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thinkertdm last won the day on August 15

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About thinkertdm


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    Physician Assistant

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  1. My pact was excellent when I started, excellent clerk, superb RN. Then the clerk retired, the RN left to go back to the ED. Since then, I’ve had covering RNs daily. You may think a half hour appointment is no problem, but the patients literally write down everything that comes to mind over the past six months and just spews it out at the appointment. Preventative health takes a distant second to chronic pain. The other biggest issue is the antique emr the va uses. Some designer in the past decided that you, the pcp, has to literally look at every single issue that goes on with the patient; they are called “alerts” and go to your work list. Patient gets orthopedic shoes- you get an alert. Patient schedules an appointment as a result of a consult you placed- you get an alert. You get three of these if two phone calls don’t work and a letter is sent. Refill requested- an alert. On average I get 100-200 of these a day, and without a consistent rn, I get to do a lot of consult management too. I asked one of the covering rns to call a patient and her response was “I’m not covering today, have him make an appointment “. Sheer laziness, and since the nursing manager has his head up his ass... If you want to see and manage conditions you will never see in the real world, the va is an excellent place. I have a panel of 1000, and four women; women’s health issues go to women’s health.
  2. It looks like this is taking data from a number of study sites, not just one. There is no information in the research protocol about actively using any particular data for admissions criteria. As noted above, many PA programs have different entrance criteria; some value prior experience, some value education, some value shadowing hours. I see the prior note about particular experience being admitted; unless you have input into the admissions interview, it is difficult to come to a conclusion on the basis of experience alone. If you are using this to justify why you weren't selected, its the incorrect path. If you are bemoaning the fact that PA school admissions criteria is less on experience and more on other things...
  3. So...how have you corrected those deficiencies? No school is going to want to put anyone in the field who lets personal and financial problems interfere with the care of a patient. Specify how you have corrected those, and I’m sure it will be taken into consideration. No need to list them here, just think about it.
  4. It was a little play on the “send every one to the Ed”
  5. I would send to the ED for the fact it is a skin condition. Heh. Ohh- you thought I meant emergency department; I meant excoriation department. Humor is not my best at any time, and especially not this early. But back to reality: based on the fact it is a "neurotic excoriation", I am figuring the work up has excluded most everything else. Starting on the legs is a bit weird. So, the antihistamine currently is- most likely 2nd generation. I use hydroxyzine a lot for anxiety. It may help. Make sure the SSRI is at the most effective dose; you could try buspirone. UDS may be negative on a first run, and make sure it includes meth and byproducts. Steroid creams are nice but if moderate intensity or above, remind them about time limits.
  6. 1. Send them to th ED 2. hydroxyzine bid or tid, if appropriate?
  7. I am personally a very shy and introverted fellow. One would say this is not the occupation for me. However, you don't need to be sociable; this isn't a club or radio station. In fact, what I do is just before I go to work, is get into character. It's a show, after all. Like any good actor, its more than just going through the lines like Edward Norton in most of his movies; each and every movie, that's Edward Norton. However, think about John Malkovitch, or Dustin Hoffman. Some roles, you are astounded. So, take the role. Own it. It will take a bit of practice.
  8. This is true in all specialties, and the aphorism of the hooves and zebra baloney doesn't really hold true, and should not necessarily be used to guide your thought process. In a primary care setting, chest pain can be anything, but if one gets tied down in a "jeez, another overweight forty something with heart burn" they are going to be the ones getting burned if they are not careful. Same with UC. In the ED, there are a number of possible fallacies; if they aren't about to die, it's not important; if it's not chest pain that meets such and such, its not an MI and I'm not going to rule it out; dizziness is "labyrinthitis" and away they go. While nine out of ten of each of these you will be right, one will be wrong, and you could have caught that one by...being human and thinking. Not letting the administrators guide your thought process. Be efficient, not fast. Here's an example. Someone went to an UC for some dyspnea for the past few months, some chest tightness. The provider on duty asked a few rote questions, stated that she didn't hear any wheezes but prescribed some steroids and an albuterol inhaler. Boom. Level four, out the door. She didn't ask about recent travel, recent bed rest, recent surgery, check legs for edema. That provider must have seen a bazillion asthma and COPD flare ups in the past week. She heard hooves, and didn't stop to think, she went with horses. In fact, don't even bother with hooves and horses and other bullshit. Do this: 1. talk to the patient. That the basis of a "full history". Who, what, where, when, how. We all learned how to do it. Keep asking questions. 2. Come up with a preliminary differential. We all walk into the room with a list based on what is listed on the schedule. This is helpful, but we should know it may change. This differential shouldn't specifically include every damn thing, because, honestly, brain tumor for headache is unlikely. This isn't hooves/zebra baloney; this is elicited by that history you just did. Length of time, intensity, etc. 3. at some point, look at what has been done. If you have a chart bursting with info, great! use it. If you can get it, get it. 4. physical exam we've been told is tailored to the differential. That's true. On the other hand, sometimes the physical exam is so unhelpful...but look anyways. If you don't hear a wheeze and you expect to find one, don't make the patient fit your differential. 5. go back to the ol' differential. By now something should be coming out. How can you tease it out? If nothing, go back to square one. I went to a museum. Like many people, I rushed through, to say, "I went to that museum!" I felt each exhibit was the same, telling me something, but there was always one ahead of it. Gotta keep moving. "Oh that's nice". Shuffle, shuffle, shuffle. This is not the way to approach your schedule. Each patient is a unique display, full of mysteries that's right there in front of you. Do not let the previous display or the next waiting to bias or color the current one. Ehh. It's been a long day already.
  9. I’m way out in left field here, but calling a few programs to ask?
  10. I found this: New scene. Mt. Sanai Hospital. Kramer is on the table surrounded by PA students. Student #1: And are you experiencing any discomfort? Kramer: Just a little burning during urination. Student #1: Okay, any other pain? Kramer: The haunting memories of lost love. May I? (signals to Mickey) Lights? (Mickey turns down the lights and Kramer lights a cigar) Our eyes met across the crowded hat store. I, a customer, and she a coquettish haberdasher. Oh, I pursued and she withdrew, then she pursued and I withdrew, and so we danced. I burned for her, much like the burning during urination that I would experience soon afterwards. Student #1: Gonorrhea?! Kramer: Gonorrhea! The lab breaks out in spontaneous applause as Mickey turns up the lights and Kramer takes a bow.
  11. I have no idea, but seeing as how they have specific licensing boards for both, I would do both. Or just call, the number is prominently displayed on the website.
  12. Wow! Didn’t read that part. Maybe I’ll mix it up between highlander, st:tng, and maybe something like ER. To keep the circuits going.
  13. What happens if we “pass” it? We still have to pass the panre next year, right?
  14. I worked there for a year. Liked it a lot, really good relationship with everyone there. I can tell you more in an Im if you are interested.
  15. One of my jobs was in a walk in, that was salaried...never going to do that again. Everything else is hourly, including the VA. It’s not so much the specialty, but whatever pricing scheme they want to pay you.
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