jmj11

I think you make some very good points. I, too, am nearing the end of my career. Some bad cultural decisions were made early on. I understand why those decisions were made as we sprouted out of physician model and nurse practitioners came from a powerful and established nursing platform. But early on, our forefathers bet that physicians would oppose nurses who wanted more autonomy and embrace PAs who said we wanted to work together. But money talks. Nurse Practitioners are more lucrative for hospitals if they don't have the required supervising physician. They have a huge lobby to promote their profession and they play dirty. After working for my first years in support of the AAPA, I became disillusioned with them for the same reason as some have with Sears. They would not change and they would not listen to the rank-n-file. I left them for 15 years and continued working on my own issues. I met with insurance companies about reimbursement. I created and owned my own clinic and had to fight like hell against many powers to do that. I had to fight to keep PA-owned practices legal in Washington when an attempt was made to close us down (I had no help from PA powers that be). However, I do sense a final changing climate within the AAPA and PA culture. With Dave Mittman taking the helm next year (and he was always been on our side) I see hope of change. The only questions remain is it too little too late and will it be like Animal Farm, as soon as we get good people in the farmhouse, they become ruined by the same system. I'm betting that there will be change so I've rejoined the AAPA and am not losing hope.

I work in a practice where vaccinations rarely come up. However, there are many other fake-medical information that I have to fight against daily. When someone says they don't "believe in western medicine," and have been using alternative treatments (and they are still suffering) I ask them, "So, how has the years of natural treatments working out for you?" But the anti vaccination really piss me off. The reason is, that early in my career I had the opportunity to work in the developing world where I saw great suffering as the result of the lack of vaccinations. I saw a kid die from tetanus and saw kids with measles. Stupidity kills. I was disappointed when the CIA used a vaccination doctor in the very town I had worked in, in Pakistan, to get DNA from Osama's kids. The reason is, I knew that the local paranoids would shut down the vaccination program there, and in many places of Pakistan, they did.

So, I guess the other Jim W organized the climb and Wickwire s the one who made it to the summit. I watched this movie again last night after thinking about K2:

Whittaker?

This is a big problem and I feel your pain. While I've never been in this situation, I've had to bear the outcome of it many times. In my cases, the older-narcotic-happy doctor retires and the new provider says "Hell no I'm not prescribing oxycodone for your headaches I don't care if 'old doctor' has done it for 30 years. So, I'm sending you to the headache clinic and they will do it." Then I have the break the bad news that I might help taper them off ASAP, help them get dependency treatment, but I will not rx them for chronic use. Then they are pissed.

I agree. I do undilated exams and it has been a godsend. I've used the I phone app, but never had good photos. Maybe that's my fault.

Bingo. That was easy wasn't it? I don't know why it was missed by the neurologist.

44 YO female has a sudden onset of left neck and jaw pain. Her husband notices that she starts to slurs some of her words. He rushes her to the ER. She had a CT and set up a brain MRI for early morning. Symptoms evolve to mostly left orbit pain. The MRI is normal. Rounded by a neurologist for 2-3 minutes. Told her she didn't have a stroke and to go home. The left orbit pain continues as does a Horner's syndrome (starting, they think, during the night at the hospital, prior to the neurologist's visit) and has persisted for the week. The pain is still focused in her left eye (8/10) and is a tearing sensation. Her husband brings her to our headache clinic. BTW, she feels a lessor pain still in her neck and left shoulder. What would do you think this is? (I have the answer but just wanted to know what you thought).

I know you have made your choice. I will chime in that any PA in a role where the fundoscopic exam is important to their work, as it is with mine, then I would strongly recommend the WA PanOptic.

I'm sure you have things to learn. However, there are those people, and I've met some physicians that way, who find great comfort in making others look stupid. So, if he/she has that tendency, then you will never live up to their praise.

If this becomes a trend with them, this is why this is important: https://www.seattletimes.com/business/how-cvs-became-nations-biggest-health-care-company/

He has our best interest at stake. But he does not take the reins until July 2019, correct?

Yeah. It is a bit rustic, but made the point. I was a new practice owner at the time.

This makes no sense either. Your note is your note. Why do they do this if the billing is under your name? In a court of law, it looks like the physician would be held accountable for your note. I've seen people attempt this for the silly reason of saving money on the software. Some software has a monthly fee based on the number of provider subscribers in the practice. But I think that would be a poor excuse for create a note under a false signature.

Just read a review in the Headache Journal and it sounds like it belongs in every ER's bookcase: https://www.amazon.com/Emergency-Headache-Management-Serena-Orr/dp/1107177200/ref=sr_1_1?ie=UTF8&qid=1542309744&sr=8-1&keywords=emergency+headache+diagnosis+and+management