?

Of course we value our continued existence more than we value a stranger’s. That’s true across the board, regardless of the job we perform. Even the hero who runs into a burning building to save a stranger still hopes to come back out alive. Such heroes just show a higher tolerance for risking one life to save two, not a decision to give up their own. And when they say “Anybody would have done the same” we feel the impact of such a response not just because we like a modest hero, but also because we doubt it. Would we really run into the burning building or would we in fact just run through all the reasons not to? thrombocite.com

I'd prefer a physical book than online study tool but curious what everyone is using to study. Lots of options on Amazon. I know there are lots of free YouTube videos but I like touchin' books. I just wanna use my fancy colorful highlighters tbh.

At my ER, we have a new edict issued that if a C collar is applied in triage,the patient must immediately come back to the ER and be placed supine. This applies to any pt that we place a collar on. My ER is small and very busy, in a major metropolitan area. This is incredibly infeasible, yet applies to even the “fall a week ago patient” that might have some head or neck discomfort. No one can figure out where this is coming from and can find nothing stating why a c collared pt cannot be sitting up. Looking at some of the newer literature suggesting automatic application of the c collar may be detrimental to a patient, please offer some insight as to what might be happening here.

I'm a visa requiring non-US img, I'd be applying for emergency medicine this year and I'm very confused about the SLOE part of it. I currently have a research job and have been shadowing EM physicians in the same hospital but I'm not sure which SLOE applies to me because all of them require grading or perfomance evaluation, none of which I would have just by shadowing or watching physicians?

I would appreciate any tips or insights on how to go about this?

Almost MS4 here going into EM. My obgyn clerkship like for many was not the greatest experience. We got three weeks on L&D and I feel I got to learn a lot about deliveries and general OB complaints. The gyn stuff was much worse though. I am a guy and I expected to have of course some patients decline to have me do any pelvic exams which I get. However I got to do exactly zero. Not for a lack of trying as I asked all my preceptors and residents. I had clinic only for one week and surgical gyn for the other two during which I didn’t get to do them either. Now as an incoming fourth year I’m wondering if doing basic pelvic exams is a skill that I should be comfortable with before going into residency or not. I’m planning electives for next year and planning to do ones that are both chill and useful skills like ophtho, rads, derm. I’m debating if doing an obgyn elective would be helpful but I’m not too sure it’s the best use of my time.

EDIT: thanks yall for the advice! I’m glad to hear that while not ideal and I should have had more experience during obgyn clerkship (tbh our program has a lot other problems too besides this), there’s plenty of opportunities to learn during EM resident and sub internships. TBH I didn’t expect this much response but it’s been super helpful in planning the rest of my 4th year schedule. Thanks again!

Posts regarding considering EM as a specialty belong here.

Examples include:

• Is EM a good career choice? What is a normal day like?
• What is the work/life balance? Will I burn out?
• ED rotation advice
• Pre-med or matching advice

Please remember this is only a list of examples and not necessarily all inclusive. This will be a work in progress in order to help group the large amount of similar threads, so people will have access to more responses in one spot.

From my own and many other experiences why is this misdiagnosed so often ? I have stared a sub if anyone would like to visit.

r/aorticdissection

Thanks

Hello. I'm wondering what would be the correct thing to do. I failed my written boards first attempt, and passed the second attempt. I now will take Oral boards this December. So I'm not technically board certified. Credentialing packet is asking me if I've ever failed a board exam Y/N/NA, if yes please explain. The next question is if not board certified do you plan on sitting for boards Y/N/NA, if so when?

So do i come clean right now about my board exam failure? Or do I say NA, not yet board certified? I would hate to start of my job with a huge stigma that I'm a failure if I don't have to. They didn't ever ask about it on interview, this is the first time anyone or any paperwork has asked if I had a board failure. And what would you recommend I type in the "please explain" part? Just all the reasons I think I failed? It just seems like a weird question for credentialing packet-- it wasn't on either of the other two credentialing paperworks for different employers I completed.

I’m a new paramedic but man, our medical system is deeply flawed. It seems like this is the life cycle of most of our patients is:

Patient: “I have (menial complaint), call 911!”

EMS: “This is bullshit, let’s just take them to the ER so we can respond to actual emergencies.”

ER: “Why did they transport this patient? It’s not an emergency, they need a consult from X specialty.”

Specialty consult: “This shouldn’t even be our patient! Their labs are abnormal, just admit them to IM.”

IM: “This patient did not need to be admitted! The family just doesn’t understand that this patient is old w/ multiple chronic conditions. They’re safe to discharge and follow up with PCP.”

PCP: “I’ve done everything I can do from an outpatient perspective. If your condition gets any worse, you need to call 911 and go to the ER.”

And the cycle continues. It seems like all we do is dump patients on one another for the sake of CYA. So many times we take patients to the ER only to later transfer them to a “higher level of care,” and then we transport them back to the ER a week later for the same issue.

Is there even a solution to this problem?

Is it something more profound than just simply insecurity, or burnout?

I have my opinion for this, however, I am curious to know from your personal experience of why this continues to be a problem.

Does anyone have any experience working/rotating at an Intermountain Healthcare ED?

Question for the ED folks, we are in the process of finding a new place to live but also looking where to possibly work. What's your opinion on this? Thank you for your time!

How to you all deal with micromanaging directors in your ED? I am a mid career faculty attending. We have two directors and both of them micro manage. They watch if you are talking to staff or if you ever said anything against management to anyone. If you raise any complaints regarding patient safety issue, they openly call you difficult to work with, not a team player etc. if you explain to them we are not well staffed, and you can’t take care of patient, they label you as unable to manage stress and try and refer you to EAP etc?

I can’t leave this job. But need to know how to survive. We have culture based values the hospital claims they follow but in practice it’s opposite. Chairs and directors harass us and violate our privacy. DEI is all about performative acts only. Retaliation against individuals for standing up or advocating for themselves because it’s considered too aggressive even when stating facts etc.

Are all academic EM programs like this? I feel disappointed with how toxic EM culture has become. I am trying to survive here. Any suggestions/advice?

I'm in the process of recerting (wtf.. I'm 10 years out??). I took the abd/gi one and wasn't bad. For those who have taken them, which would guys consider the most difficult and easiest modules?

Im also having alittle anxiety about the trauma one as I've practiced at a nontrauma center the past 10 years, any recs for latest trauma review?

PGY-3 Here: I have a couples questions regarding board certification.  1-Is the qualifying exam only offered once per year? (this year being 10/28-11/2/2024) 2-When will they implement in-person oral boards?

I’m an emergency medicine physician and always assumed this sub was for emergency medicine physicians but the majority of posts and replies sound like they are from lay people or paramedics.

Have read a significant number of replies that are of the flavour, “My doctor told me….”

Also the sub has 101 000 subscribers. I am questioning whether there are 101 000 English speaking emergency physicians in the world. ABEM in the US has 39 000 members.

Who is the target group for this sub?

I don’t mean to be exclusive but I will respond in a different manner if talking to lay people rather than conversing with colleagues.

This is a mantra that I have heard countless times over the years and it only becomes more true the longer I do this job. It is typically applied to the patient as they withhold important information or don’t tell you the whole truth but I see that it can be applied more broadly as well.

Yes, don’t trust the patient. They have had far more to drink than they are admitting to. They have far more medical problems than they want to let on. They typically cannot recall all the medications they are on. They’ve already been seen multiple times for the same complaint. You must do your own chart review and do your own digging in talking with family members, the EMS crew, the facility they came from or the doctors office that sent them in in order to verify important information.

We all know this in the ED because it doesn’t take long to get burned when you put all your trust in one source of information that turns out to be inaccurate.

I can't even trust myself sometimes. Just when I think I can have some faith in my own gestalt, I get humbled by a patient that turns out way sicker than I initially thought.

Thoughts?

Title above. Genuinely curious as a fresh MS4 applying EM this cycle. My base site does not have an EM residency, and my only exposure to a residency schedule was an IM program where it was six 12s a week. Give or take the random switch of your "off day".

I've heard that EM has more restrictions in regards to residency work hours. (I have no idea if that's true, and that's not what draws me to the specialty anyways.)

But I've heard that some places do 8 hour shifts, some do 10s, and some do a schedule of rotating acuity shifts.

What's the norm?