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Joelseff

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Joelseff last won the day on February 23

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About Joelseff

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    Primary Care and HIV Medicine

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    Physician Assistant

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  1. I agree with the article that had COVID hit in the days before vents and modern medicine it would have been much more catastrophic and I still think it could've been much worse. Thanks for sharing that. Sent from my SM-G975U using Tapatalk
  2. I remember at the beginning, can't recall the source CDC maybe?, but I remember someone making a distinction between viral infection and COVID 19 as "the disease that SARSCOV2 causes" which was characterized by Fever, cough, SOB, CP and then they added anosmia and dysgeusia a bit later and that impressed upon me a distinction between viral infection and actual "COVID" cases. I must admit I was actually on disability and wasn't practicing at the time so I was just getting articles and of course the ever confusing and contradictory news media sources.... I suppose you are correct in that we do not have the capability of surveillance that would suffice to cover what my post was talking about. I just thought that if we did, we could risk stratify "cases" like they were proposing a few mos ago with the "passport" idea and some of the people who were infected but were either asymptomatic (non spreaders) or people with mild sxs and recovered after a prescribed period (14 days per CDC guidelines?) with confirmed Neg Viral testing, can go about their life again. As we are seeing many of these new cases/viral pos ppl are not getting bad disease or not getting disease at all as the CFR trend would suggest. But, it's way above my pay grade so I suppose I gotta keep on keeping on. [emoji53] Sent from my SM-G975U using Tapatalk
  3. I have been calculating CFR since this kicked off. There was a point in early June or late may I thought this was going to hit above 7% but since we have had an increase in CASES, there has been a steady drop in CFR. Today it's around 3.1%. That's bad but I think the glass half full view is it could have been worse (may still get worse seeing as Flu season is coming... My question though is what are we classifying as COVID cases... In HIV, HIV is the virus while AIDS is the end stage (well once end stage) disease. And we have specific criteria for the diagnosis of the disease because not everyone develops AIDS...like not everyone has symptomatic Sarscov2... It seems we are including EVERY case of SARS-cov2 positive PCR tests as "COVID" cases regardless of symptomatology. If I recall, at onset the diagnostic criteria for COVID-19 was +PCR WITH high fever, cough, CP and SOB. How many of these new cases will actually become COVID given that criteria? It's great for the CFR (well in this case it's closer to IFR) but the CFR should be higher for new cases meeting COVID diagnostic criteria, which I cannot get a good source to define it. It seems the CDC is defining COVID as ALL + PCR testing...is this a good practice? I suppose it may be due to the whole "well we don't know who will develop sxs" but can't the diagnostic criteria include a waiting period say 2 weeks to see if pts actually develop sxs WHILE quarantining them to prevent spread, BEFORE we call it a COVID case? [emoji848] Wouldn't that be a better way to track this instead of reporting every new case or increase in cases on the news every day? Increased Cases, as of late anyway, don't seem to be resulting in increased deaths given the daily dropping of CFR/IFR... Am I making sense? [emoji23] [emoji23] [emoji23] Sent from my SM-G975U using Tapatalk
  4. "low-mid six figures"? Like 100k-500k? WTH? Sent from my SM-G975U using Tapatalk
  5. I graduated PA School in my mid to late 30s...i thought about Med school/Bridge the first 3-5 years then pretty much squashed it. I don't want to take on more loans having just paid off my loans a couple of years ago and now in my mid to late 40s I am not willing to go back to school... (I even thought about a DMS but... Nahhh....I'm getting too old and don't want to spend 5 figures on anything unless it has an engine in it [emoji23]) I *like* being a PA, do I love it? Some times... I love medicine. But not sure if going back for 3-4 more post graduate school years and then 3-5 yrs of residency would be worth it. I make enough money, I get enough respect from my colleagues and my patients love me or at least they say they do [emoji53]. I like being a PA... Just change our title and get rid of supervision and it would feel more like love... Maybe?... [emoji23] Lateral mobility is not as certain as before. Pay is pretty good. COVID effed up jobs but that seems to be making a comeback. I dunno... I guess you have to figure out how much YOU want to be a doctor or are YOU good with being a PA... Sent from my SM-G975U using Tapatalk
  6. https://assistantphysicianassociation.com/ They are also trying to be called "Associate Physicians" so that, in my opinion, should kill "Physician Associate". Imagine getting confused with these guys. [emoji2359] Sent from my SM-G975U using Tapatalk
  7. [emoji23] Me too a few years ago before going on a mission trip to Indonesia, Malaysia and the Philippines... I had to get YF, Rabies, and Japanese encephalitis... Which, fun fact, is made from rat brain... Yay! Sent from my SM-G975U using Tapatalk
  8. i used to think Cerner was bad but since I left that job I have had 2 other EMRs. One is Athena-this is very text heavy and more focused on billing so it was a lot less efficient at least for me. I started a new PC job (well, I went back to my first PC PA job at the practice I helped start) and now I'm using IMS/Meditabs. I gotta say...THIS IS THE FREAKING WORST EMR EVER!!!! and I would LOVE to get Cerner back! In IMS you literally have to do at least 3 or more steps to do something as simple as sending an RX. While you are writing a note, and you are in the Rx module, you write the RX and click save...You would think thats it right? no you have to go to the "Send/eFax/eRX" tab, then find the prescription you wrote, you select the small window to choose the Rx and then you open the Rx, then you click send (efax, eRX etc) and then you sign off by inputting your esignature which requires you to eneter your login password TWO TIMES!!! then you assume it sent (which it doesn't always do that) so I always check the RX history which is in ANOTHER window so you have to click out of the current window and open another module! [emoji2959] I just found out that 90% of my scripts have not been sent and had my MA call them in...OY! Not to mention the multiple signal interruptions at IMS Hq that interrupts your note or use of the EMR throughout the day. This am it happened during a televisit and i had to re-initiate the visit 3x...[emoji3517] SO...I hope you appreciate Cerner a little bit more [emoji38]
  9. Hi there... Welcome to Primary Care... Hope you stay... [emoji23] When testing always ask what exactly are you looking for and have a plan for both negative and positive results. I recommend templating your orders where you can alter them PRN in your EMR or if not have a cheat sheet on routine labs etc for whatever you see most frequently (CBC, CMP, Lipids, A1C, TSH for instance) then add anything extra you want to find out about. Same goes for imaging. Be as specific as you can be. Go through your ddx and know or lookup what tests to rule in/out each DDx. Avoid shotgunning unless it is for routines as above. Best wishes! Hang in there. Sent from my SM-G975U using Tapatalk
  10. [emoji23] I know you don't care [emoji23] but the WPP/AAPA won't put that through was my point. Sent from my SM-G975U using Tapatalk
  11. I don't think that would pass the "legality" issue. Like "Medical Practitioner," "Practitioner of Allopathic Medicine" would include MD/DO. Sent from my SM-G975U using Tapatalk
  12. I used Cerner in my last job for 5 years. I recommend getting macros/auto texts made up I would use "zz" as the prefix i.e. "zzhtn" and I made it to auto type global negatives then I could go back and change to pertinent positives as needed. Or you can also template all your usual presentations. Caveat with these tricks though is to be diligent to look over or know what it's exactly saying so u won't put in erroneous data or "clone notes". You can also share auto texts and templates across the practice so ask your colleagues what they use and if not already, shared ask them to share their templates. I'm at a new job and our EMR sucks. I used to complain about some niggling things about Cerner but having used several EMRs in the past I rank it right next to Epic with Epic having the slight edge. Bit I miss Cerner and wish we had it at my current job. Sent from my SM-G975U using Tapatalk
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