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thinkertdm last won the day on January 23

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About thinkertdm

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  1. -check with your institutions legal/quality assurance department about how to protect the clinic (and yourself). -check out the Ryan haight act. Personally, I would recommend never prescribing controlled substances over the internet. -have a low threshold for referring back to primary care or to the ed. -billing only requires two of three elements, so for billing-you may or may not need much in way of a physical exam. -you can also bill for time, especially if it is for a follow up. -get a phone number in case of equipment malfunction. -end each call (and document this) that you advised ed follow up for worsening of the condition -I would document your thought process (based on the patient reporting x, and denial of y, I suspect z, low suspicion of b, but cannot move forward with more in depth testing due to this being a telehealth appt. I discussed my thoughts with mrs yabba, including the need to follow up with her primary care provider if l,m,n present or symptoms worsen. I offered to help facilitate scheduling with a provider for follow up) a bit of documentation now may save your bacon later.
  2. I'm ordering zpacks for myself. Online from china. Zpacks improve everything. And if it doesn't help in the first go round, try it again. Maybe I'll just use both barrels and order Levaquin too. If it comes in a plain box marked "zee-pac" and levelkwin", you know it's legit.
  3. Good point, not my intent at all. I've edited it to reflect a less inflammatory comment. I have had several new patients ask me "so where's the real doctor" and "you're the assistant?". There are a lot of PA's in the area (including in the VA here) so I refuse to believe they have never encountered one before. I, in turn, show them of my abilities through my actions. And that's why they follow me. To my great delight.
  4. So I recently moved to a new clinic in the organization, and a few patients followed me; the couple today was telling me that they were told they would be seen by the covering "nurse" who was actually a NP. They became quite upset, demanding to see the PA. True story.
  5. At the VA, there is a "peer review" process, where the quality improvement people arrange the situation to be reviewed by a peer, who is supposed to rate whether "most providers would do it similarly; some providers may do it differently, and most would do it differently." The person in question has a formal chance to respond. Depending on that finding, it may or may not be elevated into a fuller investigation. In no case would I ever tell the patient a mistake was made; if asked, I just tell them that there are many ways to approach the problem, and I was not present when x decided upon the plan, and I can't not comment. On the back end, if I believe that substandard care was delivered, and not simply a variant of care that is still accepted; or if a significant adverse event happened even in light of standard of care, I would tell the quality management folks. I am not sure if I would discuss it with the provider in question. It would make no difference in the outcome if I knew of their rationale; someone was harmed and a rca should be performed. RCA's should be non punitive. In any case, I am my patients advocate, until told otherwise.
  6. Does anyone know how to give my thoughts on a question on the pilot exam? I have a beef on one that isn’t very evidence based. Have lots of issues with the exam questions, but I figure I’ll play their stupid game. This one in particular rubbed me wrong. i marked the question and went on, but don’t see a way to report it.
  7. I guess I'm missing the anger directed at providers in general. I would say the fault (mostly) is on administration and the push to move medicine, of all things, into a retail, commercial enterprise. In two of the three civilian jobs I've been at, I saw four patients an hour. Given the ma/lpn time, I have what, seven? minutes to talk with the patient about his midsternal burning pain, ask enough questions to make sure it's not cardiac, make sure it's not a GI bleed, make sure I'm not going to get sued...then talk with them about lifestyle interventions and risks vs benefits of medications. Then face administrations wrath when press Haney scores are in the soup because I didn't write him for...anything. ok, one down...twenty more to go, and the next guy has chronic knee pain that Tylenol "doesn't work". I could sell him on weight loss, any number of better, long term pain management options, but damn, I'm already burnt out, and it's the second patient of the day. Not an excuse to practice bad medicine, I know. But medicine in general is a high stress occupation, even for us assistants. Things in high stress situations are prone to breakage. That's the elevator has a weight limit. We have no warning signs, no schedule for maintenance. Vacations are not an answer, they come once a year, temporarily take our mind off of work (if we take one), then it's back into the breach. Psychology trainees and probably psychologists have a "debriefing", where the stress can be safely offloaded. We have no such outlet. Another problem is the growing lack of responsibility on the part of the patient. Little education in news and Social media.. .patients pick and choose what they want to do based upon the latest meme on Facebook. I can't tell you how many people say they have a fever, yet dont have a thermometer. How many people are not taking a cholesterol medication because it'll give them muscle pain. So yeah, lets blame docs, pas, and nps, and ignore the ceos and upper management staff who's "bonus" relies on productivity. oh, lastly- we could stand up for ourselves and refuse to do it, refuse to go at that pace. The problem is that everyone else in the practice thinks it's ok to provide mediocre care; they leave on time, and sleep well. The rebel will always leave late, run behind, and burn out far faster than his substandard but administration ass kissing colleagues. My two cents.
  8. You'd probably get better luck if you didn't use black highlighter over your name. All joking aside, I was wondering about the utility of putting down a skill set. Aren't these things a given with PA school? Plus, aren't your skills not only using those techniques, but matching them up with a disease process and thus a treatment plan? That seems like the real skill set. Not necessarily able to check a prostate, but able to assess and tell the difference between symptoms of BPH and prostate cancer.
  9. Make the pa Professional forum password protected.
  10. You need to investigate both options. I'm not going to say "more" because it's pretty clear you haven't even started. To tell you the truth, life is pretty stressful, then you die. im to take it easy on you, it looks like you went to college without a clue why, now you are trying to figure it out, three years in. The two items you picked are so disparate, it's like saying "do I want to make pizzas for a living or do surgery?". (Incidentally, that was literally my decision, a lifetime ago. ) Is there a career office at your school? They can help you do two things: identify what your passion or calling may be; and two, help you get there. One of the professions above is a sales job. That's it. You sell things, you can do it. The other is a science based job where you use evidence and training to guide people through sickness hopefully to health. Heres something that helped me through some times when I didn't know where to turn: Good luck.
  11. Ok...if you literally can not use google to find this out and depending on an anonymous forum to just give you the answer- I can’t help you.
  12. Some jobs require the actual aha.
  13. Insurance company sometimes have a list of covered providers in specific areas. When I want information about pa’s in a state, I google “pa association in cuz state”; try dietician association in Nebraska, etc.
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