ral

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About ral

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  1. I could become a millionaire sitting at home, fielding phone calls from people asking what we are "supposed to do" in any given medical presentation. We all know it doesn't work that way. Cookie cutter, algorithmic approaches to every patient doesn't always apply. Even with the best evidence based practices, each of us knows that you better be on your guard, and we also all fudge a little here or there depending on how the drive into work was this morning. First, do no harm. I am out in left field on some of my beliefs, antibiotic resistance being one of those.
  2. Having read the entire thread to this point, I am not really sure of its purpose. Wrong place to be having an SDN type of conversation, in my opinion. Best regards to the obviously bitter thread starter.
  3. Sorry you feel that way. Let me put one thing into perspective: NOBODY gets through PA school by winging it. You obviously have enough snap to have completed the program, and went on to certification. Sometimes hard to pat yourself on the back but, you are far from unintelligent. Without getting personal, take a look at what's happening in other areas of your life. We tend to suck at accepting a little outside help once in a while.
  4. I like the ACC, because I am what some people would call "an idiot", and this makes it simple for me. http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/
  5. Although I haven't lately, I have written a lot of Semprex-D prescriptions over the years. Not available OTC, and no generic equivalent. The price is ridiculously expensive. It was my go to Rx for that 0300hrs ER minor sniffle that wanted a note for work.
  6. They need to add one more answer to the sample test question (I just now went and read it): Which of the following is the most appropriate next step? (A) Anteroposterior and lateral x-ray studies of the skull (B) CT scan (C) Discharge and observation by family or friends (D) Hospital admission for observation (E) MRI (F) Look over at the patient's mother/father/sister/husband/friend. Explain each of the previous options, and what the consensus of the best experts and current research states, while carefully observing their facial expressions and/or body position/language. Quickly refer back in your mind to the current quarterly satisfaction surveys, which are sent out by the folks in the 4th floor offices, with the private bathrooms and espresso machines, and consider how this will impact your next performance review. If the patient and significant other smilingly nod in agreement with your assessment and explanation, thank you for being so kind, and ask if you have a private practice where they can establish you as their PCP, then move forward with option (C), and discharge the patient appropriately. If you pick up on any hesitation, a subtle raise of the eyebrow, a teenage type "duck face", a roll of the eyes, a comment about a relative in the healthcare or lawyer business, a smug "Hmmph", or any other flag, then quickly offer to get them a coffee and danish to pass the time while you order the CT or MRI, and put in a consult for neurology. Go home and sleep well, knowing that you were able to provide the highest level of customer service in the industry. For the next week, refer to Yelp or Facebook, to see if the patient left at least a four star review, thereby ensuring that your job remains secure.
  7. Since I won't have time to look stuff up, I can see myself sitting in front of my computer, taking the test and saying, "Hey Siri, what is the recommended treatment of choice for syndrome blah-blah-blah." :)
  8. Hmmm.... I am looking for a job...lol
  9. After nearly thirty years in healthcare, the last 15 years as a PA, I am seriously considering one of two things: 1. Leave healthcare altogether. 2. Leave healthcare altogether. I am seriously questioning whether or not any of this bullshit is worth my time anymore.
  10. Not to be confused with Yelp reviews of physicians, clinics, or hospitals by the public/consumer. I am fully aware of those, and have signed my name to the petition to have reviews of medical practitioners removed from Yelp. I am referring to reviews by current and former employees. If there are ten reviews from PA or NP employees, and eight of those reviews state that the hours were longer than agreed upon during the hiring process, there is never any time for lunch or bathroom breaks, and the clinic is micromanaged by the owner's wife, that sends a clear message to me to avoid the place. Likewise, glowing reviews with 5 stars from too many, is suspect. There should be a mix but, if the negatives outshine the positives, I am hesitant. Having said all of the above, I do agree with you that sometimes it takes seeing for yourself. I have had great rapport with doctors or hospitals that many have told me to avoid. Sometimes it boils down to compatibility.
  11. I have recently started reading reviews of companies from job sites such as Indeed, Glassdoor, etc.. Not just from the PA/NP reviewers but, employees in general. If a front desk person, rad tech, LVN, phlebotomist has not much good to say about a company, it speaks volumes about the place in general. It has actually steered me away from applying to numerous positions. Taken with a grain of salt of course, because there will always be a mix of loved it/hated it reviews. If >60% had a negative review, you can bet it's not a place I will apply to.
  12. Interesting that this topic is being discussed. My stepfather (age 73) called me this week to let me know that he had "passed out" a couple of times that day. It happened one other time, about 6 weeks prior. He hadn't sought treatment. I told him to go and get checked out. Said I didn't want him to drive, and reminded him that running over someone's grandchild should he lose control, wasn't worth it. Figured that would strike home, since he has some himself. He and mom live in Canada, I am in Texas, so it's not like I could just run over and check on him. He called today. He went to the hospital that day, and was admitted overnight. On morning rounds, the doctor informed him that he would have to notify the Ministry of Transportation. Now he's kind of ticked that he likely won't be allowed to drive for a while. Too bad, Dad.
  13. I have taken mini tests at a couple of interviews. Most of the time, it is generalized, "Which antibiotic would you use for xxx?” The problem as I see it, is that the answer list may include more than one appropriate answer. For example, to ask for a "first line" drug for the treatment of certain illness, there are typically "either/or" medications available to us as guidelines for a standard of care. To include both in the list of answers, is somewhat deceiving, if the interviewer is wanting one only. I actually had this very conversation with a physician last year. It came down to his observations of antibiograms from his region vs mine.
  14. At the critical access hospital I worked at (solo coverage in ER), the facility was a family practice clinical rotation site for UTMB PA students. We got the wording changed up a few years ago, to allow students to slip over to the ER, to see and do cool things that they would have had to fight with physician interns and residents to do at the bigger hospitals (sutures, I&Ds, other minor procedures). They loved the experience. I enjoyed the teaching aspect of it. That said, it's not something that an inexperienced provider should be doing, when they aren't proficient at it themselves. I sure as heck wouldn't take on the role of precepting a student in an area that I didn't feel comfortable in myself. It's a disservice to the student to not get proper training. "See one, do one, teach one" has its limitations.