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thinkertdm

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thinkertdm last won the day on May 19

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  1. I haven't had any students yet, but I've been trying to think, buzzing noise or just ridicule? Difficult to choose. I always think there are two ways to train a dog. The first (and, unfortunately, more common) is the beat down, ridicule, teasing. They will learn, but become sullen, bitter, and eager to pay it forward. The second is through compassion, humor, and friendship. They will learn, and love you forever.
  2. Interesting. Not much you can do while she is on something currently, as evidenced by your physical exam and observations. Cover yourself by assessing and documenting for emergent evaluation elsewhere. Worst case scenario is she dies walking out the door, and it is from sepsis, overdose, stroke, seizure, blah blah blah. I would document clearly- "low suspicion for x, y, z due to a, b, c.". Once you are sure about that, then the real fun begins. Obviously very little information sharing can happen as something is working on her in the office; however, you can't be sure that she is there for more of the same or she truly wants help. Addiction is a Rakshasa, a demon in the form of a person, and you can't be sure which one is in front of you. Be kind but firm- like you were. Thinking "well, just a little" will get them (and their friends) back for more. You can only recommend addiction specialists; MH or social workers. If they don't want the help, that's on them. The key is document everything. Even have your LPN nearby as a chaperone. I like to think a number of things. One, we can only reach out our good hand to help, because that's what it's there for. Two, we hope eventually they will grab on. If they sink, its not because we didn't reach out. I also think, when they are nasty and swearing and spitting, its not them, its the drugs. Sometimes it helps. That's all I have.
  3. I was perusing my favorite "on the can" news website (yahoo news) and noticed an article about a magical place in Oklahoma which charges a flat rate for surgeries. In checking that website out, they had an...advertisement, I guess, for an ER/hospital which does the same. I felt a little nauseated reading it, like eating cookie dough that was too sweet. ... [Dr. Rice] Yeah, thanks for having us. So, my name’s Dr. Rice. I’m an ER physician. We are starting a hospital that has been in development for about two or three years, at 150th and Penn in Oklahoma City. It’s a physician-owned, emergency hospital that has nine ER beds and a full in-patient service. Has MRI, CT, ultrasound, X-ray. And as Dr. Smith said, we’re excited. We’re trying to bring price transparency and a high-level of patient service to the area. We’re excited about the community and we’re excited about being able to do some contracting and price that will hopefully save, you know, the patients of Oklahoma quite a bit of money and allow them to have more money in their pocketbooks at the end of the month. So, I’ll pass it on to Dr. Barton. [Dr. Barton] Yeah, we’re excited to be here, and we are a group of doctors. We’re all ER doctors, and so our center focuses around the ER experience, and we make that better than anybody else. You come into our facility…the wait time and the waiting room…our waiting room is just for show. You wait there for less than five minutes. Nine beds. And what if twelve people come in? Are you going to wrap up patients 1-4 in 4 minutes? That doesn't sound too safe. You go right back to the back and see a doctor. Usually, you’re still filling out your chart and the doctors interrupting you saying “oh, how can I help you today”? And, you know, we have everything. We have the labs, we have, you know, ultrasound, MRI, CAT scan, X-ray. You get seen by a doctor, you don’t get seen by a nurse practitioner. I'm going to assume this's includes PAs too, and was made purely for advertising. "Come see the real doctors"! And our two biggest attributes are that we’re super friendly and were super-duper fast. We get you in, feelin’ better, treated, get you out…if you don’t have insurance, or you want to pay cash, we have transparent pricing, you know, and its very reasonable rates, and if you’re sick enough to need admission to the hospital, we can do that too. We can admit you right to our hospital and take care of you until you’re better. And you’re going to feel like you’re at the spa, and not the emergency room. I like spas, but if my abdomen is filling with blood, or my face is drooping, I want the grizzled ed md or pa, who knows wtf they are doing, not an md who says "super duper". If you’re at the ER, it might be the worst day of your life, but we’re going to make that a way better experience than usual at the ER. You’re going to like it. i think if you like the ER, maybe you don't have a gd emergency. heres the link: https://surgerycenterok.com/transparent-pricing/introducing-oklahoma-er-and-hospital/
  4. As a scientist, don't arbitrarily dismiss any data; take each piece, determine it's source and then weigh it accordingly. Any patient report, in my mind, never, ever indicates anything aside from the ability of some one to use "the internet". Bad reviews don't indicate he doesn't know medicine; unfortunately, it doesn't mean he's a super star either. However, there seems to be more than a fair number of reports on his manner that may-may- show a difficulty working with others. Or not. What do you do with this information? Dig deeper. Look him up on state medical board for discipline episodes. Google his name. Just investigate. It would be nice if state pa associations kept a database of "difficult to work with" sp's.
  5. It seems I'm in the distinct minority, probably having been the victim of abusive pimping - by a group of PAs no less. 99% of the time when I ask my preceptor a question, I know the answer; I either want some real life input from their experience, or I'm torn between two equally worthwhile decisions. In all cases, there is a patient waiting, because, you know, work- and I don't have time for this crap. I completely understand the "teaching" technique; I just think it's crap. Especially if you mean pimping to be shotgunning obscure and tangentially related questions, otherwise it would just be an informative discussion.
  6. Don't put me on the spot and expect me to pull answers out of my ass. If you are teaching, or even want to educate a fine point, then tell me. I don't appreciate these little games. I mean, for crying out loud, I know obscure details too, but it all amounts to guessing what the pimpor is thinking. Here's a classic example of pimping: "What have I got in my pocket?" he said aloud. He was talking to himself, but Gollum thought it was a riddle, and he was frightfully upset. "Not fair! not fair!" he hissed. "It isn't fair, my precious, is it, to ask us what it's got in it's nassty little pocketsess?" In the original post, a complex topic was brought to the sp. Instead of "this sounds a lot like blah blah, you have the such and such; check x,y,z in a week, if no better then do d,e,f" you have to play a riddle game. I've had excellent mentors who taught me lessons I'll never forget, one of which was the adjuvant effect of Tylenol with tramadol, and she didn't resort to this nonsense. Just basically laid it out. Lastly, I don't think we'll under pressure. Not someone having chest pain, u can handle that. I'm talking someone quizzing me on minutiae...my hands get clammy, I stammer...not a reflection of my clinical skills or knowledge.
  7. No. I hardly see him. If I do have a question, I'll ask one of the docs, but they are too professional and busy to waste my time and theirs. If you've worked with these clowns for five years and they feel the need to assert their dominance by humiliating you, consider finding a position elsewhere.
  8. Yes, the AFGE. A lot of people laugh but when your tour of duty gets changed, or have an OIG investigation, it's nice to have.
  9. That plus the overwhelming reliance on NPs. I have stories you would not believe.
  10. If you fail it, you get a year to take the panre. It's experimental. They dont kill Guinea pigs if they...fail...oh crap...
  11. I missed a couple too, but I was watching reruns of "Highlander" at the time.
  12. From a clinic perspective, any time you spend not seeing patients is not making money. Period. When you make a call to a patient, net income: zero. Net loss: zero as well, because you are salaried and they aren't losing money. However, you literally could have removed a lesion in that time: possible gain: 50$? Just guessing, but the point is, the office manager should realize this. From your perspective: you are a highly trained medical provider being paid crap wages a high school grad could do. They are not going to budge, so cut bait and haul it out if there.
  13. I guess there are two issues here, one is being associated with a colleague who has questionable judgement, in which case the issue is with Joe the plumber saying "oh, you work with that guy, thanks but no thanks.". The other issue is that eventually, this guy will make a decision that will lead Martucci, Martucci, Martucci, and Smith, LLC to add you to the list of defendants. The first no one gives a hoot about. Even future employers can be redirected with some words about how you left. The second situation is the one that will leave a scar.
  14. Tigers don't change their spots; while it certainly is possible that this fellow learned his lesson, a part of me thinks that poor decision making is part of his style and the episodes you reported were only the tip of the iceberg. The extra money you would have made probably would have gone towards extra malpractice, lawyer fees, or some such thing.
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