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Everything posted by surgblumm

  1. There are courses and materials that can help you to do deep closures. Surgery and first Assisting takes time and devotion. Laparoscopic and thorascopic techniques also take time and you need to continue to try your best, ask other PAs for advice and remember that you can visualize externally the area that you are approaching internally. there are also laparoscopic courses which could be helpful to you. I have done this for four decades and have never done a robotic procedure. I am amazed at the agility of all of these young, female PAs who have been birthed over the last ten years. In the military of many countries, females are used as snipers because of their steady hands. You will master all these things in due time, Penny.
  2. I appreciate the forum moderators as they are very balanced. The PA forum is the best social media group for PAs and if I were to trash a form because of interference it would be Huddle.
  3. Contact Frank Crosby of PAFT who started a program and worked in the UK. He is the immediate past president of PAFT.
  4. This is a great answer for the PA who has a cheap Doc who gives a 29% reduction in salary for fringe benefits. Let his eyes google this. Good work Ventana.
  5. There is plenty of information here for someone to write a great article, do a research project, call upon AAPA or NCCPA to respond intelligently to the question. Great question for all practicing PAs except I don't see it happening.
  6. Send him the AAPA Salary Report ora report from your constituent chapter or specialty society that has a salary scale for PAs in terms of hourly pay plus benefits. If he does not like it, seek new employment.
  7. I cannot read every response to this age old question but agree that many of us , myself included, have practiced without the on-site supervision and practiced within our education and knowledge and were gifted with intuition which told us when to turf to the physician who was our SP according to the office management. For those patients which desire to see a "real doctor" , I would simply tell them how this corporation works and they have invested their trust in you and if they are not satisfied, they are welcome to contact management or find a UCC or practice that has a physician.
  8. Nurses are the backbone of American healthcare and the last bastion of protection between the patients and medical professionals such as physicians, PAs and NPs. They are intelligent and a HN in ICU has a hell of alot more experience than a 2 year PA or NP or a resident or new physician. They have very excellent suggestions and the reason you are perturbed is that it is hard to understand that they are driven by protocols and guidelines and are responsible to another nursing supervisor and then the DON. They have saved many a PAs butt and likewise for NPs and physicians. Thank them, explain your rationale , be courteous and above all remember that when you screw up they are charting everything and will be supeoned at your EBT.
  9. As the residents assist on more cases and more diversely, the surgical errors will increase. A good, well trained SPA is equal to another surgeon at the table and can make constructive criticisms. Keep your scrubs on.
  10. Truth or Consequences Robert M. Blumm, PA, DFAAPA, PA-C Emeritus PA Advisor to CM&F Group The Bible records a Roman governor, Pontius Pilate, inquiring of a man who was brought before him for judgement. He asked Jesus: “What is truth?” To many, truth is akin to the spectrum of the rainbow with many interpretations. What is truth in our profession when it relates to providing care and counseling to our patients? There is an assumption, as healthcare providers that we will not lie concerning disease or prognosis. We are trusted PAs. The Oxford English Dictionary defines truth as a belief that is considered accurate and factual. Based upon this definition, does a physician or PA or NP have an obligation to be truthful or can they “shade the truth” to a patient? The Charter on Medical Professionalism, endorsed by more than one hundred professional groups worldwide, and the US Accreditation Council for Graduate Medical Education require openness and honesty in physician communications. One can and should not expect less from PAs or NPs. Why is lying wrong? It endangers and is an abuse of patient trust. Trust is essential to the relationship that we build with our patients. The most important tool in your medical bag should be character, as demonstrated by your virtue and your honesty. There have been national studies with physicians on this subject and, without outlining the many details, the conclusion is stark: MDs can do better. You can construct your comments with positive percentages and honesty, which states that we will work together to do everything in our abilities to treat a present illness. But you cannot sugarcoat a prognosis to give undue hope to the patient or family. There is evidence-based practice and reality-based practice; both are partners on the dance floor. I proposed a question on Physician Assistant.com asking PAs, whether it is ever ethically responsible to lie to your patient. A majority of the responses were a flat and short “lying to the patient - never.” A PA in Texas had a patient who had had a stroke two years prior; the man had not walked since. When asked if he was ever going to walk again, the PA replied, “Never.” The wife was furious because she felt that the PA had deprived them of hope, despite his answer being honest, simple and polite. The patient had to know, that when the PA tells him something, it is the truth. Otherwise, he would not be able to trust anything that the PA said or did. As a healthcare provider, you may choose not to reveal the entire differential diagnosis with the goal of alleviating stress. But to offer paternalistic statements, one PA said, is just plain bad. There are some “nevers” in our world that are not only wrong, but could lead to litigation. Never tell a patient that they have cancer without a biopsy. A smart, experienced PA related that the manner in which you present a potential diagnosis - without lying or giving false hope - is the art of medicine and patient care. I have seen patients with pancreatic cancer expire in a month and I have seen others live fruitful lives, re-creating their relationships, and living for four years. There are no absolutes when giving a prognosis, but we must share what we know to be clinically correct, as well as offer hope. Rather than play the part of the Grim Reaper, we have the ability to, as Maya Angelou writes, “Be a rainbow in someone’s cloud.” Trust is gained in small steps with each encounter, but when trust is violated it runs away as fast as a locomotive. Trust is sacred for a PA and their patient. Trust is accountability when we are speaking of the relationship between a PA and their patient. And accountability means credibility. If we lose our credibility, what are the consequences? Lack of credibility and trust invites scrutiny and becomes a barrier that can result in anger, frustration and action. That action can easily become litigation because of a medical error, a prescribing error, poor communication, or a failure to diagnose or to treat. Behind that litigation is often a person who feels violated by a healthcare worker whom they thought they could trust. Should this problem ever come knocking on your door, it is of tremendous value and comfort to know that there is a company that you can trust to defend your interests. Personal Liability Insurance is a must for active professionals and CM&F Group has been developing and providing such coverage for over seventy years and is endorsed by the AAPA. CM&F’s policy is underwritten by the Medical Protective Company, who enjoys the A.M. Best Company’s highest rating for financial strength - A++ (Superior). For more information please contact CM&F at info@CM&F.com.
  11. Someone once said, I am learning all the time. The tombstone will be my diploma. This is true of all of us as every day of our lives from birth to death is part of the (-) on a tombstone. Even as we learn , we still have the ability to add to the knowledge or answe the questions of the generations behind us. I was perusing through the last issue of JNP which is also part of my reading matter and discovered an editorial called;The Voice of Nurse Practitioners. I thought for a moment and while the NPs chose to place statistics in the article about when NPs retire, what they do, what was their age, etec. I thought that we could have an available discourse, perhaps on this forum, where PAs can ask questions of retired PAs and have this as a monthly source for our colleagues on Physician Assistant. Any retired PA can be part of the responding group and many of you may have questions of any sort. Let Michael and the administrators know your feelings on this idea. Have a great weekend. PS, I think this would be better on this forum rather than send it to AAPA or huddle for two reasons. Not every member of this forum is an AAPA member and Huddle is far to restrictive and some of us like to cuss.
  12. Thanks for the information Lightspeed. If this was going to remain as it has in the past I would tell all PAs not to be concerned with losing their jobs to NPs because time would be the deciding factor on ability.
  13. I appreciate your comments as I too have met a number of NPs akin to this and one who knew nothing about prescribing in a surgical practice after three years. It is becoming sad. I had one substituting for my primary care at the VA and she too was worthless. I had received great care up to that point and am now. They need formal training, not theory.
  14. A subtle infiltration occurred. NPs were pumped out. The AANP started their propaganda campaign, "Heart of a Nurse, Brains of a Doctor". There was a shift in educational platforms to cheap, poorly supervised on line programs that promised the moon. These higher institutes of learning jumped on the bandwagon of money grabbers and instantly, they started producing ready to work, nicely starched, "physician" equivalents with 100% acceptance, self regulated shadowing for experience and NP boards that looked the other way. And just for a nice touch, they offered rapid fire "doctorate" degrees so now these substitutes could even usurp the term "Doctor"
  15. Many of my colleagues across the nation may not agree with me but I have Medicare and a United Healthcare supplemental that my wife has from her lifetime of teaching but the program that I am most satisfied with is VA Healthcare. I know this differers from state to state and from city to city but I am treated at the Northport VA on LI for almost nintey percent of my care and am so more impressed with every aspect of care from clerks, technicians, waiting times and physicians . I have three chiefs of service and one will spend up to forty minutes with a patient. If you qualify as a veteran give it a shot although I will still have surgery in specialty hospitals such as Cleveland clinic for heart. Nope, I have notneeded surgery---yet.
  16. Of course, we need to hear the clinical presentation and this female presents with a cardiac complaint therefore we need to look at this EKG and also at whatever cardiac labs we are ordering to check for inconsistencies. I see a fairly normal EKG with NSR, No Ischemia, No depressions of the T wave , good progression and a r wave that seems high but this may be due to her heavy chest wall. Without any other signs or symptoms I probably would reassure her and have her return to the ER if these symptoms return or worsen and then be followed by cardiology.
  17. Thanks CID and SAS for your comments which will be saved and seen again in another form. Sometimes it is not until after the EBTs that the litigation goes from one of a medical error to overt man slaughter. I am interested in other ‘hidden’ opinions.
  18. As you all know, for the past twenty or so years I have written and published a monthly malpractice article to help my PA colleagues. It actually started after a number of people on the old PA forum were involved in malpractice suits and were dropped by their carriers. As in all things related to this subject some PAs found it difficult to get another policy because of their actions and could now only work for an institution. Some lost their careers, some waled away from their professional endeavors distraught over the litigious society that we exist in. Some PAs found that they were not covered for their poor judgement moment or their medical error and lost their incomes and their personal savings. Some advocated for going bareback in states that allow it but nevertheless this was a problem that I decided that I could respond to in orfer to establish hope and a foundation for my fellow PAs. From the discussions on that forum, I was enriched with ideas or stories which is why I post many of those articles on this site. I ask the question above because obviously this has happened and I want to enlist comments that will help me write a future article in this subject.
  19. Whatever you bring to the Thanksgiving dinner is appreciated by the partakers. Traditional medicine, holistic medicine and spiritual healing , all have their part in healing one of the many subsets of patients we encounter. When I think if Chinese medicine and the thousands of years that it was utilized, why should I, an American, who comes from a broken healthcare system that makes corporations rich making wonder drugs that are ultimately not wonderful and are so expensive that a family must choose between proper nutrition and a pill.? If I am on my deathbed should I have benzp's or a spiritual counselor, minister, priest Rabbi or Oman pray for and with me and sit at my bedside and fill me with the hope of passing. Yes, I think our Alaskan physician is incorporating holistic practice because she works with many tribes that also used herbs before we bought their territory.
  20. All of the early military Medics and Corpsmen were initiallly trained by a RN. As others have replied, nursing is an admirable profession. You probably will not have an interview and the fact that you were honest and state you desire nursing as a career will be all it takes. You can start off and get your BSN and then achieve a MSN through internet studies and go for the gold and become a NP by taking one of the programs for a DNP. Nursing gives you many options. Good luck.
  21. A. Listen to your wife as she knows you better than anyone else. B. Listen to the guy in the mirror. would you want him to deliver your healthcare. C. Grow a mustache , it make you look five years older. D. Listen to the comments of SAS and RevRonin, they wer tailor made for you. E. Decide what you are going to do as far as a career move or get off the horse and try a similar field. F. Write your old school and mention this deficiet in their teaching. G. I would also see the psychologist as you are too invested in your profession to let it die on the branch because you lack confidence.
  22. I've seen this before in Urgent Care in NY and when I did this as an extra job, I refused to comply and they did not fire me. When we submit to demands such as this we demonstrate our lack of self-confidence and our submission to even greater demands.
  23. Outstanding. Physician have always had reciprocity when prescribing across stste lines but this goes furthur and Arizona is a great retirement spot. Let's keepur eyes on this.
  24. I used to think that "supply and demand' was just a military explanation used on promotion interviews but yes the fact exists in physician employment. I too was amazed that with the facts that we have taken some steps to publish the capabilities of a PA in healthcare and God knows the NPs have done this with a tenacity that is to be jealous of, yet, this article surfaces and we are still the invisible profession. It is only with profound hope that our PR team can publish equally positive information that may be picked up by Reuters or published somewhere other than our journals.
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