Reality Check 2

The only dumb question is the one you don’t ask. I spend a lot of time verifying with my patient that they actually took a med, finished it, took it correctly and aren’t taking stuff leftover from 2004 or purchased in Mexico. Patients don’t remember instructions and are known to not tell the truth. Verifying their understanding and compliance is a normal part of medicine. Document confusion or noncompliance. In a new job - questions should be treated as normal and expected. ANY SP should train or mentor. PERIOD. We have a new grad NP straight from our nursing pool who thinks she knows it all and rebuffs any attempt at mentoring. She is a 5 yr RN plus a short degree with lax clinical. She is a problem that we will have to deal with and I hope she doesn’t hurt anyone. Learn every single day. Never stop asking questions. Medicine is lifelong education.

Your SP sounds like a stereotypical surgeon who is above it all and expects to be pandered to. This gig might not work out for you based on this and a few other issues. YOU HAVE TO SPEAK UP and ask questions. Feeling embarrassed won't cut it - YOU COULD HURT SOMEONE. Telling the SP that you want to learn and do things the way he/she wants it is a good thing in Ortho - they are the surgeon and there is no true independence in ortho. If the SP isn't prepared to take anyone, much less a new grad, and mold them into what they want then you are just a warm body and not someone who can make or break them. Your SP doesn't know what a new grad SHOULD know versus what he/she EXPECTS which sounds unrealistic at this point. How many PAs has this doc gone through before you? How long do they stay? What does the surgeon's license look like online? How many complaints does he/she get? How is the turnover on office staff? Can he/she even remember your name most days? This sounds like a poop show.

I am almost 30 yrs in - learning is a daily thing. I read so much everyday - so much changes - not always for the better and then it swings back the other way a few years later. Aspirin wasn't considered venous thrombotic beneficial in 2009 (only arterial then) but now is - stuff changes overnight. My suggestion - make yourself templates and check lists. I think a lot of us older PAs on here will say that we do things the same way every time - it becomes normal and you don't forget stuff if you do it the same way. Make a pre-op checklist - Xrays - what system, MRI - what system, Allergies, DM status, etc. Don't be afraid of pen and paper diagrams or check lists for exams of shoulders, knees, etc. It will help you teach the patient anyway. YouTube didn't exist when I was in school. There are some good exam videos (and some stupidity, be careful) - be a sponge. Your SP should allow you to shadow on new evals - WATCH carefully. You have to grasp this and want this - this isn't just a job - it is people and their outcomes and livelihoods. If you don't want it - move on to something you do want. Speak plainly to your SP - ask for guidance, write stuff down - show initiative and drive. As above in other posts - you are still on training wheels and it will take a few YEARS to get confident solo.

MediMike Are you putting dexamethasone in nebulizers? A Respiratory Therapist asked my permission years ago in the ER for a patient with very bad asthma. I really liked the results. Does it do any better than oral/IV? Some local doctors are putting high risk but walking COVID patients on oral dex 6 mg TID for 5-7 days. I think they just pulled that out of an orifice but I think everyone feels the need to try something - keep folks out of the hospital or off supported breathing. I do not work first line with COVID folks - I do feel very lucky, by the way. I am very high risk myself. Just curious what works best in your eyes so far with the walking wounded or on the verge of hospital/resp support. Thanks

I live in a county that is embarrassingly outdoing the whole damn state in numbers of cases. Folks just don't get it - or no longer care. Almost 20% of students who returned to a local high school are positive. HOW MANY will they spread it to? How many who will get really sick or die? We don't have a cure but we do know how to slow it down or stop the spread. I am tired of arguing about what needs to be done to protect oneself and others. WEAR A DAMN MASK. DON'T GATHER IN GROUPS. DON'T DO STUPID THINGS. Counting on an immunologic cure or a miracle drug is not working for anyone. There is no magic pill or IV. Nothing will get better until people have self responsibility to do the right thing and be citizens. Darwin is spinning like a rotisserie in his grave.

SCIENCE REAL SCIENCE This article talks about letting the virus go nuts and hoping for the best, basically. The majority of scientists say this is MAD and would lead to "DEVASTATION" https://www.nytimes.com/live/2020/10/13/world/coronavirus-covid VOTE FOR SCIENCE AND LOGIC

I left a solo family practice because the doc had no qualms about expecting 25 patients a day in 10 minute slots. He believed volume = success. Screw quality or time to dictate. It was nightmare. And he was a candy man who wanted patients to "like him". I couldn't do it - and had I still been there when COVID hit - I wouldn't have a job. Or, more likely, he would have expected to keep doing things the same with no precautions and certainly no PPE and things would be ugly. He has gone thru a herd of NPs and a few PAs since I left 4 yrs ago. Government employment has its perks. Working to make numbers sucks - it is a reality, but it sucks. Don't be a money mill or a medicare mill. Be a PA and do good work - I think somewhere else. My old 2 cents

Find another job. Nothing to win with a solo provider who won’t train you in their EHR, has unrealistic expectations and a tight wallet. You are just a mill to churn out patients.... RUN. And don’t type in all caps unless you really are yelling all the time.

There are NO NAMES of leaders in this article but the points are clear and valid. https://www.nejm.org/doi/full/10.1056/NEJMe2029812

Growing up, we saw DOs all the time - military and civilian. No issues. I taught at an Osteopathic PA program. I trust osteopathic manipulation over chiropractics any day. The President's physician caused harm by being manipulated by a celebrity patient. DOs are still rock solid.

A disease with no past, no vaccine and completely unpredictable - kills some, maims others, some go without a sniffle - yeah, let's underestimate that disaster.................... Governors had to do something, the national govt wasn't doing anything helpful. We couldn't just say "FREE FOR ALL" and let folks do whatever - millions would have died. Hello, Brazil...... Shutting down wasn't fun or easy but a choice between life and death.... I will take life please. Everything has a learning curve. Medically, I say damn the economy, preserve life - we can figure it out. Folks in WWII didn't argue about curfews, blackouts, bomb drills, rubber drives, no silk stockings and shortages. They just DID IT to be citizens. Time to be citizens and preserve each other. Medically, I vote to preserve life through vigorous disease management and prevention. The responsibilities of citizenship are there - not free. Suck it up and participate.

Except during a pandemic that has never happened in our lifetime and no one knows how to deal with it. And there is no pandemic team. And there is no belief in science. And there is mental illness involved. Shall I continue............................. UNPRECEDENTED issues

Ok, I'll bite If a country wants a productive work force and GDP, they have to invest in public health and a healthy work force. This is how vaccines caught on for adults - keep people working instead of sick. So, healthcare is a huge hot button politically and socially. As a healthcare provider - I want all my patients to have access to healthcare despite the wealth disparity that keeps widening in our country. A healthy population works - literally.

Camoman - MASKS WORK - WEAR ONE ADVISE OTHERS TO WEAR ONE The virus is airborne and lingers in the air. We have proven that - the stuff hangs out in the expelled air. Singing is worst, talking is bad. My deep sighs of frustration offer a great deal of exhalation. Contact transmission has been shown to be less of an issue than previously thought. I am so done with arguing this repeatedly when we KNOW IT WORKS. I am OUT of this - tired of beating my head on a rock for this. Do what you want. Leave me alone.

I am stepping out on this one. Boats and Camoman are way out there - not a discussion - a lecture. I will continue to wear a mask and do smart things. I will vote how I wish. Science is still real and needs a boost right now. Good day to everyone.