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EMSGuy1982 last won the day on January 11 2017

EMSGuy1982 had the most liked content!

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About EMSGuy1982

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    Physician Assistant

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  1. EMSGuy1982

    PA/Provider Burnout

    49 patients in 10 hours is insane. I switched to rural medicine about a year ago because in the UC I was previously at would consistently see 110-120 in a 12 hour shift split between 3 providers. Left most nights 2+ hours after closing due to patients coming in last minute or getting documentation finished as I will not do work on my own time. Now see 40/day between two providers on a “busy” day. I do see higher acuity patients where I am now but would gladly trade high volume/low acuity for lower volume/ higher acuity any day. To the OP: Hopefully decreasing your hours/days will help. Has the topic of a “closing policy” come up with the higher up’s? Implementing something like if say you close at 8pm that if there are more than two patients per provider in the waiting room an hour and a half prior to closing that you can stop registering patients to be seen? Might be worth asking for your own sanity at least.
  2. EM RAP is solid and uptodate material and it’s relatively cheap (under 400). I purchased the Urgent care version and enjoy getting 3.5 CME hours after every full episode. Listen, take a quiz, and they keep all of your CME backed up on their site so you don’t have to print and file it away.
  3. https://m.youtube.com/watch?v=jjCu4nxOHlQ My favorite interpretation of patient satisfaction scores... I once told a patient I was not a kiosk like you find at McDonald’s. Their reply was “Not yet you aren’t.” (Facepalm)
  4. All day interview? Gives me flashbacks to my PA school interview. Is this more of an excuse for the docs to go out to a fancy meal on the company dime? I agree it would have been nice to have them confirm a date with you prior to tossing an itinerary to you.
  5. Also, I believe the recommendation is 6 weeks before imaging for non traumatic back pain. I’ll do a prednisone taper on folks with chronic lower back pain that are already on a boat load of narcotics + gabapentin ect ect.
  6. Pretty sure it was last month on UrgentCare RAP where they covered a case of a 60+ guy with lower back pain. Given muscle relaxers. Got worse. Went to ED and subsequently got admitted.(forget why. Perhaps INR. Pt was on anticoagulant). Hospitalist sees him and pt gets worse. End of the story, spontaneous retroperitoneal hemmorage. 3 providers missed. Anything can happen folks. Age 60+ With anticoagulation + back pain. Keep that differential wide open
  7. EMSGuy1982

    Verified PA only section

    Battle star galatica is right up there as well
  8. EMSGuy1982

    Verified PA only section

    Han Solo was even worse than the spin off movies of “The battle for Endor” and the Caravan of courage movie...
  9. Assuming credentialing would take about the same amount of time regardless of job as a new grad leads me to believe that “retail” might mean working at Lowes , Home Depot, or others during the holiday season. I’d say take the time to reconnect with family and friends. After all, you were probably nonexistent to them for the last 2.5 years. I do understand the urgency of starting to make money with the student debt looming over your head though.
  10. EMSGuy1982

    Question for my fellow colleagues

    I definitely agree about <100,000. I’ve even had a few cultures come back with less than <100k who had a positive dip with leuks and nitrates (thus I try not to get to excited about dips) I still typically go for PO for results that come back with Gardnerella but a few other PA’s opt for the metrogel. I typically don’t just do a typical dip on women over 65. I try to do a symptomatic urinalysis with a reflex to culture if indicated to try to tease out that dysuria vs an atrophic vaginitis. I often question if the sample is really a clean catch vs dirty even though nursing staff gives directions every time. That whole following directions thing doesn’t work for some people. ? I definitely see a lot of those elderly women that think they have recurring UTI that fall into the same category as the one you mentioned! Thanks for all the responses.
  11. I once told a patient who wanted Norco for his sore throat for a whole twelve hours “No, narcotics are not indicated” and after they changed their tone to the “I know what I want and I want it now” I reminded them that I am not a kiosk at McDonalds and their reply was “ Not yet your aren’t”. Still left with no narcotic and surprisingly (insert sarcasm here) gave me a 2/5 stars on a yelp review. True story. ?
  12. Sad to announce that MEDEX northwest (University of Washington), where I graduated from was the only remaining Bachelors degree program left on the west coast and fought against the push for masters only option has stopped their bachelors option as of last year. I practice medicine everyday with a bachelors and see the same patients my fellow PA’s with masters degrees and I don’t feel incompetent. It’s a shame since I believe some folks who are considering our profession after a long stent in another career ( I made the decision on becoming a PA after 13 years in EMS) who might become great PA’s would see returning for a masters program more daunting.
  13. While working a shift in my rural walk in clinic/urgent care another colleague (PA) and I were discussing urine cultures. Lately we have had a run of cultures coming back with a result of Gardnerella vaginalis from the lab. These appear with varying degrees of amounts 50k- >100k as a final result. Some with coexisting e.coli or other organisms. We were discussing treatment options. Some fellow colleagues, including myself are in the camp of treating with Flagyl 500mg BID x 7 days. Two other PA’s in the clinic opt for the metrogel topical/intravaginal. I’ve seen a few bounce backs from those who received the gel and wondered if oral is the way to go. Just wondering if anyone wanted to share their thoughts. I’ve attempted to find some literature that discusses oral vs gel and have come up with nothing. On one hand I could understand the gel preparation having an advantage given it’s not a systemic drug, but I keep thinking that this is a result of a clean catch (if the patient folllowed the MA/LPN directions) from the bladder so I can’t see how a topical would be of benefit. Any comments, references to articles appreciated! Thanks in advance!
  14. I did invite them to my clinic. Doubt they will actually come but at least I offered. Thanks for the advice. Glad my gut feelings are still something I can rely on.
  15. Thanks for your response. I read the same WSQMA and it certainly came to mind. Not a list I want to be anywhere near. I had no struggle with saying no to them. They definitely understood after I explained the huge liability/ ethical conundrum I would be undertaking as not only their friend but as a professional.

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