whoRyou Posted March 14, 2015 Share Posted March 14, 2015 As the title states ... What are some lessons you have learned as a PA or a PA-S or better yet a Pre-PA? I for one have learned NEVER EVER take ANYTHING or ANYONE for granted and it's OK to feel whatever you are feeling. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 14, 2015 Moderator Share Posted March 14, 2015 don't drain a peritonsilar abscess, ever. don't put steroids in someone's eye without an ophthalmologist telling you to do so. don't suture a bite wound on a hand, no matter how clean it looks. don't cover a wound with a splint without starting abx at the same time. fortunately, I'm not the one who made these mistakes, but heard about the bad outcomes when they happened. Link to comment Share on other sites More sharing options...
lightbearer06 Posted March 14, 2015 Share Posted March 14, 2015 Curious what happened with the PTA. Gushing blood into the airway? I have seen some of these done US guided, and I am always surprised when the patient does not die... Link to comment Share on other sites More sharing options...
SHU-CH Posted March 14, 2015 Share Posted March 14, 2015 After learning about all the things that can go wrong with the human body, it is amazing to me that anyone is healthy! Link to comment Share on other sites More sharing options...
whoRyou Posted March 14, 2015 Author Share Posted March 14, 2015 After learning about all the things that can go wrong with the human body, it is amazing to me that anyone is healthy! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 14, 2015 Moderator Share Posted March 14, 2015 Curious what happened with the PTA. Gushing blood into the airway? I have seen some of these done US guided, and I am always surprised when the patient does not die... yup, and it was an ent who did it. on my pt. right in front of me.... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 14, 2015 Moderator Share Posted March 14, 2015 another- don't send home post-tonsilectomy bleeds that are no longer bleeding. they need obs. we almost had to crich one (who we put in obs after ent on the phone said send them home) Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 14, 2015 Moderator Share Posted March 14, 2015 When you and your SP have a very different view of patient safety, and you think your SP's decision is placing the patient at risk, talk to your Doc, tell them your thoughts, voice you difference in opinion and why. Then if the doc still does not agree write a note detailing all your concerns. and let it stop there.... Don't start chronic opiates for non cancer pain unless you are a pain specialist if you are ER - don't try to Dx everything, just make sure the patient is safe to DC and let the PCP follow up Never believe a drug addict about their supposed use or non-use unless they are admitting to using everything then still be suspicious. Ok to listen to them, but keep your 6th sense going and don't become a candy man..... don't piss off the patients..... even when you disagree or they are total jerks, your job is to try to help, if you are unable to do that, simply move on - these are not friends or family, they are patients and sometimes you can't make them happy ALWAYS do a job you can be proud of Link to comment Share on other sites More sharing options...
gbrothers98 Posted March 15, 2015 Share Posted March 15, 2015 As the title states ... What are some lessons you have learned as a PA or a PA-S or better yet a Pre-PA? I for one have learned NEVER EVER take ANYTHING or ANYONE for granted and it's OK to feel whatever you are feeling. The mix of supervising physicians you will encounter in a career can vary widely. The bad one's can be coped with and outlasted. The good one's you will miss when they are gone. GB PA-C Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted March 15, 2015 Moderator Share Posted March 15, 2015 - The most difficult part of working in the ED is trying to sift through someone's personality/psychological disorder to discern the presence of, or lack of, true physical ailment. You could probably extrapolate this to all of medicine - To add to this, I had no idea how many people out there whose issues could be summed up with a very fundamental problem- "Poor Coping Skills" Link to comment Share on other sites More sharing options...
Acebecker Posted March 18, 2015 Share Posted March 18, 2015 Compare new images, labs, etc. to old ones whenever you possibly can. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 18, 2015 Moderator Share Posted March 18, 2015 Compare new images, labs, etc. to old ones whenever you possibly can. yup, the most important ekg is the last one. Link to comment Share on other sites More sharing options...
Will352ns Posted March 19, 2015 Share Posted March 19, 2015 Treat the patient, not the lab or xray. Link to comment Share on other sites More sharing options...
taotaox1 Posted March 19, 2015 Share Posted March 19, 2015 Never be afraid to call a patient and see how they are doing, ask another question you forgot to ask, or change course entirely when you realize you got it wrong. You may feel a little stupid but you will sleep better at night and your patients will love you for it. Link to comment Share on other sites More sharing options...
andersenpa Posted March 19, 2015 Share Posted March 19, 2015 Take all of your vacation Max fund your retirement Link to comment Share on other sites More sharing options...
HJK Posted March 21, 2015 Share Posted March 21, 2015 Never be afraid to call a patient and see how they are doing, ask another question you forgot to ask, or change course entirely when you realize you got it wrong. You may feel a little stupid but you will sleep better at night and your patients will love you for it. Couldn't agree more. What a great relief to say hello to the pt and hearing all are better after a long sleepless night doubting myself. Link to comment Share on other sites More sharing options...
medic25 Posted March 21, 2015 Share Posted March 21, 2015 Trust a moms instinct. She knows the kid a whole lot better than you, so if she says something is wrong with the pedi patient take it very seriously. Link to comment Share on other sites More sharing options...
swooshie1 Posted March 23, 2015 Share Posted March 23, 2015 Never be afraid to call a patient and see how they are doing, ask another question you forgot to ask, or change course entirely when you realize you got it wrong. You may feel a little stupid but you will sleep better at night and your patients will love you for it. yes yes and yes! and, in spite of what your PA program tells you, patients really don't care how you dress or what you look like when you've spent time listening to them, developing rapport, and being genuine in your desire to help them. Link to comment Share on other sites More sharing options...
whoRyou Posted March 23, 2015 Author Share Posted March 23, 2015 ... you've spent time listening to them, developing rapport, and being genuine in your desire to help them. It is widely taught that diagnosis is revealed in the patient's history. 'Listen to your patient they are telling you the diagnosis' is a much quoted aphorism my psychology prof used to say. The basis of a true history is good communication between 'provider' and patient. As many of you know already a good history is one which reveals the patient's ideas, concerns and expectations as well as any accompanying diagnosis. The 'provider's' agenda, incorporating lists of detailed questions, should not dominate the history taking. Listening is at the heart of good history taking. Without the patient's perspective the history is likely to be much less revealing and less useful to the 'provider' who is attempting to help the patient. The skills required to get the patient's true story can be learned and go beyond knowing what questions to ask. Give the patient a chance to tell you their pre-constructed narrative, rather than diving in with a series of questions to delineate detail. Listening does not just involve using your ears. Use other clues such as facial expression, body language and verbal fluency to give you cues as to what is really troubling someone, and suggest other areas in which the history might need to proceed. This is very useful where there is a psychological origin for physical symptoms. My undergraduate training provided me with skills in critical thinking. "Remember that speech is not the only means of communicating." Listen first and Listen second. Use other clues such as facial expression, body language and verbal fluency to give you cues as to what is really troubling someone, and suggest other areas in which the history might need to proceed. It is important to have open questions. This gives the patient a chance to express what is on their mind. Open questions can be used to get specific information about a particular symptom as well. Open questions cannot always be used, as sometimes you will need to delve deeper and obtain discriminating features that the patient would not be aware of. However, they should be kept foremost in the mind as a way to broach a subject or unexplored symptom. Leading questions are best to be avoided. They tend to lead the patient down an avenue that is framed by your own assumptions. It is much better to ask an open questions. Also it's always a good idea to ask the patient if there's anything they want to ask you at the end of a consultation. This can help you to impart further information if there's something they haven't understood, and can reveal something that's been troubling them that hasn't been touched upon or got to the bottom of. It is an opportunity to confirm that a shared understanding has been reached between doctor and patient. Link to comment Share on other sites More sharing options...
BruceBanner Posted March 23, 2015 Share Posted March 23, 2015 I've only been a PA for 3 years, but here's a few: -Don't get cocky. Ever!!! -Common things happen commonly. -Touch your patients when speaking to them. -Give patients your assessment, but always let them know they have a choice. -Ask them about their personal lives. Job, spouse, kids, hobbies. They will be more inclined to trust you. -ALWAYS follow a complaint of chest pain, no matter how innocuous, with due diligence. -Don't haphazardly Rx opiates just to get someone out the door. -Never believe a drug addict. Approach anyone on long-term narcotics with a healthy dose of skepticism. -Like the above poster said, a good part of the job is sifting through people's personality/coping issues to see if they actually have a medical problem. -Take pride in your work. Look things up, double-check values, stay up-to-date. Always be examining the things you say to patients. Sometimes we just get into an autopilot routine or tell people things that are not factual. If you don't know, admit it, tell them, and find someone who does. Link to comment Share on other sites More sharing options...
andersenpa Posted March 23, 2015 Share Posted March 23, 2015 I've only been a PA for 3 years, but here's a few: -Touch your patients when speaking to them. Not always Each patient has unique boundaries it's your job to learn where those are in each situation Link to comment Share on other sites More sharing options...
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