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katakari

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About katakari

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  1. Yeah, I specifically looked for a low volume site to start out. You have to be a bit careful and know your limitations as people will let you work in almost any of these places. I was offered to cover a site with 70 visits/day. My numbers aren't anything special. I have had enough experience that I feel comfortable with my plans and procedural skills to successfully run a low volume rural ER, especially with good supportive back-up starting out. If you had a more specific question it would be easier to provide more information. Are you looking into doing ER yourself after 2 years of residency?
  2. I will be doing single coverage ER this summer out of residency. From advice of those around me, and my own thoughts, the situation you describe is incredibly rare, especially in a low volume center like where I will be. With 5-15 patients a day just based on probability you won't see as many emergent cases. Despite this, I made sure back-up was good as well and there will always be a physician back-up in the community who is more experienced with procedures if I find that I need extra help. Then of course, knowing your principles, doing as much reading as you can, and having a good plan for these scenarios is optimal. Start with VL, know your airway algorithm, prepare for surgical airway, use techniques that maintain airway reflexes if you are particularly concerned. Simulation can't be understated for High Acuity Low Opportunity scenarios; take extra courses to fill in knowledge gaps. And lastly, something that often goes unsaid is that, unfortunately there is an understanding that due to nature of the location that these patients live that health care outcomes may not be as good compared to living across the street from a Toronto hospital. You just simply can't get Icatibant and a specialist with an airway fellowship to your patient in five minutes. But you do the best that you can to bridge health care disparities. The more you think about it, it's pretty backwards that the areas with the lowest amount of resources also have practitioners with the least formal training.
  3. Anyone interested in doing a bit of SOOs practice over Skype this weekend? Or even later in the month? Send me a message and we can set something up. There are some very unusual group dynamics at my site that have limited our prep sessions.
  4. I don't find any of these to be challenging aspects of family medicine. Most of my management is based on history, if you have a concerning undifferentiated finding, you can always get an echo, get a chest x-ray, or do a biopsy. In a community family medicine site, often you don't have the opportunity to refer due to limited resources. This gives you the opportunity and impetus to manage a lot on your own. In all the patient's I see in a week, I would say I refer less than 5% of the time, and even then would be a likely overestimate. Often the longitudinal relationship can benefit you in high stakes situations. I remember one patient walked in on 9L of O2 and looked terrible. I sent him home because he had a restrictive lung disease and no further management could be offered him. I was able to say this comfortably because of the longitudinal relationship we had with him. His family disagreed with me and sent him to the hospital. Well of course, someone who doesn't know this guy, is going to admit him to the ICU, begin workup of this idiopathic disease and he found himself with 3 organs severely damaged due to iatrogenic investigations/management, transported inbetween several hospitals for different management of the varying iatrogenic comorbidities, and I saw him in rehab a few weeks later with no difference to his management or diagnosis. Patients seem to not mind that I look things up, especially when I am open about it. Now, for the challenges I face in family medicine: 1) Being the coordinator of care. You are responsible for everything and often have to tie together poor communication from various health fields, records, notes etc. You also can't turf your patient back to family medicine when you're at a loss for what to do or when it doesn't fit your specialty's area of expertise 2) Diversity of knowledge required. The specialists I work with often have reductionist views of disease because they see things that are already worked up. You have to begin from the ground and consider so many various possiblities, choose the right tests without choosing too many, etc. You're often admonished for not having specialist expertise in every specialty. It takes a lot of work to find a balance 3) Chronic disease. Chronic disease can often be frustrating when patient's don't get better and you have to manage their investigations, tell them why they can't have another MRI or more opioids, and this can upset people 4) Benign disease. On the same spectrum, having to tell people why they don't need antibiotics for a small cough. It's also really easy to miss something severe at the same time. Anyone can manage a STEMI - there's a basic protocol for it. But that low risk chest pain that comes into your office with a few almost-red flags, deciding what to do there is where medicine gets very nuanced. That being said, you need to shadow some family doctors. It's a great field, but it's not for everyone.
  5. You can order it pretty easily in BC. I got it in the ER there a few times. I told a preceptor this in Ontario once and she didn't believe me so she called the lab and they told her they can get a BNP but it has to ship to Toronto for the results, at which point, that would be pretty useless.
  6. What are some courses that a family med resident would find valuable to fully utilize the 7 days of professional leave as allotted by PARO? Thanks!
  7. Check out places near the water. I went to Thornbury/Meaford and was able to walk right up to the Georgian Bay from my clinic every lunch time.
  8. Learn how to take care of yourself. Not just cooking, cleaning, and grooming, but how to pursue things you truly love, surround yourself with people who care about you, and value your health in your life decisions. Medical school will often actively fight against all of this.
  9. Although I am admittedly more conservative than my friends who have worked to implement this new program, I have yet to engage in any discussion that went beyond "this is progress, check your privilege white boy." To me, I still do not understand how a separate application process is different than Separate but Equal, so I am confused as to how this is a progressive movement. Many are in support of this because, "the standards are the same." This is not true. UofT, at least when I applied, had ridiculously low cut off points for it's stats (9/9/9 and low 3.0s GPA). The average accepted applicant had stats much higher than this. I can see the accomplishments of new Black matriculates marginalized due to being vetted through this alternate process. Lastly, I do not feel that there is a need for this like there is a need for practitioners who understand populations such as Aboriginals. I have not encountered any systemic barrier to communication with Black people in my training, whereas I certainly have with Aboriginals. I am also unaware of any Black communities large enough in Canada to benefit from dedicated physicians, although I could be wrong about this (Nova Scotia?) I am aware that I am not an expert on "experiences outside my race," but I do feel that the biggest barrier to application at this time is socioeconomic status and not race. I am sure UofT will enjoy the publicity though.
  10. This was my impression as well. I know Mac will call you tomorrow if you don't match.
  11. I have heard that a school in Ontario called their students already if they didn't match. True?
  12. Any wisdom or approach for this? I am panicked by the thought of sorting through 36 different possible futures for myself. I have a very vague idea of top choices -- rural/community, close to my home school. A few programs stood out on presentations/talking to residents, but certainly not enough to easily make a rank order.
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