Reality Check 2

I have had one VA patient ask so far. More paranoia factor. No travelers yet. We have instituted questioning a la Zika and Ebola about travel. Currently still more worried about my CHF and COPD patients who won't get a flu shot..... Our global community comes with some serious consequences - wouldn't change it per se but we can do better.

I am in Washington state - Ground Zero for US first case - yay me................................... not

I have both confronted or engaged the offending provider in conversation regarding issues of care or follow up and I have reported a provider to powers that be for flagrant and dangerous behaviors. It depended on the situation for me. When the provider was one who to could handle collegial conversation - I engaged and we talked things out with both learning something. The impaired ortho provider was a danger to any he encountered and I found written and radiological evidence of his dysfunction and presented it to Medical Director noting that if it was not acted on by his administration then a letter would be sent to the State Medical Board outlining the danger. They acted. I could never stand by and watch a provider/nurse - anyone - harm a patient or do something blatantly stupid or inane. And I am not good at being quiet...................

I am sorry but my only thought on anything telemedicine for anything other than psych is - NO. Hate it. Sad state of affairs in ruining the art of medicine and personal interaction and humanity.

Even the 4000 yr old system at the VA has an Rx system that FLAGS allergies, creatinine etc. If I try to sign an RX that violates allergies or GFR - it hard stops until I bypass with commentary typed in - ie. “tolerates cephalosporins” with PCN allergy. It pulls crt and GFR on rx’s that care about those measures. This is just bad medicine. Bad hx taking, bad exam skills, poor judgment. My PawPaw was given Levaquin yrs ago on Coumadin in a Texas UC. 3 days later - INR 8 and a hematoma on his kidney. Small town ER with HUGE retired military elderly population. All I could do not to call from 2000 miles away and chew someone’s butt. Instead of the Hippocratic oath - how about - DON’T DO STUPID THINGS!

28 yrs in for me. Nearly 55 yrs in for the profession. We got a crap name - we have evolved and proven ourselves so many times now - we can't let a name kill us. I am not sure a name is all there is to this - or any job. Help people - help patients - do good things - do good things well and with style. When someone asks who you are - you can honestly say "I am the medical professional who helped you. Titles don't matter". Just in that kind of mood today - everybody work - everybody work together ----------

I have seen provider patients who are on the state monitored rehab program and have to report everything. They have appeared grateful for the chance to get their licenses back or keep it with restriction - they seemed motivated. Hate to hear that anyone loses the battle with an addiction. Always wonder how they got there in the first place. Firing that provider increased despair and eliminated a lot of options - I think folks deserve at least one chance to participate. Hope that PA has support somewhere and feels strong enough to let someone help. Sad state of affairs

We stick with old fashioned toys that require imagination..... Lincoln Logs in a big tin. Legos forever. Wood building blocks. Cars of all shapes and sizes and a rug that goes in the bedroom floor that has a map of a city with roads, etc. Costume pieces - pirate dress up and a big cardboard box. Any kind of dress up imagination works well. I do like the experience thing as well - my kids were better with it at a bit older age. More appreciated. Too many electronics and not enough self brain work, in my opinion. I was a Tonka Toy girl. I had the ones you could actually ride on in the yard when I was a kid. LOVE those things. Got to drive a real backhoe for my 30th birthday (moons ago) and dig holes and stuff. THE BEST. Enjoy!!!!

I am now wearing the in-house brand of The Walking Company - Abeo. Abeo makes shoes and sneakers. They come without insoles and the staff fits you with insoles that match your stance. I pronate so I have stabilizing insoles - similar to how Brooks and other high end running shoes do their fits. They are incredibly comfortable and the store gave me a medical worker discount. They also sell Danskos which I don't find comfortable. I have a sit/stand desk but no shock mat. These hospital floors are not forgiving.

That survey was bizarre. Not able to NOT pick adjectives to describe something - HAD to pick words that didn't even come to mind. And no choice for WTF? Bizarre. Pretty sure this group was next door to a cannabis test room and they just pulled names out of orifices..........................

haven't received any such survey...... who sent it out and when?

Met my next new PCP today and had a great visit. Respectful interaction and he appreciated that I typed out my medical hx for him. Spent time talking about things affect me and what could/should/ needs to be addressed. My BP was great - I wasn’t stressed about talking to him. So - good match and mutual respect - deep relieving sigh.....

https://issuu.com/paassist/docs/aapa_summary_of_physician_assistant_ownership Found this on a google search. See the state by state listing at the end. Not sure of the provenance of this document - who wrote it etc, but it has some good info.

I will likely stir up my millennial counterparts but - oh well, here goes..... Overall, I think we have lost some human touch and politeness as a society and think of things in Text Mode or online - no emotions detectable in many cases or taken out of context in others. We have forgotten common human decencies and social skills. We rely on technology too much and think everything fits into a neat little box of Evidence Based Best Practice. Maybe we are training new providers to be less human, less interactive and more "diagnostic" or scrutinizing. I don't think it is a good thing by any means. Somehow we managed to establish with patients, diagnose and care for folks without UpToDate, without a computer and without Google for a very long time and without telemedicine, stereo stethoscopes, etc. I fear we are losing our humanity and interpersonal skills. The internist I just saw could be a MENSA scholar, valedictorian and booksmart out the yang but she wasn't a warm or engaging person and she didn't want to actually listen to me or hear who I am or where I come from. I have to remember that with each of my patients. Some are highly educated, some are type A, some depressed and some not mentally capable of making self care choices. We can't lose our humanity or capacity to care for people as people - not statistics. Ok, done with soap box............................

For those commenting on the handshake issue - YES, I get the infection thing. But, my point is...... YES, it DOES affect the interaction with the provider. NOT acknowledging a patient's existence with even a common courtesy sets a poor tone for the encounter - I get more polite interaction with the kid at the local coffee hut than I got from this internist. NEVER saw her before, know ZERO about her - the corp med did NOT put her bio online. She did nothing to set the tone for the interaction - no introduction - such as - "Nice to meet you. I know you were a patient of Dr X and she went to full time teaching. I would like to hear about your needs and concerns". Instead I was another sheep in the herd of her daily patients with no more concern for me than someone in line with her at the bank. She mumbled that her name was Dr Y and went into my med list as though I was nothing more than a statistic. Common decency and politeness are professional necessities. I have worked with my share of colleagues who have borderline Tourettes or appear to be on the autism spectrum for social capacity but interpersonal skills are necessary to work with patients - Especially patients never seen before. Instill some confidence. Show some empathy. Be human. Then we get to the point of having no respect for any knowledge I might have - whether I am a plumber or experienced provider. And, I do shake a lot of hands and wash them a lot and offer hand sanitizer to the patients as well. And, yes, some patients hug me. So, back to original post purpose - as a medical professional do you have a good relationship with your own PCP?