r/IntensiveCare

I’m a new female ICU physician, and I’m struggling with how some female nurses treat me compared with my male colleagues. They can be extremely rude and dismissive toward me, while seemingly being much more respectful toward male physicians.

I understand that I have areas to improve and that experience plays a role in how people perceive you. I’m working on becoming more confident and competent. But does being less experienced justify being treated with disrespect on a daily basis?

I’m genuinely trying to understand whether this is gender bias, a confidence issue, or simply something that gets better as you gain experience.

Female ICU workers, have you experienced this? Does it get better with time, and how do you handle it without becoming defensive or being labeled difficult?

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Could be any people, resources, procedures, case variety, teaching, or the overall culture. What makes your ICU a great place for you to work and learn?

I imagine most would agree that using POCUS when caring for critically ill patients has become standard of care in the US.

It’s also generally emphasized, for litigious reasons, that if you are going to be making clinical decisions based on ultrasounds you perform, those images must be saved and attached to a patient’s chart.. simply documenting “POCUS shows x,y, or z can get you into trouble in court if you’re sued)

So, is anyone else in the situation I am in where my hospital provides an ultrasound for my unit, but no way to save the images or attach them to a chart?

If so, how are you handling this??

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I want to improve my communication and leadership during codes as team lead.

For experienced physicians, what are the things you verbalize when a code isn't going well? How do you think out loud, reassess the situation, identify what might be missing, and communicate the next steps?

When you respond to a code, how much of the patient's story do you want to hear upfront? Sometimes people give a very long history with lots of unnecessary details.

Also, do you listen to the entire story first, or start assessing the patient and taking appropriate action while someone gives you the report?

Recently, Obstetrics called two codes in one day, and both times I was given a very long story. When I started assessing the patient or asking direct questions to clarify the immediate situation, they seemed unhappy with it.

I know this is a very nuanced topic but have had interesting convos with perfusionists who argue that an asystolic patient on V-A ECMO is still “alive” when they have a MAP above 65. I had a patient who never stood a chance (that likely shouldn’t have gone on circuit) who was DNR after developing widespread gut ischemia per family wishes.

Of course before family is able to get there to withdraw as planned…. VT. They still wanted electricity so of course we try a chemical code, no dice then shock them to eventually get a ventricular escape that degrades quickly into asystole. They want to clamp circuit so we did so, but it begs the question — in a patient with loss of reflexes and fixed pupils who is showing clear signs of brain death without confirmatory testing, is their time of death asystole or when care is “withdrawn” when ECMO is discontinued?

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I genuinely love critical care and feel passionate about pursuing it as a career. But often I wonder whether loving the field is enough when I struggle with handling the practical demands of the ICU.

I’m still early in my career, and I know I have a lot to learn. However, when I feel overwhelmed or don’t perform as well as I should, I start questioning whether I’m cut out for this. Mainly due to fast turn over because patient get transferred quickly once ICU needs are over. there is so much going on in one patient. It takes time to absorb their details.

Can someone who struggles early on still become a good intensivist with enough experience, practice, and mentorship? Or does critical care require a certain natural ability that not everyone has?

I really want this career, but I’m scared that wanting it and being capable of doing it might be two different things. I’d appreciate honest perspectives from intensivists who struggled early in their careers.