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hrjames

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About hrjames

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  1. 29, s/p CABG x 1. He didn't present to me with the MI, but I've seen him a few times since in urgent care for other things. (he's now 31)
  2. I have some kind of public disaster bad luck, I think. I've have 3 public emergency encounters: #1 I was on a plane that was taking my 21 month old daughter to California for her last cardiac surgery. A complete repair after multiple palliative procedures. To say I had a vested interest in keeping that plane in the air, on course, is a massive understatement. They called for a "doctor or nurse" to assist with a medical emergency. Myself, an ICU intensivist I happened to know from long ago and a breast surgeon took care of a 20-something dude who vomited & passed out. He came rou
  3. These. In that order. Employer has now enabled home access for both as well.
  4. These are the people that enter the clinics & hosppitals. We, as healthcare providers, have more conact with this vulnerable population than your average hospital visitor or Walmart shopper. And we are charged to provide care for them, which often requires close contact. Vaccination is not 100% effective, but nothing we do in medicine is 100%. We have to weigh the risk vs benefit. And as healthcare providers, we bear a responsibility to provide safe care to our patients. Just like it is not acceptable to skip handwashing because "my hands get too dry", it is unacceptable to refu
  5. 20-something who texted during the entire visit. Including during the pelvic exam. I wanted to ask what she was sending and wondered if there are any abbreviations for this kind of event - OMG! I notice a lot of friends and even family members will often interrupt with "yeah, I had this exact same thing..." and launch into their own story, when they are not going to be seen. They just can't seem to let the patient have the attention.
  6. Well, I decided to go to PA school when I was 26. I felt somewhat similarly to you. I knew that to go to med school meant that I would not realistically be done with school & residency until I was ~35, given that I needed to take the MCAT and apply. I had a LOT of contact with residents (I was a drug rep at a teaching hospital) and they were, almost to a person, miserable. The PAs, on the other hand, were generally happy and satisfied. Most of the residents had told me (I was their non-judgemental lunch-bringing friend) that they would not do it over again if they could go back. This made
  7. I work for a small IHS and in my family practice clinic I have never roomed my own patients. It was brought up once by an administrator as a way to "streamline" some processes and my nurses and MAs actually backed me up and said it made no sense for me to room my own patients. This varies throughout our health network, however. I once went to the IM practice to "help out" when they were desperate for someone to cover some acute care. I had never even been in their building, didn't know where anything was and was expected to room & vital my patients and clean exam rooms. I didn't know
  8. Have been at the same place for ~7 years. First 4 years i was an at-will employee and got paltry 0-4% raises with the other employees, not really based on merit. Went to contract 2 years ago and now can negotiate my raise. I have gotten 10% each year plus this year was able to add on a reasonable incentive, which is 15% of my base salary, so it is more than a 25% raise, asuming I make the incentive. 1/3 of the incentive is "project based" because I do a lot of uncompensated leadership stuff in my clinic. The rest is based on production. Interestingly, the docs have no cap on their incent
  9. I'm 6+ years into my practice (urgent care + nursing home, weird I know) and while my job is different, the above really resonated with my feelings during my first year of practice. I felt weird picking up Sudafed at the random grocery store pharmacy because they would see my ID and say, "oh, so YOU'RE the new PA" and I just cringed about how they judged my practice having seen my prescribing habits. I can say that it slowly, slowly gets better. 3 years in I stopped worrying so much and now I am confident enough to go toe to toe with our practice docs or call a specialist to ask them why the
  10. I was hoping you might respond. I follow your blog some and thought about sending a PM, but you seem way to busy to get pestered by a small-town PA you don't even know. I appreciate the response and value your opinion. I didn't have another name for this, so I went with what I know - TN. Your explanation makes sense. I keep thinking his history makes it sound like the physical trauma of the cough actually caused some nerve irritation or stretch perhaps. I've used tegretol in TN, although my experience is far more limited than yours. Thanks again & good luck in your new venture. I'm ro
  11. $3000/year, 1 week paid CME hours. Got this increased a year ago - it was $1500 and 4 days paid for CME. We successfully argued that we require as much CME as the phsyicians in our network and that while the registration fee might be less for a PA than MD, the airfare, hotel, food etc is just as expensive for a PA, who gets paid less to begin with. They pay all licence, prof memeberships, DEA, ACLS as well.
  12. I got killed in clinic today, but this case is sticking in my craw. I'm tired, so perhaps I have missed something. If I have, my apologies, and thanks in advance for the input! 51 y/o male seen by a partner 6 days ago, dx with bronchitis and conjunctivitis. Placed on zpak & vigamox drops. Returns today with c/o persistent left red eye, bad cough not improved, occsionally productive, low grade fever and pain in right cheek when coughing. (The eye is a subconjunctival hemorrhage). The pain in his right cheek had sudden onset 2 days ago with a cough, where he felt a sharp pain starting in
  13. I work part time so I can still be a mom to my (small) children, although I did work full-time for 1.5 years as a new grad until having my first baby. We're in a small town, so this is specific to my institution, more specifically to my clinic, but we would likely hire a new-grade as a part-timer IF they had done a rotation with us AND they were OUSTANDING. I get a fair amount of input into PA/NP hiring, and we would jump at the chance for an awesome new grad PA over a new grad NP or even one with experience (most of the time). to be honest, we would probably preferentially hire someone who
  14. My first appy (as a student on surg rotation) was ~85 y/o male (no kidding). I did my long-student intake and he gave me a classic presentation of sx, had a fever ~103 but no elevated WBCs. I thought it was an appy but the surgeon & PA didn't believe me (which I DO understand - it was my first rotation, after all) and it wasn't well visualized on CT. He went to the OR late in the evening after he had perfed & became septic. It gave me an interesting case presentation. Interesting thought about limited MRI on kiddos. We try to go with serial exams when possible, but I've orde
  15. Other than when I was a student, I have never used paper charts in clinic. We used to dictate EVERYTHING (could do URIs in my sleep, though I'd question the accuracy). We got an expanded EMR which allows for "point and click" notes for common complaints such as URI and UTI. With these, little to no typing is required so we can actually finish the note in about 30 seconds after the patient leaves the room. I enter the history as I take it and can quickly add the exam and plan right after they leave. I can type fairly well, so I do put in a few specific details in the encounter, mostly so I can
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