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RealityCheck

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RealityCheck last won the day on September 2 2015

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  1. RealityCheck

    PAs asking to see MD Only?

    I had that happen a few times in a specialty but not many. My ortho patients really liked me and it made the surgeon mad because they would often ask if they could have their next appt with me instead of him. Oops. Guess I have a personality and actually explain things clearly. It did not make our relationship any less awkward than it already was. The office staff is very clear about who the appointment is with. I had one guy throw a fit when he found out I was "only" a PA. I told him he could reschedule with the surgeon and the next available appt was 3 months out for a new patient - he was so rude - I told him all that politely and then left the room telling him to decide how he wanted to proceed and go see our receptionist. Some of my new intake ortho patients were docs from other specialties who had bad habits like trail biking and mountain climbing and they were always pleasant and very open to explanation as ortho was not their niche and they were in pain and couldn't work 100% with their current injury. It usually worked out well. I try to give patients an explanation - no song and dance - just remind them that they took time out of their day to work on a problem and they were in the office and I was in the office and we had some time together - would they like to work on their issue….. worked most times. Education, education, exposure, exposure, professional promotion, professional promotion…… PAs need a LOT of professional promotion that we aren't getting.
  2. RealityCheck

    Medical history on work physical

    Some employers have not updated their forms since the 1960s. Not kidding. I just did a DOD physical on a retired Vietnam Vet to go to Japan for "security" training. This guy just oozed Blackwater black ops vibes - very weird. The DOD forms were unbelievably bad - the bottom right corner of the form showed "Rev date 6/1969" - I am not kidding. The form had STD questions and vague references to mental stability and psychosis. Completely inappropriate and out of date but all I had to work with. A lot of employers have no idea what they are doing or what is legal, ethical etc. Someone somewhere got this physical form going and no one ever changed it or looked at it. Read a current DOT physical form - it isn't great either - Yes or No and NO is normal - huh? So, do right by the patient, I always say and, I agree, if it doesn't apply to the job activity, it is not the employer's business. We also just had a guy walk in wanting a physical to clear him to swim the English Channel. No guidelines - just a very badly photocopied, crooked copy with one paragraph and a space for medical provider signature stating this person could "attempt" to swim the channel. We deferred him from our walk in clinic and stated he would have to establish with a PCP to have PFTs, EKG etc to get this kind of clearance. The guy is not a swimmer by sport and had never done a triathalon much less marathon. A walk in UC clinic is NOT the place for these kind of physicals..... My 2 cents
  3. You polluted at least 10 threads with the same questions. Really?….. Stay on point - that is annoying.
  4. It is also very common in Eastern Indian Medicine to have a healer - usually an elderly female - present at birth and she adjusts the baby's chakras by holding it upside down and kind of flipping it like an omelet. My weird patient manipulated each of his 6 unvaccinated children DAILY from birth. One has severe Aspergers and the others just aren't quite right. They also home school, don't vaccinate and believe that daily manipulations are needed to keep the body centered. Kind of curious how much traction he put on the kids' spinal columns and brainstems during those crucial developmental years……. We have had local chiros telling parents they can fix allergies and ear infections with adjustments and there are at least 2 chiros in town who hold "special certification" in Sports Medicine and want to work on ADOLESCENTS by doing adjustments and helping them with strengthening and core training. One of my kid's soccer coach tried to force us into paying $110 for the players to "participate" in the training. The coach knows what I do for a living and I made it painfully and rather verbally clear that under no circumstances would a chiropractor be touching any member of my family and particularly NEVER one with open growth plates and those pesky nerve roots in the neck and spine. He was appalled that I wouldn't incorporate "complementary" medicine into my family's healthcare. I hung up……. My kid moved to a new club for soccer. I too am appalled at the scope and breadth of their stretch with little to no scientific backing or logic. I find it strange that people will come to me demanding a pill for everything and would still trust someone to violently thrust their neck and "cure" them. Seems contradictory at best. I will keep fighting the good fight for my patients to receive sound medical care. The battle rages on…..
  5. I have never worked "with" a chiropractor because we simply do not speak the language or seem to understand the human body in the same way. Chiropractors have never communicated with any of the PAs or MDs or DOs I have worked with in either Texas or Washington - nothing collegial. I too am appalled by adjustments forever and ever, amen and the ever present leg length discrepancy and abnormal spinal curvature and those pesky ribs that keep coming out...... One of my weirdest families was led by a DC dad with 6 unvaccinated kids whom he adjusted DAILY since birth but all his kids were on State Ins because he wasn't a successful chiropractor. They were first to call with any sneeze, cough, etc and wanted Kenalog injections YEARLY for everyone because allergies were just too tedious to cope with. Absolute hypocrisy in action. As for the original post - professional integrity is priceless and if you are working in a situation where billing supercedes medical decision making and appropriate delivery of medical treatment then --- can you stay there and not risk your professional integrity? You are not comfortable with the interactions and subversive actions and it could ultimately harm a patient. It sounds as though the SP and other docs are not willing to intervene. Easier to say than do - look at what you can change and what it will take and decide its worth versus your integrity and happiness and fulfillment at work. Let us know how it works out. My 2 cents....
  6. I really like the phenergan DM and use it when sparingly. Tessalon works for a lot of people - not the ones who tell that "nothing else works but hydrocodone". One even told me Roxicet - seriously - the ONLY patients I have ever had on Roxicet were on hospice…. I talk about atelectasis and suppressing central breathing effort and won't give any narcs to my severe COPD patients - waking up dead not an option…. My favorite at home lung exercise - have them buy a pack of party balloons at the drugstore when they pick up their Rx - not water balloons - the bigger ones. They have to blow up one balloon every hour on the hour while awake and cannot blow up the same balloon twice. It is better than incentive spirometry in my opinion. The most common uses I see for codeine are surgical short bowel and using codeine 30 mg TID to slow down the bowel a bit a few leftover "migraine" patients who get #12 T#4 every 90 days and that keeps them happy and out of the ED. Stick with phenergan DM. Compazine and the tremor side effect sucks - super hard to regain patient confidence once they have had a significant side effect. My very old 2 cents…...
  7. The ortho offer sounds awful and very gruntworkish, if that is a word. I wouldn't commit to every Saturday, ever - unless some magnificent ER position came about that offered multiple days off in a row. Anyway, the ortho offer doesn't sound healthy. Be careful with the transplant and night shifts - they can make you batty and aren't real conducive to spouses and children who live during daylight hours. I have never been paid overtime - always an exempt full time professional employee. Take care of yourself and hope it works out well.
  8. Epic has a version called ASAP that is supposed to work in UC/ER settings. My now previous corporate employer uses that for UC/ER and the clinic system for all other entities/clinics. The UC staff is Meh about it so far. They make it work for 12 hour shifts with 3 providers seeing 140+ per shift at UC. The corporate behemoth has gaggles of geeks who come "train at the elbow" for go live or new training. The corp suits haven't let any MD/PA train as super users and I doubt they pay ANY of the staff from Epic. Do not see corp suits allowing that. You get the "prestige" of having a superuser logo on your badge as an MA or rare RN or manager. Which I am sure goes a long way to paying bills and making one feel valued.... I cannot imagine a go live with no extra staff and an MS4-plus-one-day resident. Nightmare scenario. All my condolences and hopes for survival!
  9. RealityCheck

    PA vs MD didactic portion

    My take is a tad different: I cannot remember who introduced this idea to me but it has stuck with me all these years. I understand the basic pathophys of disease processes. I am not a research scientist nor an epidemiologist - the PA strongpoint is helping the PATIENT understand their condition in terms that they understand and makes sense to them. My patients could care less about Krebs Cycle or nephrons for the most part but want to know why their kidneys don't work right. They don't get endotoxins and gram negative - they understand sick and feel like crap. If I can explain it to the patient and family and they gain understanding, comfort and can participate - all the while the patient has received the right meds, IVs, labs etc from me -- we have a winning situation. The best compliment I can get from a patient is that they understand their disease, illness, injury and know how to help themselves. Not to say physicians do not know how to do this - I am not sure it is stressed in their education or demonstrated. My program all those years ago touched on a key to healthCARE - education and participation. In moments of bitterness or feeling unvalued - I have wanted to prove my worth and take the FLEX and become a doctor - but wouldn't want it to change the provider I have become over the years. I know what I know and don't know and know where to look for answers. I have to be proud of what I do and stop comparing myself to other professionals - no purpose in it. Yep, old and waxing philosophic.....
  10. RealityCheck

    GI offer

    It is not logical nor sound medicine to see anywhere near 60 patients in an 8 or even 10 hour day. That sounds like the Russian assembly line cataract surgeons who might not even wash their hands between patients. I would not want to be a patient of that kind of practice either. My thought would be to consider the integrity of being associated with a practice that pushes that kind of agenda.
  11. RealityCheck

    Online PA Programs

    We still aren't addressing quality versus quantity. No program should graduate 300 PAs at a time - just ridiculous. No new programs should be accredited without an overall look at the number of schools, number of students, percentage of PAs who might be retiring and the market. Flooding the market with newbie grads is not good for our profession or for those of us who are still in the workforce and need to be here for another 20 years or so. So, I still do not endorse online education of our profession but I am more worried about overwhelming the market with tons of grads who come out in mass numbers with not enough docs or jobs. Also, I could care less if it is Yale or Cornell or whatever. Reputation - meh. Do you know what you are doing? Are you a good PA? One of my kids had a teacher in middle school who went to Grad School at Duke for Poli Sci. He had a certificate on his wall for his Masters. He often pointed at it while teaching and said "As you know, I went to Duke for my Masters AND that said, I know blah, blah, blah". Somehow, his certificate was taken down and a new sheet was put in front from the Muppet University. It took him a while to notice. It was hysterical. Moral of the story - don't talk down to me or be grandiose because you went to X University. One of our Presidents went to Yale and he is an idiot…… I am more impressed by what you do and how you act than where you went to school. Education does not equal wisdom or talent. Nor does quantity equal quality. My very old 2 cents.
  12. RealityCheck

    Online PA Programs

    I just found this thread and started at the beginning. I have to say I am AGAINST anyone becoming a PA by online training. The camaraderie with your peers speaks volumes about your clinical abilities and since our profession is dedicated to patient care which involves one on one interaction - I firmly believe the interaction should start on day one. To be quite frank - some folks in my class 25 years ago were complete flakes and it showed in the classroom and in doing physical exams on each other with a proctor and in their ability to group-solve and interact with the general public. Some folks just aren't cut out to be PAs or MDs for that matter. Those people who stood out as poor communicators or selfish loners with superiority complexes did NOT make it through my program in Texas. I wouldn't want to waste the space in any class for someone who can't cut it. As I posted elsewhere - Quantity does NOT equal Quality. We need good PAs not a lot of mediocre or Meh PAs. Unless our legal standing changes, we are going to flood with the market with newbie grads who will either have no docs or jobs or will diminish the earning capacity and put us old folks out of work by taking lower salaries in hopes of paying off their staggering student loans. More is not better. We need quality and that only comes from hands-on in my opinion. I would vote against this type of educational model. PERIOD.
  13. RealityCheck

    Urgent care offer

    My husband makes more as an electrician WITH benefits. Ouch! That is a painful offer. I haven't seen UC less than $65 per hour and even up to $80. I have never had to carry my own insurance….. What a world, what a world…...
  14. RealityCheck

    Best note-taking apps for PA school?

    I have a connection between written notes and my brain. I can tell you what color I wrote in and what part of the page it is on. If I write it - it has a permanent place in my brain. 25 yrs in, I came from the days of xrays on actual film and paper charts the size of phone books and written notes or a transcriptionist. I still firmly believe in pen and paper......complete w doodles, to-do lists and the occasional coca cola stain.....
  15. I always tell people I am not a possession - then I have to explain that an apostrophe makes a word possessive - deep sigh - basic grammar….. Anyway - I agree that someone who has researched the profession would and should know. Unfortunately, I still to this day see business cards with the 's and I see corporate medicine announcements with the 's and I cringe. Evidently, editing, copywriting and general proofreading is a thing of the past. If spell check doesn't catch it - it can't be that bad. Then, you add iPhone autocorrect and we have a whole new era of painful and unfortunate wordings that don't get caught before we hit SEND or publish the damn thing. To show how old I am - we need to go back to teaching cursive in school and how to use a typewriter….. and write a basic business letter. I fear my teenagers will write business letters in text-ease and a bigger fear that someone somewhere will think it is ok. I will go back to my rocking chair and candle and read my hardback book now……..
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