A Strange Mixture @doctorjustine - Tumblr Blog

Represent! #4 - “Believe You” (2021)

written by Nadira Jamerson art by Brittney Williams & Andrew Dalhouse

This is so important. There are literal studies proving white doctors don’t think black patients (especially black woman) feel pain the same way white people do. Please advocate for yourself and stay safe.

doctorjustine

White doctors: recognize the implicit biases you carry and actively fight against them. Think outside the box. Advocate.

everythingfox

“Medical professional having to deal with an unruly patient trying to take off their mask”

(via)

weavemama

PSA: Halloween is pretty much here and it only takes on second to send a sick child in the hospital a Spook-o-gram. The best part about this is that $1 gets donated to CHLA’s Helping Hand fund each time you send one out. So let’s help some kids have a spectacular Halloween by sending them spook-o-grams and helping cause!!

tinyspaceel

This literally costs nothing but your time so please do it, you could make a kids Halloween.

winterrose527

I want to mourn her death. I want to honor her. I want to pay tribute to who she was as a woman, as a mother, as a lawyer, as a fighter, as a wife, as a justice, as a patriot.

I want to mourn her and celebrate her and thank her for everything that she did, all the decisions that she made that helped me grow up in an America where I was safe to pursue all the things I wanted.

Instead the first emotion I felt wasn’t sadness, or humility, or solemnity. It was fear. Chill down the spine, tears in the eyes, heart racing, muscle clenching fear.

And I will never forgive them for that.

highreevecain-deactivated202502

biggest-gaudiest-poltergeist

educate people & tell social stigma to fuck off with the help of technical language!

i’m having a depressive mood = “my brain isn’t correctly processing serotonin at the moment”

i can’t concentrate on a fucking thing bc adhd = “my brain is in full dopamine-seeking mode”

anxiety attack = “due to an unspecified perceived threat, my brain has elected to enter lockdown mode”

everything’s just a mess right now = “my neurotransmitters are a mess right now”

stellophia

#just bc your brain is doing something doesn’t mean YOU are doing it#there’s a lot of automatic processes there we CAN’T control #you deserve to be able to separate your symptoms from your choices #some days living with mental disorders feels like a constant game of ‘build a mousetrap’ #where i have to come up with increasingly bizarre but effective ways to coerce my brain into doing the things it needs to #yes in this analogy my brain is the fucking mouse #my toolbox of coping skills are the increasingly wacky and zany tools i use to build the mousetrap #sometimes it helps to replace ‘i’ with ‘my brain’

bisexuanal

You can really tell who’s never experienced poverty and food insecurity when it comes to discussions around food costs and how unhealthy food is cheaper. Some fucker always comes in with the price of like… lettuce or… apples. And it’s like yeah bitch but can you work an 11 hour shift after eating some salad and an apple!?! Find me something cheaper, and more filling than the broke ass staples of boxed mac and cheese, hot dogs, noodles, bread, beans, and rice. I’ll wait.

It also ignores the mental toll that poverty takes like maybe your home made veggie filled recipe isn’t crazy expensive but it also involves prep time and cooking time and organization in terms of fresh food that a lotta poor people can’t manage.

Not to mention if you can only afford to get to the store once every couple weeks via bus or cab then you can’t keep fresh veg on deck.

But ya know.. poor people are just dumb and lazy.

ishouldbeoverfanficsbynow

It’s also ableist as fuck

doctorjustine

Or if they CANT AFFORD A REFRIGERATOR!

I decided not to take my mini fridge with me on rotation and DAMN I’m eating terribly even though I love me a good salad.

3tych

kind of belated, but Happy Pride y’all :)

womanh0od

So beautiful

eljayetc

This is from 3 years ago, but desperately needs to be brought back

superhusbands4ever

Here’s a fun tale from your local Target employee:

I was pushing truck for OTC today which is the pharmacy area. I was pushing cases of hand sanitizer because we got the “good stuff” in today (purell) and it goes quick even with the the product limit put in place. People were literally taking it from my hand before I could put it on the shelf, but that’s not the point.

As I was putting the goods on the shelf, this woman comes up to the stand and she’s very excited. “Yes! You guys have it! How many can I take, is there a limit?” I say yes, 3 per person per transaction per day. She nods, accepting, and grabs her three. “Sorry, that was weird. I’m a teacher, I’m trying to stock up. I promise I’m not a hoarder.” I smile and nod and say it’s fine. She starts to walk away but stops and turns back.

“Do you have any Clorox wipes in stock by any chance?”

Heart sinking, I shake my head and say no, sorry, and we don’t know for sure when we’ll get more. (We get them maybe once every two weeks, but the product limit for those is one per person per transaction per day and they usually sell out within hours of going on the shelf.)

Her face dropped and she kinda looked down at her hand sanitizer and said “that’s okay, with the product limit I wouldn’t be able to get enough before school starts anyway. It’s only 4 weeks away.” She laughed a little but I could hear the frustration in her voice and see the tension in her face. She sounded defeated. The most I could offer her was one of the small bottles of pure bleach. I honestly wanted to cry. For a second there I thought she would. I had no clue what to say as she turned and walked away.

This is what teachers are dealing with. Even in years when there’s not a pandemic they have to rely on donations from parents or their own money to be able to buy hand sanitizer, wipes, tissues, etc. for their classrooms. Now they’re being forced to return to school with no extra funding, no extra supplies, no support from the government; they’re STILL expected to provide for and protect these kids *on their own.* All while, now, risking their own lives and their own health because the government doesn’t want to admit that they fucked up handling this pandemic.

Every time I hear someone say “kids don’t die from it, it’ll be fine,” I realize that person does not give a flying fuck about teachers. Sure, *maybe* the kids will be fine. But the teachers are not children. They are adults with underlying conditions, adults living with elderly family, adults who are over 50 and are at more risk. Adults with at risk family at home. Adults who are at risk themselves. But they are STILL trying their hardest to protect your children in the classroom.

It’s honestly fucked up that we live in a country where police departments get millions or even billions of dollars in state funding, yet teachers have to buy their own cleaning supplies and doctors have to reuse PPE in hospitals. Police get tens of thousands of dollars worth of riot armor to wear and terrorize peaceful protesters, while the Navajo Nation get sent body bags instead of medical supplies.

Honestly I don’t know where I’m going with this, but I’m tired y’all. I’m tired and frustrated because leadership in this country doesn’t care enough to prioritize human life. Idk, it was a small moment in the grand scheme of things but it really was a slap in the face reminder of how this country treats it’s own people. I feel like we’ve all been getting those lately.

cephalopodvictorious

Kids don't die from it except when they DO, and teachers CARE and when they can't prevent it and they know that their kids are dying and hospitalized and irreparably harmed and they couldn't stop it, you're setting a lot of people up for a LOT of trauma, on top of everything else too.

doctorjustine

Learning all the ways this pandemic could have been handled and should have been handled by a world power makes me hate this country for their terrible prioritization of ten people’s money over hundreds of thousands of human lives and want to burn it to the ground and start anew from the ashes. Unfortunately they scammed me into drowning in medical school debt and the only way to dig myself out is to continue working in this pathetic excuse for a first world country.

loveallthegays

Our apologies

livepoultryfreshkilled

redhatz2

3 things.

1: Bailey is like what 10? A little young to be diagnosed with gender dysphoria.

2: The doctors and nurses familiarize themselves with the situation via the charts before comming in so they DON’T look like bafoons (pretty sure i mispelled that)

3: Not only would the chart show bailey as a male but this is a hospital you dumb fucks, we use medical knowledge. Do you have ANY ideo how many ailments only effect one sex or have varying factors based on sex?? Your personal feelings and identity mean nothing in a situation where treating a man like a women could LITERALLY,

LITERLLY,

Kill someone, a drug effective on women can cuase heart failure in men.

(i doubt anything that serious would happen but the point stands)

mewithanie

Hi! I’m a doctor.

1. 10yo is PLENTY old enough to have dysphoria. A lot of kids realize they are trans (not by name, of course, but they do FEEL it) as early as 2 years old or so, which is when kids start realizing what gender is and where they belong in that respect. It’s true that many kids don’t realize this until puberty or even later, but that is not the only path.

1a. You don’t have to have gender dysphoria to be trans. You don’t have to have a diagnosis to be trans.

2. Doctors and nurses absolutely familiarize themselves with the chart before seeing the patient (if there is time. Looks like here there probably is time). Awareness of social history including family/living situation, custody issues, recent life events that may require sensitivity, and CERTAINLY gender as well as biological sex would definitely be a part of the chart. So for instance I have seen patients who are trans; usually when I write a note for them I would put it in the very first line of the note: “John is a 15yo transgender male (assigned female at birth) who presents for X”

2a. It’s “buffoons” :)

3. Generally speaking this is……not the case. Yes, knowing someone’s biological sex is important, though I am honestly more concerned with any particular therapies they may be on for a medical transition, or health maintenance (eg pap smears, prostate checks) than I am with their chromosomes or whatever. For kids, some diseases have a tendency to affect one sex or another, but there’s not much I can think of that has such a strong association with one sex that I would be screwed if I didn’t know the kid’s biological sex. (Plus, as mentioned in 2, we can know both their bio sex AND their gender!!)

3a. I do not know of any drug that is effective in women but will literally literally cause heart failure in men.

zebrasaursaylor

It really fucking pisses me off when ppl claim kids cant have gender dysphoria i was really close friends with someone who later came out as trans and looking back its very clear they always were who they were on the inside but had to pretend to be who everyone thought they were to not get bullied.

bitterbadfem-harpy

I’m so sorry your friend internalized homophobia at such a young age but no there’s no such thing as a trans child

zebrasaursaylor

Im so sorry you were butthurt enough from someone elses personal life expirence to both like and comment on it, random person.

Anyways. My friend had gender dysphoria as a child and some butthurt troll on tumblr doesn’t change that 👍

bitterbadfem-harpy

Your friend was a perfectly normal gay kid and all the silly fads on tumblr doesn’t change that but again I’m really sorry they felt so disgusted by and ashamed of who they were that the only way they could cope was with cosmetics and hormones 👍

I hope they’re at least healthy and haven’t undergone unnecessary surgeries to validate this nonsense trend

zebrasaursaylor

Uhhhhhh no sweetie. First off. It was over 10 years ago. So it wasnt a Tumblr fad but its sad you think being condescending will get you anywhere 😂

Like you are making ALOT of assumptions. Who said shit about cosmetics? Or hormones? No one.

Last time i checked they were happy and healthy living in the body they always knew they should have had and ngl they fucking kill it. They are hot as fuck 😘

Like i have no idea what makes you. A complete stranger, so upset from me talking about my friends childhood but honey. Sweetie pie. Child. You werent there. You do not know. And you can not twll me what was and wasnt so and its so fucking adorable you even tried, like thank you for the laugh.

But see. You are a stranger. A rando on the internet who saw my comment, went to my blog, liked my post and then commented your sad little bullshit on it. No one but you gives a?fuck honey. Answer back all you want but i dont give a fuck 😂 i know the truth and you crying doesn’t change shit. Have fun pissing and moaning to yourself while i laugh at your bullshit 😃

bitterbadfem-harpy

Anyway transgenderism as it exists today is only about ten years old and it’s an ugly homophobic fad but like congrats on thinking your friend is hot I guess

geoffscrabshack

@mewithanie from what I’ve seen you’re not even in med school yet, quit while you’re ahead

mewithanie

ok cool thanks for the advice.

From the American Academy of Pediatrics, the biggest and most respected association of pediatricians in the US:

https://www.aap.org/en-us/Documents/solgbt_resource_transgenderchildren.pdf

You can doubt my assertions and my claims all you want; I know what I’ve achieved and you can’t take that away from me with a nasty comment on tumblr. Meanwhile, though, you should know that no matter what you think my credentials really are, an organization representing 64000 pediatricians in the US supports transgender children and their transitions.

doctorjustine

People who don’t think transgender people exist are why the president’s executive order is so scary. If I could take care of all the trans patients myself I would but unfortunately I can’t, especially if I go into rural medicine.

Glad to see that most actual medical professionals support the trans community though. Our school in particular had quite a few lectures on gender dysphoria (spoiler alert: most patients it experience it before adolescence), treating trans patients, and making them feel as comfortable as possible so I hope that is the standard in the future.

greenwraiths-deactivated2022042

oi guys for the love of fuck, i’m not gonna be nice about it

if you’re a non black poc, or worse, white, do not fucking make this about you. do not make it about aesthetics. do not make it about anything other than it is.

greenwraiths-deactivated2022042

rebloging myself bc someone asked: the point of this post is beyond whether you can or can’t reblog it. the point is whether you should or shouldn’t.

if you’re a non black poc, or a white person, what you’re called to do now is to stand in solidarity.

see someone making BLM into a relatable aesthetic? call it out

see a post with donation links? reblog it and donate if you can (x), (x), (x)

the MN freedom fund itself is bringing attention to other fundraisers. check their twitter.

most importantly know this doesn’t end in the internet, that is not enough. family or friends saying anti-black bullshit? say something. read on the subject of racism and anti-black state violence, prison abolitionism, etc etc

if you’re not from the US learn about what is happening in YOUR country re: black communities and learn how to help them

do not speak over black people

deplatform racists

go to a protest (with the necessary precautions)

sign petitions

do not donate to anything shaun king posts because he has a history of asking for money in the name of BLM and then the money vanishes. the mn freedom fund has made the clarification already

etc etc etc

listen to black people, and stand with them. interject in the situations that you can, and educate yourself and others. as riots and protests spread know many states and cities freedom funds will need donations. check with national bail fund network, or free them all.

don’t ask me if you can reblog, ask yourselves how can you contribute. you shouldn’t be asking if you can help, but how. it doesn’t begin by reading theory, it begins by caring about people

mothurs

friend: you look stressed me: haha yeah it’s the stress

e-bert-deactivated20230704-deac

NZ traditional haka for black lives matter, video posted june 3rd 2020

thickemo

For those of you who don't know, this specific haka was written by a father to acknowledge his son's wrongdoing and basically tell him to get his shit together. It is also modernly used as a haka tautoko, or acknowledgement, in some contexts.

Y'all see how symbolic this is, right? It's both acknowledging current events as a show of solidarity, but also calling for world leaders to get their shit together and admit their wrongdoings and try to change things. This shit is powerful.

The user quobbo on tiktok did a little rundown analysis of it here:

#stitch with @tonifui 👈(credit) | Tika Tonu (a ngeri/haka) in a 60sec tt #blm #poc #sons #aotearoa #māori

anatomicaletymology

What advice would you give to someone with back pain?

I don’t actually need advice, just curious what people think

anatomicaletymology

I know I have a fair few med student followers. What are you taught about back pain?

flyonthewallmedstudent

My advice (as a doctor) and what I’ve been taught is that if it is bad or very persistent go see a doctor (a GP/family doctor or the emergency room). Get properly evaluated.

What you want is for dangerous things to be eliminated from the differentials. The idea (and cliche) of better safe, than sorry.

When I say bad - simple over the counter analgesia like ibuprofen won’t cut it, and when I say persistent - it wakes you up at night, isn’t going away. Or, the pain changes in nature or has very concerning features (you can’t sit or walk for example).

Back pain is a very vague and broad symptom on its own, we look for a constellation of signs and symptoms to determine what it could be. WebMD will probably tell you it’s cancer and it’s not wrong - it could be.

If I asked my med students for differentials for back pain..

actually I won’t give the answers. Medical students out there - give me your differentials on Back Pain. What are the red flags. (When I was an intern, this was the last thing I wanted to go see, it’s just so broad and 99% of the time, very boring).

Depending on what the history and exam suggests, it determines the investigations I do to confirm the differentials I have. That then determines what I do - whether it’s advice (take more ibuprofen, go see a physiotherapist) or a referral to a surgeon or rheumatologist. etc.

I also would not want to miss is a treatable chronic condition that requires specialist management. For example Zach from the Try Guy had a missed diagnosis for years and he talks about it here.

yourfriendlyneighborhoodrabbit

Okay MS2 here, no clinical experience yet but based on what we’ve learned about back pain in preclinicals, my differential would include:

Infection –> Osteomyelitis, Potts disease

Trauma –> Fractured vertebrae, herniated disc, strained/sprained muscle

Neoplasm –> Metastatic cancer (likely lung, breast if female, if male prostate also likely), multiple myeloma, primary bone cancer

Nerve-related –> Sciatic nerve impingement, cauda equina syndrome

Degenerative –> Osteoarthritis, osteoporosis, osteomalacia, spinal stenosis

Autoimmune –> Ankylosing spondylitis, polymyalgia rhematica, fibromyalgia

Red flags –> Acute, change in quality, location, etc, bowel incontinence/urinary retention, associated fever/weight loss, night sweats, preceded by significant trauma

flyonthewallmedstudent

Lotta good answers in here, coincidentally across the full range of med school - pre clinical and clinical.

Just reblogging the last one, and going to mention the other comments.

Nice to see the surgical sieve being used! (for reference - VINDICATE is one form of the mneumonic - VINDICATE: vascular, infection, neoplasm, degenerative or drugs, iatrogenic or intoxication, congenital, autoimmune, trauma, endocrine/metabolic)

Glad to see multiple myeloma in there, as back pain is a very common presentation for this, sometimes the only one and MM is so easily missed.

Pre-clinical years is all about first exposure to a disease usually text or lectures. And at least considering the list of potentials, as a thought. Once you get to the clinical years and beyond, they turn into drop down menu’s. I used to be really annoyed by lists as a student (I still am) but I get that it serves a purpose in the early years.

From @loreleys-road-to-md

Huh okay this is so very far from my interests but hey let’s embarrass myself online. This should be fun.

It depends on so many things, like where exactly or how long or other symptoms etc, but given no more information, it could be:

Not back-related: heart attack, kidney stone, pancreatitis.

Back-related: discus hernia, trauma, osteoporosis (and subsequent fracture), tumor (metastasis or local, solid or haematological), arthritis, spondylitis ankylopoetoca and other rheumatic causes.

That’s all I could come up with from the top of my head…

Red flags would be: pain waking up pt from sleep, sensory function damage/motoric function damage in the limbs, tumor in pt history

(sorry for the mix of Latin and English, I had a lot of trouble trying to figure out what are things called in English…)

That’s a good system - actually MSK/back related vs other organ system causing “back pain”. For sure, one thing you always want to consider is aortic dissection. location of back pain will also help you in your differentials. Only thing I have to add is back pain that isn’t improving or is getting worse - hence the importance of following-up particularly if you’re in primary care.

from: @doctor-jonathan-strange

Swooping in to add aortic dissection to Things That Must Not Be Missed.

Sudden-onset tearing pain between shoulderblades? Get help.

Thoracic back pain is a lot more likely to be something serious than lumbar pain is, and I’ve seen it counted as a red flag even.

The idea of having one clinical presentation to go off of sets you up for the future even if you don’t know it yet. My take home here for students is to have a system.

A triage note if you’re in the emergency department could literally go, 35 year old male, with back pain. If you’re juggling a few patients in a limited time frame, you’re going to prioritise seeing the next patient and that one line also structures your process. Similarly, a page will be a one-liner, or a referral from an ED clinician (you’ll always ask for more info on the other end, but again, past experience helps you decide fairly quickly whether you need to see the patient sooner or later). A code may give you even less information. What remains annoying is that it’s always broad and you have to think about how to tackle it. (At a code you would rely on your Hs and Ts). When a code goes off, on the way to it in the hallway you should already being listing off differentials in your head of what it could be, as time is critical.

I wouldn’t go memorizing lists, you could write it down once. But as you start seeing patients, those cases will cement those diseases for you and how they present.

I also wrote off epidemiology as preclinical year student, but it’s fairly significant later. For instance, a 65 yo male with chest pain will always be more concerning than a 20 yo with chest pain, and the provisional diagnosis will no doubt be different for each.

And someone answered correctly in the comments, Zach from the Try Guys has Ankylosing spondylitis. If you watch his youtube vlog on how he was diagnosed, essentially his diagnosis was missed for years. Which is tragic as the longer the disease is left untreated, the more disabling it becomes as inflammation is given free rein for years. And it’s a very manageable disease on the right medication.

I’d love to keep going on this point, but it is a very broad topic. otherwise, if we were on the wards, the next questions would be what investigations would you request to confirm your diagnoses and what in the history and exam would you look for. It’s hard to envision as a pre clinical, but every question of the history is often very specific to rule in and out every diagnosis listed as above. So, within 10 mins I’ve narrowed the list to a couple of differentials, and just need a couple of investigations to confirm using whatever relevant criteria laid-out there.

For fun, anyone know what in the history and exam would suggest a diagnosis of ankylosing spondylitis and what investigations will confirm the diagnosis? (Clue: What clinical criteria must be fulfilled?). Also - what on the history and exam would suggest multiple myeloma and what in the investigations would suggest this? (not necessarily diagnose but brownie points for this)

doctorjustine

I LOVE all the medical info here, but as an OMS-3 I feel like I need to bump OMM! Most back pain is simply somatic from bad posture or leg dysfunctions that have misaligned the legs over time. Any good physician will clear you of disease, but if you get to the end of the road where you really only can have NSAIDs, please please please find a local DO who offers OMM! I have seen such amazing results from OMM sessions where people have gotten to the point where their pain is controlled without NSAIDs so even that small chance of peptic ulcers and renal dysfunction is drastically reduced!

flyonthewallmedstudent

Hadn’t touched on management as the diagnoses above are very diverse.

But certainly, if it’s simple MSK back pain without red flags, the next step is physiotherapy and analgesia - tailored to the patient.

On the side, DO is unique to the USA. Unfortunately OMM isn’t universal across the globe.

doctorjustine

Fun Fact: while DO programs are unique to USA, “osteopaths” are educated in other countries and are trained to do things similar to OMM without the rest of the medical degree. So basically chiropractors. Which is great! Until DOs from the US try to practice in other countries... it takes a little more convincing to say “no, I am not just a chiropractor, my degree is equivalent to an MD”.

Honestly with the current state of the US I have put a lot of thought into moving to a different country completely, but because our healthcare system is so broken the US is the only place that will pay me anything near enough to be able to pay back my loans, so I’m stuck here until I can at least do that. Someday I’ll be debt free and maybe I’ll move to Byron Bay Australia and become the Hemsworths private doctor because they’ll all be on their deathbeds at that point 😂