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  1. README.txt +25 -0
  2. dev.csv +22 -0
  3. test_data.csv +57 -0
  4. train.csv +229 -0
README.txt ADDED
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+ # Dataset Description:
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+ HIPA-AI includes 100 Reddit posts, including:
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+ 80 posts in a labeled test.csv
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+ 10 posts in a labeled dev.csv
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+ 10 posts in an unlabeled train_data.csv
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+
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+ This task uses binary classification to predict whether something is HIPAA or not. No need to change the predictions to 1's and 0's--this competition uses "yes" and "no." It also uses "no" as it's scoreboard metric to calculate scores.
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+
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+ A 2000-post unlabeled dataset and annotation instructions are available if you would like more data.
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+
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+ # Tips and Tricks
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+ Here are some tips and tricks for uploading your submission:
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+
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+ 1. Make sure your prediction is called preds.txt and is inside a zipped folder called submission.zip. For a quick and easy method, just download my sample submission and delete my preds.txt and swap for your own. If you do create your own, check for nested folders and try zipping and renaming the preds.txt file.
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+ 2. Due to my baseline only predicting "no," the scoring looks at the F1-scores/accuracy of the "no" label rather than yes. If your model only predicts "yes," it may give an error.
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+
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+ 3. Make sure your preds.txt does not have headers. Also make sure yes and no are lowercase.
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+ 4. Download the scoring output to see a more detailed list of your results. Also download the scoring error log if you're stuck.
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+ 5. Feel free to reach out if you need anything!
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+
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+ Have fun!
dev.csv ADDED
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+ Features,Label
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+ "I was my hospital's go-to guy for cognitive assessment of possibly impaired docs and employees. I've heard several similar stories, but in each case other people--usually nurses-- intervened BEFORE the serious mistake was made. Granted, I've only had one job for the past 30 years, but it's been decades since I've been in or heard of an OR where hierarchy prevented anyone present from speaking up when they saw something amiss. There is something seriously wrong in the culture of that hospital.",yes
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+ "Has your gestalt been rigorously tested for validity and reliability? I feel like I want to hire some patient actors to check you out, because if medicine can replicate your gestalt nobody will ever have to wonder who is really in pain.",no
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+ "For something this unbelievably extreme, I am having so much trouble wrapping my head around the *why...* since it is so far beyond just incompetence... clearly I am intellectualizing as a coping technique since in the first post about this I figured there had to be more to the story that explained why certain anatomical anomalies could be present to make it more in the range of incompetent but not full on crazy. Outside of substance abuse, which makes sense, what else? Acute psychosis (maybe a manic episode with psychosis to explain the grandiosity of insisting the liver was a spleen to pathology), with but early enough in the psychosis to not appear frankly psychotic? Some other acute psychosis? Something neuropsychiatric like maybe early Huntington's or Lewy Body? I don't work in neuropsych, but the craziness of it reminded me of the case of Dr. Benjamin Gilmer (great This American Life podcast episode [Dr. Gilmer and Mr. Hyde](https://www.thisamericanlife.org/492/dr-gilmer-and-mr-hyde).
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+
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+ The big clue here is that staff agreed to work with him that day so even if he was kinda sketchy at baseline, it couldn't have been anything close to this, AND it sounds like they were somewhat paralyzed in the moment by the complete shock and unbelievability of what was happening- so yeah, I all I can come up with is a lot of meth or some other drug(s), acute early psychosis, or an undiagnosed neuropsychiatric condition. I guess the horse in this scenario is probably a lot of meth/drugs. Just... wow.",yes
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+ "Great question! As it turns out, people tend to respond very well to a slightly science-y explanation of IBS. In lay terms, I talk about the concept of visceral hypersensitivity, and the interactions between the enteric nervous system and other parts of the autonomic nervous system. So for instance, I will describe nerves as having a volume knob that can make sensations louder or quieter in different people or different situations, and talk about changes in pain sensitivity or motility as being no different from other physical manifestations of stress (like heart rate, blood pressure, sweating, etc.). I include the point that physiologically, excitement (positive emotion) and stress (negative emotion) are virtually identical to each other, which is why their kid has terrible symptoms at birthday parties, sleepovers, etc. I talk about the microbiome and how that can impact their tolerance for certain foods (FODMAPs).
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+
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+ So, IBS patients can be challenging to deal with in a lot of ways, but they really appreciate when you take them seriously and help them understand why they feel terrible so much of the time.",no
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+ yes I agree with stabilizing patient first if possible. I was disagreeing with your comment about always giving sedation for each intubation and hoping for the best,no
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+ "If it's 7:30 and you have 3 patients you still need to get report on, and you are having a whole tea spill sesh with the secretaries,don't throw a fit when you are called out on it by the very tired off going nurse.
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+
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+ Thank you for coming to my TED talk.
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+ ",yes
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+ I'm a student midwife and I have been at hospitals where I could count on this and then I've been at hospitals where the horror stories are true. I'm glad that you take your patients' pain seriously.,yes
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+ "Ok, fair enough. Report to the OR for surgery. What's wrong? Oh, you can't. OK, fine, then I want you to independently read this radiological image and write it up appropriately. What do you mean you can't? Leave at 3? But there are still patients....",yes
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+ "Tangible data. Monthly revenue, billing vs total. Yearly same thing. You can track procedures. Number of patients. Make sure you have access to all of these.",no
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+ "I'm not sure. I haven't witnessed any as a nurse. Before I became a nurse, I was patient. And then, as a nurse, I had an adenomyosis. My doctor was not aware that I was a nurse.
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+
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+ My experience with a female doctor was a nightmare€”months and months of being tormented with pain around my menstrual cycle. I wasn't sure why she was this way. She was my OBGYN who didn't want to prescribe me contraception but would instead order narcotic medication I didn't like. I explained to her I could not have this medication based on my experience with its side effects.  I don't like being drowsy and would get stomach pain. I'm not too fond of the feeling of it. Anyway, she sent me for a vaginal ultrasound to find the source of my pelvic pain. It was normal.  She stopped here. I asked for the pill. She declined to renew it after 12-month of supply. I felt a lot better with this, so I stuck with it.
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+ I found a male OBGYN. He diagnosed me with adenomyosis. It was a tiny part of my uterus that got affected. It hurt like hell. The doctor told me that if contraception didn't work, surgery would be the last choice if I wanted to get rid of the pain. My life has been great since I started taking pills regularly. I don't miss darn periods and certainly do not forget my pill. The pain was unbearable.",yes
test_data.csv ADDED
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+ Features
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+ "in Canada the gender split for family physicians is 50/50.
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+
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+
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+ and THEN there are all the other issues"
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+ "There's precedent. The federal govt has found New York City guilty of gender discrimination by not putting nursing on the physically demanding jobs list.
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+ https://www.justice.gov/usao-edny/page/file/1396636/dl?inline
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+
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+ 18. The field of nursing has been, and remains, predominantly female.
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+
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+ 19. In 2013, the U.S. Department of Labor reported that 90% of registered nurses
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+ were women. See United States Department of Labor, Women's Bureau, 30 Leading Occupations of Employed Women, 2013 Annual Averages, https://www.dol.gov/wb/stats/ leadoccupations.htm.
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+
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+ 20. Nursing involves the performance of duties that require heavy physical exertion, as well as a tremendous amount of physical effort, on a daily basis.
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+ 21. Nurses' daily physical responsibilities include lifting, moving, turning, transferring, supporting and restraining patients, many of whom are heavy, sometimes mentally ill or intoxicated, and even combative. The majority of a nurse's workday involves walking or standing. Moreover, nurses are vulnerable to workplace violence, in particular, physical assault from patients or patient family members.
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+
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+ 22. The physical nature of performing nursing duties substantially increases the risk of back injuries. Nurses suffer a disproportionate number of musculoskeletal disorders during their careers, stemming from the cumulative effect of repeated manual handling of patients.
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+ 23. More than half of nurses complain of chronic back pain and 38% of nurses sustain
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+ significant back injuries that require leave from work.
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+
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+ The policies and practices of defendant City of New York described in Paragraphs 1 through 30, supra, constitute a pattern or practice of discrimination with regard to City- employed Nurses with respect to their compensation and the terms, conditions, and privileges of employment, because of their sex, in violation of Section 707 of Title VII, 42 U.S.C. § 2000e-"
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+ ">This level of dishonesty and fraud is incompatible with the level of integrity that is necessary to be able to practice safely as an osteopathic physician.
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+
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+ The report really couldn't be more damning short of alleging intentional harm (which of course isn't what happened) and makes no attempt to soften its dripping contempt.
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+ What a tragedy."
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+ "This is why most of the nurses I work with are DNR-DNI. There is nothing more awful than doing an awakening trial on my intubated patients and we cut off their sedation and expect them to be all chill while CPAPing on the vent. They look terrified. I'm so sorry for the trauma you went through. It's part of weaning from the vent and successful extubation, but truly awful when patients are awake, aware, and restrained. It's no wonder there is such a high incidence of ICU PTSD for patients. For any painful procedure, I don't want to feel it, hear it, smell it, or remember it."
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+ ">you're not going to solve all my problems.
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+
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+ I appreciate you saying this; but some people absolutely expect this. Not only that, they expect it *now*.
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+
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+ I have an appointment on my schedule today that says PA CustomerLittle needs to fix my knee RIGHT NOW. Its hard to estimate how many patients really behave this way because we index for negative experience. But I can pretty firmly say this mentality is getting more and more frequent."
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+ "Shockingly, most females prefer a female Ob/Gyn so they see more patients. Meanwhile payments for Ob/Gyn services are horribly low. Across the country hospitals are closing their Ob department as they lose money. Female healthy is low priority.
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+
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+ Many health organizations alot 15 mins for a female Ob exam. While a male with a urinary problem gets 45 mins with a urologist who gets a significantly higher payment from the govt or insurer.
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+
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+ NPs were brought in to alleviate the crunch on physicians by dealing with simple routine cases. Docs deal with these too but also have 8 or more years of training/debt and deal with the complex life or death problems. Because I did some welding in HS doesn't mean I should be paid the same as an underwater welder.
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+
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+ The hope must be that the NPs lawyers can pull a jury who thinks anyone wearing scrubs is essentially a doc so they should all be paid the same. Suspect the judge will knock the case out on motion practice long before trial."
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+ "This is anecdotal, but when I had appendicitis, sitting down for more than ten minutes would make me see stars, so I was standing up when my back needed a break for laying down. I was also on my phone because how else would I have distracted myself? And I was waiting for surgery, so the pain was obviously intense and the situation serious.  
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+
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+ You cannot make broad statements like this. People are different and cope in different ways. This is even more true if the pain is chronic - an acute pain will knock you off your feet and scare you, but if you have chronic pain you learn how to managed flares so that they're not all encompassing. This doesn't mean that your pain isn't high.   
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+
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+ Some things are objective - if a patient is jumping up and down, switching what part of their body they're guarding because they forget where the pain is supposed to be, doing push-ups or whatever - but a lot are subjective and you cannot use to gauge if your patient is actually in the referred amount of pain or not. "
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+ "I waited it out and researched heavily. I worked general ortho for a bit when I moved back to town - I knew I wanted to do spine but I wanted to be picky about who I worked with (I feel like general ortho in comparison is pretty easy to be somewhat happy for me, I like ortho clinics, casting, injections, and the surgeries are usually decent with most of the guys I have worked with) as I previously had worked for a super scary ortho spine guy. So I scoped the area, talking to patients and other docs, and waited for a position to open up within my current company. We were lucky to be a good fit, I work with two surgeons who have somewhat different styles (one does more MIS, the other does larger deformity work) but we mesh really well. All that to say - a little bit of luck, knowing what you are looking for, and being willing to wait for the right job to come along. Being friends with my surgeons and coworkers was a lucky bonus!"
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+ "> Insurance doesn't reimburse us for the medication and/or supplies and barely covers the cost of the device. It's shitty that we have to even consider it, but that is our reality.
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+ But are you up front with the patient? Do you say, ""This can be an incredibly uncomfortable procedure for some women, but I'm unable to offer procedural sedation because of reimbursements""?
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+ This right here highlights the exact issue I was discussing. There is a lack of transparency when IUDs are offered and it makes women distrust their physicians. Many women may pursue other methods of birth control if they had transparent doctors telling them about the pain level associated with insertions/removals. There are plenty of women speaking out about their traumatic insertions and there is now a ton of published journal articles about this as well."
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+ "I had a doctor ask me to find the ultrasound for him. I finished what I was doing and went looking for it. I found it on the other side of the ED, with that same doctor standing next to it talking to another doctor. Then he asked me to take it back to the room he needed it in and proceeded to follow right behind me to that room.
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+
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+ It's like seriously?"
train.csv ADDED
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+ Features,Label
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+ "From a practical medical standpoint, I agree it's probably not all that important. Particularly if the patient is hypoglycemic. But from a CYA standpoint, it's considered standard of care and could create legal issues.",yes
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+ "Someone still trying to point the finger my way, I'm sure.
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+ ""Blood loss would have been less extreme if anesthesia kept BP lower.""
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+ I wish I was being facetious. A spine surgeon documented this and told something to that effect to the family after he put a screw through the common iliac and killed a patient.",yes
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+ "Reminiscent of Covid, when nurses had no incentive to work with Covid patients or during the peak of Covid. Hospital leadership rarely give a shit to their foot soldiers. It's always about the money.",yes
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+ "I've worked in healthcare for 15 years (CNA/tech partner/mental health tech) and MOST bodily fluids don't bother me, except for lung butter. Had a patient with a trach shoot lung butter on my forearm while coughing and I almost horfed right there. Mad props to folks that work in respiratory because I absolutely can not.",yes
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+ "Multiple things can be true at the same time.
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+ You can have legitimately never seen anything similar happen in your career or personal life.
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+ Likewise, out of the billions of patients in the world, there can exist an amount who have had their symptoms completely disregarded and their pain not treated.
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+ Respectfully, if you can not see beyond your own personal experiences, you should probably check your internal biases.",no
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+ "I'm an NP and live in Canada where I'm tied to a physician for consultative purposes ONLY if I need help with a diagnosis or treatment plan, which the requirement will be changing very soon because we have enough NPs to take over that role for new graduates. Also, we have the ability to curbside consult specialists just as a GP would. I practice completely independently to the scope of a GP. The GP has no say over my practice and is not responsible for my practice in any manner. But I would never expect to be paid the same amount. Like 75%? I'd be happy with. 
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+ I'm with the physicians on this one. I didn't have to sacrifice my 20s and early 30s for my career. I started off with a good paying job as an RN after graduation. And now as an NP my patient benchmarks and roster are like half what a physician has to see. But that being said, I think the education argument becomes less once an NP has been practising for several years - considering we don't just graduate and stop learning (if you're a good NP). And the education in Canada is pretty rigorous and standardized and there is more regulation coming down the pipeline that will improve it more. 
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+
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+ That being said, I'm relating this to a family physician, not a different specialty. I'd never agree with NP basic education being similar to another specialist without having additional didactic and residency experience equivalent to that specialist's post grad requirements.   
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+ Plus, aren't these NPs required to have supervision by an MD? They are not independent then. You can't expect to be paid independent wages when someone else's license is at stake.
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+  I also think that GPs are grossly underpaid compared to other specialties. And NPs are also grossly underpaid. But equal? no. ",yes
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+ "The pay is not just for the work, but for the knowledge and experience, which NPs certainly can't remotely compare to physicians.",no
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+ "I had a patient who got transferred to us from another hospital because they had no idea why they were in cardiogenic shock. Young, healthy, no family or personal medical history. Barrage of viral and bacterial workups, numerous vials of blood to test the most rare diseases that could lead to it. Must have drawn hundreds of vials, and even with the patient having an A-line, it was annoying sitting down to chart, and then ""hey we ordered a few more labs that we might need."" I hit em with an annoyed, ""that's the last of it, right?"" They say yes, then they send an intern to tell me they needed other ones a few mins later. It's not hard to discuss among each other for a bit, then decide to order them all together.",yes
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+ "This was my thought. It absolutely happens in rural medicine. I literally field these patients almost every day I work. Sometimes it's legit no one worked them up, sometimes the patients are legit dramatic and have their story wrong. Trying to decipher which is which can be, interesting at times.
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+
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+ not sure if city, metro area type docs are similar or not",no
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+ Unfortunately I could not stay any longer. I understand your point. I did however stay over two hours to help code this patient and handle the coroner call and organ donation paperwork. There was also a call team that could have stayed but I also don't think they should have had to do that.,yes
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+ We had a patient that got Wernike encephalopaty after a cancer gastrectomy...so it checks all the boxes of restrictive diet + thiamine deplection in a malnourished patient ,yes
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+ "Ableism absolutely is a problem. And it is a shame, because there are a lot of people who would make excellent, intelligent, and empathic healthcare providers if training programs were accessible and just more humane.
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+
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+ I think privilege is an issue as well, and that's something that isn't necessarily discussed and it's something we can be completely unaware of despite good intentions. We can say ""I'm not biased!"" while being ignorant of privilege. In my own case, when I was pregnant in grad school, the linguistics and anthropology departments I was in worked closely with some of the med school professors (20+ years ago they were trying to design ""virtual patients"" for the med school, and there were MD/PhD programs in med anth and public health, as well). So I was introduced to my maternal-fetal medicine specialist by first name and treated collegially in a way that I had no idea wasn't normal--I had nothing to compare it to. Over a decade later, when I returned to grad school to focus more on bio anth/evolutionary medicine and related my story, which included teasing banter with the geneticist and sh!t like that, during a discussion of birth trauma, the professor basically jumped down my throat, and I was humbled--which was fine with me! I love learning new things, and I have no problem being wrong. But she basically used my experience as a jumping off point to talk about socioeconomic disparities to obstetric care, and lit my fuse as a social justice warrior. Some things we just don't see until someone points them out to us--and all the bias training in the world won't help us see our own privilege until we are open to seeing it.
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+
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+ And I think that comes back to what you're saying about ableism. People who can pull 48 hour shifts \[or can they? really?\] may not realize that that is privilege, not the norm, not something to measure others by.",no
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+ "I've worked in colorectal surgery for 10 years and have supported 5 surgeons to varying degrees over the years. 2 of them have been absolute delights and I could bet money on how they would manage their patients. 2 of them were a-holes, but again you'd be done with clinic by 3 pm and practiced reliably the same. 1 surgeon treated every patient uniquely, you could never anticipate what she would want, and she had a deep martyr complex. Depending on the other interactions she had that day, you may get cookies or you may get the silent treatment or maybe you get yelled at in front of a patient. I finally left the group for a non-surgical specialty and I have no clue what to expect bc my whole career I've been surrounded by surgeons.",yes
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+ "no one knows everything about everything. If I have family in the room, I always bring my computer with me so I have access to the patient chart as well as up to date. If I look something up and I can't find it, I'll tell them let me get some more information about that and I'll let you know. Another of my favorite phrases is I don't want to give you incorrect info so let me double check and I'll get back to you.
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+
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+ The most important things are to be honest and to remember to come back and tell them what you've found out.",no
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+ "I had a patient scream at the top of their lungs when I die, bury me upside down so the whole world can kiss my ass!",yes
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+ Plenty of NPs equally smart as MDs yep. I don't blame you for looking for work life balance as an NP and I'm not questioning that you're probably a good clinician. But in no way in hell should a NP be paid the same as a Physician.,no
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+ Give clear discharge instructions. Include what the patient needs to do and what they should come back to the ER for. I like knowing what your plan is for a the patient. If this doesn't get clearly communicated ideally in the discharge paperwork the nurse either has to clarify with you or figure out the DC instructions on their own which isn't ideal.,no
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+ "no time for a phone call when you're 50 meters away lol.
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+
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+ But that does remind me of my EMT days in Oakland back in the mid 2000s where we would call the ER from our nokias and give them a heads up that we were coming in with a disaster-splash and they would be like, ""mm-hmm, mm-hmm, okay, **click*/*""
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+
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+ And then we'd show up and watch the patient code on the gurney while the intake nurse asked me to spell their last name for the third time.",yes
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+ "Someone I know is an ""herbalist"". She diagnosed ""acid wave"" in a patient who complained of vague abdominal cramping and early satiety. By the time this patient presented to the ED she had painless jaundice and extreme ascites. Hepatocellular carcinoma. 10L paracentesis removed.
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+
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+ How is this legal?",yes
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+ "Ask the more senior PAs what their salary trajectory has been like. If they have gotten good raises over time, then doing one year of lower income with good training would be an investment if time. If training is great, then consider it similar to a post grad training program with you having more responsibility to being a self starter as well as for patient care.",no
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+ "This sounds like a big mess long before the liver came out. Can someone tell me what the real idea was for the surgery?
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+
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+ Why didn't anyone anticipate the mega colon? The colon would be pretty obvious on pre-op X-rays. The abdomen would be distended.
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+
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+ The picture I get, you slice open the abdomen and colon comes spilling out like party balloons. How do you see anything?
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+
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+ Then you dissect out the wrong vessel and transect the IVC. The field immediately fills up with blood and the patient codes. You can't see anything, but now you are up to your elbows in distended colon swimming in a pit of blood. They are doing CPR. Everything is sloshing back and forth. You don't have enough suction to get ahead.
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+
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+ Removing the liver is a post mortem event. You already killed the patient at the IVC laceration. Take out anything you want.",no
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+ "He swore he'd never been told that. Had never taken water pills of any kind before. He had no diagnosis of CHF with our office previously -I'm attached to a larger pcp office so I had his PCPs chart also. I was kinda dumbfounded but from everything he told me, (always take that with a grain of salt) he stated my cardiologist told me my heart was fine and wasn't causing my SOB so I'm here to figure out what is causing it if it's not my heart, he thought he had pneumonia or something lung related.
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+
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+ I know patients aren't always great historians but I felt like this was more than just him being forgetful considering how much history he gave me.
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+
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+ I would love to know how the convo with his cardio went. I had him take his labs and xray with him.
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+
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+ We're out in the boonies, so care is questionable sometimes, even with specialists who should know much more than I do.",yes
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+ "Depends on the job. There are Psych positions with 0 physical demands. On the other end of the spectrum there is Ortho, but likely still not as high as paramedic. In the OR, you'll have to stand for several hours a day, help transfer patients, pull hard on retractors, etc. I'm in Ortho and I could probably do it until my goal retirement age of 62 considering there are surgeon operating into their 70s. However, I did have to start working out because of the demands of doing reductions and such.
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+
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+ However, given you already have a 6 figure desk job with good benefits, I couldn't recommend you go back to PA school. Sure you can make a bit more money, but you'll be spending at least 100K for school, and losing 300-500K in your current wages and benefits while in PA school. I don't think you could catch up financially, and even if you could I don't think it's worth the effort.",no
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+ Did you get a training period? If not I'd ask to be properly trained because you not knowing what you're doing (due to lack of support) is going to affect your patients. Either they train you or find a new job.,no
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+ "Anyone who says they never made a mistake, they r either lying or dumb!
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+ An example of critical thinking is when u go back and review an event, see what went wrong and what can be improved upon. Most of the time you'll find out it's a combination of human error System error etc.
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+ The healthcare system has had these issues forever. When I worked in the hospital in the 90's, I can think of 4 examples of significant major errors that have changed the way we do things today.
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+ All is well, you're okay, the patient's okay, and move on LOL. The fact that you reported it means you're pretty outstanding!",no
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+ "Male np here, this is asinine. If you want physician pay go to med school. ",no
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+ "Well the general thought over this is, that the NP(s) in question haven't really thought through this, surprise. Let them give equal payment. now which profession are hospitals/ clinics more likely to hire, physicians or midlevels, who can do less and who need more supervision?",no
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+ "Don't write stupid shit like provide a sandwich on your ED orders - it's demeaning af. Find out where the pantry is and provide it yourself, call it building a patient-physician relationship.
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+
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+
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+ Don't put down an order sheet and then come back every 5 mins to add more. Collect your thoughts. We have 4+ other patients, we don't have time to stay with one patient with you while you tick off items in your plan of care one order at a time.
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+
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+ Respect your experienced nurses. Ask them their thoughts. Say things like so, how bad is it? How do they look what do you think about... Don't be afraid to share your thoughts, or how you would assess certain things. Everyone wants to learn and improve, especially emerg nurses.
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+ Good luck :)",yes
92
+ "Everyone brings up drug prices, and while I think that's a fair focus, ridiculous drug prices tend to only affect certain new drugs/ older drugs which get a new indication and thus the companies opportunistically price gouge. We need to focus more on the fact Americans are being lied to that they can readily get care in general. I live in the Sacramento area, it's actually a happening place where a lot of people are moving, but a number of my patients can't get into a primary care physician for 3 months if they have Cadillac insurance, more if they have one of the many plans that have been dropped by most systems in my area. The state expanded Medicaid coverage massively last year, but both pcps and specialty offices aren't taking Medicaid for the most part other than already overburdened FQHCs. Kaiser got a nice cushy contract with the state to supply Medicaid coverage, but patients already in the Kaiser system already struggle to get in with their PCPs and if they need a specialist it's an added struggle. When I did locums last year I paid for kaiser. I was not able to get into a primary and kaiser refused to pay for my adhd medication because I didn't have a kaiser psychiatrist, which likely would have taken over a year to establish. I certainly felt like I was cheated out of thousands of dollars, paying a monthly premium for insurance and not even being able to access services, but I can't say i was particularly surprised. The public as a whole seems to be absolutely blindsided when they really need medical care and get turned away at every corner because there aren't enough doctors to take care of them and none of the hospitals in the area want to deal with their insurance.",yes
93
+ "I'm so sorry... no excuse for that treatment, none.
94
+ I have a feeling you are an exceptional patient advocate and empathetic nurse.
95
+ Please take care of yourself.",no
96
+ "Oh this is my biggest peeve. I have spent many years flight nursing and I can't tell you how many times my partner and I have arrived to find a tachycardic and tearful intubated patient because the nurse ""gave rocuronium because they wouldn't tolerate the tube"". Like what. A physician ordered a paralytic and a nurse was like oh yeah this is a great idea without fucking sedating a patient. I got to be known as the candyman, I medicated the shit out of everyone (appropriately medicated), I have zero issue with emptying my med box on a patient to make them comfortable. These fools would even start meds to control the hypertension and tachycardia, you know, because the patient was AWARE of literally everything but was paralyzed. There were so many other instances of major injuries and patients receiving one dose of a pain med hours before and nothing else, patients were often in tears or almost in tears when we arrived. For the love, medicate patients, there is nothing wrong with taking care of their pain and/or anxiety but there is something wrong with not taking care of it, SMDH.",yes
97
+ "What're the medical tropes you see that make you laugh or just get your goat?
98
+
99
+ I've been binge-watching ""The Mentalist"" -- in one episode, he knows someone's not a doctor because their handwriting is legible, and, in another, IDs a victim as a doc by their crappy handwriting. And i felt called out.",no
100
+ "Male (former) ICU nurse with a large beard here. I think making assumptions about other people bodies, and what they want it to look like, is definitely a bad idea. Shaving largely a US/western practice. Many people see hair as a religious or cultural belief. Also, what families and other nurses like is irrelevant. What matters is the patient's preference. If you don't know what it is then I wouldn't impose my personal beliefs on them. Also, my wife would drop kick a nurse across the unit if someone shaved my beard. Ha",yes
101
+ "This hospital system is huge. It has many, many hospital campuses throughout the state, none of which are actually affected by the storm, just the community around this specific one. They are not hurting for money. They asked for volunteers to go 3 hours away to help work nights at this hospital. Lodging at the hospital included...meaning a shared conference room or something. (Obviously the hotels are full, that isn't the issue.) But to not offer crisis pay or incentive pay or anything beyond base pay?!?
102
+
103
+ Maybe I'm just really selfish with my sleep (I have a hard time sleeping anywhere other than my bed, am effected my any noise or light, can't sleep with snoring, and will wake up easily and not get back to sleep. If I go, I won't sleep hardly and I can't work that many shifts in a row on no sleep and not kill myself or a patient. I was considering it anyways up to that point. May still if they are desperate).
104
+
105
+ But I feel like this is just another little thing that is just piling up and up on all the shit we deal with as nurses. They tug on our heart strings, knowing we will help out of the goodness of your heart, that we don't want to abandon patients, even risking our own safety, our patients safety, allowing hospitals to get away with short staffing us and tripling us and making us take on more and more roles outside what we are nurses should be doing (housekeeping, secretary, phlebotomy, patient tech) with less and less resources!?! All while paying us shit, never giving us raises to reflect what we do more and more or matching cost of living, never giving us incentive pay, and guilting us into picking up extra shifts or extra roles to make up the slack!
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+
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+ Maybe I'm just tired on very little sleep and going through post-vacation depression and hurting for everyone affected while happy my area was spared, and getting seriosuly burnt out after 4 years of this shit. Maybe I'm wrong to be mad about no extra pay, that this specific siuation is greater than that and my opinions about my hospital system and my lack of sleep lately are clouding my judgement. Just needed to get it off my chest and see what others feel like.",yes
108
+ "Hard to say but it's 6-12 months to start feeling some confidence in EM. That said the missing ingredient here is time spent in the main ER which is why I am always a little skeptical of UC or fast track jobs when starting out. You should be able to identify a sick patient hopefully after graduation, but identifying subtle presentations of other serious pathology takes time and if you aren't getting that exposure to these types of patients on the regular it can be stressful when starting out. Pathology can be sneaky and these patients will absolutely find there way into FT from time to time
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+
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+
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+ I would really clarify what it means to have support from an MD in main ER, because 99% of the time this means that there will be a very busy doc working with acuity and won't have time or doesn't really want to be bothered to review cases with you. Maybe ask some of the other PAs who have been there for awhile what this actually looks like and then make your decision.",no
112
+ "My first job was inpatient cardiology out of school. I didn't know anything when i started. now being one year into the job, I am much more confident than I was. I think that's how you feel for any job out of school, regardless of specialty. You're talking about going to outpatient, I've now transitioned into an inpatient AND outpatient role for cardiology. I can say I would not be half the provider I am in the outpatient setting if it wasn't for my experience while inpatient. You learn the most in the hospital setting. I would recommend staying in this job unless it is detrimental to your mental well being. A first job in cardiology is hard, but it gives you an extremely solid foundation for the rest of your career once you get your feet under you",no
113
+ "The pacu and floor nurses afterwards marking the patient off the list ""yup, knew he wasn't come back to us by cancellation or otherwise""
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+
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+
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+ I didn't see nothing this bad in the OR during covid, but we saw some wild things and I totally can visualize in my head how this entire circus went down.",yes
117
+ "I worked with this one psych nurse who's known for working 6 12s (night shift), like back to back, She's very pleasant. I was trying to get to know her, She then hit me out of nowhere with the first dark humor i've heard in this field, She said it better, but it went along the lines of, *I used to work in med-surg, but I honestly couldn't take it anymore. My patients deaths were just taking a huge toll on me. So I switched to psych. At least in this field it isn't us killing the patients*. Mind you, my jaw dropped and no she has never killed or harmed any patient in med-surg. She just meant with the code blues and stuff, and sometimes them not being successful with trying to resuscitate the patient,",yes
118
+ "Ok. As a medical doctor, if I ever had to go through alcohol withdrawal, I would not want it to be managed by a psychiatrist. It warrants medical supervision. Of course there is some mild withdrawal that can be managed in an outpatient setting, but if it makes you sick enough to be in a hospital, you should be in a medical unit and may even require telemetry.",no
119
+ "If he was an organ donor then why was he even sent to the morgue? We keep ours, as we are supposed to, on the vent until they get into surgery to remove the organs otherwise you risk rapid cell death in those organs. Especially, too, if holding the patient for family. They should've been able to walk to the surgical suite doors with their loved one. I've never seen an organ donor not be on a vent as the drs usually don't remove them immediately after death. They are planned surgeries. Unless there is a rush for an organ, that is. Do they not do this anymore and, if not, why? Are the docs getting to the organ donors quickly after death? Hmmm. I can't see where cell death would not occur without oxygen circulating.",yes
120
+ "Alcohol-consumption favors thiamine defficiency.
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+
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+ Alcohol withdrawal often happens in psychiatric hospitals, where patients are closely monitored.
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+
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+ So, it€˜s probably a statistical overrepresentation of alcoholics in withdrawal state, as they are monitored more closely.",no
125
+ "I like to know things like patient can be a raging cunt for no reason instead of being blindsided by it. If there are any family members that cause issues.
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+
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+ Otherwise, why they're here, how they move/toilet and any issues you had on your shift that can affect me. The rest I can look up as I need to know.",no
128
+ I'm not a nurse but nearly all of my friends are. Every single one of them have told me a med error story. It happens to everyone. You did the right thing by reporting it and checking for allergies. This is going to stick in your mind the rest of your career and you'll be a better nurse because of it. From a chronically ill patient- thank you guys for everything you do!,no
129
+ "Yeah, like now where am I going to find a doctor who's willing to go ""eeny, meeny, miny, moe"" with my organs to determine which one he wants to remove?",yes
130
+ "I didn't realize that these procedures were done without sedation until reading about it on Reddit (didnt do any outpatient gyn as a med student) and was shocked that anyone would consider doing such invasive procedures without sedation or at least IV dialysis. Same thing with cystoscopy. Just out of control, frankly.",no
131
+ "Also, there are formal medicolegal definitions of what comprises a patient-physician relationship, and telling your spouse to take an OTC NSAID, regardless of your licensure status, does not qualify. This is some juvenile tehehe I could get a speeding ticket because I flew on an airplane going 250mph going over a stretch of I95 where the limit is 70 nonsense.",yes
132
+ "I was in a similar situation when I first started in 2022, albeit in family med. However, even with a doc not necessarily on site full time, there were still a handful of them a phone call away. The other thing to remember is, you're working in a low acuity outpatient setting. If anything ever seems off, no one will ever blame you if you call EMS. It rarely happens, but I have had to do it a couple times. So between your SP and EMS being able to respond in minutes, this should at least give you the peace of mind to go about your day and adjust to the new gig. There will always be a learning curve. Think of it as an opportunity to grow as a clinician. It's turned out to be great for me and my own medical decision making, personally.
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+
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+ Also, it would be helpful to know some details about why the other PA quit. People leave jobs ALL the time in healthcare. Chasing sign on bonuses and whatnot. But high turnover at a particular office can also be a huge red flag. Do you know why they left? How long they had been with the practice?
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+
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+ tl;dr don't let this turn you off before you even start. You always have the option of walking away, but it seems to me that it is far too early to make any conclusive decisions about this job. Barring any additional info anyway. Best of luck!",no
137
+ "I really feel for that OR staff. How traumatizing to have watched all of that happen.
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+
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+ This case is insane.
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+
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+ He also accidently removed part of a pancreas from another patient instead of the right adrenal gland. Wild.",yes
142
+ "Welcome to the ED and thanks for asking this.
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+
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+ I love learning. I was always vocal about that and being so meant a lot of docs would grab me to help with interesting things. Be open to letting those that are curious have opportunities to grow.
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+ It's a great opportunity to mentor if you're into that at all.
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+
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+ Do your best to lead with kindness.
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+
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+ Champion mental health for all of us, including you.
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+
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+ Reassure the rookies with confidence, humor, and support.
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+
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+ Communicate. Really important to stay in the loop when we're interacting much more with individual patients and families.
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+
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+ Know when to ask for help and demand the same from your nurses.
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+
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+ Good luck!",no
158
+ "I start working on the floor next week and im kinda nervous to start. I keep hearing about how my floor is kinda like the wild west of the hospital and if i can make it there, i can make it anywhere.. it's making me nervous about my performance as it's possible i can be let go if by end of orientation im not up to their standards and handling the full patient load. I was under the impression (during my interview) that id get 12 weeks orientation, but i just found out it's 6 weeks. It makes me nervy cuz at another hospital it's 8 weeks for the same ratio, but here is 2 weeks less??
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+
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+ I had clinicals in arizona where the ratio was 6pts to 1 nurse, so i thought i could handle 4 pts by end of my orientation. now i just feel slightly scared after hearing those comments and everything. I kno that we all start somewhere, it just nerve wracking. I also do not want to be let go, so im going to try my best because i tried so hard to land this job. I desperately need this job to work out for me, i cannot go back to being unemployed. Anyways just dumping my thoughts here",yes
161
+ "I don't work in the OR, but reading the order of suspension makes it sound like they couldn't actually see what he was doing (especially considering the surgeon himself was apparently operating blind too),until he handed them a whole ass liver at the end.
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+
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+ At that point the patient had been dead for 15 minutes already. This report doesn't say so, but *surely* multiple OR staff spoke up and reported this after the fact,right?!",yes
164
+ ">Legit question, why?
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+
166
+ Because it's disingenuous and irresponsible to pretend that lexapro and dilaudid have identical risk profiles, whether for typical use or severity of withdrawal symptoms.
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+
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+ >SSRI's cause withdrawal too but you are ok with that?
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+
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+ yes? Why wouldn't I be? SSRI withdrawal is far easier to prevent/taper than opioid withdrawal. And the morbidity from SSRI withdrawal is far less severe than with opioid withdrawal.
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+
172
+ >now it's pounded into everyone's head that it's going to make everyone an addict.
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+
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+ Agreed. MDs are too scared of opioids.
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+
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+ >But again not everyone that is on an opioid medication is misusing it
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+
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+ Agree, and I never said they were.
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+
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+ >even if there is chemical dependence that is just the nature of some medications.
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+
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+ And it is the nature of some medications that the *degree* of chemical dependence is far higher than it is with other meds.
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+
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+ I think you've misread me as an opioid gatekeeper. When really my point was, you can't throw all dependencies into the same category and dismiss them or accept them on the same terms. Some patients are dependent on opioids in a negative way, others are dependent in a positive way (or at least in a neutral way). Replace ""opioids"" with ""SSRIs"" and that statement is still true. *However,* all the data we have (and our best understanding of neurochemical pathways), tells us that opioid dependence is much more *relatively* dangerous than SSRI dependence.
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+
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+ Like i said, the more philosophical question of whether America is focused on the wrong dependencies, is entirely valid and worth discussing. But it's a different question from whether certain dependencies are more medically dangerous than others.",no
187
+ Some insurance company has my hospitalist group listed as infectious disease. We get calls everyday looking to set up care and have to tell them we're an inpatient medical group. Our coordinator has spent about 6 years attempting to fix this to no avail.,yes
188
+ "Part of the problem is that patients learn, and some of them have been trained that only a pain score of 7+ is taken seriously. Some hospital systems have rather rigid prescribing guidelines based on pain scores, where a score below 6 is not treated, and a 7 or 8 will get APAP.
189
+
190
+ Then those patients go to a different hospital system and never rate their pain below a 7 because they want access to NSAIDs if they feel they need them.",yes
191
+ "> wheels to imaging, sits in the control room while the study is performed, reads the study, does some procedure
192
+
193
+ I have actually done that, when a patient is very unstable, and it's a weekend or holiday, and there's not much staff. I have never ever drawn labs on the floor (only in the trauma bay with a femoral stick) or looked at slides (other than a path rotation).",no
194
+ "NP never made it to med school, she did not go through the grueling and long weeding out process of undergrad, med school and residency for quality control and public safety. She did not pass the difficult tests. She did not do the 10 12 hr shifts for years straight in residency. She did not see enough cases under proper supervision. She did not have to do the hundreds of hours to maintain her medical license and board certifications every few years. She has not been tested and pass the mental endurance a physician has to pass. She's inferior in every way in regard to quality medical care a physician can provide.",yes
195
+ "Hypoglycemia is an immediate neurologic injury risk so not treating it to wait 30min to 1hr for thiamine is indeed an obviously bad idea. But having banana bags in the pyxis and starting it right away can nearly eliminate that malpractice risk too. Problem is shortages are constant on thiamine IV solutions... Bigger issue is not thinking of thiamine in a non-alcoholic patient that is malnourished (cancer, eating d/o, major weight loss/GI surgery).",no
196
+ "I understand that and respect that, but if I know I'm getting report from long-winded nurses, I will try to avoid them first, too. I also have years of experience where I will tell long-winded that I want the cut and dry basics, which helps speed things along. But that comes with experience to have the cajones to tell those people to abbreviate report.
197
+
198
+ But you are right, where people take too long. But if you're going to pounce, tell me why. *""Rncookiemaker,I got dibs for report to you first because long-winded RN has your other five patients.""*",no
199
+ "This is a feature, not a bug. When insurers do not want more patients with a particular type of ailment they simply refuse to credential more providers in the hope that those patients will change plans.",no
200
+ "Yeah, it was awful. I'm pretty sure my patient thought I was going crazy. It is like my vision becomes tunneled. I can't think or say proper sentences. I'm in the process of finding a new prescriber right now. I'm just on the 20 mg. I'd love to bump it up.",no
201
+ "no, the bill rate is wildly inflated because if you overbill insurance pays you the max amount and you can bill the patient the rest.
202
+
203
+ If you underbill, insurance pays you that amount and you lose x-extra amount. So to get the ""max"" money you always have to overbill. BEcause hospitals don't have these neat nice insurance agreements like you want.",no
204
+ "I think people wrongly believe that their ""pain"" needs to be exaggerated to get some attention or prioritization. not making a statement about the system here - just speculating. I do not personally do this. I've had some pretty bad pain as of late but wouldn't classify it north of a 5 even though it is impacting sleep and scaring me as to what it is. When doctors or nurses clarify that 10/10 is the worst pain I've ever felt, the pain I'm there for is NEVER that bad (flipping in a golf cart several times down a mountain, breaking ribs in a rugby match, etc). But, I think a lot of people are responding to how impacted they are in the lives by whatever issue is at play. I suspect folks posing the question need to have some examples, like a 5 is when you miss the nail and hit your thumb wiht a hammer, or 3 is a wasp sting. When someone tells you their stomach pain is a 9 or 10, you say ok so this is you gearing up to give birth type of pain?",no
205
+ Or assess a patient ,no
206
+ "Admitting a transfer patient with an irate borderline belligerent mother, granted it was 2AM but the icu was out of beds and this patient was the most stable to transfer out so they could take a trauma. The mom complaining this is bullshit the doctor himself won't even come see me I'm reporting everybody there's no reason I don't care that somebody else needed his room they should have figured it out. Me knowing the doctor is 4 rooms over trying to keep a patient alive long enough to save the organs to be donated and the family to say goodbye, knowing that's why the doctor refused to tell her himself and why they needed the bed.",yes
207
+ I had a dayshift bully me into helping transfer a stable patient down to another unit. They have more staff than we had. They only wanted someone since the bed is difficult to steer. I was almost an hour late leaving the hospital and had an hour drive home. Like look if it was an emergency or the patient was unstable I'd get it. But that wasn't the case. I was so mad I cried half the way home.,yes
208
+ "I actually begged to be transferred to the pediatric side of the hospital because I'd had several hospital stays on that side and was never treated that way. Unfortunately my injuries and being so close to 18 made me an adult case, so I was just made to lay in my own bloody mess until that nurse came along. She actually made sure my linens got changed the same day by advocating for physical therapy to get me out of bed and it made me feel so much better in such a bad scenario. She was my first glimmer of hope in a dark time.",no
209
+ It never goes away. Nurses claim to save patients from doctors. But most nurses don't even know basic physiology.,yes
210
+ "This sounds very inappropriate for a new grad.
211
+
212
+ Also stop being afraid to ask for help. That doc is there, ask every time. Sit down today with your superior and discuss this. You need more close training and mentorship.
213
+
214
+ If this post is even real (sorry OP, when there's no post or comment history I question if this is made up by someone to repost on anti PA forums) - you need to immediately cry foul to protect your patients and your license, leaving if need be.",no
215
+ "assuming you only work inpatient?
216
+
217
+
218
+ outpatient pain management has higher risk of consequences, i think.",no
219
+ "Minimum wage doesn't lend itself well to doctor shopping. The reason your disheveled patient may be agitated can easily be attributed to: literal pain, loss of time of work, having to arrange for travel. They are more likely to ""wait it out"". The office visit = gas, the medication = groceries. So to be to withstand so much before you seek care and the sacrifice you must make to present for medical care to be denied it arbitrarily based on the mood/bias of the doctor you see that day... I don't know how to not be in pain in America right now.",no
220
+ I don't get why it's confusing? One has less education and one has more? Like an NP Vs a physician.,no
221
+ "We had a guy a few years ago that was a no code but not officially hospice/CMO. He deteriorated very quickly and we were trying to call his sister (for decision making on short notice as she adamantly refused opioid analgesia and he was suffering at this point and badly needed it) and for hours she didn't answer. The guy died and when she finally called back an hour later and then came, she went ABSOLUTELY BAT SHIT over the fact that his face had been clean shaven. For reference he had a nasty ratty beard with mats and food and one of the techs during the day cut it all off for hygienic reasons. The patient was very rude and quite unpleasant when he was alive. His sister was more upset over his damn face being shaved then him dying ffs",yes
222
+ "I don't have advice but solidarity. I don't have near the experience you do, but know that your time is invaluable. I agree, nurses coming out of school don't understand the time it takes to fully understand the patient population. They expect sick patients right out of the gate. There is no patience anymore. I left the NICU because I moved states, I've tried serval different specialties for one reason or another and I've always found myself wanting to go back. I've had the sickest of the sick and I don't need that adrenaline rush anymore. I'm simply happy to have the feeder growers because there is no unit in any hospital like the NICU",no
223
+ This is why I really believe all nurses should start at the bottom and work their way up. I was a CNA first and I really think this opened my eyes to how skin ulcers and hygiene are very important. We can do better. Our patients deserve better. I can't imagine being in a bed helpless. I can't.,no
224
+ "Consider your sample bias. I'm sure there are folks in your institution like this, but likely far fewer. I practice in a rural area where the provider to patient ratio is 1:2,300 and so even the clinicians who do care simply don't have the time or ability to handle the zebras well or to afford the bedside manner that better ratios provide. I went to school in DC (GWU) which was a starkly contrasted experience that sounds more like what you're used to.",yes
225
+ "Agreed. My office is nicely nestled inside of our hospital and gives us access to almost immediate labs and imaging. We have one urgent care slot an hour for same day appointments so I feel like I've cross trained in both urgent care and family med. I'm sure once my patient panel grows to unreasonable limits that the urgent care visits will slow down, but it's nice to throw in a URI or two after seeing my cirrhosis and ESRD patients.",no
226
+ "I was told if the family stands at the bedside praying enough and yelling at the staff this is the likely outcome. Coma--> procedure or 1 dose of ten RIGHT med--> sleep --> happy, healthy patient. But it all depends on the amount of yelling the family does on their advocacy work. ",yes
227
+ "I worked on a med/surg floor for about 5 yrs. Saw a lot of admissions from nursing homes. It was never necessary to know which one they came from, from a medical point of view, but there were definitely a few facilities that became infamous for the condition the patient would be in. These patients were always the sickest, the dirtiest, untreated and undocumented bed sores and, possibly bed bugs or roaches. One facility even got the nickname ""Gateway to Heaven"" from staff because of the blatant lack of care their residents received.",yes
228
+ "Eh, toileting patients can be really time-consuming, and I don't expect docs to do that. It's also why I'll delegate it if able - I can start a couple of IVs and medicate someone in the time it takes grandma to pee.",no
229
+ "I stopped asking numbers as well. It's so hard to base pain on a numeric scale. I ask does it hurt really bad, if meds are ordered, which do you prefer, the lower or higher dose. A lot of my patients I've found don't want to over medicate so they will take that lower dose. It's probably unconventional but whatever.",no