there was an exam in undergrad physics that I felt strong going in. The format was that you only select 2 out of 3 main sections, but if you somehow complete all sections you are marked based whichever two brings you the highest score. It was one of those rare cases where I knew every single question asked like the back of my hand. Asking for a second exam notepad and seeing my good friends panicking thinking that one of the questions must have been particularly hard and lengthy (i mean, why ELSE would this dude need an entire extra notepad?!) was a core memory that will stick with me.
With a work ethic like that, that student will be ready to break into, I mean, Investigate patients' living spaces whenever Dr. House asks, maybe even before he asks.
Recently had a few urines positives for legionella antigen... No idea what the patient history was (I work in a hospital lab so I'm not privy to that stuff), but I'm absolutely sure that the infectious disease doctors must have been absolutely giddy with the idea that they managed to catch actual cases of legionnaires disease in a couple of patients... To be fair, I'd be lying if I said that the positive test results weren't exciting for me as well, but I'm almost positive that the ID docs consulted for those patients were orders of magnitude more excited than I was lol.
@@fulltimeslackerii8229 I don't know if there were specific diseases intended, but both beer making and cheese making involve intentionally creating environments for lots of microbial organisms to grow, and there's lots of ways for unintended organisms to sneak in.
When we can't get an infectious disease consult we just stand next to a patient in a circle and chant meropenem 3 times loudly. 60% of the time it works every time.
Yeah Infectious disease doctors got to maintain a bit of that savior of Mankind sort of megalomania to keep going. The recklessness with which doctors prescribe antibiotics for literally any stuff on God's green Earth would have made them go insane Otherwise.
There's no way infectious disease & Texaco Mike haven't had a one-off, Men in Black-esque adventure together identifying an ancient disease debut from an unearthed Mayan temple in the rural boonies of Florida. They'd see each other, and maybe just do a quick nod in approval of each other because, despite their extremely close, Indiana Jones & Short Round relationship, the CIA prohibits any discussion of the temple, or anybody you met at the temple due to the possibility that, if discovered, "tik tok alien sleuths" would destroy the place in their "investigations."
Out here asking the real questions XD I wonder if they'd be impressed and be studying his unique "antibiotics", or be screaming at the cross contamination that makes them work because the contrast stain just murks the bacteria... then ask him to show them in order to learn his techniques
@@xalaxie"we've got a 50 year old farmer who raises cattle and sheep, and works as a heavy equipment operator digging holes for ponds and foundations for extra money. There are ticks in the woods and mice in the barn. He had to have his nephew take over a difficult lambing in order to come to the hospital today" Is it - a) Brucellosis b) Lyme c) Q Fever d) Anthrax e) Valley Fever f) Hanta Virus g) All of the above
Last time my father was hospitalised I started mentioning that ID had interviewed my mom and I and written something in his notes whenever we got new doctors or a different specialty in his room (Dad wasn’t cogent). EVERY single one of them clicked into that tab of his notes. They were so thorough that they had me fill a cup with water to the approximate amount that I filled my Dads wineglass at home so they could more accurately judge his alcohol consumption!
I tested positive for Chagas disease after donating blood about 12 years ago. There were only something like 12 cases of verified endemic Chagas in the US at the time. It was like the opposite of winning the lottery. The doctor was compassionate but I could tell he was already writing up the case study in his head when he was talking to me. I couldn't blame him, I would have been practically giddy too if it weren't me. But he got me some Nifurtimox, so I didn't mind. It may or may not have done anything, but it was worth a shot. After seeing this, I think I practically handed him his note on a silver platter from the history I gave him with almost no prompting, because I had looked up the disease myself and gone through my own history with a fine-toothed comb trying to pinpoint the likely source and date of infection. I was lost to followup because I moved and I think he either changed jobs or retired. If you're still out there Dr. Brown, thank you.
It’s so uncommon that they only test you for Chagas if you’re a first time donor or you have a travel history. I worked in the relevant lab for five years and I don’t think I ever saw a positive Chagas.
Dying laughing because my experience in ID and IM was literally this. It’s like the ER refused to admit anyone without starting vanc and zosyn first. I WISH I could put people in ID jail 😂😂😂 about to start my IM residency in July and then I want to be an ID doctor!
I'm working for the ID department (but more on the HIV/AIDS side of things), and the consult notes being a literal detailed CIA report is on point! ID notes are nothing like I've seen before in other specialties. 😂
My daughter's ID Dr. Was exactly like this Dr. The most insane note taker I've ever seen not to mention the smartest human that I've ever met. every time we spoke he inspired me to learn he was an amazing physician.
The notes are too offload some of the information so that you can put more into thinking and problem solving. Is this much technique that makes someone look smart as it is being smart when it comes to complicated systems like that where you need to be watching for outbreaks and transfer mechanisms to head them off before they get out of control.
After 6 specialtyconsults, I was sent to ID (on a Friday) my consult lasted 107 mins. He said my case was “interesting” and not straightforward. He wanted to read my records over the weekend. 😮 As a side note, I went on a medical mission to Cambodia 🇰🇭 the following year and one of our clinics was on a floating village…you know where they’re so poor they float their house to avoid taxes. This means they drink the same water they clean their laundry in, defecate in, swim, fish. You get the picture. We had no EHR there, just a paper record 😂 Glad I brushed up on my ID before we left. 1300 patients in 6 days.
I don't think the floating villages have anything to do with tax evasion. The Vietnamese migrants to Cambodia were stripped of their identification documents under the Khmer Rouge and effectively live as stateless people, unable to buy land.
I feel like I stopped paying attention to the video for 1 second and somehow it transitioned from niche medical problem into spy film dossier retrieval
That line about "What's going to be on my tombstone?" reminded me of an ob-gyn I used to work with. Her tombstone line is going to be, "Keep scooting down. Little further. Little further."
The correlation between those who refuse to take vaccines "because they don't want to mess with their immune system" and those who demand antibiotics for a fever of 98.7 and a runny nose always amazes and amuses me.
I’m not amused by those doctors who write Rx’s for antibiotics for a 98.7° and a runny nose. Isn’t the overuse of antibiotics what got us into antibiotic resistance hell in the first place?
@@stephenmcginnis5789 I did; I didn’t misread what you wrote or what I meant. The patient can’t get the antibiotics without the physician, right? Maybe our thoughts just went in two different directions.🙂
@@Crymeariver227 Hard agree. They even told us in our molecular biology classes that "Doctors should be taught not to overuse antibiotics." You're telling me they didn't know that already?
Antibiotic resistance is no joke man; my microbiology professor at Med school used to scare the shit out of us when he would tell us how close pharmacists and doctors have gotten to inventing the super bacteria 😢....felt goosebumps like u r in a literal Avengers movie 😭
@@sarahelo009 Nah bro, microbiologists and Infectious disease doctors are the whistleblowers medical professionals need before they accidentally make the most resistant concoction of pathogens and end half the human population like Thanos 😭 The world shall always be grateful to u guys
@@sarahelo009 microbiology undergrad I think will cover alot more than med school microbiology, We usually only read about pathogenic microorganisms in medicine... But U gonna read about the good and helpful ones as well. I bet u gonna have a complex love-hate relationship with microbes 😅
Then there’s the problem of not enough work/research going into new antibiotic treatments cuz that’s not where the money is… so Pharma isn’t funding the studies…
Yep... As a "horse-people", I'm seeing VERY similar issues in the barn - Over the past 20 years or so, we've effectively lost several previously very useful and effective dewormers to rapidly increasing resistance among the target worms. Today, we're starting to see clear sign that resistance to currently used ones is increasing rapidly, and at last word, we have practically nothing "on the drawing board" that's at all likely to come into accepted use anytime in the next 15-20 years, if that soon, to replace both the ones we've already "lost", and the ones that we're actively "losing" right now due to mis-application.
I worked at the FDA in infectious disease area for 30+ years. My colleagues were so interesting! My husband then was an animal foreign infectious disease specialist.
I am in ID now and I have to sift through notes of a recurrent admissions from years back and do a summary and I want to cry. It is giving me another level of crazy.
This was very amusing. Especially from the perspective of someone who still drinks raw cow's milk from the dairy farm I grew up on-- and I'm told, in my infancy, my folks used a wheelbarrow of straw for a cradle while they milked. On the other hand, I recommend pasteurized milk for anyone who has not had a lifetime of exposure to a specific farm's biota.
To all the infectious disease doctors out there, thank you for saving my life! I didn't really have any idea what goes into doing your job, I met so many different doctors, apparently my case went up before a panel?? The entire panel decided to not tell me just how bad I was doing, because they didn't want me stressed out since I was experiencing organ failure. The director of ID came and visited me finally on my last day before being discharged, and apologized for not giving me fully informed care, he had told my next of kin and told them to not tell me 😳 I didn't know that people can and do die from sepsis, and mine was absolutely antibiotic resistant, they just kept putting up new IV antibiotics hoping something would work. Thank science for modern medicine, and all the medical staff that makes treatment effective ❤
My fever of unknown origin about five years ago was only West Nile. It wasn’t interesting enough to even get an ID consult. My PCP told me to go sleep it off because there was nothing more to be done. Five years later, I’m still sleeping. All. The. Time. Roughly 12 hours per day. That got me the ID consult. Nothing tested positive. The sleep never went away so we called it PVFS (Post-Viral Fatigue Syndrome). It might be regular CFS, but the hilarious part is that there’s no way to tell the difference! ID doctor lost interest in me after that diagnosis…or lack thereof, more accurately.
Doc here, check your ferritin levels, and vitamin D, B9, and B12 as well for good measure. I've seen incredibly low ferritin (storage form of iron) in postviral patients, and that can explain severe tiredness and cognitive dysfunction.
@@radicalratx7790 trust me, I have EXTENSIVE blood work done every three months. Every test - ferritin, all vitamins, every hormone, liver & kidney function, everything - comes back in the normal range. The only ones that fall outside the normal range are the ones related to the Type 1 Diabetes I’ve had for 44 years (A1C of 6.2 on my last test), occasional dips in testosterone (I’m on replacement therapy), and liver enzymes that sometimes creep up due to lingering effects from near-failure of my liver a few years back due to toxicity from a prescription drug I was taking - a drug that doesn’t have liver toxicity as one of its common side effects. Oh, and my cortisol levels tend not to rise in the morning. That one puzzles all my doctors, but it might explain at least some of the constant fatigue. I’ve had extensive neurological examination, which discovered a cyst on my pituitary. (We initially thought it was metastatic melanoma, but it turned out to be just a cyst, thankfully. Probably congenital.) Without more tests, we can’t determine if the cyst is affecting any of my hormones, but my neurologist didn’t think it would be causing my CFS. The thing is, my chronic fatigue started suddenly. I can pinpoint the week I started sleeping way more than usual. That week coincides with the West Nile recovery, coming about a week or two after my West Nile symptoms faded. That’s why the doctors are fairly confident in calling it PVFS. I went from my usual nine hours of sleep per night to about 14 hour of sleep plus constant daytime fatigue in the space of a few days. After months of tests, scans, and imaging, the doctor’s advice was to try to wait it out to see if it got better. Then the world shut down for the pandemic and I didn’t work for a year (I’m an opera musician and all live theater was shut down until mid-2021. I continued to sleep 11-14 hours every day, more on days after I did something as strenuous as going grocery shopping. My iron levels, ferritin, B & D vitamins have never fallen outside the normal range. Being on testosterone replacement, I’ve actually had trouble with elevated hematocrit levels in the past, requiring regular therapeutic phlebotomy, but it’s been about a decade since that last happened and we altered my testosterone treatment to prevent elevated hematocrit. I’ve seen my primary care physician, my endocrinologist, and also a neurologist, a hematologist, an oncologist, an infectious disease specialist, a vascular specialist, an ENT specializing in apnea, and probably a couple of other doctors that I’m forgetting about. I have had to cut back on work by about 90% because I’m either asleep all the time or too exhausted to function, so I’m living below the poverty level. I can’t afford any more tests or doctors except when absolutely necessary, like last year when we discovered I had stage 2 melanoma. That, along with all the MRIs to look for metastasis, wiped me out financially - and I have insurance. The copays just drained all my savings, which I had only started to build back up after the liver failure of a few years earlier, which sent me into medical bankruptcy. So there’s nothing more I can do to try to find a cause for the fatigue. I’ve resigned myself to just sleeping away half or more of the rest of my life, too tired to do anything else despite the fact that I’m only in my mid-50s. If I could afford to move into a retirement facility of some sort, I would, but I’ll never be able to afford that. Oh, and I’ve been turned down for SSI/Disability three times - all three using disability attorneys to help me navigate the process. If the melanoma comes back, I’ve decided that there would be no point in trying to fight it. How’s that for a fun little comment?
I suggest checking with endocrinology next in case there's a hormone issue involved. I really hate the catch-all I don't want to deal with this category of illnesses and the whole oh you had a virus before and now you just have lingering effects for the rest of your life, sucks to be you type of mentality is something that bothers me a lot. Obviously something still wrong, we just need to understand how the something is still wrong so that we can fix it. It's great that you figured out a virus is the reason something went wrong, but what does the something?!
While being trigger happy with antibiotics isn't the way to go being gun shy of them can be just as bad. Jim Henson passed away after he was sent home from an emergency ward with a respiratory problem that developed into pneumonia. I don't envy doctors trying to find the right balance in those situations.
Ok...I'M NOT the infectious disease guy But, I play one on tv.... This can be the problem Do you start a wide spectrum antibiotic NOW (Like the dopey ED doc on the weekend) Or a type specific antibiotic that may not cover the bacteria you fear and then wait for the cultures And if you guess wrong...that patient MIGHT be in extreme condition by the time you have the results to justify using the right antibiotic
I thought he died from flesh eating bacteria from a toe cut that he didn't seek help with in time. The whole reason people know now that if you get red lines radiating out from a small infection that you need to see a doctor immediately is because of his case and all of the publicity around it. I can't think of who that could possibly be confused with to lead to the idea that his death was a pneumonia based death and pneumonia is not necessarily bacteria and way more complicated than I care to get into right now but I can guarantee you that if pneumonia is involved there's a darn good chance that antibiotics are not going to be the solution anyway. Bacterial infections alone very rarely actually lead to pneumonia, there's almost always another complicating factor at the root of it and It remains a symptom that is very very deadly regardless of what causes it. I just think it's important people understand that most of the causes of pneumonia are not actually bacterial in origin even though at one point in time we thought that. Also please get your vaccines against the various organisms that cause pneumonia, it matters a lot.
@@rickystassi2466 But trying antibiotics then stopping before the full course is done is also terrible stewardship. It's not a thing you should be jumping to as a default.
Keep harping on this issue, Dr. G, as well as all the other issues in medicine. You are the cutting edge of this fight. Thanks for all you do and do so very well.
"It's a little light" and "I didn't start catfishing until I was in fellowship." Has me rolling on the ground. ID physicians take their job sooooo seriously.
So I've been binge watching these videos for last three days instead of studying for my exams and I'm so amazed by the acting skills, like I keep forgetting it's all the same person, with just expressions and speach you can know exactly who is who and I totally love it. I also haven't laugh so much in months, so, thank you. (I have also deep compassionate feelings for emergency's burnout, it's like, I'm feeling this on a personal level.)
You should do a trauma rounds one where it's only 95 year old patients needing PT/OT/Facility Placement, somehow thats' what like 70% of the "traumas" were at my hospital because ortho refused to admit them lol...
I am a semi-retired doc in Public Health and Addiction Medicine. In 2020 when COVID hit, the medical profession really depended upon Infectious Disease. To me it has always been very interesting and we thank ID for their service.
Because I have Cystic Fibrosis and have Staph and Pseudomonas, infection disease is consulted quite a bit for my IV antibiotics. Fun fact about me, at one point in my life, I tested positive for staph, pseudo and MRSA, so I used to walk around joking that I was basically a walking biohazard. No need to worry though, I have always been very careful to stay away from anyone who is immuno compromised. 💜
Yep. I'm an RN on the gen med / respiratory ward. CF get single rooms as 'protective isolation' to stop you getting any resp bugs you don't need..... But there is an unspoken awareness that it's also bc if anyone is going to cultivate their own personal science project of an antibiotic resistant bug, it's gunna be y'all
I made the mistake of reading notes while I was still in the middle of a two-month hospital stay, so I had to laugh out loud at the copy/paste. I would get so mad about errors that would be propagated for days when someone mistyped e.g relevant medical history. And by days, I mean weeks. Fixing those errors practically took an act of Congress.
I'm having awful flashbacks to my surgical intern rotations where I'd have to explain my consultants rational - or total lack thereof - to the ID consult reg.
Dude excellent job. I was losing confidence in your ability to get new jokes in but you are delivering! Thank you for all of the good laughs through my training and beyond.
What I love about my ID folks, is that they are JUST as direct and blunt as this. They always cut to the shit in conversation but leave crazy consult notes.
The only problem I have with Infectious desease is they are not accounting the super bacteria has bigger odds to be zoonotic in origin, the overuse of antibiotics from the meat industry severly overshadows human medicine.
The raw milk!!!! It's this huge movement in Christian fundamentalist circles and extreme crunchy groups right now. I don't understand why they are putting themselves and their families at risk, but considering all the other risky behaviors they do, I am surprised more kids haven't been gravely injured or died. Certainly many of their kids are going without critical pediatric care.
They don't see it as a risk, and they do see things like pasteurisation as a risk. They're wrong, but because of their views they're not just convinced they're doing the right thing, they're also convinced that the people trying to help have a secret evil agenda so they don't believe it when people try to explain this stuff. It's not an easy problem to address
Oooh: histo/blasto, rabies, Legionnaires, Q fever, listeria, leprosy, all the parasites and cryptosporidium and giardia, Infectious disease must have a lot of fun when a veterinarian comes in sick.
As an absolute infectious disease geek (though sadly only medical scientist not medicine) I love this and need more of it! Hook it right into my veins!
I don’t think people who are not doctors, actually realise how funny you are. They are genuinely missing such good content on RU-vid. And also almost a large part of the medical fraternity of the world comes to your channel and enjoys this content . Thank you for doing this.
Okay I know the random people with interesting descriptions are probably jokes, but I do know a person who was born and grew up in a remote and impoverished region of south-east Asia who has a combo of a bacteria and a fungus infecting her GI tract so badly that she went from having ulcers to sepsis, but I swear to God those same infections seem to be fighting her stage 4 cancer.
Horrifying for one reason or another, but you get that in meds. As a total layman the ones I know about is "the sickle cell mutation protects people from malaria because the cells implode when the disease attaches" and of course the famous cow-pox-prevents-smallpox
@@FrommermanActually extremely likely. Cancer needs fuel to grow. GI tract infections are usually treated by putting the patient on a low-residue diet (very low carb, no fiber) so they don't have much poop. Cancer needs carbs to grow, so that's one way to starve it out. Not to mention the infection in the GI tract was sopping up that sugar for itself, also starving the cancer.
@@FallacyBites it's no more effective than plain vaseline, the antibiotics in it aren't concentrated enough to actually kill anything, but are likely to contribute to antibiotic resistance. Also, it's occlusive (meaning it keeps dirt in and air out) and sticky (dirt sticks to it). I hates it.
I have an unbelievable story regarding being prescribed antibiotics for something for MONTHS, and it turned out i didn't need them at all, and i had a condition that mimics a certain infection. Developed leaky gut from all of the candida. Opportunistic it is.
Pro tip: _artisanal_ "skilled, related to craftsmen" does not mean and is not pronounced the same as _artesian_ "related to Artois, especially of wells relying on ground pressure to bring up water".
Nice! Only thing missing is ID's usual mysterious discharge recommendation for "4-6 weeks" of their antibiotics. Well which is it, 4 or 6?? And starting when??? 😛
I am not an infectious disease specialist but if I had to guess, start immediately and 4 weeks after symptoms resolve so it's 4 weeks if they go away immediately and 6 weeks if it takes a long time for the symptoms to go away. But that's just a hunch based on how it's done for animals and plants.
Friendly reminder that 80% of our antibiotics in the US go to animal agriculture. Antibiotic stewardship, ideally, should include what you do or don't put on your plate.
Beautiful simply beautiful! Really appreciate the much needed laugh. I love how every aspect is perfect including how ID wears his glasses. Thank you and your family for being yourselves :) you're pretty darn awesome!
in the hospital i work in, the infectious disease doctors just come into the micro lab with the ID pharmacists and they ask us questions directly. its a fun time!
I love how he goes from disappointed in the volume of material being less than expected to impressed by the quality of the material and means taken to procure it.
In fervid defense of emergency medicine, we often TRY to be antibiotic stewards (I even will tell people not to take the pointless antibiotics that urgent care prescribed them) but the administration makes it so difficult. They are absolutely obsessed with sepsis markers and scores (because it affects their reimbursement) so we get nasty emails and pointed comments if we don't empirically order broad spectrum coverage on practically everyone with two abnormal vital signs 🙃
I had never answered so many questions & had so many tests in my life until I had to see an infectious disease specialist lol. I had mollaret’s syndrome.
Ooooooh I’ve been on zosyn! It sucked! …okay, it might have been the circumstances that required it (sepsis the week the CDC decided to take COVID seriously; discharged home with a PICC line for home administration for two weeks, but there were no home nurses available so my husband had to do it all, and no, he’s not a nurse; etc etc you get the idea). Because it has to be kept cold, you have to get it out for administration 90+ minutes to at least warm to room temperature before administering, and that’s still very cold in your body. So you get this icy rush towards your heart and then are just COLD. (But it also means the person administering the zosyn never gets more than ~3.5hrs of sleep, because it’s administered every 6hrs, took time to infuse, etc.)
A friend used to work on a sheep ranch in camarillo, and one the shepherds got cutaneous anthrax. The doctor was super excited, because the population is mostly city. They hardly EVER get to see zoonotic stuff. The doctor was calling in all the other doctors and med students to come have a look. It's always fun to be weird enough to be found fascinating.
Dude!! I had (have) a yeast infection for over a decade, initiated by antibiotics and perpetuated by alcoholism (since recovered). Antibiotic stewardship!!! Gut health!!
It must be the 'don't meet your heroes' because infectious disease are my kind of people. The snark, sarcasm and comments. I almost wanna drink river water, feed pigeons on my balcony, clean cat litter trays and travel to Mediterranean country to contact leishmania...just to meet one of these guys!
Dr. Mark Crislip has a fun podcast called "gobbet o' pus" where he discusses interesting cases he's run into. He's the reason I know to avoid raw goat milk/cheese, and also that heroin addictions involve A LOT of heart valve infections from using non-sterile water sources...ew...
I had a fever for TWO WEEKS from bacteria!! Every one said, “oh there’s a stomach bug going around.” Not me though! The nurses and doctors wouldn’t budge. Omg it was the worst intestinal pain ever. It was worse than giving birth. Finally, I got the damn nurses and doctors to let me do a stool sample, and shock, the results caused the the health department to get involved. All I needed was a round of antibiotics!!! So “simple!” That restaurant I got my food poisoning bacteria from also got a surprise visit.
I recently read a (news) article about an individual who was suspected to be carrying a new to the US strain of an illness. They could tell because they had found signs of the disease in sewage samples. The “fun” part came in when they said they lived in either city 1 and commuted to city 2 or vice versa because their stool had been isolated to those two cities. There was a large population in those two cities who did have commute patterns in either direction depending on their industry.
