misboxie, MD

Dr. J. | GP trainee doctor | medicine/health-related reblogs. | personal page @yellowgrapes | social media: @misboxie | #Medblr.

[misboxiemd]

You are strong, you are powerful, you are changing peoples lives. I see you snd I’m grateful to you. I know it is hard but think about why you started and how much progress you have already made. You will be an amazing GP and a safe space for WOC

🥺 thank you so much 💛

[misboxiemd]

cried all night last night.

worried and stressed about a number of things. and feeling overwhelmed.

feel like im simply not good enough for this job

wish i could take a break. maybe work Less Than Full Time. but i dont want to increase my training time. would really like to be done next summer. and dont want even more salary cuts by going LTFT.

i dont think i can go in to work for my next clinic.

[misboxiemd]

7/2/23

might just be back to posting here. Can get my thoughts off and leave it at that.

Of course id end up with a needlestick injury.

Was assisting the reg in a planned elective c-section. The patient was bleeding a lot.

I had to de-scrub, wash and bleed the wound and go to occupational health. Had to have some bloods taken and get a hep B booster shot and consider whether or not to take PEP in case of HIV.

The patient was HIV negative on her bloods months prior, so i decided not to. Thankfully her repeat bloods came back negative.

Will need to get repeat bloods done and follow up in a couple months.

[misboxiemd]

It’s been a looong time since i’ve posted on here. Something happened today and i didnt feel like posting on my twitter.

Currently in my ST2 (2nd year) of GP training (ie General practice/Family Medicine). This year is one of integrated posts. Half of the week is in the GP practice and the other half is in a hospital/other clinic.

I’m currently on Obgyn and GP.

This morning, im in one of the outpatient obgyn clinics. I got to work a couple mins before clinic started and went to my room. My consultant and the reg hadnt yet come. Id occasionally pop into their rooms but they didnt turn up till like 9:13ish or so.

So i hear the consultant’s voice and go to her clinic room. Because they have the patient files for their clinic and share the ones they want the reg and SHO to see.

I see her coming out of the room and I say “Good morning Miss ABC” and she ignores me and walks past me. I figure she’ll be back in a moment. She comes back with a patient and as im trying to explain to her that I’m with her for clinic for the morning, she’s like “can you come out I’m coming in with a patient.”

So i wait for her to finish with that patient and pop back in and tell her im on the team for the morning.

She says ‘hello Jackie, the clinic starts at 9 …’

And i say ‘yes, i’ve been here since about 8:55 and kept coming to check if you were here’

The rest of the clinic goes fine.

I found it extremely rude how she just ignored me at first when i tried to speak to her. When I went in she also didnt know who i was.

the obgyn consultants dont even recognize your face or name even though they’ve worked with you before a week or two ago. Like you’re just a body getting their work done for them. Havent experienced this with any other group/on any other rotation in the last 3.5 years i’ve been working in medicine. NHS service-provision at it’s finest.

(meant to post on Monday 6/2/23)

[misboxiemd]

selfies while gettong a discharge letter done.

[misboxiemd]

👩🏾‍⚕️🏥

[misboxiemd]

rounds.

we go all around the hosp to see the new surgery patients admitted + our known patients.

[misboxiemd]

i stay getting those elevator selfies

[misboxiemd]

Surgery SHO life.

On nights when im on call as the surgery SHO (senior house officer) i get referrals for all surgery patients—ie general surgery, vascular, urology, trauma & ortho. It can be quite a lot tbh. There is registrar for T&O and i have the gen surg reg as well.

On these set of nights i had to call the ENT reg at a diff hosp as that was my designated ENT reg. She yelled at me and shouted at me for calling. Smh.

I think aome things could be structured better in this training but i doubt i can bring about any change. Anyway, im glad i am done with all my on-calls for surgery 💃🏽

[misboxiemd]

Somehow imade it to the end of Fy1.

I was happier a few days ago after my last shift. Today, however, after a few days with a couple of occurence, im not in a happy place.

I dont think i’m cut out for this medicine life. Along the year, some different stuff happened that made me want to quit. I thought it was just me not being good enough. When i shared with my colleagues in other trusts (who i was in med school with), they told me they felt some workplace bullying and other things were at play.

I’m back here feeling as I did during F1, questioning whether i should even be in medicine. I dont know if im just being sensitive or if some of what happens is from other external factors.

I do feel like i want to quit, tbh. I dont know how long i’ll last. I’ll do my best to stick it out and finish Fy2, so that if i decide to continue in medicine i still have that option.

[misboxiemd]

FY1 life.

[yellowgrapes]

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🎶bloom baby, bloom 🌸🌼🌺#plusone #latepostasalways😅 #naturalhair https://www.instagram.com/p/B-QCTidpnVv/?igshid=8h6bhxg5hbcg

[whitepeopletwitter]

[movioletta]

Dear medical Publishers, a book containing 700 pages is hardly a “pocket guide”, thanks for coming to my Ted talk. 

[md-admissions]

I was wondering if you could elaborate on the biases toward patients with opioid addiction and what you think we should do better. I see a lot of infective endocarditis patients, and it's frustrating and sad and I know I'm guilty of biases.

@runner-kat, this is an EXCELLENT question. 

Let me make one thing clear: I am no saint. I did not come out of life or medical training aware or ‘woke’ about this issue. I learned, as my hero and inspiration for this blog, Anthony Bourdain did when he acknowledged his contribution to toxic masculine kitchen culture: by fucking up, listening to people who knew better than me (patients themselves, social workers, addiction psychiatrists, my attendings, residents), changing my ways, and continuing to learn. If I can change, you can, too. 

I think there are two very major, pervasive biases I see across disciplines and healthcare professions that can also be easily remedied. 

Common bias #1: Language What we do: “This is a 28 year old heroin addict” “This is a 32 year old IV drug user” “This is a 48 year old opioid abuser”

Addict, user, and abuser are words with blatant value judgement behind them. It changes the way we think about the patient before we even see them. It hurts our patients, too. We as physician know better, we know that illness does not make a patient more or less valuable as a person. 

We KNOW that addiction is a physiologic illness. It’s not “all in your head” or “weak will” or “poor upbringing”. One that comes with stigma, its symptoms manifest as behaviors, its side effects and endpoints catastrophic to patients, families, children, and communities. One of the saddest things I heard in the past year was when a twenty four year old with terrible septic arthritis told me, “I’m a drug abuser. I don’t deserve this surgery, you guys should just leave me to die.”  It told me how little she thought of herself and how hopeless she felt. It told me that someone who claimed they loved her said that to her. That’s fucked up. Use instead: “This is a 28 year old with heroin use disorder” “This is a 32 year old person who injects drugs” “This is a 48 year old person with opioid use disorder” This is non-judgmental language that succinctly addresses the medical illness of the patient at hand. Disorder, of course, in the medical sense, and not the colloquial sense. Common bias #2: Patients with a history of or current usage of opioids do not provide learning value.What we do: Residents. Attendings. Med students. Raise your hand if you’ve ever heard or said: “Ugh, another opioid user you’re going to learn nothing” or “I prioritize teaching on my service, so you’re not gonna get the annoying stuff like placements or drug users.”

I’ve said all those things before. I’m not proud of it. I don’t say shit like that anymore. And I educate residents to not say that, either. 

There is teaching and learning value so long as you look. But why do we say shit like this? Because we’re burnt out and patients with opioid use disorders need a LOT of multidisciplinary services, time, and help we often cannot give as a lone med student or resident. Their suffering and sometimes their behavior forces us to confront things about ourselves, our healthcare system, our society that we’d rather look away from. These patients can also often press our buttons and stir up emotions that we’d rather not feel and can test our compassion. 

Let me offer some suggestions for teaching points for both teachers and learners:

-Ask your patients about the first time they injected or took more pills or fentanyl patches. The stories will break your heart. The number of patients I’ve met who were given an injection against their will? Too many. Patients who took pills because they felt their life and future was going nowhere? Too many as well. -Learning about injection habits and learning how to educate people on safer injection habits if they’re not ready to stop to prevent life-threatening infections is seriously interesting and lifesaving medical education. Maybe I’ll do a post someday soon.-Learning about medication-assisted treatment (MAT) to help patients ready to stop using opioids. Interesting and educational from a pharmacologic perspective, physiologic, and medically. Attendings out there, find out if you can get certified to provide MAT! I’m in the process of certifying!-**Framing injection drug use as a medical condition with its own focused review of systems, questions, physical exam, and work-up. Ask about fevers, night sweats, systemic symptoms. Injection methods: you must ask because it will address where infection lies on your differential and what else you need to work-up. Ask about prior methods the patient has tried to stop injecting. Have they tried quitting cold turkey, tried methadone, suboxone, vivitrol, etc. What were those experiences like? What have they heard? Would they like to try? Looking for back pain (potentially a concern for an epidural abscess or vertebral osteomyelitis), a good MSK exam for septic arthritis or muscle abscesses, murmurs for endocarditis, etc. Work-up for transmissible diseases like HIV, Hep C, blood cultures for bacterial or fungal bloodstream infections. Do I have your interest yet?

Obviously there’s more to do. But I think if medicine as a whole could do just these two things, we’ll be doing a whole lot better.

Fantastic question, thank you!!

md-a

[cranquis]

I learned a lot here.

[misboxiemd]

Hi there congrats on graduating! I am a Canadian citizen looking to pursue medicine ( ideally in Canada). However I have also applied to schools abroad like in australia and Uk. I have gotten interviewa to a few schools now but i am still on edge about if I really wanted to study abroad. Could you speak to the experience of studying medicine in a foreign country as an international student (im assuming you are)?Are you planning on practicing in your home country or in north america?

Hi! i’m so sorry, I'm just seeing this as i don't check my tumblr regularly and i don't know when/how long ago you sent this message. I’d say if you want to become a doctor and the canadian route isn't working, take other opportunities that come up. In the end, i also want to end up back in Canada, so i’ll figure my way back sometime. with regards to the experience as an international student, i’ve always been one (when i went to canada for high school and uni) so it wasn't that much different. it was just a bit different being in a non-english speaking country, but it wasn't a big deal as most of the time you’re with english students. and we took polish and learned to communicate and have basic conversations in polish. it was nice being in a new place and to live close to places i wanted to travel to. it was also a great escape from canadian winters lol.i want to practice in either the UK or the US first since canada isn't an option right now(since i don't have permanent residence or citizenship) and eventually move back to canada. i also want to work in my home country (Ghana) a few years down the line.I hope your interviews worked out. If you see this, let me know how things worked out for you. All the best!

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