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How each type sleeps at night: INFP: Curled in the fetal position with an anxiety blanket, a special teddy bear they had since childhood, and a strange gothic style dagger they keep under their pillow for some reason. Usually with ambient music playing in the background. INFP also may have a cat that sleeps in their bed with them. INTP: They do not sleep at night, they remain awake until they are physically too tired for their thoughts to interfere with their sleep and they usually pass out in the middle of the day in a reclining gaming chair, in their windowless basement gamer-cave while still wearing a full emersion VR headset. The only light being emitted is from their massive neon-lit CPU beside their gaming PC. INTP also may or may not have a Katana hanging on the wall next to them depending on how big of a weaboo they are. How INTJ: In an ornately decorated room with some obscure posters on the wall around them. INTJ most likely has white noise or some ambient music playing in the background and possibly a whiteboard, corkboard, or some other visual chart, list, agenda, or visual model detailing all their plans and obsessive notes. INTJ definitely has a Katana hanging on the wall next to them, regardless of whether they are a weaboo or not. ISTP: They don't have a scheduled time for sleep, they sleep whenever they feel like it. They will often drink themselves to sleep with whiskey, vodka, gin, or some other hard liquor and pass out wherever they feel like it. They may not have a Katana hanging above their bed like some kind of nerd, but they have shit loads of other weapons like blades, guns, hatchets, projectiles, and possibly illegal explosives hidden around their house and in their room while they sleep. ENTP: Cannot sleep until they have successfully defeated the person they are arguing with online in a debate and added that to their tally board of debates they have won or brainlets they have rekt. Their room is filled with ridiculous meme posters, possibly anime posters, they may have a waifu body pillow ironically, but not sleep with it and only to use it for shock value. Their room is probably filled with neon lights and various novelty items everywhere. They may use the time they are asleep to farm Bitcoin. ENFP: They probably illuminate their room with ridiculous amounts of neon lights. They probably don't need the anxiety blanket like the INFP, and unlike the INFP, they don't sleep in the fetal position but sprawled out flat of their stomach. They probably have ridiculous amounts of plushies, pillows, snd stuffed animals in their bed, and they may sleep with a pet as well. ESTP or ESFP: Either falls asleep immediately and sleeps like a rock, most likely surrounded by dirty clothes on the floor, empty beer bottles, sports drinks, or energy drinks, or they sleep next to the person they passionately banged that night. Maybe more than one person. Maybe they banged 3 people at the same time and now they're sleeping in their post-orgy funk.
Attention incoming interns! Here's a list of TIPS I WISH I KNEW starting my intern year, some things you can start working on now and some less commonly discussed but very important parts of your job
It’s that time of year and yet again I’ve seen plenty of incoming interns asking what they can do to prepare. I wrote this post to share some tips for all of the not-exactly-medical stuff I wish I knew before I started intern year and to share a few things that interns can do before they start to feel like they’re well prepared for the long white coat. As a quick background, I was a surgery intern in the first half of the 2010s and much of this is informed by my notes and memories from that time in addition to everything I’ve learned since, particularly about professionalism both in medicine and in the business world with work I’ve done in the healthcare startup arena. I’m also not perfect and very much a work in progress myself and, outside the intern-specific items here, I try to do most of these things myself—sometimes more successfully than others. So take what you think are good ideas here, leave what you don’t think would be useful, and if anyone else has anything to add, please feel free to chime in. TL;DR: Intern year is hard. Here are some not-so-commonly-disucussed tips that may help.
1. Being an effective intern is, at its core, about being responsible, effective and reliable.
Your day to day responsibilities are nearly always dominated by the need to get things done and to do so in a manner that lets your other team members focus on their own roles and responsibilities. What about learning clinical medicine? You'll learn plenty and fast. Don't worry. When reading through these tips below, view them from an angle of “would this help me develop an effective system for making sure everything gets done and nothing falls through the cracks?”
2. For your in-the-hospital life as well as your outside-the-hospital life, remember this one thing: you will forget.
You will be busy and have responsibilities in a way you likely have never experienced before. This will naturally make the day-to-day things in life more difficult than you’re used to so developing ways to outsmart your forgetful brain will pay off.
3. You are a professional now. This is your career. You’re in it.
It’s easy to view your life as a trainee as a sort of advanced student or something in between a student and a “real doctor”. But that’s not true. View yourself as a professional building your career. Your intern year is just the first step of that career. You’re a real doctor as much as any other now.
4. One of the hardest things about being an intern or resident is dealing with feelings of isolation. It will take work to actively manage and overcome those feelings.
Imposter syndrome, feeling like you don’t know what you’re doing or that you don’t belong, feeling like you’re not the person you used to be, that you don’t have time to do all the “normal” things that other people do, thinking your co-residents or attendings think you’re dumb, feeling that you don’t have time for friends/family/hobbies, ruminating on “what if I screw this up and hurt a patient?”, or “this doesn’t matter -- the patient is going to XX or YY anyway” etc are all common feelings and they all share the same undercurrent of feeling isolated in one way or another. You need to actively work to find ways to confront and overcome these feelings or else they will control you. When they control you, you’re burned out. It may not seem like it at first, but nearly every single tip below is geared towards avoiding feelings of isolation. Feeling like you’re not in control of your finances will make you feel isolated. Feeling like you’re losing a handle on your relationships will make you feel isolated. Feeling like you’re behind on your email and haven’t done all the little things in life you need to do will make you feel isolated. Read these tips through that lens.
What you can do before you start
1. Organize and update your contacts. Seriously.
Here are some ways it can help you maintain and grow your relationships.
Use the ‘Notes’ feature in your contacts for everyone important in your life and all the new people meet.
You will forget your friends’ kids names and ages. Every time you get a birth announcement or see a post on social media, go to your friend’s contact, edit the notes and put in the info. Then, when you reach out to your friends, ask about their kids...by name.
You will forget your friends’ boyfriend/girlfriend/wife/husband/partner’s name, especially if you’ve never met them or haven’t seen them for a long time. Put their name in your friends’ card with a note like “Started seeing Sam in June 2020, he/she’s a software engineer”. Someone you know gets married? Add their wedding date to their card.
You will forget how you knew people in your contacts. Met at a conference? Was a medical student on your heme onc service? Friend-of-a-friend you met at a wedding? Someone shares an interest you have? Make a note in their contact card. Tip: these notes are for you, not them. So if someone reminds you of an actor, or didn’t stop talking about bitcoin, make a note. It will help because you will forget.
Tag your contacts or add them to lists and use those tags/lists to your advantage.
Make lists or tags for your family, your medical school friends, your undergrad friends, your coresidents, your attendings, your medical students, the hospitals you’ll be working at, etc. Put those lists or tags to use like this:
You will forget to stay in touch with people important to you. Set reminders in your phone for every week / two weeks / month, etc to pull up a list (family, medical school friends, etc), pick someone on that list you haven’t chatted with in a while and text them and ask them how they’re doing. Aim to start a conversation, ask about what’s happening in their life. Texts are more personal and meaningful than liking a post on social media or sharing a meme. Initiating conversations with your friends and family will help you feel connected and will increase the likelihood they reach out to you.
Don’t label your medical students like “MS3 Laura” or “Sub-I Juan”, etc. Label them with their full name and treat them like the colleagues they are. Put them on a list, clear it out next year if you want, but don’t treat them as “MS3 XXX“ or “MS4 YYY”. I’m sure you remember feeling like a nameless/faceless medical student at times in school and I’m sure you didn’t love it. So don’t repeat that behavior. Add a note or two about them while you’re at it. Take enough interest in your medical students to treat them well. You never know when or how you’ll cross paths with them again.
If you rotate through different hospitals, you will forget which “ED” or “PACU” or “nursing station 3rd floor” numbers are which. Tag them or put them on a list. It’ll make finding them when you need them much easier.
2. Use a good note taking app and a good task manager app to help with both your in-hospital life and your outside-of-the-hospital life.
Here are some ways to use a notes app.
Make a note for each rotation you’re on. Add in any unstructured tips as they come up, like “Send all of Dr. X’s patients home with Y”, “Use the call room in the basement outside of the locker room, passcode 1234”, “Park in the X lot on the weekends”, “Dr. A likes to manage Z with Y”, “The case manager, NAME, usually sits at the computer behind the 2nd floor nurses station”, etc. Don't overthink them, just write them down when they come up. Review those notes the next time you rotate through because you will forget all those little things and they will help you in the future.
Create a master grocery list of all things you typically get at the grocery store. Share it with a roommate/partner so they can keep it updated too. That way if you ever stop to pick something up, you can review the list to make sure there’s nothing you’ll forget.
Make master lists for other things in your life too like “packing for a conference”, “packing for a family trip”, “Target/Wal-Mart household master list” so you can quickly review anytime something comes up so you minimize the chance of forgetting something
Make notes for all of the other stuff you have to manage in your life like your car, your apartment/house, your loans, etc and update them every time you work on that thing. Change your loan repayment? Add it to the note. Have to get your brakes fixed? Add to the note where you got it done, how much it cost, etc. Talk to your landlord about fixing the shower? Add it to the note. Have to call the medical board to sort something out with a license? Add it to the note.
I like two note apps on iOS: Bear for personal notes since it’s fast and has great tagging and Apple’s Notes app for shared notes
Pick a good task manager app and use it for all the things in your life that aren’t your day-to-day work
Cousin getting married and you can go to the wedding? Make tasks to ensure your time off, book your travel, buy a gift, rent a hotel room, etc. Then put all the relevant info into your note because...you will forget.
Pandemic is over and you get to present a poster at a conference? Make tasks to review your draft with your coauthors, print your poster, book your travel, submit your reimbursement, etc. Then put all the relevant info into a note. Otherwise, you’ll forget.
I like Things and have also liked OmniFocus. There is a ton of content on how to set one of these things up for productivity so review it and use it YouTube search
3. Take charge of your finances
When I was an intern, I figured all I had to do was pay my loans and not go into more debt. I wish I had done the following instead:
Read these two books: The White Coat Investor and I Will Teach You To Be Rich. Both are very good and have different strengths. The WCI is directly applicable to you and will help educate you in ways medical school didn’t about your financial future. IWTYTBR is much more of a “millennial” book but it’s very good for explaining big concepts and for providing a system to set yourself up for success. They’re both easy and relatively quick reads and don’t require any financial background. WCI is fine as an e-book but IWTY has a bunch of dialog boxes that make the e-book a poor experience, get a physical new or used copy.
Set up a budget. I use and swear by You Need A Budget. It’s the best money I spend every year. Their system is easy and straightforward and it doesn’t take long to get the hang of it. I can’t recommend it highly enough.
4. Update your CV now and keep it updated regularly
You will no doubt have to share your CV with someone at some point whether it’s for fellowship or a research project or any number of things. The time to work on it is not when someone says “can you share your CV?” -- that’s a recipe for omissions, typos and mistakes. The only thing you should be doing every time you share your CV is giving it a quick once-over to make sure you don’t spot any mistakes and to make sure it’s up to date There are plenty of templates online and your training institution may even have a preferred format somewhere on their website. Your ERAS application will give you a good head start but most of your medical school CV lines will either be condensed or removed all together unless something was particularly notable. You can almost always find example CVs online from senior people in your department or institution with a quick web search -- use a few as a guide Set a reminder / task to update your CV at regular intervals. Quarterly is good, yearly at least. Save new versions of it each time so you can refer to the old ones if you need to and name them in a way to let you know you’re always sharing the most recent version, e.g., LASTNAME_FIRST NAME_CV_2020-06. You will forget if the one marked “CV” only is the right one you want to share.
5. Subscribe to a couple of newsletters to stay up to date with the world outside of your hospital
For general news, your preferred newspaper probably has a daily email briefing. Otherwise, Axios AM/PM and Politico’s Playbook are both very good quick reads to stay up to date with current events.
Keep up with healthcare news so you know what’s going on in the healthcare system broadly
Politico’s Pulse and Morning eHealth are both very good and have quick facts at the beginning if you just want to skim
Rock Health’s Rock Weekly is a decent summary of each week in the healthcare startup and technology world
Pick a few of these and aim to get through them each day. If you can’t get through them, unsubscribe to the ones you think are least relevant to you so you never feel “behind” in staying up with the news. You can breeze through the few you pick in a few minutes here and there throughout the day -- don’t make it any harder than that to feel like you’re “up to date” on the news.
General tips for maintaining relationships
For any romantic relationship, do these things if you don’t already:
1. Make a rule: no phones at the table. * Don’t put your phone on the table face-up. Don’t put your phone on the table face-down. Keep your phone off the table and set to silent. * Focus on the person in front of you and show them you care about them by paying attention to them. We all know what it feels like to be with someone more interested in their screen than in interacting with you. If you’re on call, say “sorry, I’m on call, I may have to check something here and there”, apologize if you do check it and then put your phone away. 2. Make another rule: no phones in bed * Same principle as at the table. Want to feel like two strangers just passing through life who just so happen to share the same bed? Wake up, reach for your phone and scroll through your feeds like a zombie before getting out of bed. Same idea before bed. Your phone can wait. 3. If you’re at the point where you share finances, set a regular meeting to review how you’re doing. * Ideally, this is a “red, yellow or green” meeting and should only take a few minutes. Money can be a big conflict issue for relationships and avoiding talking about money is a surefire way to eventually turn to conflict. If you have a budget and shared goals, this should be quick. * A monthly check-in is good. Create a recurring calendar event, attach the shared notes or spreadsheet document you use, add your goals for the meeting and honor the meeting when it comes around.
Eat with people who are important to you, if you can.
There’s something about sharing a meal that’s special in human nature. Friends who are important to you? Partners? Mentors you’re looking to get to know better after you’ve had a few chats? Try to eat with them when you can. And keep your phone off the table.
The same idea works with your coresidents and teams in the hospital. Eat with them if you can. Eating with others builds, strengthens and maintains relationships. Keep your phone off the table if you can.
Think about it this way: who would you consider a better mentor, the person you’ve met with a few times in their office where they sit behind their desk and you in front of them while they glance at their computer screen every time it pings or the person who’s invited you to get coffee or food and they kept their phone away the whole time? Now turn that around and realize the power of the message you can send to people you care about by trying to eat with them and show them they have your full attention.
1. Learn to think about tasks as a continuum from start to finish instead of as a binary 'done/not done'.
Let’s say you have to order a CT for a patient of yours.
Instead of marking the task as complete the second you place the order for the CT, recognize that the whole task is not just placing the order, but also knowing when your patient is going down to the scanner, when they’re back, when the CT is up in the system, when the report is up and also that you’ve looked at the CT yourself and have read the report.
When your senior or attending asks you, “Did patient X get their CT?”, a not-so-great answer is “Yes” or “No”. A better answer is “they’re down at the scanner now” or “the scan’s done but it hasn’t been read yet. Want to look at it?” or “Yes, it’s negative for XXX but did show YYY”.
Whatever system you eventually adopt for your day-to-day task management in the hospital, whether it’s a list or index cards or a printed signout sheet, make sure you’re tracking both when orders go in, when they’re complete, when they’re cancelled, etc. Just marking things as complete once you place the order isn’t enough.
2. Signout is taken, not given.
What I mean by this is that when you take signout, that means you’re accepting responsibility for those patients. They might be your patients, you might be cross-covering, it doesn’t matter. What matters is that when those patients are your responsibility, it’s your responsibility to get what you need to know to take care of them. Is someone signing out to you in a hurry and not giving you what you need? Ask them for that relevant past medical history, those exam findings, and so on. It’s not enough for the person handing off to say “we’re worried about x or y”, you’ve got to follow that up with “in case of x or y, is there a plan for what the team wants me to do?”. Get the answers you need. A lot of covering patients on call is playing defense whereas the primary team generally plays offense. But that doesn’t mean you can play defense in isolation. The last thing you want is for the primary team to feel surprised by your choices.
* Here’s two ways for the above example to go when turning the patients you were covering back over the next day or whatever: 1. You: “For patient so-and-so, you said you were worried about x or y. Y happened.” Them: “What did you do?”. You: “Z”. Them: “Shit, my attending’s not gonna like that”. 2. You “Y happened so I did A like you said, it went fine and here’s the current status”. Them: “Great, thanks” * See the difference?
Along the lines of taking responsibility for those patients, that means that if you couldn’t get the information you needed at signout then you have to go and see those patients and get the information you need yourself.
You’ll hear this idea said a bunch of different ways like “trust but verify”, “trust no one” and your comfort level will change over the year as you become more confident and comfortable. But always error on the side of going to see the patient and getting your own information at the start.
3. If you will be miserable without something when you’re in the hospital, bring it with you. You won’t reliably be able to find it at the hospital every time you need it.
Need coffee otherwise you turn into a demon? Bring it with you. You never know when you’ll get caught doing something and won’t be able to run to the cafeteria for your fix.
On call overnight and know you need food so you don’t go insane? Bring it with you. Here’s a hospital food rule: never rely on the hospital's ability to feed you. The hospital will let you down sooner or later, I guarantee it.
Know you always get cold on call? The day you forget your jacket/sweatshirt is the day you won’t be able to find a spare blanket in the hospital to save your life. Put a backup in your locker (if your hospital respects you enough to give you one).
Miscellaneous productivity, professionalism and lifestyle tips
1. Aim to “touch” everything only once
Example: your physical mail. You know, the stuff made of dead trees that accumulates in that box you check every once in a while. For every piece of mail you get, you should either trash it, file it, or act on it. Don’t touch it until you’re ready to do one of those things.
Example: your email. Either delete it, archive it, reply to it or do the thing it’s telling you to do right away. Don’t fall into the trap of using your inbox as a to-do list -- that’s a recipe to get burned. Use a task manager for your to-do list and aim to keep your inbox at zero. Realize that email’s true power is communication and use it as a communication tool and nothing else.
I’ll use the example of going to a wedding again as something to “touch once”. Aim to accomplish all the tasks at once or at least create tasks and reminders to complete those tasks all in one go. Respond to the RSVP, create the calendar invite with all the information from the invitation, share the calendar event with your date, book your travel, book your hotel, book your rental car, buy your gift from the registry and set a reminder to get your suit/dress cleaned a few weeks ahead, etc.
2. Lean to use your calendar as a tool
Professionals in the “real world” tend to live and die by their calendars. Some people, especially many senior people in medicine, don’t manage their own calendars. But you manage yours. With it you can:
Make sure all events—even small ones like dates or errands you want to run—have locations so all you have to do is click the location for directions
Send invites to friends / family / coworkers for anything you talk about doing that has the relevant info
Make reminders for yourself to prepare for upcoming events, i.e.., don’t count on seeing your parents’/spouses’/whomever’s birthday “coming up” to remind you to get a gift or send a card. Create an event two weeks before their birthday that says “Buy Mom a birthday card”, set it to repeat yearly and buy a card when it comes up, send it a few days later and don’t worry that it won’t get there in time.
3. Learn to use email well
Ever get an email from someone and feel their tone was terse, condescending or rude? Don’t be that person. Error on the side being polite and professional and writing in complete sentences without textspeak. It’s not hard — you type fast, even with your thumbs, I’m sure of it.
Learn to communicate effectively. Keep it short but not terse. State why you’re writing to someone, be clear if you’re asking a question, and think about it this way: “How am I making it as easy as possible for this person to understand why I’m emailing them and do what I’m asking them to do?
Don’t use a canned salutation like “Best, NAME” or even worse: “Best, INITIALS”. Use your salutation to continue to communicate your message and remember that politeness and professionalism extend through your signature.
I don’t know why “Best,” is so common in medicine but it’s meaningless, unthoughtful, inherently passive aggressive and I seriously read it as if the person writing it were signing off by saying “Go f*ck yourself,”. Same thing for “Regards,” and its ilk, any abbreviation like “vr,” or any form of cutesy quote.
Write your salutation fresh each time. Did you ask someone for something? Say “Thank you for your help”. Are you writing someone senior to you and want to sound somewhat formal? “Sincerely,” never goes out of style. Are you sharing information and essentially writing a memo? Use “Please let me know if you have any questions”. Your salutation is communication, treat it that way.
Sign with your name, not your initials. Signing with initials is a common way senior people will try to remind you they’re senior to you. If you do it, it’s like you’re trying to prove you’re a Cool Guy Big Shot too. It never comes across well -- even for those senior people. Initials are terse. Lowercase initials are even terser. Although they may look different at first glance, all initial signatures functionally come across as ‘FU’. Write your name.
If it’s a few rounds back and forth of email, it’s normal drop salutations and signatures and treat email more like texting. Keep using complete sentences without textspeak, though. I promise you’ll come across better that way.
Use the ‘signature’ feature of your email client to share your professional details and contact information
Your institution (not department) will hopefully have a format for this that’s standardized and includes minimal or no graphics. If it doesn't, then I feel sorry for all the inevitable IT headaches you will eventually endure at your institution since they clearly underfund and undervalue contemporary IT and professional services. It’s the wild west out there so find some good examples of clean, professional signature formats and make one for yourself.
Note: this signature lives below your salutation and sign off. It’s essentially the letterhead for your email that lets your recipient fill in the details you may not otherwise provide like your department, mailing address or fax number. It’s not a replacement for signing off of your communication professionally.
Never use bold, italics, underlines or different font sizes in your emails. They only make emails harder to read and jumble your message.
If you want to highlight something, put it in a numbered or bulleted list.
If you can’t communicate what you want with 2-3 bulleted points, then email is not the right medium to use. Do you like reading long emails? Of course you don’t. Write a memo, attach it as a PDF or shared doc and use the email to tell your recipients to review the attachment.
You will eventually, in some way or another, ask someone to introduce you to one of their contacts and or refer you for something. Learn how to write a good forwardable email that utilizes the double opt-in concept and how to make it easy on the person doing you the favor. Read more here, here and here.
While you’re at it, understand the power of using CC and BCC to communicate effectively.
Aim to answer all emails written directly to you within 24 hours.
If you can’t respond fully right away, respond briefly saying you got the note and that you’ll work on it and get back to them. Set a reminder or create a task to do or review the thing and get back to them once you’ve done it.
Do you hate being left on read in text? You do it in email every time you don’t respond to someone in a timely fashion. It’s better to share a quick, “I got it and I’m working on it message” then not replying until days or weeks later.
4. Don’t let someone else’s negative energy and/or anxiety transfer to you
You will frequently experience things like this in the hospital:
A co-resident disagrees with a management decision made at rounds and mentions that so-and-so is an idiot. So-and-so probably isn’t an idiot. Your co-resident probably isn’t an idiot either. Form your own opinions from your own experiences.
A nurse pages you with a tone that says “THIS IS REALLY BAD”. It might be, go and see. And on your way, stay calm and go over the steps in your head of what you’d do if it is, in fact, REALLY BAD. But don’t freak yourself out before you even get to the room. You won’t be able to make decisions with a clear head if you’re already worked up.
You’re a surgery intern and all your patients are normally on the med-surg floor. Every once in a while, one goes somewhere like heme-onc if the med-surg floor is full. Someone on your team says something like “great, now they’re going to screw up our patient”. Recognize that that floor isn’t full of terrible nurses and may just have less experiences with lines and drains and that the best thing you can do is go down there, talk to the nurse and say “here’s what we want to be called about” and “this thing may look bad but it usually isn’t and we don’t need to be called, here’s why”, and so on. Doing things like this will mean you get fewer calls. Fewer calls are good.
Your attending is having a bad day and you’re not enjoying your interactions with them. Don’t let that make you have a bad day too. Medicine is hard enough as it is, stick to your own bad days instead adopting other people’s. Then pull up your friend list, text a buddy and feel better.
5. Don’t neglect your physical health. Trying to eat well and stay active are even more important when you’re insanely busy.
The #1 thing you can do to help your waistline is cook your own food and pack your own meals. It doesn’t matter what you cook or how good of a cook you are, as long as you’re aiming to pack meals that an adult would eat, it will be healthier than takeout and cafeteria food. It’s better for portion control, you control all the ingredients and you get a sense of satisfaction for being on the ball. It’s better in every way. I know it’s not realistic to always prep and pack your own food on the busiest of services but you should try to hit at least a percentage like 25% or 50% of your meals. There are no lost causes in your own health. It will be hard to exercise and work out. You should still try to do it anyway. You will go long stretches without exercising at times. Don’t beat yourself up about it. Every day is a chance to do the thing you want to do so get back out there.
6. If your social profiles are private, consider doing some housekeeping and making them public.
Instead of thinking about them as a liability to be that needs to be hidden, think about them as a narrative you can control. Nothing is private on the internet. Even your private profile. You never know who knows someone you know or what may get screenshotted and shared down the line. It’s natural to run a web search on anyone you’re meeting for a date, interviewing with for a job, or researching in general. When you search your own name, what comes up? What do you think when you’re searching for someone and they have a private page? Do you ever click on a few links to see professional stuff from LinkedIn, and then some social pages to see what else you learn? So does everyone else. Use your social pages to put forward a version of you that shows who you are, shows some interests true to yourself, makes you seem like a totally normal and reliable person (which is exactly what any potential date, partner, fellowship director or hiring manager is asking themselves about you) and doesn’t share enough information to let a patient show up at your door. Medicine lags behind other industries with people still commonly hiding behind private pages. In the tech world, it’s more strange to not have a public page. A private page says more about you that you might want to hide red flags whereas a public page says “go ahead and look, you won’t find any red flags”. One is much more powerful than the other.
Closing and something to read
When you view your professional life, it’s natural to view your professional relationships as being a binary one between patient and physician. That’s certainly essential and certainly important, but as a professional you now have relationships to consider with so many more types of people: co-residents, faculty in your department, faculty in other departments, administrators, support staff, medical students, and so on. Just as you had to learn how to work with patients, you will have to learn to work with all of the other people in your professional life. Truly effective professionals will treat all interactions importantly and give thought and consideration to each one. All these interactions and relationships will all affect your day-to-day experience, your well-being and, ultimately, your professional experience. You will find yourself being not just responsible for your patients, but also for yourself, your career and your relationships. It takes effort to succeed in all of those areas. And even with effort, sometimes you’ll be winning in an area and losing in others. And in a few months it will be different -- that’s just life. I want you to consider looking outside of books and resources written specifically for physicians when you’re trying to tackle these issues inside the hospital and out. Medicine is a much-smaller-than-you-realize bubble with a long history of personality-driven examples of “that’s just the way we do it” or “that’s how we’ve always done it”. There are good books about medicine out there, to be sure, but you’ll benefit more professionally by learning from the wide world outside of hospitals since there are quite simply many more successful and accomplished people who’ve written great resources for all aspects of professional life that medicine tends to ignore. I’d recommend you start with this book: Andy Grove’s High Output Management (a review by another Valley titan here). Andy escaped communist Hungary, taught himself English and rose to be CEO of Intel and went on to be a sage of Silicon Valley before he passed. This book is a how-to guide for how to be an effective professional in an organization (hint: you're now a professional in an organization) and if you’ve enjoyed this post at all, you’ll love this book. You may think that this book applies to ‘managers’ and ‘business’ and not medicine but you couldn’t be more wrong. Although it was probably written around the time you were born, nearly everything in this book is a lesson that directly applies to your professional life in medicine and when you start seeing it, you’ll feel like you’re in The Matrix. Congratulations! You've worked hard to get here. Be proud of yourself, your degree, your long white coat and be the best doctor you can be.
Help building gaming/work pc for VR/AAA gaming and video editing.
What will you be doing with this PC? Be as specific as possible, and include specific games or programs you will be using.
My wife and I play VR games with our HTC Vive pretty often and my Gigabyte Aero 15 laptop has been struggling. Although boy does it do a pretty good job for a laptop. I'd love to have a Beat Saber experience with 0 hiccups and be able to run the Witcher 3 on Ultra without any stuttering. I've also got my eye on Squadrons in VR too. Additionally I'm a video editor by trade and while work provides me with equipment for that, I would love Adobe Creative Cloud to run well on whatever I end up with.
What is your maximum budget before rebates/shipping/taxes?
Let's go with 1,200 USD but I can be convinced to invest a little more if it makes a huge difference. Let's call it a comfy starting point. Mostly I'm just looking for the most bang for my buck, not the latest and greatest. If we come up with a $1,000 solution, all the better!
When do you plan on building/buying the PC? Note: beyond a week or two from today means any build you receive will be out of date when you want to buy.
For the purposes of moving forward let's say this week. There's really no rush so I can be convinced to wait if sales or new launches (that make current stuff cheaper) are imminent. I'm open to your suggestions.
What, exactly, do you need included in the budget? (ToweOS/monitokeyboard/mouse/etc)
I have a keyboard, wireless mouse, battery backup, and a cheap Acer monitor from 2016. But beyond that I own 0 parts of the pc itself and have no extra copies of Windows lying around. You can include a monitor recommendation if there's a spectacular deal/opportunity right now or leave it off.
Which country (and state/province) will you be purchasing the parts in? If you're in US, do you have access to a Microcenter location?
Southern California, United States. There's apparently a Micro Center an hour south of me, so if it saves on shipping or tax to make that trek and pick all the parts up there, that is an option although a LITTLE inconvenient.
If reusing any parts (including monitor(s)/keyboard/mouse/etc), what parts will you be reusing? Brands and models are appreciated.
Not necessarily using but own: 2016 Acer monitor (nothing special, has HDMI) Anker wireless mouse, generic noisy keyboard from work.
Will you be overclocking? If yes, are you interested in overclocking right away, or down the line? CPU and/or GPU?
I'm too inexperienced to know if this is necessary for my needs or not. I want my games to look gorgeous and smooth. I want my setup to be as quiet as possible. I guess in a perfect world I would want the setup to be as simple as possible so maybe "no" to overclocking? You tell me.
Are there any specific features or items you want/need in the build? (ex: SSD, large amount of storage or a RAID setup, CUDA or OpenCL support, etc)
My priorities are good graphics, smooth painless experience, in a quiet unobtrusive machine. I'm not coding, bitcoin mining, storing teraflops of data or hacking the pentagon. I'll set up a simple backup solution on an external harddrive for minimal person files.
Do you have any specific case preferences (Size like ITX/microATX/mid-towefull-tower, styles, colors, window or not, LED lighting, etc), or a particular color theme preference for the components?
I do NOT need flashy. I don't care about LEDs or little screens in the case. I don't need an elaborate watercooled system (unless you tell me that's the only way to have a relatively quiet PC experience). I guess I would choose smaller and more low profile for a case unless that makes things hotter (read: noisier). I'm a minimalism guy if that helps. Function over form. A window is fine but not important. If color makes no difference, white would match the room better than black. But again, low on my priority list.
Do you need a copy of Windows included in the budget? If you do need one included, do you have a preference?
I guess I do. I'm used to Windows 10 at this point but I do NOT want any extraneous software installed. No bubblewitch or bloatware if at all avoidable. I'm open to suggestions for antivirus solutions
I know just enough about PCs to get myself in trouble sometimes. I can comb through forums to troubleshoot problems, I can install new drivers and but struggle with knowing how to optimize my pc experience. (ie. Why is my laptop so loud right now? Why are these system apps using 100% of my CPU? WHy does this game run amazing one day and terribly the next?)
I can follow directions pretty well and I know that's really all pc building is. Expensive, sharp, electrified LEGO. I used to do basic repairs on apple computers back in the day so I'm no stranger to static free workspaces and keeping track of tiny screws. But even with all that, feel free to treat me like an idiot and walk me through this new world slowly. I'm here to learn and ask questions. Thank you in advance for your help, kind internet person! SomeKindOfRobot
My stock study watchlist. would appreciate criticisms or red flags
Core - FB ecosystem This is the stock that i believe is invested in the right places and has a path forward in the global market. I work as a React developer in fintech and I greatly enjoy their technology. The reason I stopped using snapchat was because I couldn't use it on low connection in Mexico, but Instagram worked marvelously. I use Whatsapp to stay in touch with my family in mexico and Facebook to stay in touch with my mom. There's something extremely powerful about that in my opinion. They're conservative with their push and development of camera and VR technology which is wise in my opinion give the many opportunities that exist in that space. They're pushing along with fintech in India, again with small business through Whatsapp. And they provide a suite of customer services for small business and entrepeneurs. - Microsoft I think they will have a great run during the cloud era of software development. Their acquiring of Github AND NPM goes to show how in touch they are with developer servicing. - Paypal Paypal has a marvelous history and is a battle tested pioneer in the fintech space. I see them repeating their previous successes by acquiring Honey. I work with Honey in the fintech space and now I'm understanding that Paypal has an auto coupon scraper on my Amazon purchases while my Visa ones don't. This is the forward thinking I love from Paypal despite not being as flashy as Square. - Disney Disney is quintessential american entertainment. I believe their deep roots in American culture and the entertainment industry will provide a solid bedrock for them for the generations to come. - Waste Management Sanitation and environmental, like internet connection technology, are about the same when it comes to market penetration. It is a scarcity. Sanitation is a critical part of any society's development and wellbeing. I think WM will be there to benefit from increased urbanization and industriousness from technology and wealth growth. - Kansas City Southern I'm Mexican and my family are avocado farmers. I believe in the future prospects of Mexico and its relationship with its neighbors. Mexico is a bustling nation and many youth are international students that carry degrees. This is a far cry from having military policing streets in rural neighborhoods decades ago. Kansas city southern is part of the supply chain that connects Mexico to main industrious Mexican states like Monterrey, Jalisco, and Michaocan. I like rail in this regard because it's a lot of weight in one operation of heavy materials. So Canadians that use Mexican mining will also benefit from this railroad. - Nintendo I believe in the future of gaming as a market and if I were to take a shot at who would be the most stable, I would vote for Nintendo. Like Facebook, they approach the family unit and grow generationally. I love their curveball approach to gaming and I think that creativity, along with it's customers trust, will be something I can hold onto for a long time versus companies that have a history of developing games like Call of Duty or World of Warcraft. Nintendo can take different forms: in the living room, at sweaty tournaments, online, mobile, on your phone, on a TV, in the movies, etc. Closely watching - United Health or Cigna This is only going to grow and wont change due to American politics for 8 years at a minimum. - Cisco Same as Microsoft but for IT. - Impossible Foods IPO I've been vegetarian for 10 years and Impossible Burgers has been one of the most mindblowing experiences of my life. The product is phenomenal and on a league of its owned compared to Beyond Meat. IMHO Beyond taste like cheap school lunchroom burgers and Impossible tastes like something I would be excited to feed my family. If their pork products are great then I am ALL in because Chicken products are by far the easiest thing to replicate. I'm extremely excited about this product. - Visa They make a ton of money on transactions. I saw them hiring for blockchain development so it leads me to believe that they're adapting. - Square I work in the fintech space and I like their modest approach to financial services. Their acquiring of a bank charter is actually incredibly important due to all the procurement and legal processes that go behind being a fintech company (abiding by federal security laws, etc). The one reason I like Chase banking is because I enjoy their app. I see Square as a competitor to Chase, surprisingly. - Apple Apple designs its products with customer service in mind. I think the future of education technology will likely go to Apple because of this. Their screens and cameras are wonderful and I can see them pioneering computer vision products because of this. They are THE American Tech company. - TMobile Aggressive as hell and grew to be a large player through savvy moves across time. Their customer service is a highlight for me. - JPM Customer service for banking is unmatched IMO. If any legacy banker will make it across changes, I believe Chase is doing what it takes to adapt and think forward. - Planet Fitness $10 gyms, clean, and casual enough for the general population. You can't beat $10 gym membership when you're broke as fuck. I've been a heavy lifter before and still used Planet fitness in my transitions across states and whatnot. I need to look at their numbers more closely. - Volkwagen I trust Europe and Japan to take EVs more seriously. I don't know who will seriously come close to competing with Tesla in the long run but they'll have to. - Panasonic Panasonic, much like AMD, did not immediately reflect the value of what they have produced. AMD did not explode inline with bitcoin or cheaper GPU consumption, in the same way Panasonic did not reflect a massive spike in price after speculation in Tesla grew. They're an important arm to the EV market that spreads across many players ranging from Tesla to Toyota to big tech. - Lyft I think Lyft's focus on customer service and regional clientele will pay off against Uber, who is growing too quickly and spreading thin. Lyft will benefit from the development of computer vision and Big tech's interest in automanufacturing. - Crypto (Bitcoin or XRP) I like crypto as a technology as a software engineer. I see the value in a faster process for procuring and exchanging legal tender that does not have to go through the bottleneck of the ACH process or through legal issues like the PATRIOT ACT or the Bank Secrecy Act. It still fundamentally respects those laws without the frustrations of banking service bottlenecks. I think the halvening protocol has an interesting affect on Bitcoin and supply and the market that it's trying to generate. -
Global internet / internet everywhere is being worked on with Space-x "StarLink", thousands of satellites connecting everyone globally to the internet. Therefore infrastructure for the digital currencies,
Too private makes it ideal for illegal activities. / Can't be controlled as easy, taxed as easy.
All of the above is a partial list of factors devaluing the Dollar and trust in it from several ways and views. At the end of the day it has a huge amount of enemies, that are all looking for ways to get out of it. Some of what I'm seeing personally.
Prices are outpacing wages.
Education is required for a good job vs how things used to be, jobs are getting more technical for same wage value.
Real Estate has been rapidly climbing in price, even homes that haven't been remodeled. A $80,000 home in my area is now $180k in the last 6-7 years. Wages haven't moved.
Rents have been climbing with the real estate prices.
Taxes have increased on said real estate
Insurance cost are up
Repair costs are up
It is a death spiral for the working person, where it used to be "No more than 30% of your wage going to housing" It is now well over 50%....Just look at this recent post in Frugalhttps://www.reddit.com/Frugal/comments/ifqah1/is_it_normal_for_a_third_to_a_half_of_you?utm_source=share&utm_medium=web2x&context=3 This death spiral I foresee getting worse. And historically any "tax" / regulation cost will just be passed down to the consumer in form of increased prices until people / businesses move elsewhere as we've seen in several cities around the US. So what can we do? Buy Gold! Silver! Bitcoin! Stocks! I hear people roar, They aren't exactly wrong as history shows... but have you considered the 30-40% tax on the "gain"? Even when that asset buys the same value before tax? What if the government makes it illegal like the 1933 order: 6102 Where you couldn't own gold for nearly 50 years? You're frozen out, or even out on taxes (which will likely be more strict and controlled later in time). I'd say Invest in things that will
Help you be independent
Can help you save
That you will use anyways in normal living
Things that can be productive not only for you, but for others $
Bonus points if its easy to trade off / has demand
Extra bonus if it is durable (lasts many years)
Helps your health
Metals are the next step when a person has plenty of the above. You get to a point where you have hundreds of thousands, if not millions that you need to condense into something real. It is all about the savings or productivity gain of the investment. For instance I would wager that many preppers have gotten more use / value out of a $800 clothes washer than a $800 rifle. (have you ever had to do manual laundry???) Sure the rifle will hold value...but it often doesn't pay you back with time / what it saved and / or what it has produced during its life unless you are using it. Same can be said of security cameras, a generator, a tractor, trailer, garden, tools, ect. Look at history even, in countries that have experienced hyperinflation people that already had tangibles they regularly use were way ahead. It could even be honey, a tool, extra maintenance parts, can of food, that bottle of medicine, a computer to keep your intel on point, (cough # PrepperIntel plug) use of your equipment to do or make something for someone. Real Estate is good too, it rides inflation well and has many ways of being productive. Your metals could be sitting there like the rifle, and could be subject to hot debate and laws. Meanwhile that garden is paying back, chainsaw is helping saw up wood, or your tractor is helping a job, your tools just helped you fix something / saved you much loss, Your security stopped a loss not by a person, but an random animal stealing things. Or that $25,000 solar array is paying you back by the day in spades...while making you independent...running all your tools you're using to make things to sell, and even heating / cooling some of the house with the extra juice while places around you experience rolling blackouts. You were even smart and took the current 24% tax benefit the government has saving you $5000 on it for batteries. Don't get me started if you have an electric vehicle with solar... I'm rambling at this point...and all those stealthy / direct and passive background savings...even if the crap doesn't hit the fan. So anyways, With out of control central banks and big governments, digital currencies, How do you think it will play out? Are we heading to dystopia?
Those keen to dial in can find more details on the Bitcoin VR Degenerates Telegram. Tech conference Collision, meanwhile, has announced that its June event will go ahead – only it won’t happen ... So many of the top brands and companies are using VR, it would probably be easier to list those who aren’t. According to Forbes, 75% of the world most influential companies, have some form of VR contained in their marketing strategy. ImmVRse, the blockchain platform that will be the Youtube of VR content has compiled a list of the top 10 industries looking to utilise VR: Gaming. The most ... This harks back to Bitcoin’s early days when Bitcoin faucets gave out free Bitcoin. An early one even gave out five Bitcoin at a time, an amount now worth $57,000. “You can use this faucet until it runs out! Send it to your friends, print it on a poster, etc,” the poster said. I take out a satoshi using the Bitcoin lightning network. A ... NEW YORK, Oct. 13, 2020 /PRNewswire/ -- myKlovr (a one-of-its-kind employee benefit powered by artificial intelligence and predictive analytics) is continuing to help high school students prepare ... We did an experiment with VR to visualize real-time Bitcoin transactions. Try it on your phone!
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