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thinkertdm

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thinkertdm last won the day on March 4

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About thinkertdm

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  1. I would love primary care, except for two facets, one of which is derived from the other: first, medicine becoming a retail, "customer service" field. It's not. And second, the general decline? Or lack- of self responsibility- and I'm not talking about weight loss or even following my advice. I'm talking about this: don't come to me when a basic understanding of science or biology would have answered your question. Don't come to me with the expectation that it is my job to keep you healthy. It's not. It's my job to give you the tools so you can keep yourself healthy. If you can buy cigarettes, you can understand lung cancer and it's treatment. I'm not talking about knowing individual receptors, but knowing the difference between viruses and bacteria ...
  2. In one state (I forget which) md's would see for the first visit, or need to see every three or something like that. Those rules tend to change with the seasons and may be facility specific. Personally, in the four states I've worked, there were no specific rules, but sometimes patients thought there was an MD waiting in a back room in case they snapped their fingers and wanted an md.
  3. Google (your state) physician assistant laws. Easy. You will find a boat load of information about specific laws, especially if you are wondering about the legality of seeing a pa vs an MD. I would also Google similar laws regarding np's. If you want to see an MD, ask for this when you make your appointment. This also demonstrates the need for a verified section.
  4. Being primary care, I don't often state my role, I always thought that was evident given I'm the only person not wearing a lab coat, plus I've seen these people many times. I usually bring them back from the waiting room; "Mr Smith, there he is! how are you. Mr Smith?". Sometimes I pretend to review his vitals and meds sheet, which I already know, because I reviewed the chart beforehand, but I save this for patients who are bent on making the world around them miserable. The dance continues on the way back to the exam room; "Who is this young lady you brought with you today?" (Usually the wife, if it's a daughter, I use "oh, you brought your sister today!" Usually breaks the ice and makes them smile, and gets me introductions. At this point I can see them and get an initial assessment; they don't necessarily know it, so no exaggerating going on; sometimes extreme like a 35 yo walking like a 90 yo In the room, down to business, but I still like to let them set the stage; (if I've never seen them before) "Hello Mr so-and-so, I'm Thinkertdm, I'm a physician assistant"; but then: "what brings you in today?" I usually sit and face them; if it's an acute, serious sounding concern, I'll start looking again at previous vitals, labs if they are back yet; I'll periodically look at them to engage. If it's a routine follow up, sit and talk, they'll tell me everything, sometimes without me having to ask. You can make an Ros without sounding like an interogation. I avoid PA because it sounds like "MA", but I suppose "assistant" sounds like "assistant".
  5. So... acknowledge the patient as a person? Talk to them? Make...eye contact? Human sacrifice, dogs and cats living together... mass hysteria! Just kidding. One last thing: turn away from the computer. It's not your lover.
  6. While I wholeheartedly agree with everything you said, I do not see where having any other name would have changed the requirements of chart co-signatures, or the requirement of "supervision". You would still need the FU money, because the hospital would have still thrown the people requiring "supervision" off of the bus.
  7. I go to the doctor early, but the last few times when I showed up- 30-45 minutes before my time- the staff seemed pissed, like they were expected to get me in, when it's actually a break for me. I get to sit and watch TV and read magazines. Honestly, I really go early to relax and price is right.
  8. You're right, it was early. However, I semi-disagree with you about the name change.
  9. True, it was a sample size of 1. Maybe they were having a bad day. Maybe they felt unappreciated. Consider this: "I'm an assistant" said no NP, ever. 23 states allow NPs to practice independently, without any apparent limitations to their scope of practice. 50 states, plus the District of Columbia, make me have a physician attest that they are providing oversight in my clinical decisions as a "supervising physician". NPs are actively moving forward as establishing themselves as a credible alternative to seeing a physician. Their newsletters, forums, and day to day conversations focus on getting the next state to allow them to practice independently . Malibu Stacy is the same, just with a new hat. And that hasn't even appeared yet.
  10. I don't think the "assistant" in physician assistant ever, ever meant "stand there until I ask for something" or "get me coffee, Moneypenny". Today I did not hold a single retractor, kiss any surgeons ass, run around in my scrubs looking flustered while the surgeon strolled in. I met with my team, made clinical decisions on 15 patients, advised one on life sustaining measures, refilled numerous prescriptions, but had to review the chart to make sure they were still needed and appropriate until the next appointment; and dealt with one pompous asshat DDS who did not understand how the VA deals with prescriptions from non VA providers. I did hold the door for one of my patients, so maybe that makes me an assistant.
  11. If it's just you and a nurse, perhaps a door flag system; maybe a place on the counter where you put patients chart who need x y or z. Put a tracking sheet to tell the nurse the next step; ua, then back to me. Put a shelf thing on the door where you can put the tracking sheet. For the hipaa lawyers out there, you can turn it face down, fold it in half.
  12. thanks for the update! I agree, not much you can do about someone who is untruthful or trying to game the system. However, practicing good medicine can cover you a bit: -think before you prescribe/order any therapy. What am I treating, why am I treating it this way, what alternatives are there, is this is the safest/best way for the patient. I understand that in an UC setting there is pressure to see more faster, but this is basic stuff, and slow down. The key words above is "is this what they always do for me". At that point, you need to stop. While it is handy to know what has worked in the past, it by no means absolves you of responsibility if something goes wrong. Writing "patient claimed it worked in the past" in your note isn't a magic shield. There are times when administering a medication in the clinic are necessary and times it is not. Think before you do it. Lastly, document your thought process. Have dot phrases if you need to. This documentation may save your career, mine has saved mine.
  13. "My pain...it's like getting shot...in the head..." Me: "have you ever been shot in the head?" "Well, no. It's what I imagine getting shot would feel like". Me: "so, instead of MAKING shit up, take the worst pain you have ever felt. Then compare this to that. It's easy. Hell, just make up a number that's realistic, I just need it so I can bill you higher, and ain't no one is gonna believe ten out of ten, shot in the head pain while you sip your Starbucks". After a pause: "I'm going to write president trump" Me: "fine. Make sure you spell my name right- it's I-m-a D-u-m-a-s-s. Don't let the door hit it on the way out." "What about my viagra?" Me, a little exasperated by now: "Dude, you got shot in the head pain AND a letter to write. You ain't got time for that. Buy her chocolates. You're still not getting methadone for your dental pain, I don't care who prescribed it in the past" Him: "but it huuuuurts" "Yes. I know. Like a bullet. In your head. You were here for antibiotics just last week!" Him: "it's the other tooth. The antibiotics only worked on the first one, the other one still hur..." "For crying out loud, I know!"
  14. I had an occasion where a colleague sent in a prescription for Zofran for nausea secondary to gastroenteritis. Was it gastroenteritis? I was vomiting, had diarrhea, chills and aches for a few days. Probably. No record made, and that made me uncomfortable, most likely because of the ( I admit low) chance of side effects, and they really didn't know anything about my history, even though the PA in question asked some basic questions. On the other hand, with my recent ICU experience, I did not tell anyone of my PA background, but I did not want the "regular joe" talk, I wanted to be talked to like a big boy. So I asked questions like an intelligent person would; they caught on and asked where I worked, so I told them. I was treated better, but I was also polite and not rude and demanding. I did ring my call bell a few times, because they wouldn't let me walk around on TPA. @#$@ ICU nurses. I nearly made it the whole week without pooping, because I was not going to let a pretty nurse wipe my bum. Anyways, I just used my background to help me understand what was going on. Made it a bit scarier, but I also knew I was in capable hands. I did downplay my symptoms for at least 2-3 months. And ignored the gradually increasing dyspnea, and hemoptysis. The chest pain wasn't pain at all, it was a stretching sensation in my right chestal area. And that's how I ended up with a bilateral PE with right heart failure. No DVT in legs found; maybe in pelvis. Actually, I take it back. A colleague at my current job saved my life, because the nurse told me to go to the ED, then she called an MD, who told me. He then recommended a top notch PCP I could follow up with and pulmonologist. The only thing I know about symptoms is that they are different for everybody, and most times if someone has the textbook symptoms, you won't find a textbook case. That's the art of medicine. I had dyspnea that I attributed to asthma; went to a NP in an urgent care (first mistake), then an overworked MD in a family practice (second) who ordered pulmonary function testing. In truth, the only reason I didn't go to the ED was because I didn't want to sit around, have someone listen to my chest, and be told it was nothing, like had happened twice before. The doc (and it doesn't have to be an MD) actually listened to me, but also looked at me.
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