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ellorie last won the day on July 28

ellorie had the most liked content!


About ellorie

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    danger zone
  • Birthday 07/22/1989

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    Toronto, ON
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    Medical Student

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  1. Overhead is basically just anything you need to buy or rent to keep your practice going - ranging from office space to equipment to staff to materials. Overhead varies a lot by specialty because different specialties require different amounts of equipment and space to run. If you work in the community you typically need to pay for those things yourself. If you work in a hospital, much of it is likely provided for you so you don’t need to buy it yourself. If you are part time in the community and part time in hospital, you’d likely need to pay for those things that you use in your community office but have things provided while you are at the hospital. However some hospitals will take a percentage of your billings as overhead, and the percentage varies from hospital to hospital. I work in a hospital and am not salaried - I make a stipend per half day worked plus what I bill minus some fees charged by the hospital including a percentage for overhead, but it’s a quite low percentage of my billings. Certainly lower overhead than I’d pay if I had to rent an office and do it all myself, as they provide space, admin support, EMR, office supplies, and all sorts of other things I’m sure I’m not thinking of because I don’t have to buy them myself.
  2. Helps if you stash all your call stipends into a savings account. That savings account pretty neatly covered my Royal College/CPSO application/other final year expenses.
  3. Depends what you mean by "decent lifestyle". I did not use my LOC at all during residency and in fact steadily paid down about 30k while living alone in Toronto. If you are not supporting any dependents and live relatively frugally it's pretty fine. We make decent money. If you are supporting kids or a partner who does not work, maybe more dicey.
  4. It depends what you mean by "safe". Your confidentiality should be kept either way, whether it's associated with your school or not - but certainly you have more privacy seeing someone not on campus - less risk of e.g. running into another student in the waiting room. However if what you're asking is about licensing, then you're the one who has to answer any questions on the licensing application about past diagnoses - so it doesn't matter where you were seen, because you are expected to answer the question honestly no matter where your records are. However, mostly they ask about medical conditions with the potential to impact your ability to practice medicine, so most people who seek counselling can get away with saying no. However, you may want to make sure your disability insurance and any other insurance policies are squared away first, because some do ask if you've ever sought counselling, and you don't want to be lying on your insurance applications.
  5. So many reasons I became a psychiatrist. Out by 10 am post call, and that only because we hand over at 8:30 or 9 like merciful people who like to not show up to work at the crack of dawn.
  6. It's hard enough to assess violence risk in psychiatry when we spend a lot of time with people and often know them well - I can't imagine the difficulties of trying to accurately predict risk in a WIC environment when you don't have much time or much information. The best you can do is never let anybody get between you and the door, look for red flags when you can, leave the room at the first sign of agitation, be aware of potential weapons in your environment, and have some sort of protocol for how to call for help - but without trained help available to call on, by the time anybody gets to you, as in a case like this it's likely already too late. This doc could have done everything right for all we know - sometimes if someone's determined to get you, they just will no matter what you do. Truly, most violence is not due to psychosis, and I would hesitate to interchange the two. There are some messed up, violent people out there, and unfortunately once someone takes it into their head to do something like this, sometimes it's not predictable or preventable with the kinds of resources that we have in the community or even in hospitals. At the hospital where I did call, we would not infrequently have to call SWAT to come in and disarm people because even our security wasn't going to tangle with it. Not like every week or anything, but it was a known thing that happened a couple times a year. Awful for this poor doc and their family. And for everyone involved. Collective trauma for the whole community.
  7. There can be a big mental health component to chronic pain - and for some people who experience chronic pain or any other chronic physical symptom, it's really difficult/impossible to accept that there may not be a "medical" diagnosis/explanation or cure, so people continue to request demand more tests and more treatments (e.g. opioids) that are not really clinically indicated, and this can be a point of major polarization. In many cases, we feel it might be most helpful for people to accept that pain is likely to be part of their life going forward, that there may never be a clear medical diagnosis that can be "fixed" and that it may be important to do things like rehabilitation, engaging in daily activities as best as possible, trying to get back to work, and working on addressing ways of thinking about and interpreting pain, whereas some people may experience that as invalidating and continue to request/demand that a solution be found to the point of being unwilling to engage in any other kind of approach. Also high comorbidity with various mental illnesses, and many non-psychiatrists don't always enjoy working with people with things like personality disorders or trauma or somatoform disorders or substance use disorder or things like that because it isn't always really imminently fixable and it tends to create difficulties building and maintaining a therapeutic alliance, leading to anger, lots of emotion on both sides, etc. Many doctors also struggle with treating patients with problems that can't be fixed, because for some people, that doesn't feel as satisfying and can feel pretty frustrating. Others are ok with it - it's just a personality thing about what we derive value from in our work. That would be my best guess - I don't work in pain but I do see a bunch of these folks from the other side.
  8. Potentially. You can also see if your school would accept a quantiferon but you might need to pay for it out of pocket.
  9. People are not obligated to tell you "nicely" when they are asking you to look at your own racism. When somebody tells you to look at your own racism, you are obligated to swallow the instinctive urge to deny it and really take a good hard look at yourself. Even if it's painful and doesn't line up with your own self-concept. Tone policing is yet another form of violence that is rooted in privilege. Even those of us who do not see ourselves as consciously believing that Black people are inferior still a) benefit from living in a society that is systemically racist and b) are steeped in that normalized racism such that even "good people" can believe, say, and do racist things without meaning to. I also don't understand how it is possible to argue that Black students are not systemically disadvantaged in Canada today. If that is true, how do you explain the underrepresentation of Black people in the medical profession? It can't be purely moderated by SES without any interaction between race, racism, and SES - otherwise you wouldn't see the racial disparity. SES is absolutely also important and we should be supporting low SES applicants as well - but that does not directly address systemic racism, which is in fact still alive and well in Canada.
  10. I didn't have any research at all and I ended up with 3 Ontario acceptances including U of T. Although that was 10 years ago now (yikes!) so my experience might no longer be relevant.
  11. Some staff are also honestly just really really picky and need things "their way" to feel comfortable signing it off. So you don't always need to take it too much to heart. When I correct clerks' notes, if I make changes it's often related to considerations that I don't expect them to know about yet - e.g. I make a lot of corrections and additions based on addressing medicolegal risk. I document very defensively, especially in the ED, and while I teach the clerks why I am doing what I'm doing, I don't really expect them to have the language for that yet. In my specialty there is also just very specific language around things like consent, capacity, and risk - certain words or phrases that need to be used in a very particular way, whereas if it's not your specialty you might never need to know that. I remember when I was a clerk on paeds ED I thought a kid's belly looked a bit round so I wrote "distended" on my note and I got absolutely reamed by the staff because apparently that meant something very specific and pathognomic to her, but I just didn't know. You could definitely ask your staff if s/he has any overall feedback for you about what to work on next - it can be hard to just see their changes and distill it down to how you need to change your approach. Often with clerks it's about some combination of getting more concise (excluding details that are irrelevant to the audience and including everything that is important) and using certain specialty-specific language/phrases that convey certain things. But really the reason our training is so long is that it really does take time. If a clerk were ready to function at the level of a staff, there would really be no point in any of the rest of it. So I wouldn't interpret it to mean that they're displeased with you as a clerk or that there's something wrong with your performance.
  12. How's everybody feeling, aside from all of the exam drama? It feels completely surreal to me! I've been a resident longer than I've been anything/anywhere else in my adult life, so even though I'm staying at the same hospital it's still a bit bizarre. However - CONGRATS everybody!
  13. Oh I don't know, I don't go to UBC - I was just reacting to @PlantZaddy's post.
  14. I think it's like - even in weeks or rotations that are really demoralizing, there are bright spots that remind you why you're doing it. Times where you really helped someone, or made a cool diagnosis, or learned something that really made you feel intellectually stimulated, or had a bonding moment with a colleague. And I think you sort of hang on to that stuff rather than focusing on the shitty supervisors or sleep deprivation or the patients who treat you horribly. And then you just take it one moment or day or block or year at a time, and go on living your life around it as best as you can. I think I've also sort of learned to ration how much I give a shit about things, and what things are worth giving a shit about. You can't take everything to heart or you'll lose it. When I used to care about what every supervisor thought about me, it felt kind of impossible. I also still care very much about my patients individually but I've learned to divorce my morale/self worth from the outcome, a bit, and instead focus on the care I provide rather than feeling like I've failed if patient or environment factors still result in things going wrong. When I'm feeling burned out and have limited resources I try to be very conscious about maximizing them and focusing them where they do the most good.
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