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surgblumm

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surgblumm last won the day on August 18 2019

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About surgblumm

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  1. What a story , depressing, realistic and a happy ending with fine conclusions. It's painful to write something like this as it should never happen but unfortunately it is all too common today. Your final analysis had seeds of faith and vision and one cannot steal either of them. The seeds of faith are always with each of us but they often require a crisis to both nourish and encourage their growth. I wish you good fortune, Rev.
  2. AS a person who has both written and advocated for "Associate" for twenty-five years, the Walmart Associate got to me. I am delighted that our name does not make us sub-serviant. The early points about why we were assistants in the sixties and why a "C" was important starting in the seventies are both relevant and historical. It is finally looking like the dawn of a new era. Let's hope it happens quickly.
  3. Approval is approval and the need is ASAP but let's face it, this was the fastest decision ever made by the FDA. In the words of Kissenger;"Next week there can't be any crisis, my week is already full.
  4. We need to look at the history of the pandemic in the Spring and realize that non-essential surgery was prohibited as were other procedures such as in radiology and cardiology. We are at the highest levels ever and the buzzword is that we are in terrifying times and have not seen this type of disease in America before. It would have been nice for the federal government to have worked on this over the past six months. Nero played the violin while Rome burned and Trump played golf while this disaster took place. Inexcusable.
  5. You seem to have a sweet deal except for a non-compete which is a big no-no. The lack of vacation and other perks is also a sign of a Doc who is cheap and you will be last on his list of concerns. There are no advocates if you have any problems. My attitude---Are you comfortable with moving out of the area? You can also get a job in any different sub-specialty without breaking your contract. I'm sorry that you are in this potential mess. BTW- check your malpractice policy and ask for a copy of it.
  6. I agree with Rev Ronin----if it wasn't written, it didn't happen. There was not enough intelligence gathered to take a pre-emptive strike.
  7. For the PA who saw Dr. NP. I agree with Rev Ronin that in many states this is illegal but people will do it until they are censored. I always look for their ID card that they should be wearing and at times have seen the same situation in NY. It's true that the NP has earned it but it is also true for the PA and we are accustomed to following regulations. I used to think that nurses were both female and acquiesced to the AMA but my wife reminded me that back in the day, PAs were mainly male and it is the PA who worshiped at the throne of the AMA and were always fearful of reprisals. I say that we need the boldness that our counterparts have already demonstrated.
  8. P- I was in the first wave of PAs and I retired this past year. I have faith in our practice and education and accomplishments but it will be an uphill battle and how many will have the stamina to run the course? As far as Karen -- this will make no difference for PAs as our numbers are the smallest in the mix.
  9. From an administrative viewpoint, you would be told that you are doing the same job that you did yesterday. Congratulations on your PERSONAL accomplishment.
  10. I'm definitely in the hot zone and have a few co-morbidities and am moving toward my decision. If the FDA is waiting two months before emergency distribution, I would consider Dr. Fauci's words yesterday. He mentioned that if the FDA clears it, both he and his family would get it. I respect Fauci regardless of the negative hype he has received from some individuals. First Responders are supposed to go first followed by senior citizens and then a potpourri of the public shared evenly over all Americans. I am fine with that roundup, and since I am now 72, if it fails, I have lived my life and am just as ready to take a chance as I did when exiting an airplane with a parachute. Most of us made it!
  11. Regardless of the argument as to who has the better training, it still comes down to a plus for NPs when looked at from job opportunities. The NP must first be an RN which makes this particular professional hire-able in all fifty states. The Master's and NP title allows them entrance into a vast number of specialties whereas the Doctorate gives them a legitimacy to the public that we are lacking. The playing field is getting narrower and students are doing more intense investigation.
  12. I read the initial post and could not help but have a little empathy for this novice PA. All too often we shoot our wounded instead of being good medics and stopping to compress the wound and remove them from harms way. Every one of us has made medical errors and exercised poor judgment so on a personal level I was wondering how I could give good advice in this situation. This was the springboard for the article that I wrote this month on Chronic guilt. Let's hope that the lessons learned on the journey prevent future hardships.
  13. For CJ and MediMike- I have on numerous times disclosed my relationship to one of the insurance companies at the request of Administrators and a couple of colleagues. I have an agreement with the administration that I would not place any insurance company in the text and outside of something on Facebook or Linked-in I have been faithful to this request. The articles are meant for the practicing PA and deal with clinical, ethical and stressful situations where I can place an insight as an article with the last paragraph mentioning malpractice insurance in general. I have removed all mention of the company that I have written about for the last 25 years which is CM&F. Back in the day, many PAs found themselves in lawsuits and had poor insurance that did not cover their litigation and which had caused a fair number to leave the profession early or be in a situation where they were dropped and could no longer get malpractice insurance. When I was president of the AASPA , our board studied all of the companies selling insurance and we chose CM&F. When I chaired the Surgical Congress, now eliminated, I met with the presidents of all of the surgical specialties, and after research we decided to endorse CM&F because of their quality, longevity and excellent reputation and standing in the market. Yes, I am a paid PA Advisor to CM&F and deal with other issues relating to troubled surf in the PA waters. I am a consultant but have practiced every day as a PA and was never on salary but on a paid retainer for a monthly article. If the Administrators would like me to drop any mention of malpractice insurance altogether and just eliminate the last paragraph I would submit to their request, but the purpose of the last paragraph is to remind all PAs that this is necessary for their protection. I hope I have answered your questions and that you can look beyond the last paragraph, MediMike. Remember,"Don't throw out the baby with the bathwater." bob
  14. Clinician Chronic Guilt Due to Inexperience, Poor Judgement and Mortality. Robert M. Blumm, MA, PA, DFAAPA, PA-C Emeritus, PA Adviser for CM&F I reflect on the famous words of a great president, John F. Kennedy: “When written in Chinese, the word crisis is composed of two characters. One represents danger and the other represents opportunity.” These two words are the opposite sides of the same coin and illustrate the focus of this article. Fortunately, most healthcare practitioners are not in hazardous duty specialties and are not in a constant state of mental fatigue when performing their duties. The cause of this fatigue is stress. Some of us deal with stress during every shift - if we work in trauma, surgery, emergency medicine or intensive care. Hospitalists deal with daily stress as they inherit patients who are in guarded condition, require medications and life support in order to survive. This is not to demean our fellow clinicians - but the differences between dermatology and the SICU or other high-risk practitioners are significant. The source of this stress problem? Inexperience. In my honest opinion there should never be a novice PA or NP in acute care areas without onsite supervision. There are too many new graduates, driven to find first employment so desperately - that they enter a field where they lack training, by both experience and mentorship. This can be deadly to the patient as well as to the careers of these well-intentioned clinicians. Experience is the cornerstone to quality healthcare and is won in the trenches by repetition, guidance from our peers, and continual study. An excellent medical provider, regardless of the initials after their name, must study every day of their life. Guidelines are always changing, and medical advances never cease. Our second focus is on judgement or, rather, poor judgement. We face new situations every shift and try to maintain a state of readiness. But sometimes our decisions can be faulty because of our lack of experience. Every healthcare provider has made a poor decision or exercised poor judgement - this is how we are forged - in the crucible of pressure and heat. None of us is ever prepared for every eventuality. This is an odd admission but is, in fact, our reality. Our decision-making process is only advanced when we have been in the heat of the kitchen over time and have learned to respond to challenges in a methodic fashion. Such decision making cannot be taught in our schools exclusively but requires an official or unofficial residency. Mentorship and collegiality are essential. Value the time that a colleague works with you: learn to understand the critical thinking of their thought processes rather than following a script. Limited experience and poor judgement can lead to negative outcomes including lengthy hospitalizations, medical complications, patient pain, family pain and most sadly - death. Death affects everyone; patient, family, primary provider and the rest of the medical team. Death represents not only our failures, but in reality, our limitations. We need to come to grips with our limitations: not every patient who receives the highest degree of care will survive the insult of surgery, trauma or illness. Perhaps Covid-19 has demonstrated this to us. I vividly remember my first patient death, a post-op patient from a urological surgery who had SOB and chest pain. I did an ECG, but the 12 lead on the floor was not working, I immediately sent the tracing to the SICU, where a physician promptly came for oversight. He asked the patient to take a big breath and he tried and then gazed upwards and went into asystole. We called a code immediately; six people appeared like genies from a lamp and they administered every treatment. Yet, ultimately, I heard those most dreaded words, “Time of death…” I felt that guilt personally for three weeks. Many colleagues tried to assuage my guilt until an anesthesiologist friend used some tough love: “Bobby, if it’s too hot in the kitchen, get out.” But I stayed. And I am glad that I did. The loss of a patient is a deep loss. But we cannot surrender to guilt which only exacerbates self-doubt and renders us impotent in our roles as care givers. We can try our best to console the families, but must never yield to the emotion of saying, “It was my fault and I should have done more.” This does not create closure, but opens the door for what is called in legal terms, “discovery”. To summarize this article, I need to point you to an important tool which helps to deal with insecurities, guilt and your professional future. The complexities spoken of here require more than study and mentorship, they require a plan. Part of that plan is to accept the realization that what I have written is the truth as so many of we healthcare providers have experienced. In a worst-case scenario, a patient’s family may not be able to bear the loss of their loved one and may seek compensation; and compensation means litigation against all those involved. You will be served with a blue document that informs you of the lawsuit which you are required to pass on to your malpractice insurance company. If that company is the same one that is defending the hospital and all its employees, they will look to share the burden or shift it to protect the interest of the policy owner - the hospital. This is certainly unfair and potentially very costly to you. But this inequity can be mitigated. You can purchase your own personal liability policy which covers only you - with your own defense team to fight a judgement against you. PA Malpractice Insurance is important to understand, easy to get and provides the stable and individualized protection your career demands. Accept the reality of our personal limitations and the possibility of making a poor judgement - but rest comfortably knowing that you have chosen the very best personal liability insurance. Career management is a very important lesson rarely taught in schools, but is increasingly vital in our litigious world!
  15. I've written three books and have a chapter in two large medical texts and about four hundred articles. I like writing but not highly academic writing as a researcher. Ron, you always give logical, honest and great guidance as an administrator which has made many of our lives richer. Go for it. JAAPA is not an easy publication to get the nod from.
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