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  • Posts

    • I interviewed with multiple hospitals right out of PA school(1987 ancient history), with only one offering me a IM job 2 weeks after the interview, which I accepted. Two weeks later my preferred employer offered me the ED job I was seeking. Each had similar salaries and were teaching institutions and I would be relocating from Seattle to New England without any assistant. So I took the job that I truly wanted and sent my regrets to the first hospital. Oddly 18 years later , I took an ED job at the first hospital after resigning my IM job at the second hospital!! Full circle w/o pain for anyone.
    • Yes. You have one foot in the grave at 27. Focus on the time you have left with your family.   Good luck.
    • So interns and med students ask me this question a lot.  First step is to look at official guidelines from various societies (AAP, ACOG, etc) as well as uptodate or medscape or some other resource.  I think those are good places to start.  But while you should know the official recommendations, eventually you need to read the original studies and go through their methodologies.  That is super helpful because you will build up a knowledge base that will let you see flaws in the recommendations and when you could and should deviate from them.  There are a lot of "evidenced based" guidelines that aren't worth the paper they're printed on. For my interns, I expect them to read and learn the guidelines. For my second year residents, I expect that they've looked at the studies behind those guidelines and have some understanding of their strengths and weakness.  At this point, towards the end of my residency, I am getting to the point where I can knowingly deviate from guidelines and have solid scientific reasons for doing so.  And it also gives me insight into what studies need to be done in the future that perhaps I can look into doing or getting involved instead  (publish or perish :p).   For example, look at the mammogram example you mentioned.  Why do the recommendations differ?  It has to do with the number needed to treat vs number needed to harm, probably the two most important statistical items to consider.  Look at the study - for a 37 year old woman with no risk factors, what is the risk and benefit ratio of a mammogram? What about for a 52 year old woman with no risk factors? 42 year old woman with a strong family history of beast cancer?  If you look through the data, you will find very different answers to those questions, which will affect your choice in what to do - and you can make a decision on which guidelines to follow, or maybe why you shouldn't follow any of them. Remember, this field we chose - it's lifelong learning, and that involves lifelong questioning.
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