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About d-wade

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    Physician Assistant Student

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  1. I like being a PA. We seem well respected in the medical world, and the comments I've heard from other providers, including NP's and MD's/DO's seem to reflect that. We've developed a niche in the procedure and surgical world, as well as being highly valued in other fields for our high standards of education across the board, and for our adherence to the medical model. We also seem to manage a pretty high level of standardization of our education, rather than an education system that is variable in preparation, or in rotations. I see in the future less HCE prior to school, and more of us going into a short residency, which will further delineate us from our NP counterparts. I don't think the solution is piggybacking onto the NP lobby, but rather spearheading our own path, and further developing our own niche.
  2. That would certainly suggest a physiological addiction process, which seems highly likely. A good follow up would be a comparison of withdrawal profiles, particularly long term relapse success.
  3. Lots of anecdotes in this thread, no great evidence. Kratom is an opioid like substance that partially acts on the opioid receptors, while suboxone, or methadone are opioids themselves, albeit the prior with naloxone to prevent overdose. The argument seems to be that because kratom has a partial effect on the opioid receptors, it is dangerous... which is a fallacy if you accept that suboxone itself is safe, which also agonizes the opioid receptors. Overdosing on Kratom alone as far as I can tell is very rare/difficult, and overdoses that do produce death, almost always involve something like fentanyl and alcohol in conjunction. The same of which can/does happen with suboxone, to my knowledge. As far as the argument that Kratom is addictive, well I'd say that's true as it partially interacts with opioid receptors and when you come off, they don't like being unoccupied. Suboxone has the same effect, is an opioid itself, and is highly addictive. So much so that the most recent evidence shows that we have much better outcomes when people simply stay on suboxone indefinitely. Treating substance abuse disorder similarly to hypertension. I have a friend (once again, unfortunately an anecdote in the absence of studies), who is doing great on kratom, and a functional member of society/professional. Hasn't used in 5 years, and is even tapering the kratom. Obviously safety trials, and dosing needs to be established for kratom, before the medical community can recognize it, as we are evidence based. My fear is that kratom will suffer from the fact that is a useful herbal medicine, and cannot be properly patented, and monetized... unlike suboxone... a life-saving drug, that is also a major cash cow. The blowback to me, feels manufactured and sensationalized as a reflection of that propaganda. Propaganda, because the evidence of the dangers is based on loose evidence, from those who wouldn't accept so much loose evidence for other facets of medicine.
  4. You're right literally/technically, just not figuratively. Doctor, and physician doesn't necessarily mean MD/DO, however, in practice we know what physician or doctor means. This is as simple as it becoming common use after really what was a hijacking of a somewhat general term. It would have probably been more correct that they call themselves MD's, or DO's all this time, or some other proprietary term, rather than a general term, but that's where we are at. In appealing to tradition, but really, just to avoid confusion among patients I don't think we should start using the term, even if it is technically true. As a huge addendum to this, it really calls into question the name of our profession. If the previous is true, then why is Physician's Assistant not accurate? Why do we get so up in arms about the possessive s? Does Physician assistant imply that we are indeed physicians, just assistant physicians? If this is true, then we definitely need a name change by MD/DO's logic that we are "non-physician providers". And if the prior is true, that we are actually just Physician's Assistants, then that is simply inaccurate by virtue of our job description, or at least many of ours. In conclusion, while we should respect the term physician, we shouldn't be afraid of any of the kickback in pursuing the name change. We also shouldn't be afraid of any kickback of the term 'provider' 'clinician' 'medical practitioner', etc. It's ridiculous that any name besides assistant is unacceptable to many in the physician community. Nurse's don't have this same problem; nowhere in their title is the word assistant. We need to find our identity as a field, and that is not as assistants. Medical assistants already have that identity.
  5. Honestly I agree with Lt Oneal up there. You need to re-establish your confidence, and if you have to channel the energy of someone you look up to... or a fictional character i.e Dr. Green... etc then do that. Basically start acting. I think if you can put yourself into the proper mindset you will stop second guessing yourself, and you will be surprised at how competent you really are when you're not having mental blocks secondary to what seems like extreme anxiety due to past experiences and maybe a little bit of your natural disposition. Additionally, it's OK to ask questions, and when you do so, do it with confidence; square up your shoulders, don't hunch, stand straight up, make good eye contact and be deliberate. It's okay to seek therapy for your issues as well; you aren't unique; plenty of people have gone through this.
  6. The two + years I've spent in long island and NYC have felt like a constant cash hemorrhage. Boats touched base on a bit. It isn't just the rent, everything is expensive. There are too many people, and the demand is too high for goods/services. The salaries here are honestly pretty average - because once again there is a high demand to live in a 'cool' city. Other professions can do quite well - for instance nurses absolutely kill it here in NY (from my understanding). I don't know what your normal standard of living is, but expect an overpriced tiny apartment, or living with roommates, and never putting away any money. Oh yea, and make sure you get a water filter, because even in Manhattan there are hot zones where there is 3x more lead in the water than Flint, Michigan.
  7. I'm a new grad, but in rotations I would just give a brief risk/benefit, and make note of the harmful effect on the microbiome, then give a time frame until abx were warranted.
  8. You can turn FFEL's into direct loans I believe.
  9. The anticipation from the incompleteness of this sentence is killing me buddy
  10. Also in loan re-payment hell and pursuing PSLF. My thoughts are to consolidate under Fedloan, as they are the ones who verify your payments for the forgiveness. Might as well not mess with an outside loan service and all that (i.e great lakes or navient). If the PSLF does screw us after 10 years, there is always the 20 or 25 year IBR forgiveness (not excited about that). IBR is at 10% of discretionary income, so it's not an incredibly high monthly payment on a PA salary ($560 or so every month). Additionally, you can deduct interest paid on loans, so during those 10 years there is at least that. I am applying for loans to buy a home in a couple of weeks; I'll update you on how it goes if you remind me via message.
  11. I really liked my endocrinology rotation. Lots of diabetes, osteoporosis/zoledronic acid infusions and thyroid disorders including nodule workups/FNA's, RAI's. Commonly saw prolactinomas, PCOS, calcium disorders, occasionally non-congenital adrenal hyperplasias, and sometimes incidentaloma workups. If you work in a hospital clinic, there is a lot of consults for insulin management of inpatients while they are taking steroids, or for the psych inpatients. It's a very functional science, and it the management of diabetes beyond lab numbers is a lot more complicated than people think if you keep up with the research.
  12. Kind of illustrates the necessity of a name change, once again.
  13. It should be noted that these were case studies on 3 boys, not necessarily established science, and things that need to be studied further to establish conclusions.
  14. Scribing is great experience; you're with the doc 24/7 and you're present during critical interventions recording measures. You'd be surprised at how much experienced scribes infer from their own experience rather than dictation from the doctor. If the doc knows you, there is a lot more trust involved, and a good scribe will make suggestions if the doc missed something (with a lot of tact). Plus they check your note anyway. I worked in a mid-sized E.R and the doc's trained us really well, and provided a lot of invaluable education. By the end of one year, I felt I could perform emergency medicine from an algorithmic standpoint. I felt much more confident the PA and NP students rotating at the emergency room at least. When I went to PA school everything clicked, and my emergency medicine rotation felt very easy.
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