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Everything posted by Hemegroup

  1. http://www.inlander.com/spokane/a-new-approach/Content?oid=2260498 What's interesting is how they make sure to note how NP autonomous clinics have no connection with Medical Doctors, but PA run clinics do. Very good point.
  2. Well, our organization has a satellite clinic with a NP Office Director and I found her in a few mistakes on my first day filling in there for a few gaps, which she did not take well at all. She nastily berated me on patho and diagnostics until I opened Current and showed her what correct procedure was. She huffily said, "what book is this", I looked down at her, said "it's yours" and put it back on her shelf. I don't think she's ever opened it in her life while mine is tearing apart due to so much use. Here, let me help you take your foot out of your mouth. She even had the nerve to refer to me as 'her PA." I just stared at her in disbelief, thinking, 'sorry, did I miss something somewhere, have you gone to Medical School somewhere?' I'm a Physician Associate/Assistant, not a NP Associate/Assistant. I brought all these points up to the CEO and guess who they turned around and hired to work there ... a longtime PA with loads of hospital experience, her resume shreds mine to pieces. That's gonna be sommmme fireworks! All in the best interests of patients and life is learning for everyone so as long as patient care remains the top priority then we'll be fine. Not sure about her but whatever. Hopefully the female thing will be good between the two of them and they'll become a strong team. Pretty sure who the Office Manager is going to be tho and that's probably going to be such an ego pop that they'll end up having to hire a second provider. Who knows, we'll see. As to that job ad, it might be due to the PA going on the MD/DOs malpractice while the NP might have to pay for their own, just a thought.
  3. i've taken both psych stats 1 and 2 and biostats. apa-style shredder here.
  4. yup, knocked out acls and pals this weekend, have a rutgers pance/panre review course to finish up then i'll grab that em boot camp course (THANK YOU kbarro, that is so perfect for me) and fill in with some freebies. gonna be a busy few weeks. here goes! thanks everybody.
  5. I've got less than a thousand dollars left of my fifteen hundred allowance and trust me that I'm just thankful to finally have landed with an employer who is decent and covering the fees. That being said ... 4 weeks. Needs to be Category I and by all graces of God, online. Any tips?
  6. just started a clinic which is about an hour from town and it turns out that wow ... this is rural medicine lol. i worked solo last Friday and took a bolt out of a leg and rearticulated a shoulder. it's a very small community where ive been placed, about two to 400 people spread out over a very large region. many are 'off the grid', it's all loggers and growers. went to the hunting raffle last night (you shoot your dinner here) and church this morning where all 25 attendees insisted on hugging me. signed a 5 year contract. town is a burger trailer and a post office with 200 PO boxes. and a meat shop connected with a small bar. all local grass fed meat. hunting, fishing, pulling rods out of people ... i'm home. time to brush on some atls, it seems, altho half the clinic is ems.
  7. Migraineurs who visit the ER for headache are often given opiates simply due to time constraints as well as issues of laziness. Basically, the headaches get them hooked to the point where they end up returning either for the headache or craving/pain from withdrawal. I remember on my ER rotation, the PA gave Dilaudid to a patient who was swinging her legs in my testing of her "bad back" and smiling and laughing while she talked. The PA gave her Dilaudid. I asked her why she did that. "Oh, it's the holidays" (with a lighthearted laugh). Providers like that simply. Do. Not. Get. It. They have no idea of the potency of these medications or their dependency and abuse issues. I personally was given Dilaudid once in the ER for severe pain related to kidney stones (BP was 220/140, diaphoretic, vomiting, could barely make it into the rig) and so I know first-hand of the relief that is available from that drug. But for headache or smiling and laughing "back pain"? HELL. NO.
  8. Hello and thank you for sharing your story, I know that took a lot energy and thought to put together and I commend you for your candidacy and honesty. I'm also glad that you've found a natural medication that works for you, especially in place of substances which can have much higher potential for dependency issues as well as damage to the body with long term use. Public attitude towards marijuana is changing such as can be seen with full legalization now in WA and CO, with AK putting it on their upcoming ballot. That's all fine and dandy but my main concern is there being a pervasive forgetfulness regarding the medicinal properties of the cannabis herb. Sure, we all recommend it to people who have loss of appetite from cancer but now they are finding huge results as remedy for other pathologies. http://www.physicianassistantforum.com/forums/showthread.php/38773-medical-marijuana-for-Dravet-s-syndrome?highlight=marijuana http://www.physicianassistantforum.com/forums/showthread.php/39849-Marijuana-users-have-better-blood-sugar-control?highlight=marijuana http://www.physicianassistantforum.com/forums/showthread.php/38310-Family-uses-pot-to-mange-kid-s-autism?highlight=marijuana A good friend of mine is a MD/ND, he would understand and is one of the Docs who will justifiably write a recommendation for medical marijuana based on symptoms. Many Doctors who are up to date and free from dogma will do the same. However, your average Doc or PA Program Faculty may not be as understanding. Most important to remember is that a PA or other provider has their DEA from just that ... the DEA. The DEA still classifies the plant as Schedule I and until that changes, my advice to you would be thus. Remember that you could be tested at any time ... in your healthcare experience leading up to PA school application, during your PA Clinical Rotations (I was tested on only one, Ob/Gyn) and in employment after that. And that's the final point, the 'after that' ... you would have to find an employer that understands or that simply does not test. I for a while worked in a region where marijuana was widely accepted and so I assume that's the reason why they state on their application that they do not do drug testing lol. That being said, it's going to be up to you to find a position that works for you, if and when you graduate, but until then it will be in your interests to abstain and make it through without once you reach the point where it could potentially start becoming an issue. Best of luck and welcome.
  9. Wow, remind me never to ever send a patient to you. Your lack of compassion is staggering. Society has created lepers of certain groups and I would say that same society has an obligation to help repair that effect. It's your choice to disagree, but again, I would not send patients to you, no matter who or what they were. Speaking of want, you have a lot to learn about nicotine addiction, apparently, as nicotine is the most addictive chemical known to our species along with morphine, only surpassed by heroin. Do you speak to all smokers this way, or just the ones with different sexual orientation? You have a lot to learn about addiction issues, apparently. Further, your blatant disregard for ANYone with self-worth or self-esteem issues needs a serious second look, imo. What a sadly cruel post from someone I up until now had respected as a colleague. I definitely would not want you seeing a single Psych patient. Environmental factors can have a profound impact on development of depression. Orientation. Is. Not. A. Choice. http://www.sciencedaily.com/releases/2008/06/080617151845.htm But guess what, how we treat people is.
  10. isn't that the truth? most people think of SF as being the gateway to OR lol
  11. Santa Cruz/San Francisco is actually more like Northern Central, to tell you the truth, as it's a 6 hour drive from SF to Humboldt.
  12. fresno is definitely the headcheese of ca, worst air quality too, i believe. but i hear they have a great mall. i never saw it, only a strip of hwy running by countless shacks of homeless individuals and i do mean countless. ah well, life exists in its forms as it does. maybe someone can go there and help clean things up a bit.
  13. lol We had a pt swab positive for e. coli in her nostril yesterday ... I said what, does she pick her butt and then pick her nose? laughter. seriously tho, it can reside there, always good to be mindful of these things in the surgical environment.
  14. Yup, but access to the subscriber list would be impossible so we'd have to somehow start a survey asking the general public that subscribed to the magazine. It could be started on Facebook. For that matter, they may already have a public Fb page where we could inquire of subscribers. It might give a statistically significant number, if enough were willing to answer a brief survey. Oh look: https://www.facebook.com/parentsmagazine
  15. What's the number of readers? How many of them would turn away from seeing a PA instead to see a NP? There you go.
  16. inland empire here as well, msmedic. i had been considering OR as well except in reading the PA constitution of practice it looked less than desirable. i forgot the specifics, look into it.
  17. Sorry to hear about the A.S., my dad was diagnosed with it in his 70s. I don't take anything for my back either, except the relaxants when the tension headaches become too severe. As for the Crohn's, might I suggest turmeric without black pepper extract ... many of the turmeric supplements now do have the b.p. extract due to its increasing absorption by up to 2000%. However, for issues of intestinal inflammation you don't want the absorption into the bloodstream, you want it to go pass through the intestinal tract.
  18. I'm not going to get into a long discourse or argument regarding clinical sense, warrant, picture that's up to each of us individually as providers. Let's just leave it at 'good sense' based on evidence, as much as we have or can acquire as necessary. In answer to your proposed situation, no I would not get an MRI and yes I would order PT. If there was difficulty of gait then that would up the ante for me. The pt you presented would not be a candidate for MRI at this point in time for me, no. I am full on-board with you about surgery, however I have had better success with minimally invasive procedures such as discectomy ... which is no more invasive than an epidural under fluoroscopy. Slightly different mode of action, but the invasion is about the same. I've ordered (and assisted) in many epidurals after which it's 40/60 for pt's to receive long-term relief (dare I say even 30/70). That's just been my experience and again, we're lucky to have a surgeon here who will take the 'minor procedure' cases instead of the full-on fusion nightmare surgeries (at least they more often than not turn out to be).
  19. I am fortunate to have found one who will do them, considering the underserved status of most of the patients who he'll consider. Of course, I only send people with clear evidence (as in MRI) of severe herniation or bulge as well as extreme neuropathic pain or focal deficit. As for chronic meds ... whatever works. My lumbar issues give me severe tension of the cervical paraspinal mm. and relaxants are the only primary form of relief for me. If I had time to do yoga I would although I do try other relaxation techniques (I have a board I lay down and hang my neck over which presses hard into the knot and that will bring much needed relief albeit usually temporarily ... if I could find someone who would inject the muscle with Botox I would, the primary cause of my pain is severe tension of semispinalis capitis).
  20. For multiple and/or severe bulges, I'm a huge fan of minimally invasive discectomy. We have a great Spinal Surgeon here in town who seriously rocks them. I'll choose that, for severe cases, over PT anyday. The PT can come afterwards. Like I always tell patients who are treating their muscle tension with opiates (versus relaxants), better to get to the cause of the pain than attempt to mask over it. I'm not saying PT doesn't have its place, it can do amazing things, but some cases warrant and others warrant other alternatives. My story of the pt who was given the wrong PT regimen wasn't meant to scare anyone away from PT without a MRI, just a story to remind caution. I'm glad I'M not the one who he's taking legal action against; I found the 11mm bulge (with MRI), I certainly didn't throw him on the ball and start rolling him around incorrectly. And just so I'm clear, when I stated clinical sense I figured that was obviously inclusive of exam. Sense, warrant, etc. I can't count the number of normal xrays that come back with serious MRI-determined abnormalities. Just like the recent pt who had a normal xray of her knee but had a MRI showing full thickness cartilage tear as well as meniscal rupture. I ordered the MRI due to her limp ... it doesn't take a genius. She's consulting with Ortho Surg 4 days later, after advice to stay off her feet. physasst, I don't mean to be intrusive, but can I ask you if you have any chronic pain issues? Because I have two desiccated discs and a 3 mm lumbar bulge. I wouldn't survive without relaxants. When I have a subluxation that presses that bulge into the nerves, I have to call the ambulance to get me off the floor (thankfully hasn't happened since 2010 after some amazing PT). If you had been in my face telling me I needed CBT while I was spasming to the floor trying to get to the bathroom, I would have popped you one straight in the smacker. Proper management of pain, including pharmaceuticals or whatever other means provide relief for a legitimate patient is what's important in the end; quality of life is what's important. That being said, ending up on high doses of opiates can oftentimes be a nightmare. It's a fine line.
  21. Disgusting. You bet I'm going to write a letter, how about with threat of legal action.
  22. As I stated but no problem, will again, in clinical sense situations.
  23. don't forget the violent, screaming drunk pregnant woman that security plus staff are chasing as she runs out the doors towards the OR
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