Hi, I ’m an Attending and I am READY to Complain About Billing.
I barely knew anything about billing before becoming an attending – the only tidbits I knew were: 1) there are levels 2) gotta have a certain number of systems in your ROS with at least 2 specifics per system 3) the reason I document “fundoscopic exam: unsuccessful” in a 7 month old instead of deleting the line like a sensible person who understands 7 month olds has something to do with min-maxing billing, and 4) ED charts say “MDM” a lot. These are the charts our coders gave me during my 10 minute billing orientation: So that’s good – theoretically I should be able to just consul...
Source: Action Potential - September 18, 2019 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

So I ’m a fellow now
I always “knew” that I was going to be the nice fellow. Partly because I’ve had some terrible experiences with fellows during residency (which I’m still salty about, by the way. I mean, listen, there is never a scenario where I, as an intern, am ‘deciding’ to consult you. The intern is just doing what they were damn well told) – but mostly because I figured I didn’t know anywhere near enough about pediatric neurology to be mean or even a wee bit testy. … I was perhaps wrong. This gradual realization reminds me of being an intern and “knowing” that I was goi...
Source: Action Potential - December 16, 2017 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

Acute Strokes: Peds vs Adults – Everything You Need To Know
Pediatric strokes: “Heparin first, ask questions later.” Adult strokes: “Guns don’t kill people. Heparin kills people.” (Source: Action Potential)
Source: Action Potential - November 9, 2016 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

Differences Between Pediatrics and Adults
I am making a comprehensive list of excuses perfectly good reasons for why I, a senior pediatric resident (fearless leader of interns! attending in the making! resident of the month x 3! winner of a multitude of teaching awards given by med students!) – make a terrible adult neurology intern. 1: Adults with normal potasasium.. need more potassium. In peds, we are pretty much cool with anything over 3.2, and super scared of any number that starts with 5. So in adult medicine this year, it wasn’t until the 3rd time I got a sign-out of “His K was 3.6, so we repleted IV” and reacted incr...
Source: Action Potential - September 17, 2016 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

My First Week of Adult Neurology
Monday: Attending: So! Dr Action Potential, what AED would you like to initiate? Me: Keppra. Attending: Correct. And why? Me: Because… because the answer is always Keppra. Attending: Correct. Wednesday: Attending: So we all agree that the patient’s seizures are not well-controlled on Keppra. Dr Action Potential, what is at the top of your differential diagnosis? Me: … not enough Keppra. Attending: Interesting! So what would be your recommended course of action? Me: … give more Keppra. Attending: Correct. Friday:   Attending: Aha! You see, in THIS patient, we find ourselves con...
Source: Action Potential - July 13, 2016 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

Things I learned in Pediatrics (Now that I ’m done forever)
The family rarely needs you to be their friend. As a general rule, the family has a lot of friends. What they really need is someone who looks grave and important, who looks like they know what they’re doing, right there at the bedside, telling them exactly what’s wrong and what is going to happen. I mean, it doesn’t hurt to be a nice person. That’s great as long as everything’s going according to plan and the patient isn’t actually sick. Your intern can be the nice person. But the most important thing I learned in residency is that when shit goes down, all anybody wants for their l...
Source: Action Potential - June 21, 2016 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

Things I learned in Pediatrics (Now that I’m done forever)
The family rarely needs you to be their friend. As a general rule, the family has a lot of friends. What they really need is someone who looks grave and important, who looks like they know what they’re doing, right there at the bedside, telling them exactly what’s wrong and what is going to happen. I mean, it doesn’t hurt to be a nice person. That’s great as long as everything’s going according to plan and the patient isn’t actually sick. Your intern can be the nice person. But the most important thing I learned in residency is that when shit goes down, all anybody wants for their l...
Source: Action Potential - June 21, 2016 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

Me in The Pediatric ER
  … faced with a waiting room full of “Congestion” “runny nose x 3 days” “fever of 99” “bumps on tongue” “needs stitches removed” “father wants him drug tested” and “sneezed twice and the second time green mucous came out of nose” (Source: Action Potential)
Source: Action Potential - June 3, 2016 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

10 Things Med Students Shouldn ’t Do
This is my first year of being a senior resident and it is only January; and yet I have seen all these things happen. Sadly, this has all led me to the grim realization of why I got such good evals as a medical student: it wasn’t because I was some sort of social genius. (And yes, I really thought I might have been a social genius.) No, it was because I did not do the following things, ALL OF WHICH I HAVE SEEN WITH MY OWN EYES. Seriously, if you don’t do these things, don’t worry. You will be fine. Your residents will love you. Do not claim to be late to rounds because you had a “Cat...
Source: Action Potential - January 26, 2016 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

10 Things Med Students Shouldn’t Do
This is my first year of being a senior resident and it is only January; and yet I have seen all these things happen. Sadly, this has all led me to the grim realization of why I got such good evals as a medical student: it wasn’t because I was some sort of social genius. (And yes, I really thought I might have been a social genius.) No, it was because I did not do the following things, ALL OF WHICH I HAVE SEEN WITH MY OWN EYES. Seriously, if you don’t do these things, don’t worry. You will be fine. Your residents will love you. Do not claim to be late to rounds because you had a “Cat...
Source: Action Potential - January 26, 2016 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

Thoughts From The NICU, PICU, and Nephrology:
The parking garage elevator at 6:05am is a comforting Who’s Who of other residents who don’t have their shit together. Strive to write the kind of H&P that, years from now, will still be worth blatantly copying. The NICU is the perfect place for people who want to spend their day doing only 1 thing really well. The PICU is the perfect place for people who want to spend their day bitching about the ineptitude of the floor teams. The secret to a successful intubation: More anterior than that. Keep going. Keep going. Goddamnit, AS ANTERIOR AS HUMANLY POSSIBLE. There. “So, wie es ist, bleib...
Source: Action Potential - October 4, 2015 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

File Under “Med School Never Taught Me This”
So I’m getting an admit with a complicated history, right? One of those “__ year old male with h/o X, Y, and Z now s/p M complicated by A, B, and C with resulting D requiring M which is now s/p revision of X with resulting D who is now presenting with chief complaint of C ” patients. Anyway, so that was fine. I have clinical skills. First things first – I carefully considered the most likely causes of C based on my extensive education in pathophysiology and instinctively deduced AHAHAHAHAHA aaaaah, haha nope. sorry, can’t take myself seriously there. Yeah, no, first things first – I...
Source: Action Potential - June 25, 2015 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

The NICU: My Own Personal Hell Is Repetitively Stabbing Babies.
It’s sort of the exact opposite reason of why I went into pediatrics in the first place. Because I like babies, damnit. I especially like babies who keep their blood inside their bodies. … unless I need said blood, in which case I like just clicking on a “lab draw” order, pretending the Magical Blood Fairy shows up and waves a magic wand, and – poof! – the results magically pop up in the EMR. But my faith has been shaken: it’s hard to believe in the Magical Blood Fairy when you’re staring at your hand holding a needle the size of an invisible artery. It’s alm...
Source: Action Potential - May 26, 2015 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

My Old Nemesis, The NICU: Part III
“Hi. I’m the new very, very late intern. Where should I be?” I just didn’t want to get yelled at. I knew I could make it through the day if the attendings and NPs were just politely irritated with me, but if I got outright YELLED at I’d definitely start crying -, and if there’s one thing I’ve learned neonatologists have in common with surgeons, it’s absolutely zero tolerance for clinician breakdowns. So that was going to be my order of priorities: #1, Absolutely no crying, and #2 demonstrate that, on the plus side, I’ve already had the month of hell...
Source: Action Potential - May 13, 2015 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

My old nemesis, the NICU: Part II
So we’ve established that my NICU Sub-internship as an M4 left me with nothing but the strong, permanently ingrained sense that “this hell had damned well better be worth it”. And it sort of was, in that I came to the NICU rotation as an intern already knowing all the lingo and TPN calculations. Which is half the battle! On top of that, I spent the weekend reviewing all the popular pimp questions, making flashcards, and preparing myself for battle. I was ready. I was going to show those goddamned former residents that this former-M4 was, in fact, perfectly capable of being a NICU superstar and permanently...
Source: Action Potential - May 8, 2015 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

My old nemesis, the NICU: A flashback (Part I)
Some of you might remember the many subdued, nuanced posts I made in 2013 about how my NICU sub-internship made me want to quit medicine, quit life, become a hobo who hops trains for a living and never have to calculate a TFL or realize I forgot to write down a UOP or adjust 42 meds for the brand-new weight of +5 grams ever again so help me god. But more likely none of you remember these NICU sub-I posts because, in looking back to link to them, I realize I must have deleted them all in a fit of self-awareness. Regardless, it was in 2013 – and lucky for you I lack that same sense of self-aware pr...
Source: Action Potential - May 6, 2015 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

Last month of general peds as an intern
This is beautiful. I can answer almost all RN questions in satisfying ways that include a confident explanation of the relevant physiology and discharge criteria. On D/C day my scripts are signed, my follow-up appointments are made – and when attendings ask questions I get to answer “Yes, I thought so too, so I already called X and scheduled Y as an outpatient” and see said attending nod happily in approval as they make a little tick mark on their sign-out sheet. Sign-out is quick and painless. I finally understand that when we talk about ‘correction’ insulin it refers to slidin...
Source: Action Potential - April 9, 2015 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

Newborn Nursery
… is the closest medicine will ever get to an assembly line. Sure, I have a certain appreciation for how evidence-based newborn medicine is: The NRP algorithm (the process we go through with neonatal resuscitation) is rock-solid. The science is satisfyingly pure physiology. There is no Past Medical History. If the baby so much as blinks at you funny, you simply send it to the NICU for a rule-out sepsis work-up. And the answer to 99% of new parent questions is “Ah, that’s perfectly normal newborn behavior. Your baby’s body is just trying to figure out how to adapt from being in a dark swim...
Source: Action Potential - March 28, 2015 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

Peds Urgent Care
“My baby has a cough. Does he have ebola?” No. “My son got this lump on his neck right with his cold, do you think it’s cancer?” No. “Lovely presentation. Do you want to do any work-up?” No. “What about a CBC, CRP, LDH, LFTs, Monospot, and CXR?” No. “Okay, we’re going to get them.” Okay. “Do you think this kid needs to be admitted?” No. “We’re going to admit him.” Ok. “It’s a soft call, but it’s a Friday, and I have 32 years of experience. This is where experience tells you if a child will get worse ...
Source: Action Potential - November 21, 2014 Category: Universities & Medical Training Authors: Action Potential Tags: intern year Source Type: blogs

I just – when were we supposed to learn how to wrangle babies? WHEN?
I feel like I generally actually do a really great job with kids –  but somehow seniors only see me at my worst moments. Case in point: This morning I was on pulmonology consults, seeing a baby in the PICU. Baby was lying face down and I wanted to listen to her heart, so I gently turned baby face up…. … and oh my god, guys – this is not a thing you should do in the PICU. She immediately thrashed all 4 of her tiny limbs and got herself enmeshed in ALL OF HER WIRES which between the 12 lead EKG, the IVF, the pulse ox, and good god I don’t know what else – this baby was slo...
Source: Action Potential - November 15, 2014 Category: Universities & Medical Training Authors: Action Potential Tags: intern year Source Type: blogs