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thinkertdm

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thinkertdm last won the day on April 3

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About thinkertdm

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    Physician Assistant

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  1. thinkertdm

    Should PAs Hug Their Patients?

    I talked with my wife, apparently, I am emotionally disabled by not hugging. But yes, i agree, in extreme examples, hugging would appropriate. However, I think those situations are not common and really should have more than you and the patient in the room.
  2. thinkertdm

    Should PAs Hug Their Patients?

    I wasn't able to read the article, and I've given bad news, and only once have been asked for a hug by a depressed woman going through a divorce. -the context was ringing alarm bells. Sorry, and next visit, she was seeing someone else. I'm not a friend, I'm a guide. Plus, I'm not a hugger. There's a distinct line around me that only my wife, son, and mom cross. I keep that part separate from my work. I get to work, I put on work persona; it allows me to compartmentalize and not take home my work stuff. Hugging crosses over. Plus, scabies and bedbugs.
  3. This might sound rough, but this exact same question has been asked about a million times. Employers don't give a rats ass about where you went to school, the name, the city, or your rotatations. This isn't med school; Daemen college has the exact same prestige as Arcadia University. They have no idea of the education or cme requirements either. They think the Pance is something you get at walmart. They do care: can you see patients, and can you make them money? If you are worried about finding a job, you should be- what makes you so special about the other thousand new grads? Shine through your rotatations. Get good lors. I graduated from a school in the middle of new York, then got a job in the middle of Illinois.
  4. thinkertdm

    Weirdest/funniest complaint

    Folded, huh? I think I read about him...
  5. I like "super power house practioner EXTREME!" That's how I feel most days.
  6. thinkertdm

    New Grad Licensure Question

    My advice (and I'm just a stranger on the internet): if you know a state you like, start the application process.
  7. You could live in a van. Down by the river.
  8. thinkertdm

    Weirdest/funniest complaint

    "bump on head" which turned out to be his occipital protuberance...or "bump on chest" which was xiphoid process. Not the wierdest but came to mind fastest.
  9. thinkertdm

    Any Mystery Cases?

    The differential could include (forgive me, I just woke up): bilatal (pitting) edema: acute right sided heart failure, portal vein obstruction, acute renal failure, bilateral dvt (apparently already ruled out); less likely, hypothyroidism, lymphedema Pain: sunburn, increased skin turgor, new medications, polymyositis. And dog bites. Time for coffee. Start with metabolic panel, with alt, ast. Toss on tsh, though low yield. CBC too. As mentioned above, bnp, but if you have copd or hyperthyroid, or any kind of fluid overload state, will be high. Esr and crp, I like both. Please list meds both prescription and otc. Bmi. Smoking history. Travel history (consider travel related things if positive). The pitting suggests fluid. Is she dyspneic at any point? Orthopnea? I hate these guessing things...
  10. I don't think my initial comment was clear- yes, ultimately, things will be taken away. But don't come to the table with that attitude, because people have been trying to take their goodies away for years, and they ain't having any of it. Instead, convince them to give it it away. It was their idea. That's the goal. We know it's dangerous, and deadly- they may too. The art of medicine is to listen and work with them. Lots of options for ambien- trazodone, melatonin, warm milk. If they counter "it doesn't work", and they will, be frank. Be clear. This combination could kill you. Why hasn't it yet? Luck.
  11. That's 85% chance of living. Not going to change anyone's mind. Remember, work with them but don't argue.
  12. In the VA we have these things called alerts, civilian practices have similar things for when something needs your attention. The problem- it's never the patient. Ding- needs orthotics. Ding- orthotics ordered. Ding- orthotics released. The number one thing I've heard over my first two weeks is that no one's listened. Because we've been trained to address the alerts, the treat releasing lever. A monkey can be trained to do most of those. Turn away from the computer. Look at the patient- the person- in the eye. I hear " I'm too busy!" I got to work that lever for the treats! We made this system. It ain't gonna change until we stop it. I went with my wife to a provider. My wife could have been on fire, but the provider would never have known, because the computer took up her attention.
  13. Easy. Don't go in with the attitude you are going to take anything away. Take each problem, asses it, then discuss with the patient the best- safest and most effective course (which may be opiates). Discuss that being on various combinations can increase side effects, including death. Don't be scared to say death. The patient will probably cross their arms and reply "well, I haven't died yet". Don't fall for that- don't get into an argument match with a three year old. Don't forget you many times you can't discontinue cold turkey, and be prepared for well thought out replacements. Refer to pain management for weaning ideas. People die on these things. Period. They worry so much about myalgias with statins but have no problem with the sleep of death by temazepam AND Clonazepam? Please. Hold fast to your belief, but sometimes these Are useful tools, if used right. Ps- there's a difference between addiction and dependence.
  14. thinkertdm

    Cocaine + Ativan

    Sometimes you go to a party where they are throwing around big clouds of cocaine. What are you supposed to do, leave?
  15. You are using your medical training and license to state "this child is healthy enough for..." 99.9 percent of the time, it doesn't matter. But when little Jimmy drops dead because he had HOCM, I hope your spouse works, because your malpractice won't cover it and you will lose your license. And your job. When a relative asks medical advice, I ask them who their doctor is, because that's who they need to call. But it's your license. Roll the dice.
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