#pgy-11ty

[pleasedotheneedful]

what's new in pdtn land

became a dad last month

had to fight tooth and nail to get 8 weeks of unpaid leave for child care though, because I have < 1 year in service and HR/admin in my hospital system is a fucking disaster. my wife has similar rules about her maternity leave but her admin waived them without any pushback. she works for a different hospital system and gets 12 weeks fully paid. guess who's more likely to retain their physician?

2. had my teaching titles/roles stripped back in January, rather suddenly. I admittedly let myself get into an unhealthy cycle over the winter and wasn't doing a lot of teaching, but I'm surprised they took me off the schedule entirely for a year. I'm not sure how I'm supposed to get better without actually getting reps on service. I talked to the PD about it, who acquiesced but when the new teaching schedule came out I wasn't on it. yet we share the same vision for the program and its residents.

3. moved into a new house to accommodate #1, which unfortunately meant moving out of the city. the housing market is total insanity still, houses were impossible to find without an HOA and even then, flying off the market within 48 hours.

4. given #1 and #2, I have limited prospects on staying at my current job. the pay is good and the day-to-day work on non-teaching is pretty manageable. but it's not what I want out of my career long-term. I'm toying with the idea of going part time or PRN here, and putting that time into being a mercenary. locums pays well and requires fewer hours--there aren't any benefits but since I'm on my wife's plan that doesn't matter to me. so I can use that time to be at home more, and expand on my private practice hybrid concept. the locums gigs also offer me a chance to get a diversity of references instead of being tied to one employer. if I'm not back on teaching with some frequency by next January, I'll probably scale down to PRN by the subsequent summer or walk.

[pleasedotheneedful]

Got into an argument with the GI NP about a consult I placed. they said "happy to see the patient but not sure why the consult is needed"

So I explain that the patient's ileus is nonsurgical (passing gas, already seen by surgery) but after his NG tube was removed his presenting symptoms (severe bloating) started rapidly accumulating. Etiology remains unclear. I'd like to blow out his colon and see if that helps reduce the bloating.

She goes on to say that well, surgery said he's still passing gas and he's improving so I'm not sure what else we would offer. We can see him in the office.

I say yes, I know what they said but what I see/hear from the patient is different. I understand if you don't think a full consult is needed but I would like to know your thoughts on doing an aggressive bowel regimen, as it's evident he has quite a bit of stool regardless. A curbside/your off-the-record input is fine.

She then says I don't know if I would do an aggressive bowel regimen, miralax is fine. and mainly, please save inpatient consults for acute inpatient issues. Surgery says he is improving.

...

My headspace: I WILL DESTROY YOU, I WILL COME TO YOUR HOUSE, STEAL YOUR PLANTS, AND PISS ON YOUR DRYWALL.

I take a deep breath.

"I realize that's what surgery said, but he wasn't improving when I saw him yesterday. Though passing gas his symptoms were ramping back up. This was shortly after the NG came out. I was looking for additional guidance, you gave it. I am pretty judicious with my consults coming from a program where I was expected to discuss my rationale over the phone."

Don't you talk down to me, motherfucker. I don't have to chug dongs the way I did for the previous five years.

An hour or so later, I get a message saying she saw the patient and would discuss with the GI attending.

I love that I have the support of my division in pushing back on petty shit like this. I usually just give my chief a heads up in case anything gets back to him.