1/ You're (a resident) in ED seeing a 37yo pt w/an artificial heart valve secondary to complications from IVDU who's presented with cannibis-induced hyperemesis & inability to keep their warfarin down. They've been clean from IVDU for years & smoke marijuana occasionally.

2/ They've got an a critical K of 2.5, an INR of 1.4 & troponin of 36 [RR <14]. Your attending laughs & says, 'You can't fix stupid!' loud enough for the pt to hear then medicine & cardiology argue over who should accept them.

The pt immediately stops answering questions from

3/ the teams involved in their care & is labeled obstructive.

WYD?

This happened to me recently. In the space of 2 seconds, a consultant shattered the rapport I'd built & progress it took me 30 min to make. Yet day in & day out we see attendings criticizing residents for

4/ behavior *they've decided* is unprofessional - bikini photos, holding alcohol, having progressive political opinions, being a POC. So forgive me for gagging at the hypocrisy of it all.

Also why aren't scenarios like this on the USMLE? Cause I could tell you all about the exam

5/ findings (no murmur on auscultation or peripheral stigmata of IE), but that's not really addressing the 'problem' or the 'treatment' here, is it?

We all took an oath to Do No Harm.

If you're not prepared to fully embrace what that *actually* means, then GTFO of medicine.