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thinkertdm

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thinkertdm last won the day on August 13

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  1. Honestly I see this as a “not my problem” issue. adults sick with lung cancer/colon cancer/sleep apnea/chronic back pain made the choice not to quit smoking/get colonoscopy/sleep study or lose weight/lose weight and outcome is on them (yup cold but I am tired and burned out) peds is a different issue (<12 as no vaccine). Honestly think we should be D/C unvaccinated adults home with VNA/Hospice and prioritize the peds. we are the sum of our decision and if you decided to skip vaccine it is your problem not mine. Enough people realize this is a medical issue and not political then we might just stand a chance. I agree. People who do dumb shit deserve what they get. This was in my wallet: I swear to fulfill, to the best of my ability and judgment, this covenant:I will respect the hard-won scientific gains I will remember that there is art to medicine as well as scienceI will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.I will respect the privacy of my patientsI will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. I will prevent disease whenever I can, for prevention is preferable to cure.I will remember that I remain a member of society.If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. I just tore it up
  2. To me, working from home is as close to a sin as you can get. Work late if you have to- I do, but when I leave the clinic, I leave the clinic. You work to live, not live to work. The va uses (or tries to use, depending on your team) a huddle concept, as reality said above. I’m lucky enough to have worked with two excellent teams in the past (not currently, unfortunately). It will trim up some time if you talk about your upcoming schedule with the rn/lpn. The key piece of advice common is you need to take control of the conversation when the patient comes in. You direct the flow. It may not be your personality, but you’ll have to change that, at least while you are in the room.
  3. 1. I get 30 minutes with each patient. 2. I get them from the wr. “Hi mr smith, I’m thinkertdm, pa. What’s going on with you today? (As the rn already asked, I know. I just want the patient to tell me) usually at this time, they say I’m just here for my yearly, which is not what they told the rn. So, as I’m typing into my general use template, I casually say “so…is there anything you want to talk about today specifically?” Usually this is where they can voice what’s on their mind. If it’s a lot, or minutiae, I say, ok man you got a lot going on. I have some questions, then we can see if they answer yours (or something similar). then I go through my list, date of colonoscopy, if they are a smoker, if they want to quit, family history etc. then I have their labs printed out, so I go over each one, and write on the page notes for them, like what the tsh is, etc. then listen to their heart, etc. that’s for a yearly physical type of deal. For a follow up- (and no one actually knows what they are following up for, they think it’s a chance to tell me more issues) I just go down their problem list in a conversational tone. luckily I get 30 minutes per patient. as far as keeping them on track- you need to learn to interrupt them and keep it a q&a. Unless you are drinking a cup of coffee with them, they aren’t your friend. You are their guide. Guide them.
  4. I have noticed that no one has really identified the failure of the health system specifically, aside from saying "failure of the health system". The nurse heroes get loads of attention, but very little attention to the villians, like the CEO's, board members, and administrators who used "just in time" product delivery systems, who rigged the system to production and speed rather than quality, and who would rather get a sweet, sweet bonus rather than hire a few more damn providers. We are all in this together, my ass.
  5. Sometimes simple is best. I ordered my high school French teacher a year of Newsweek by writing her name on that post card and sending it in. I also kept unplugging her computer. This was thirty years ago so I also unplugged the floppy drives too. Bon jour!
  6. Treat others how you would want yourself to be treated. And if they are still nasty, steal all their pens.
  7. Holy crap, I thought I was the only one who saw that movie! I'm probably the only one who saw it three, four times.
  8. agreed. In fact, I can not agree more.
  9. It appears the MD prescribed the methocarbamol. Who knows what goes on in their vast minds?
  10. https://www.medscape.com/viewarticle/955557 my bad
  11. This article dropped into my email earlier, and I’m speechless. Really. Read the article, but basically a woman was seen by a PA, recovered. A few weeks later, her husband, who had “significant comorbidities” had similar symptoms and went to the same PA. The suit alleges the “wrong” test was ordered, and no treatment was given? and the patient ultimately expired. There’s a lot more I’m not including, but you have to remember this happened in nov 2020. First, there are some details missing, such as why the guy didn’t go to the Ed. Second, I’m not sure why a test was even ordered, let alone waited on- there’s no treatment in an outpatient setting. Third, this fellow had pretty bad issues, another lawsuit he and his wife were involved in he apparently had uncontrolled diabetes. Finally, the comments truly terrifying. https://www.medscape.com/viewarticle/955557
  12. Just to play devils advocate here. Aside from the sizeable fringe element, do you suppose that at least some of the unvaccinated remain so because it hasn't been sold to them right? Take a step back from the craziness and walk with me here. Here's a scary virus, hundreds of thousands have died, we see nurses sobbing on TV- then, almost overnight, poof. A vaccine. Now, you and I know what goes into drug research and development. But for the average person- and remember, we aren't talking about the willfully stupid here- the average person's science understanding is barely above knowing how a light turns on. Stick with me here. In the past, it would take years- years- for a drug to get made. Now we have one in months. Our government doesn't have a good track record with health-and now everyone! is told to get it. No side effects at all! Its close to magic! So - again, talking about the average, not the stupid- do you think people would benefit from a calm, nonfrenzied explanation of basic science? remember, although the patients nod their heads, they do NOT understand.
  13. A belief in UFOs, astral projections, mental telepathy, ESP, clairvoyance, spirit photography, telekinetic movement, full trance mediums, the Loch Ness monster and the theory of Atlantis.
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