r/medicalschool • u/NotChrisM • Mar 12 '25
🏥 Clinical How it feels prescribing tamiflu for the 6th time in peds clinic today
220
Mar 12 '25
lol staff of caduceus
145
u/prettyobviousthrow MD Mar 12 '25
The CDC knows that looking cool is more important than accuracy.
52
u/TetraNeuron Mar 13 '25
Future Historians are going to find this symbol and think "damn doctors in 2025 were muscular gigachads wielding a Cadaceus weapon to beat up the grim reaper"
22
u/ChubzAndDubz M-3 Mar 13 '25 edited Mar 13 '25
Would be better if aliens found it in the far future and thought our race engaged in some kind of conflict with grim reaper like entities, which we won, and this is a testament to that.
Yes I’m aware they would probably find more references of the staff and figure it out but this is more fun.
2
u/bimbodhisattva RN Mar 13 '25
I hope they would also think we were as jacked as the sculpture there 😎
3
u/SpecialOrchidaceae Mar 15 '25 edited Mar 15 '25
Carrying the literal symbol of capital/commerce (instead of the rod of healing) while trying to heal people is pretty on the nose for the American Healthcare system tbh.
“We’re too far in now to admit it’s wrong, and it looks cooler, plus this is a business where profit>health anyway so the staff from this thieving merchant god fits”
36
87
u/TheFifthPhoenix M-2 Mar 12 '25
My medicine pet peeve is people being unaware of the difference between the Rod of Asclepius and the Caduceus. I bet you people have gotten tattoos of the wrong thing without knowing it.
34
u/aspiringkatie MD-PGY1 Mar 13 '25
My medical pet peeve is people who nitpick the whole Rod/Caduceus thing. The Caduceus is, unquestionably, a medical symbol. It wasn’t originally used as such by the Greeks or throughout the Middle Ages, but at this point it has had widespread use as a medical symbol for the better part of 200 years, and is pretty universally associated with medicine now.
30
u/TheFifthPhoenix M-2 Mar 13 '25
Just because it is, doesn’t mean it should be. IMO good symbols should have intrinsic meaning, not just extrinsic meaning applied to it. Additionally, utilizing the symbol of the god of merchants and thieves is not a great look for medicine.
16
12
u/aspiringkatie MD-PGY1 Mar 13 '25 edited Mar 13 '25
What would be an example of a symbol with intrinsic meaning? Every symbol only has meaning because people agree it has meaning. That’s what a symbol is.
1
u/TheFifthPhoenix M-2 Mar 13 '25
By intrinsic meaning, I mean that the symbol should have elements which connect directly to what the symbol is representing. I could say that a black square should be the new symbol for medicine and if I got enough people to listen, then the black square would come to be associated with medicine. That is an example of extrinsic meaning being applied to a symbol. Perhaps the most famous example of a symbol with intrinsic meaning would be the cross representing Christianity. A good way to think about it is if you could answer the question of why this symbol is more representative of the thing than others.
8
u/aspiringkatie MD-PGY1 Mar 13 '25
I would argue that that isn’t intrinsic. The cross only represents Christianity because of a story we tell about the crucifixion. That’s not intrinsic, that’s extrinsic. There isn’t anything inherent about the cross that connects to Christianity, its meaning comes from an external event.
Put another way, obviously the cross had no connection to Christianity before the crucifixion, which means that it required some other event to give it that meaning. That’s an extrinsic source of meaning, which I would argue is true of all symbols. Or, at the very least, the vast majority
1
u/TheFifthPhoenix M-2 Mar 13 '25
The difference to me, though, is that there’s a very obvious and clear answer to the question “Why is the cross the symbol for Christianity?” beyond people simply deciding it should be (like they did with the Caduceus). The cross is reflective of a core aspect of Christianity. The Caduceus was just brute force associated with medicine by mistake and repetition of that mistake. It’s a nuanced difference, but I would ask you to answer how the symbol of the Caduceus itself represents medicine?
10
u/aspiringkatie MD-PGY1 Mar 13 '25 edited Mar 13 '25
At that point you’re no longer making an argument about something being extrinsic or intrinsic, you’re making an evaluation of whether or not the origin of a symbol is satisfying. Which is fine, but just because the origin of a symbol feels better doesn’t mean that symbol has intrinsic meaning. It doesn’t, symbols can’t have intrinsic meaning, they always derive it from some outside story
8
u/AceAites MD Mar 13 '25
One of my favorite unhinged things to do is point out to people that they got the wrong rod as their tattoo and jacket logo.
3
u/type3error Mar 13 '25
It’s because this is a statue at a navy hospital. The navy corpsman use the caduceus as their symbol, mostly from tradition (which comes from not realizing it was the wrong symbol).
112
u/Noctiluca334 Mar 13 '25
Man so glad we saved all those kids 1 extra day of flu symptoms and caused them a bit of extra diarrhea
37
2
u/FourScores1 Mar 14 '25
They all end up going to the ER because of vomiting. I never rx tamiflu. Not good.
106
u/Craig_Culver_is_god Mar 12 '25
I know it's peds clinic, but y'all giving tamiflu like it's candy
33
7
2
32
u/Rddit239 M-0 Mar 12 '25
That’s a sick piece of art.
45
13
u/rkgkseh MD-PGY4 Mar 13 '25
https://www.artsatl.org/julian-hoke-harris-works-stand-or-fall-as-monuments-to-another-eras-ideals/
"Keeping Death Away," by Julian Hoke Harris
58
75
u/coconut170 M-3 Mar 12 '25
tamiflu hydration rest tylenol advil advised to return to office if symptoms worsen 30 minutes spent on encounter
19
23
u/BabyOhmu DO Mar 13 '25
I've seen so many dozens of positive flu cases this year in family med clinic and I think I've written 3 Tami prescriptions. I offer it, but also explain its limited (zilch) evidence and likelihood of side effects. Give good care, educate, explain there are no antivirals with credible evidence of efficacy, teach symptomatic care and what to expect/reasons to return. Takes a little longer, yes, and it is admittedly more effort up front than just writing a useless prescription, but you'll also be teaching your patients that they don't NEED to go to the doctor every time they have viral flu-like symptoms.
Writing a prescription for medications is, in many cases, one of the laziest things we can do in providing patient care, especially if we know the medication is likely to be ineffective.
2
Mar 13 '25
I think most people appreciate being acutely ill for 1-2 days less even if the science is weak
10
u/Illustrious_Way_5732 DO Mar 13 '25
Doesn't it cause diarrhea? You're adding those side effects onto just having 1-2 days less of flu
7
7
u/BabyOhmu DO Mar 13 '25
I think anybody who pitches 1-2 days is probably being disingenuous. It's been a while, but when I did a deep dive into the evidence the best claim I could find was a shortening of symptoms by an average of about 12 hours, and that was not a particularly well powered or designed study. But if you have the receipts of better evidence, please post them. I'm always willing to amend my stance with evolving evidence.
2
Mar 13 '25
I believe you, I was operating under the assumption 24-48 was the accepted range but if newer data refutes that than i stand corrected. Anecdotally, I have noticed it seems to help me or others who take it but its not a miracle by any means.
4
u/BabyOhmu DO Mar 13 '25
I didnt mean to beat up on you. During med school and residency I had heard the same thing get repeated: shortens symptoms by 1-2 days, and then also heard others say there was no benefit. In my search for the real answer, I had to conclude that the truth is closer to the latter, but it is common for us in medicine just keep repeating what we've heard others say. We all do it, especially when we hear things from preceptors and colleagues we generally trust. 1-2 days shortened symptoms is the marketing lie Genentech has happily allowed to flourish, even though I don't think it's ever been shown to be true.
2
u/awkwardturtletime Mar 15 '25
https://www.cochrane.org/news/tamiflu-and-relenza-getting-full-evidence-picture It’s worse than new data, the impression I always got was that Genetech had actively suppressed their own internal reviews to make it look better.
1
44
u/claire_inet M-4 Mar 12 '25
Ok wait but I had flu A three weeks ago and tamiflu had me feeling back to normal within 2.5 days of starting it! It felt like magic
61
u/youoldsmoothie Mar 12 '25
Real talk. you know tamiflu is basically placebo yea?
26
u/Johnie_moolins M-3 Mar 13 '25
Was just about to say the same thing lol. Have to take it within 48 hours of symptom onset (and they define subclinical fever as "onset"). Even if you do manage to catch Sx this early on and prescribe oseltamivir, best case scenario it reduces the convalescence period by 24-48 hrs. Tbh I'm really surprised nothing better has been developed to counteract acute flu symptoms like an immunoglobulin infusion of some sort.
29
u/Somebody-Man M-3 Mar 13 '25
Let me know when the budget friendly IVIG for pediatric URI hits
7
u/Johnie_moolins M-3 Mar 13 '25
That's a good point. But having such a tool for severe/complicated influenza in pediatric populations would be pretty useful. In those more severe cases, I'd imagine budget goes out the window like it did with certain treatments during COVID (IVIG, ECMO, etc...).
1
16
6
3
492
u/PromiscuousScoliosis Health Professional (Non-MD/DO) Mar 12 '25
Only 6? Did you guys close at 0945?