I swear to God I'm year 5 in medschool. I've reviewed acidosis in so many different classes. Biochemistry, physiology, physiopathology, nephrology, semiology. The truth is... not even the teachers truly know what it's about.
Well acid base disorders are way too abstract, if you are not working with them constantly (at least in my opinion). I find them particularly useful in the ER and/or the ICU. They still aren't easy but with real life cases day to day you'll get used to it. They can give you an idea of what's going on very early, thus they help... A LOT! I recommend studying them to all our newer and lesser experienced colleagues (and some of the older ones too). As soon as the "switch flips" and you finally understand what's going on, it's like a whole new world has opened up.
It's about the overwhelming of your body's buffer systems. pH and electrolytes are tightly controlled in their normal ranges. If they are abnormal, something has gone wrong. Anion gap is simply a count of the major positive ion electrolytes (Na, K) minus the negatives CATMUDPILES pneumonic for high anion gap metabolic acidosis.
When I was a nursing school, there was a doctor was easy in his 60s. We were told by our instructor to seek out the attending to discuss a pediatric patient. We went to this physician. Mind you this is before the requirement to put resident, intern, physician, etc. when we asked if we could present to him, he said he was a resident and would love to hear our presentation. Apparently he retired as a federal judge and decided to become an MD as his retirement job. This is a true story. It happened in 1993.
If you were in military medicine, you would get credit for your medical knowledge. You’d also get credit from the military side for using your initiative, overcoming obstacles, and commitment to completing the mission. The Double Whammy.
Nothing is worse than preparing, being terrified that you missed some key fact, insight or potential curveball your professor/attending might throw at you, stressing to the point of physical exhaustion about that potential embarrassment and how it may reflect badly on you, forever tainting your future in the medical field, then stressing even further because the person holding the lecture/rounds is taking a lot of time, leading to you fearing they may expect you to somehow present something you could barely press into 10 minutes in the span of 2, then be utterly shocked by them just dismissing everyone, upon which you realize that all this work was for nothing, and you can't even say anything because if you do, everyone will have to stay around for longer, which will gain you the wrath of all your peers. Totally hypothetical scenario, of course. Not at all overthinking anything, of course. Great mental health in us med students, of course. Also, I never wanted to scream "I ASKED YOU ABOUT THIS BECAUSE I ALREADY RESEARCHED THAT SPECIFIC TOPIC AND FOUND NO SATISFYING ANSWER, HOW DO YOU EXPECT ME TO PRESENT THIS IN LESS THAN A DAY?!"...
Wouldn't say sleep apnea causes snoring. Snoring could be a sign of disturbance to airflow during sleep which can contribute towards obstructive sleep apnea
Yea snoring can be a sign of sleep apnea, but in the vid he was naming differential diagnoses for the cause of the snoring, not what the snoring was a sign of
I was taught by senior residents to be a good senior and interject, "don't forget the talk that student X was going to give on topic Z!" just before the attending could turn and leave. They'd almost always allow the presentation (sometimes grudgingly). Granted, this was Peds, so people were nice.
@@snatchX626 Yep! I mostly fly under the radar and feel content to work regular Monday through Friday 8-4 hours. I don’t prescribe or see patients directly, but I’m completely fine with it. If I weren’t a pathologist, I’d have chosen radiology or ophthalmology.
Oh my gosh, yes. Every now and again, if they wanted PowerPoint slides, I make them look at them anyway. They wanted it, I took the pictures, by God, they are going to look at them.
Back in med school there was nothing I would hate more than asking a question and then being told to look it up and present it the next day. Not only would you not end up presenting it, you get conditioned to not ask questions because you're not going to get answers anyway, and that is just a waste of plenty of good learning experiences
I always thought it was weird that these specialist docs were running their own MRI's and breaking into houses. Maybe some extra B&E to pay for those student loans?
Love the home invasion aspect. Bonus points for creative use of a reflex hammer! Also, naturally the doc is listening to The Doors in his car. Somehow, that detail is absolutely perfect
Academic hospitalist here. You have a new, perhaps unexpected, fan in my 7 year old son. He came in while I was watching this video yesterday and has watched it on his own at least a half-dozen times. He is now insisting that I assign increasingly more presentations to my own learners and is constantly checking to see if they've shown up at our home.
Breaking and entering requires some muscle. Ortho? I can't see Ortho caring about pH, but if memorizing it will get him the grades he needs to work on bones...
There's a little known secret as to how to improve med student mental health that very few in the medical education system know about. The secret is to treat students like human beings :)
Do you want a neurologist? Because this is how you get a neurologist. Look, he's already got a reflex hammer. Might be future infectious disease though with the home invasion and all.
@@loganleroy8622 Hey med student has to start somewhere. Neuro would likely give him one of those inflatable hammers you get at a carnival before a proper hammer
“there is no way to improve med student mental health-that’s just the way they are” third year med student here. this is absolutely correct (also perfect timing given I’m about to start my internal med rotation tomorrow lol)
I feel that answering questions instead of wasting their precious sleep time would help. And btw, I'm a lowly language teacher, and when I get a question I don't know the answer to, I usually say something like "well this how the word/phrase is used, not 100% certain about the theory behind it, let me look it up for tomorrow so I don't tell you something wrong".
@@Julia-lk8jn I hated this the most in med school. Like just answer my damn question cause we both know you know the answer and just too lazy to explain it.
As a scientist and person who has done scientific outreach during my PhD to help my local area with science education: This seems like the single best way I have ever seen to ensure people don't ask questions they have! Glad to see that our medical profession is still so excellent at acting like the old guard! I was starting to get worried with all this stuff about "humane treatment of residents" and "technically physically possible working hours" that it had gone soft!
So you were worried that the system was failing and crumbling down because the system was taking care of kind, compassionate young people who are invested in the wellness of everyone else? 😂 treated "humanely" - as in like normal person with basic human needs like sleep and family time? with time to eat well and clean their living space? with time to go on a walk in the park so they done spiral down self doubt and all the sadness they see everyday? of course god help if we were kind to the young folks who are invested in wellbeing of others, who put other's well being before their own; physically, mentally and emotionally, who sacrifice their youth and their time with loved ones, the one who are their own worst enemies when it comes to criticism. we are "soft" if we treat them "humanely"
See, this is why I love general surgery, there is no “after rounds” rounds finished at 5:30 in the morning and “after rounds” consists of 12 hours of surgery followed by afternoon rounds, followed by an ER level 1 trauma. I much prefer staying up all night to read about the cases only to be asked questions specifically about what I didn’t read and never asked questions about what I did read. Surgery is the best because I hate any form of down time, including sleep
I watched this while procrastinating studying for my renal pharmacotherapy exam on acid/base disorders. I feel like the universe is trying to tell me to either start studying.
He’s NEVER gonna learn about metabolic acidosis from the Wills Eye manual!😉 Also, I love that you’re reading it…it’s basically the only reference manual we need in the clinic (we just won’t tell the BCSC writers that)
Glaucomflecken always hits too close to home, I start IM inpatient rotations tomorrow. Gonna have to work on my lock-pickings skills so I can get that sweet Honors.
Happens in other fields too. In France, after 2 years of preparatory training for engineering schools (in an environment where teachers literally bully students), when I finally got to an engineering school and the teacher said "I leave the proof of this theorem as an exercise", I spent the night on it, and got so disappointed he didn't ask for the proof the next day that I followed him to his office and handed it to him like "you forgot to ask us for this, here you go". Needless to say he was confused.
An exercise... not an assignment.. no wonder he was confused, why was this try-hard begging for recognition that he had gone above and beyond trying out an exercise to benefit him. It's not like you can't look up the answer online if you want to ensure it's correct...
When the med student gets home, he's going to find the Neurologist waiting in a darkened corner of his room to lecture him on the improper use of the reflex hammer
I will see my 30th birthday before I graduate. This is accurate. These kids are crazy. Did you ever think doctors could be underemployed? I’m pretty sure they can given how hard these people push in a pass/fail curriculum.
The correct solution is removing peer evaluation entirely and having a set of clear requirements for competency that are reasonable and not intended to weed out students arbitrarily like a clan of clandestine supernatural forces unpredictable by the students who are subjected to them. Nothing is more frightening than the unknown.
Med school positions from US and IMG schools already vastly outnumber the number of residency positions available. The competition will always remain extremely high with many qualified individuals never obtaining a residency as long as residencies can't keep up with the demand generated by med schools in the first place.
This is masterful. They say medicine is both an art and a science - this small high value production was a swell specimen that delivers both substance and levity, much needed things for mental health. Laughter is the best medicine and I wish I could dispense it to all my patients the way your shorts do. This primary care doc and not so long ago Med student thanks you for your service!
apart from the truth that I cant still fully understand the causes of acidosis (even though i am at 5th grade on med school) I UNDERSTAND MED STUDENT'S ANGER, because; a) why wouldn't professors explain the answer to our question instead of saying "go learn by yourself" b) why everytime they tell us to do something then completely forget about it? these videos hit so real at my heart and I'm glad i can express my anger in here, in this comment section with my fellow med students who are also suffering.
😅 Ok, I have to comment. I’m an optometrist, trying to get caught up on charting at 11 pm. I took a break to watch this and am giggling to myself trying not to wake anyone. This EXACT same scenario happened to me. I even did a case review lecture about it years later, all because I never got to present to my attending!
Woah this was crazy but so funny!!!!! I also loved all of the different scenes you showed and how creative each scene was!!!! Thank you for this video!!!!
I remember on my ICU rotation in PA school preparing some whole presentation on some random nephrology subject I can no longer remember and never got to present it… still upset about it even if I can’t remember what I was supposed to present 😂
I feel that pain! my first year of clerkship, felt like I was asked to look into something and present the next day at least 2x/week but was rarely ever asked. So overtime, my “research” became briefer and just looked at the gist of the answer. But then one day an attending actually sat down to have me present to the group (ofc at this point, I had expected it was the usual forgetting to have me present so I only research 5 mins!) and was not ready at all!! Found it so tough with those changing expectations!
I have absolutely NO respect for people in power who do this. When someone asks a question, fucking answer it. You are TEACHING. That is YOUR JOB. If you had classes teaching people how to effectively research quires and present them quickly and concisely you wouldn't need to play mind games with students! You could treat them with...GET THIS...ACTUAL RESPECT. I work in a research department as an admin and my boss has pulled shit like this on me. Asked me to compile an FAQ about the new Expense report system (a month after it went live, NO ONE knew how to use it and the new rules WERE NOT given out. They buried them on the website.). I worked for about 10 hours over the course of two business days, e-mailed it to him, just as he requested. That was two years ago. Still have not heard back. A couple of months ago he did it again. This time when I just didn't do what he asked I brought up the above (not the only time he's done something like this. But that was the biggest. Document was over 15 pages, examples and screenshots). He stared at me blankly and I told him, "I don't do things for fun at this job. When I ask a question I don't want to do a scavenger hunt for the answer and I don't want to spend my evening researching something you will never think about again. My time is more valuable than that to me. If you have a specific assignment with a deadline and a review timeline I'm glad to discuss it, otherwise, I'll continue with my workload as normal." Hasn't asked me to do anything stupid since and he replies to my e-mails in a more timely fashion. They're up the creek if I'm gone. I've been there five years and outlasted six other people. No offense to anyone in the age brackets ahead if you are a compassionate human being, but I can't wait for Boomers and Gen X to shuffle off. Y'all make it MISERABLE for the rest of us. Y'all missed the golden rule lesson in school and govern your lives by a fuck you got mine, I had to suffer so you do too mentality. No compassion. No empathy. No critical thinking. Disgusting.
You clearly have a lot of very strong feelings about this. I totally understand that... my dad often says, "I may have gotten a little... radical about it," but I prefer to say that I'm being "passionate." However, I also know that regurgitating a response isn't going to help the student internalize the information in a way that will help with understanding or future recall. But 100% if you're going to ask someone to prepare something, it's disrespectful not to follow up and give them the opportunity to demonstrate what they learned. Even if that means you have to put a memo in your phone so you remember yo ask about it the next day.
You are bringing up so many memories of my (failed) time in grad school. So many questions answered with an "I already told you." (No, you didn't.) So many things not fully explained. He was annoyed at needing to explain MS-DOS to be. (Sir, it's the mid-aughts, and my first home computers were Macs.) The failure to understand that tall people can reach things short people can't.
Okay, "great question, read up on it and present to us" sounds like the cruelest possible punishment for asking the instructor something they don't know themselves.
Back in 3rd year on medicine rotation, an attending asked me to read and report on mucormycosis because we had a patient with it in the sinuses-- I got so excited after reading about it and how it related to our patient, I called him at 10 pm. Not a great look thinking back on it.
Reminds me of life as a music performance major! Sadistic professor selects an incredibly challenging orchestral excerpt and accompanying etudes to learn in one week. 😈 Practice your arse off to play all of them at a professional level. 🤯 Show up to class prepared for a death match, when called to perform the assigned music for the professor. 💀 Never get called to play. 😡 Professor ends the class and you want to whip up your instrument and play the music in his face, because you’ve damn near worked yourself to death preparing it! 🤬 Good training, for working in healthcare, ha! 😂
Dr. G. Thanks for the laughs! I have seen 8 different orthos in one practice. (I live hard 🤣) One does feet, another knees, different one for the back and another for the neck; shoulder and hip guy who told me he really doesn't do necks, saw a wrist guy elsewhere. Skit idea: different ortho for each individual finger, toe, and vertebrae. And the back guy and the hip guy try to pawn off the SI joint on the other. Thanks again for the laughs. New viewer. 🙂
Ortho never helped me with SI joint. Didn't even manage to diagnose it. PMR is my hero who not only DXed SI dysfunction but also remedies it. (remedies in present tense because the treatment lasts up to 18 months and then I need it again.)
@Joy21090 thanks for the idea. I had to look up PMR 😄 and I remembered one of those orthos had physiatry in his blurb. I will check for a PMR in my area. Best wishes for your health. Thanks again.
Hmm....he's reading from the paper though, not off the top of his head. Our teacher would call this "regurgitating the information like a high schooler" and WOULD penalize you, sometimes fail you, for it. Which sucked because it was a medical case, so you'd have to start over from scratch with a new case
Haha, I was so excited for the answer! I have been in dka a couple times from viral infections, never high blood sugar and once as a side effect of innvokanna when it is being used off label in. Type one diabetics about ten years ago. And every time I have ever presented to an ED as a type one with normal blood sugar but said I’m in dka! The door every bloody time says no you’re not, then comes running in like the building is on fire when my labs come back showing the anion gap is open. “Miss, you are in dka, this an emergency, you’re being transferred to the icu!” Every damn time……I find this shocking as once you’ve beeen in metabolic acidosis you know exactly what that feels like, have never experienced anything else like it, and they never listen to us if we say we are experiencing it 😢
Yeah, that doesn't make any sense to me. You ask a question, and they basically tell you to go find your own answer. If they could find their own answer, they wouldn't have asked!
My clinicals instructor did exactly this to me in nursing school a couple weeks ago. I checked my classmate's BP and my instructor asked me what a pulse pressure of 40 meant and what we should be concerned about. I asked what pulse pressure was and she said, why don't you look into it and present it to all of us next class. She never followed up. Now I know about the risks of low and high pulse pressure when I could've been studying for my midterm...😅
My inability to remember the causes of anion gap metabolic acidosis (aside from diabetic ketoacidosis and ethylene glycol toxicity) is now going to haunt me for the rest of the week. Thanks, Dr. G!
I don't blame the med student. Honoring is everything, but scaring the crap out of your preceptor is going to get you bad reviews. Who is not going to match now.
I like how much of the actual medicine isn’t portrayed in the video. I was thinking it was going to end when the med student scrunched up the paper so Glaucomflecken didn’t have to research any non-eye related medicine. Eyes don’t make HAGMA after all
I love "that's just the way they are," you don't have to be in medicine to want to smack the "teacher" and say, "that's the way _you made them!_ " It's pretty obvious that the entire system needs an overhaul, and just as obvious that this will _not_ happen 🤨 Poor Med Student 💔 (Extra marks for 'originality of/dedication to, presentation!' A+)
When I studied for my degree in Biochemistry in the 5th year I had a 6 month course of "internal medium" which was basically acidosis and alcalosis related stuff, its mechanisms and treatment assesment. I was the one of the class who used to ask questions about it because you know, I was learning, and the professor was not happy about that. He got me disapproved in 2 exams and barely was any difference with the others students ones.
This is the best video since ElectroBOOM introduced ElectroCUTE when they... I think they were starting a car with AA batteries, but I'm not truly sure.
Attending is in the passenger seat because he finally has money after paying his loans off after 20 years Med student is in passenger seat because he has no car and used his last money to Uber
This is why euphemisms are quite counterproductive at times. Instead of just admitting he doesn't know the answer, he deflects and hopes everyone forgets or doesn't care about it at all. It's all about appearances.
I always felt relieved when the presentation got skipped / forgotten about. Would I have rather not been assigned it? Sure. But I hate public speaking so it was still a win.
