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Everything posted by dchampigny

  1. See if you can do a day in the clinic following one of the PAs around. Then you really get a sense of the day to day operations.
  2. Mistakes happen constantly in health care. Some are of no consequence and never get noticed, others are front page headlines. Certainly after a mistake occurs, we become hyper-vigilant. We triple check the dose of every medication, ask for a "another set of eyes" on that baby with a fever, spend extra time reading our documentation. If you let it, this will consume you. This is unhealthy to your practice and overall wellness. You will learn from it and move on. Medicine offers a lifetime of opportunities. Learn, reflect, adapt and become a better provider for it. You should always have a back up x-ray read by radiology. In our practice, I am asked to give preliminary reads, but radiology always makes the final call. Shame on your SP for thinking you would be comfortable reading chest x-rays 16 days into practice. The blame is more on him than it is on you. If I were you, I would have a candid conversation with him and let him know your concern. Hang in there, medicine is a roller coaster. Every slope down is an opportunity to climb back up.
  3. Is there any rhyme or reason behind this? I too am entering the 1099 world and I was not sure how much I should take out? Does it vary based on total income or 1099 income?
  4. A few red flags here..... 10 days off is only 2 weeks. As a new grad, you will need to unwind. Trust me! The health insurance is the make or break. If not covered, your salary becomes a lot lower. CME should be higher. I would pass on the offer.
  5. yes, everyone thinks that they have it and no, most of them do not
  6. For those of you who work per diem/hourly, if you were hypothetically asked to cover a shift with virtually no notice, what do you think differential should be? Do you make more on holidays? I work at an urgent care and was asked to cover a shift same day for about 4 hours after my regular day in family medicine was over. If this were you, would you ask for more on top of what you usually make due to having to change plans/adapt your life to work?
  7. If you can't come up with a definitive diagnosis and there is question about supplemental information (labs, imaging, procedures) to be done to help clinch the diagnosis, they need to go to the ED. Things I've sent in the past four shifts: two appys (fever, nausea, vomiting, hunched over), both were slam dunks. Syncope of undetermined origin (Hx of a. fib, heart disease etc) 90 something year old with "heart thumping". 80 something year old with rattly chest, confusion, decreased PO intake All were admitted. My general concern is that if I can't come up definitively what is going on, they need a higher level of care. If there is high suspicion for something (pneumonia, pyelo, etc) but I'm not sure they will do well with oral antibiotics, they will go. I'm a firm believer that complicated lacerations and dislocations should go. I'm not about to make something worse by trying to put it back in place if I can't control pain and have a risk of making things worse. I'm also not going to spend 1 hour on a laceration that needs sedation etc. The gut feeling is important. Clinical gestalt is something that comes. Another good thought is that if the thought crosses your mind of them needing a higher level of care, you've got your answer. I learned this from a podcast a long time ago. Another good thought is that if you feel like you'll go home and lose sleep about them, they should go (I.e., I wonder what the white count was, I wonder if they are able to keep their doxycycline down). One thing that I'm trying to be better about is that if the patient is leaving personal vehicle reminding them of the Monopoly saying "Do not stop at go. Do not collect $200". I notice a lag time between when I send them and when they arrive, sometimes a couple hours. Our ER is at most a 5-10 min drive. I always try to remember patients who might need surgery to ask them not to stop at Chik Fil A, etc prior to ED trip.
  8. I think it varies based on the medicines. Our clinical staff are trained to do all of the above research before sending a request to us such as seeing when patient was last in the office, when next appt is, are they filling it routinely etc. For regular medicines, I am fairly lenient. I will look in the chart to double check that the patient has been coming in regularly. An extension of this is making sure they have an upcoming appt. A lot of times it is an education thing. Sometimes I will get a refill for like 90 tablets of lisinopril with 5 fills and I educate the staff to make sure patient has a lab slip and an upcoming appt. I see it as an opportunity to help them learn about hyperkalemia, etc. But usually I will go in and change it to say, patient will get 30 tablets with 1 refill and would recommend they get a BMP drawn. Patients should know via their contracts that any refill can take 48 hrs to process. For example, with controls, our clinical staff know to look up in the data base when the fill was and talk to the provider personally if there are any "red flags". If there's any doubt, the prescription can wait a day or two to be filled. Patients should be accountable about not calling the day they run out of their med.
  9. No bearing whatsoever.... And while we are at it, neither does GPA or Board Score. As long as your name is followed by a C, that is all that matters.
  10. It took me way too long to calculate that per month salary into a yearly salary.........long day. Sprint don't run.
  11. Get out while you can. I fear for the patients being cared for at your facility (no disrespect to you), but most of that sounds like a recipe for disaster. What do you do when two patients crash at once?
  12. Education is really important. Likely the provider who was writing for 1 MG xanax 4 times per day did not sit down with the patient and have a conversation about the Beer's list, falling, addiction. A lot of folks will respond well to explaining the dangers of the medicine(s) they are on and realize the true dangers associated with some of the medicines. The ones that are motivated to get off it are the ones who stay....
  13. Our hospital has a simulated care through occupational therapy that tests reaction time, motor skills. Very, very useful. I've found driving evals to be a very touchy subject....not an easy thing to do. On a different note, what are some medical indications to take a license? The obvious ones would be seizure, syncope, etc. Any specific cut off in your state regarding A1C?
  14. I'm still stuck figuring out how holding my hands too high in the OR contributed to me breaking sterile technique from back in PA school.
  15. There is a function where you can put in a paragraph and then save it under a catch phrase: Example: I type a paragraph for well adult exam: it talks about USPSTF screenings, diet, exercise, stress. Each time I say "Dragon Well Adult" that whole paragraph comes in. For a healthy male in his 30s who comes in for a physical without any acute complaints, sometimes the note is already completed before I'm out of the room. There is no limit to them, I have about 35. Maybe half I use regularly. But even for acute things you can say "Dragon viral URI" and have pre-typed up instructions
  16. Make it so a normal physical exam populates automatically into your note. Save templates for normal assessment and plans: "hypertension has been stable, tolerating lisinopril without side effect. Continue to work on diet and exericse. Follow up CMP in 6 months". Adjust as necessary. Let your MA/LPN work to the top of their scope. Train them to call patients with normal labs/imaging/etc. Get dragon if you do not have it. Worth the investment.
  17. We use Dragon, which is an absolute life saver. I can simply say "normal mammogram" and it will spew out all of the information that the patient needs. MA reads most of labs: for abnormalities/concerns I will sometimes call personally. Forms continue to be a challenge.
  18. Look for IMPACT testing online. This is what we do in our area. You can actually be come a Certified Impact Consultant. I think the 6-7 hour course is about $1000. I am currently taking the class.
  19. There is much, much too much to be imagined with this offer. Keep looking.
  20. I'm a newish PA (about a year in) and am looking to sign up for some CME to do at home. I had heard about Audio Digest from a couple of colleagues. Anyone have any experience with this? The flyer states that if you sign up (I'm family medicine) that you can get a $500 amazon/apple card.....pretty appealing, but if I am going to use a majority of my CME $, I would like to make sure I also get a good amount of information from it. Any input? Any other CME?
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