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Reality Check 2

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Reality Check 2 last won the day on April 11

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About Reality Check 2

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    Physician Assistant

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  1. Reality Check 2

    Share from your personal experience?

    WOW, this is so bad. The grammar is horrible. The structure is so fake. WHY is this on our site? It is obviously a PHISH or a scam for some advertisement or something.
  2. I am not in an ER anymore but have experienced this ad nauseam. My team at the VA now is awesome. I tell my patients we are a team and that the nurses know what they are doing and they should A. Follow instructions at some point and B. Know that we function as a team. In the past I found that once I broke the ice with a few nurses - it worked. Never got along with some - ever. Just how it is. I worked on remembering names. I helped with clean up. My rule of sharps always made nurses happy - I remove all my own sharps - PERIOD. No one touches the tray until I pull my own sharps. I draw my own med if I am injecting - that peeved a few but once explained - they came around. You might have to pull admin in on some of the flat out refusals - that has to stop. Medicine isn't really a choose what you want to do type of thing. I tried the loud verbal thing in the station as well. I would ask - loudly enough for others to hear but not in the hall - "Hey, Cindy, did you see that Mr. B needs to ambulate with a pulse ox? If his sat drops while walking - we have to change our plans." Out loud in front of others sends some peer pressure to do one's job. Good Luck to you - you sound compassionate and thorough - please don't change that.
  3. Reality Check 2

    Unused scripts, resigning

    If in a large enough organization - take them to the ROI - Release of Information or Medical Records or whatever they call themselves these days and watch them be shredded there or put in a locked industrial shred bin. Our shred bins in our room are locked and one person comes by and clears them into an industrial size rolling locked bin. Some places just put an open bin under your desk for shred - nothing good can come from that. If you have a fire pit at home - enjoy....................
  4. Reality Check 2

    Job posting with NP salary higher than PA...

    At the VA - NPs are under Nursing and actually don't fall under Medical - which makes no sense as they are in Primary Care with the rest of us. PAs are under Medical - duh, and we fall under that hierarchy. Different pay scales, different grades and methods of monitoring and scoring. The NPs have the WHOLE nursing union and lobby behind them setting a completely different pay scale. This was just rectified locally for us PAs after strong and much appreciated work by admin to attract and retain more PAs. We are now roughly on the same scale. NPs need to be put under Medical if they are practitioners and not nursing, in my humble, old and much crusty opinion. Tired of the "US" and "THEM"
  5. Reality Check 2

    Job posting with NP salary higher than PA...

    Two Words Nursing Union (or lobby)
  6. Reality Check 2

    Violent Patients

    The VA does whole training sessions on this. Steady voice, set boundaries - "please do not use profanity. We can talk if you can sit down and we can focus on the issues" Sounds hokey but works. Threats don't respond well to threats. Posturing yourself doesn't help. I have 2 keys on my keyboard that - when punched together - bring the police to my room, exact location. I also keep a clear path to the door in my room setup so as to never be trapped. I use my spidey-sense to judge the situation at the get go and have someone outside the door listening for escalation or interrupting at a set time to see if all is ok. My old office had a hot key under the front desk that called the sheriff's dept. Never had to use force but I have stood up and used firm gaze, steady voice and ended the encounter. Threats are serious - reporting them to the police is a must. Keeping records in the chart. ANY threat against you or your family has to be taken seriously. We lost a specialist in town to moving away quickly - a patient's family threatened his children and named their school. He couldn't take it anymore and took a job over 2500 miles away. In a private practice - threats of harm or any type of violent outburst usually meets with the certified letter dismissing from care. Had a guy chuck a waiting room chair in the past - other patients were in the room. The police came - he didn't get arrested but was dismissed verbally and by certified letter and the police told him that because the doc wouldn't press charges (another story) that he wasn't in the clear - beat it, don't come back and they would be checking on him. Set the boundaries - don't challenge - they ARE angry - worry about the rationale later - but don't be a doormat.
  7. I don't like nonfasting lipids - I actually had a guy do nonfasting one day with LDL 160 and Trig 300 and repeated fasting 3 days later with marked reduction in both. LDL now below 130. So, I really have no use for non-fasting labs - my opinion. I have seen the issue and don't think it is worth it to "hope" that a nonfasting is ok. If all the years past - the labs are fasting and we have graphs and grids comparing - should just stay fasting. One day of not eating for 10-12 hours is not going to hurt anyone. We allow our patients to do labs up to a week before their appt or same day. We have a cafeteria - they can go eat after labs and before their appt.
  8. I am Primary Care or more accurately Internal Medicine at the VA. We don't have as much paperwork as we have computer communications - referrals, updates, refills, specialist consult results, etc. I answer computer driven messages and documents a lot. My day consists of annual exams on very complex internal medicine patients, mostly male. A problem oriented visit mixed in a few times and the walk-in issue that the RN wants me to see. My max patient load per day is 14 with 30/60 minute appts. My job is not for new grads. Period. You have to have time under your belt and prior exposure to a lot of complex medical issues to be in this position. It can be daunting and tiring - a ton of psychiatric issues and lots of polypharmacy with overlapping intense medical problems - CHF, DM, Afib, HTN, lipids, psych, thyroid, derm and a lot of ortho issues, a lot of neuro issues - all in the same patient. I am blessed with an LPN, RN and my own clerk. I have two PharmDs in my hall, 2 psychologists and several social workers. I am not alone. Private practice was never like this - Family Practice - cradle to grave - 25 patients a day in 10 minute or 20 minute slots with no nursing support and the same myriad of medical issues along with overprescribing of abx and 'soft' medicine where paying one's copay means getting the Rx of choice. I like my VA job a lot. Challenging, sometimes depressing but I am practicing medicine and feel valued for the first time in a long time. As a multigenerational military brat - I get to give back as I couldn't serve. That means a lot to me. I still hold my tenant that corporate medicine sucks and volume does not ever equal good medicine. Just my crusty old 2 cents.
  9. Reality Check 2

    State Medical Board Rep Opposing OTP

    I read Dr. Howe's response. If THAT MANY people responded negatively then he should have realized a few things: 1. PAs DO read their publication 2. PAs do care about their profession and future 3. Mr Anderson's article was not appreciated for content or tone and for being in a state publication 4. The article was NOT labeled editorial I don't understand how the author is allowed an opinion but the rest of us are 'unprofessional' for responding. None of us are allowed to reply or present a rebuttal article. We have been disinvited in participating in our own state board. I find it shameful and a poor representation of the PAs in the State of Washington as I do not believe the PAs ascribe to the article or response.
  10. Thanks for the info. Never been on Facebook. Not my thing. Saw the Darth thing on YouTube, I think. Call me old or whatever, too much to do every day to do Facebook, Twitter, Instagram or SnapChat. My kids can’t do Facebook - house rule, but I couldn’t win on Snapchat. Thanks again
  11. Who is this guy and why do we care what he is ranting about? Seriously, never heard of him.
  12. Women are just as capable of inappropriate behavior as men and toward women or men. By preventing you from seeing female gyn concerns - the University is saying men are not acceptable in that role and that is very wrong. Female patients need to learn to trust providers - male or female. Chaperones exist for a reason. I have to have a male chaperone at the VA to examine male patients if disrobed. PERIOD - it is policy. I have to have a female chaperone to examine a female vet at the VA for breast or pelvic exams. All patients have the right to ask for a chaperone at any time. The knee jerk reaction to prevent male providers from seeing females perpetuates the stereotype that men can't be trusted or women are more trustworthy in that setting. That is a load of crap. The legal battle may be rough on you professionally but I applaud your willingness to stand up to a dumb decision. My support is with you!
  13. I hear bitterness and jealousy of some bizarre sort. Would LOVE to know where he/she went to PA school and how he/she was as a student. Then what med school - US or on some island somewhere - and placement in residency, etc. These types of articles don't help anyone and to be anonymous doesn't lend any credibility either. I don't have time for these types of hateful jerks at this point in my career. I DO know what I know and how to use it best to serve patients. Moving on.....
  14. I can tell you that swallowed semen containing cocaine does NOT test positive for cocaine. Used to do Occ Med and the Medical Review Officer declared this take on it to be a load of crap. If he was THAT stoned - could he even have intercourse at all? I don't think semen in the vaginal wall could give her a systemic positive. Might burn though....... Back to my boring life.
  15. Reality Check 2

    PA Respect

    All my military folk at work call me Doc - they are used to PAs taking care of them, being the flight surgeon, running the Medivac and all else. They call most of the PAs and NPs doc as well as the physicians. I noticed that one particular NP who isn't super well liked is addressed as Ms. So&so instead of doc. It's the little things you notice every now and then. I correct folks to make it clear and I have a name tag but I accept their respectful means. Just don't call me Honey.....

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