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About quarternote

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  1. Do any of you work in Rural Health? I work in an RHC in Georgia. For those of you who don't know me I've been a PA 8 yrs now. I switched from surgery to a RHC IM (pedis/adults) last fall and have been very happy. Today I went back to work after vacation and was told that I can no longer be in the clinic alone. This has nothing to do with my ability. The practice manager wasn't clear but said something about it having to do with WellCare (Ga Medicaid) & BCBS. She then said it has something to do with the physician having to sign 100% of those notes due to reimbursement. She said they aren't comfortable having him sign if he isn't working in clinic that day. He never sees my patients unless I have someone come in that I need a second set of eyes or I need him to admit as I don't go to the hospital. Our practice admin is on vacation so I can't ask her. This isn't such a big deal for me as I am pretty much independent in my practice. BUT, It effects my day off. I work 4 days. No weekends or holidays. I have had flexibility with my day off which was a draw to this job. Example. I normally have Wednesday off. Today I told the office manager I was switching Wed for Friday in a few weeks. She had switched me to Thursday off that same week without telling me, then told me because I needed Friday off I would be off Thursday and Friday because of having to have a doc in clinic. 2 days off would not be an issue but I will have to use my time off. Normally I move my day around and it isn't a big deal. This makes no sense to me. RHC do have different guidelines though and I'm still learning. Georgia law states I do not have to have a Dr present 100% of the time. Do any of you have a clue what she is talking about? Can you direct me to where I can find information on this? I will ask the admin next week. But would like to have ammunition to back myself up if needed. Thanks Kim
  2. Has anyone seen this doctor app? See attached pic. This is from the Apple App Store. I'm sure it's available on Android as well. They are charging $40 for visits. They are even giving an RX. Urgent Care without leaving home.
  3. Derm is my weak point. I have an 19 yr female patient who presented last week with swollen chapped lips, angular ceilitis x2 weeks. Had tried everything OTC. She had some mild perioral rash. Did not seem like an allergic reaction. I had her stop all OTC and use Vaseline. She took 7 days of diflucan at 100mg/day and has used nystatin ointment. It improved. But did not resolve. 2 days after stopping the diflucan it started back. I have photos of yesterday and today. I'm not sure where to go from here. I'm thinking she may have a secondary infection. We are in a very small town and a derm referral is in the works but could take months. Can anyone offer any insight? I've read everything I can get my hands on. Do any of you have clinical experience with this? Thanks.
  4. Has he done any job shadowing? The VA is a good place to do that.
  5. Has any one done sports physicals for Special Olympics? I am in a small town and have been asked to do S.O. physicals for the middle school. My question is how do you all do it. The form is straight forward. I'll try to post a pic of my part. I had 3 kids today. 6th grade (10-11 yrs). 2 were not our patients and I had no records. One of those 2 was an 11 y.o. Female with Downs, B.P. 149/93, wt 166. Not our patient and I didn't have any medical records. I did not clear her but sent her to her primary care. One has Asperger's, vitals were ok and I put him through a regular sports physical so even though I didn't have medical records I cleared him. The last one was our patient for years, Downs. One question on the form is if they have had c-spine X-rays, specifically C1 & C2. And if they have atlantoaxial instability. He has not had imaging so I sent him and told mom we will clear if all is ok This was all last minute, I wasn't forewarned or asked. They appeared on my schedule. This is new for our office as well. I've only been there since Sept. The office staff gave me flack and expected me to just clear the kids. Instead at 5 pm on Friday we were at a standstill with 3 patients while I tried to get in touch with the administrator. I did ask the office manager how I could do this without records and she told me to call the administrator. I was told (by the front desk) they only throw a ball a little and do light activities that I should just sign the form. I won't go into my reply.. From my experience with special Olympics it is truly competitive sports. My question is how do you all handle these? I was not asked physical exam findings which is what most sports physicals are. I was asked if they have specific medical problems. (See photos) Did I over react? Thanks for any input--Kim
  6. How long do you all have, is there a limit? Lol I see all acute sick, call ins and walk-ins. You examine a sick patient diagnose and treat them and at the end of the visit the patient says: "I understood that I had to see you but I really need a RX so can I get an appointment with the Dr.? SAY WHAAT?!?! |:-O I wrote the script .... Smh Sent from my iPhone using Tapatalk
  7. The front desk receptionist has an issue that you are highly experienced in treating successfully yet she asks the just out of residency MD. You hear the MD give her a mediocre treatment plan that may or may not work. Sent from my iPhone using Tapatalk
  8. I just started working in a rural office. The physicians (2) are dual certified IM/Peds. We have a heavy peds practice but see all ages. I mostly see sick patients. All ages. Prior to this I worked in General Surgery/Bariatrics x5 yrs, 1 yr of Adult Hospitalist & then 1 yr of Neurosurgery. I love this job. But I do have some questions. I did a lot of wound care in my first job which did include some pediatrics. We took them to the OR for I&D's. But these were pretty bad abscesses. I have plenty of experience with adult I&D's, etc. My question is this: In an I&D of a simple abscess 1-2 cm in a 1-2 yr old or older - the doc I work with does not use lidocaine, etc... He just does a quick I&D. What do you all do? Is the dosage for lidocaine in peds 4mg/kg & with epi 7mg/kg? I have spent a good deal of time researching this but would like a consensus of what some of you more seasoned providers do. Thanks for any help
  9. Wait for your score. I felt the same way but my score was similar to my previous PANCE score. I walked out thinking my career was over. It may all be fine. Let us know after you get your score.
  10. I also recommend "Anatomy of an Illness" by Norman Cousins. Great book for students prior to PA school.
  11. Thanks for the replies. She was being picky. She just happened to look and see my Epocrates open. I was actually looking at a disease and not a drug. I usually do double check things between epocrates and medscape. I'm not sure if the practice would pay for it or not. They just bought my epocrates a few weeks ago. I generally use amoxicillin, augmentin, omnicef, etc. Same drugs over and over. I tend to take my questions to the other Doc there as he will give me a straight forward answer. All that said. This is now a non-issue. She resigned today. Not that it was an issue. I practice separate from her and as I said she isn't my boss. i can use what I want but after she said that it made me question the accuracy of it. I've not noticed a difference for the drugs I use. Thanks again
  12. I'm not trying to start a debate on which program is best. I'm sure they all have their strong and weak points. I truly need this answer. I'm in a rural IM & Peds group. Been there 2 months and my background is mostly surgery with a year of hospitalist so I'm still learning. I mostly see urgent care-Walk ins & same day call ins which keeps me hopping. Yesterday in clinic one of the Docs (not my Boss) pulled me aside and said "I'm not trying to be picky but Epocrates is not accurate for Ped's dosing" she says she has compared Epocrates, Harriet Lane & Lexicomp. Lexicomp is the most accurate. Now she has recently finished residency and is known for spending too much time, ordering too many tests, etc. I've used this program for 10 years and have a new paid subscription. I'm comfortable with it and have never had any issues. Can someone give me honest insight on this. I've not noticed it to be inaccurate. Thanks
  13. I would never take a job making that low. Derm is a high pay specialty. I would seriously think about NS before you did that. I just left a job 2 months ago with a very nice boss, loved all the people. Wearing a lead apron bending forward caused me to have a low grade spondylolisthesis. This was due to a pars defect that I was unaware I had. If I continued In That job I would be crippled or need a fusion myself. It may still lead to that. I worked in Neurosurgery for her for 1 year. It is not worth it, no amount of money is. I didn't feel like I had a life. Never home. Because I ended up unable to wear the lead I have over 6 months of a great deal of radiation exposure. I took a pay cut for my present job but I am happy and slowly regaining my life. My spine unfortunately will never be the same not to mention the worries from radiation exposure. Sent from my iPhone using Tapatalk
  14. If it isn't malabsorption could it be dietary? Are you at a VA? You mentioned she is a vet. I think we will see more of this as a strictly Vegan diet is becoming the "in" thing. Many people are avoiding soy also (so tofu is out) due to it being a high GMO product. Also the price of meat and dairy is going up so many people can't afford meats. What about age >50, long term PPI, hypothyroidism, alcohol? With our bariatric patients we gave oral. Just some thoughts...
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