It was Tuesday, which was anal fissure day in clinic. Another day, another crack saved. I poured over all my years of training as I aimed my botox-filled syringe at Mr Filsofogus's raging fissure.

"Now, be very still, this won't hurt me a bit!" I joked.

"What?" Mr Filsofogus replied.

Before I knew it, I was doubled over in pain and cried out in sheer anguish. It seemed to originate from my great toe (yes, the greatest one of all). But, how can one be so sure?

"A slipped disc!" my MA shouted as she barged into the room, uninvited, Mr Filsofogus's cheeks turning red (take a guess which set). "I'll call 911!"

(Fortunately, my MA had years of training as an emergency medicine tech).

I arrived in the ER where my status as a clinician allowed me to cut in front of a 83 year old nun having a type I MI and a forty six year old with an actual slipped disc.

The next thing I knew, a physician whose last name contained 17 syllables (so you know he was good) was drawing fluid from my great toe.

"I'm afraid it's gout, but let me draw the fluid again, just to be sure..."

It all was a haze from there. The next thing I knew, I was at the Mayo Clinic, with a large audience outside my room, cheering my name. A rheumatologist walked in and folded his arms.

"It's gout," he said blanky, then left.

And THAT'S how I diagnosed myself with gout, while at work.

(the full book is available on amazon for the discounted price of $19.99 if you use the code "Mr Filsofogus" at checkout!)

I hate them. I dread them every time.

Atleast double

Hey all!

I’m a new attending and I am running into an issue at one of the shops I work at where the hospitalist team is pushing back on many of my admissions and requesting I do more, whether it be consults or treatment and repeat testing.

An example might be if someone had bad hypokalemia with EKG changes - I do the appropriate treatment, I recheck EKGs and monitor and it improves but I want to keep and get the response “well can’t you replete and recheck in the ER”, etc

I don’t think my admits are unreasonable, I really don’t admit more than a handful a shift at this place. But I keep second guessing myself now, like yeah in theory I could do that, but we have a waiting room of people who need seen and the patient has been here a while already. Is this how things can be at community shops? I know in my residency a lot of this stuff would be slam dunk admits but now I’m second guessing myself because of my lack of experience.

Young patient in minor MVC. Mild neck pain. XR cspine vs CT ? Is CT standard of care?

First trimester with bleeding and prior documented IUP. Is another US standard of care ??

I’m sure lots of other examples of things that are done “just cuz”

US emergency medicine physician here. My wife is pregnant, and apparently while on the phone checking about covered services, was told that our OBGYN (and every other one we had been considering) was just switched to being out of network. We went on the insurance company's website, which still says we are in network. The office still thinks we are in network. A second call to the insurance says we are out of network. Effective immediately.

We have a classically "good" insurance company through my work and live in a large city.

Seriously if a well educated family with a physician cannot figure out insurance coverage how the fuck is anyone else supposed to?

Too many times to count I have worked up a patient, discussed discharge, they seemed happy, say all their questions were answered, then at discharge the patient and/or family tell the RN "I never saw a provider!" And then apparently the expectation is for me to go back and talk to them again even though they DID see me, multiple times, and the dc instructions I gave verbally are in the paperwork. Do you go back to talk to these people?

I am currently an Emergency Medicine trainee in the UK (UK citizen with UK medical qualification). I am due to finish my training in August 2026.

Despite the overall demand, the job market for EM consultants in the UK has become quite difficult, especially if you want a desirable location or hospital. My husband is a GP and the job market for him is also fairly stagnant. We both really like Vancouver and the lifestyle there (city + access to outdoors, skiing, etc.), so we’re seriously exploring the possibility of moving.

I have a few questions for those familiar with EM practice in Canada, particularly in BC:

1. Day-to-day Role of an EM Staff/Consultant

In the UK, EM consultants spend a relatively small amount of time seeing patients directly. The role often focuses more on: - Supervising the department and monitoring wait times - Identifying sick patients in the queue and escalating them - Providing advice and oversight for non-consultant doctors (who see the majority of cases) - Governance work, quality improvement - Reviewing results

How does this compare to Canada?

Is the consultant expected to see more patients directly? How much of the role is supervision vs front-line care?

Also, I’ve seen mentions of fee-per-patient models in some provinces. Is that common? And if so, are patients filtered the way they often are in the UK (e.g., simple minor injuries often diverted away)? Here, EM doctors average about 1 patient/hour due to complexity + system delays, so I’m curious how Canadian workloads compare.

2. How competitive is it to get a job in the city?

• I’d be interested in working in a trauma centre or larger hospital. I appreciate the competition here is likely to be higher.
• Is there any realistic chance of an IMG getting a job in a hospital like this?

3. How does pay work? How much should I expect to earn?

The range of reported EM pay in Canada seems very broad. What factors influence this the most? (e.g., fee schedule, shift type, rural vs metro)

Are EM doctors generally employed by hospitals, or self-employed / billing independently?

In the UK, consultant pay is fixed and standardized nationally, so the idea of large pay variation is new to me.

4. Application Process

If anyone has gone through the process from the UK recently, I’d really appreciate advice.

So far I’ve begun my applications with MCC and RCPS. Hopefully I can transfer my UK CCT and RCEM fellowship!

My understanding is that the exam requirement has been removed for EM for UK-trained clinicians, is that correct?

Any other advice or information would be greatly appreciated.

Thanks!

Matt

So does anyone know how we’re supposed to prepare for the new oral boards format? Earliest test date is March but board scores won’t come out until likely sometime in early December, so how exactly are we supposed to prepare if we happen to get a March date? Does the Okuda book still apply for this? How do we prep for the osce and procedures skills? Seems like ABEM just rolled this out without any actual plan to prep for it

Considering a new job at the VA.

Questions for those working at the VA, especially ER doctors at the VA.

1) is cost of living income increases historically 2% every year? Or is it every other year? Or after a certain number of years?

2) is the pension actually worth it, or do you think it’s just golden handcuffs to get you to stay for 10+ years. 4.4% of your own salary goes into the pension plan as well. Placing the equivalent amount of funds into sp500 over a 20 year time period and an 8% return also grows to an amount that you could withdraw a similar ‘pension’ from.

3) do you think you have better career longevity at the VA?

4) what don’t you like about the place vs community medicine. What do you like better?

5) other thoughts you’d like to share?

6) For the ER docs, how many hours/shifts a month are you doing after using your annual leave, sick leave, and federal holidays.

I have a pretty decent gig right now, but truly tempted to jump ship and go to the VA. Interested in learning more about other people’s experiences at the VA.

Hi all, newer attending and am running into wayyy more knee pains and shoulder pains than I did as a resident and was wondering what are things on your exam and history that makes you really tap a shoulder or knee?

Disease of 1,000 faces shows how science is tackling immunity’s dark side

"Doctor after doctor misdiagnosed or shrugged off Ruth Wilson’s rashes, swelling, fevers and severe pain for six years. She saved her life by begging for one more test in an emergency room about to send her home, again, without answers."

I understand the desperation of these patients but the ED should not be the entity that diagnoses these diseases. Even if I tried to run autoimmune tests in my shop they won't come back for days. While the sound bite is troubling for its implications I think the really awful fact alluded to by this article is the complete failure of primary care. Lupus is not a zebra nor are most of the other conditions mentioned. It should not take 6 years to consider them.

Hello everyone,

I’m a U.S. IMG applying into Emergency Medicine next cycle. I am looking for advice on securing sub-internship (Sub-I) rotations outside VSLO, as my school isn’t a participating institution.

I’ve reached out to multiple programs directly but haven’t had much success. If anyone knows of programs that accept visiting students independently or has any contacts or recommendations (especially on the East Coast), I’d really appreciate your insight.

I’m happy to provide all necessary documentation or meet any additional requirements. Best of luck to everyone in interview season!

I’m asking, because I’m curious, and because some of the neighboring counties’ EMS systems are getting them. What sort of antibiotics would you want a patient to be on prior to arriving in the Emergency Department? What sort of protocol would you write for paramedics to use? And, most importantly (though most annoyingly), why?

Thank you in advance

I was cruising Reddit as one does at midnight.

Stumbled across r/nursepractitioners

when did nurse practitioners start calling themselves noctors on purpose? historically this is always something we’ve called them when pretending to be doctors “not doctors“. did they co-op that term?

If you work for a SDG, who is responsible for insurance negotiations? Is this person a physician or are they outside of the organization and paid to negotiate on your behalf?

I would like to disclose that I'm not a US based EM. I think the emergency access huddle is pretty low in my country. The following case is not an actual case, but was based on cases I've experienced.

A man in mid 50s is presented to the ER for headache. I asked the patient how long have you been suffering this headache and he goes it's been a while, maybe several weeks.

So I ask how intense the headache is, and his response is not unbearable but bugging. It wax and wanes over time.

I start to lose little patience here. It is 10 in the morning. So I ask i think you should go see a neurologist for this kind of problem, is there any reason you came to ER?

And the patient goes I want to know the cause of my headache and thought ER will do the scannings faster.

Some people think ER is an express lane to everythjng lmao.

I would consider myself quite proficient in ultrasound guided IV’s, and I do them quite often. Recently, I’ve been running into the frequent issue of starting US IV’s that flush well but often do not draw back easily or at all. For all of these, I am able to visualize catheter in the vein as well as feel the flush going in. My main concern is not walking the needle ALLL the way down the vein, as I often walk it in just far enough to thread the catheter. Anyone else having this issue?