thinkertdm

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About thinkertdm

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  1. From "Roadhouse": : If somebody gets in your face and calls you a jerk, I want you to be nice. Ask him to walk. Be nice. If he won't walk, walk him. But be nice. If you can't walk him, one of the others will help you, and you'll both be nice. I want you to remember that it's a job. It's nothing personal.
  2. Well, it wasn't the flu as the swabs were negative. I didn't see vitals in the note, and the a/p didn't say "influenza" or "influenza like syndrome". If the note doesnt convey to other providers what you did or why you did it, you lost. I was just as baffled the third time as I was the first as to why this was chosen.
  3. I saw a fellow yesterday who was prescribed tamiflu last year by his PCP for a cold for five days. She also prescribed levocetirizine and ordered a boatload of labs, from CBC to flu swabs (negative) to esr. I'm not sure what she was looking for, as both the history and A/P sections were templated from the EMR. But it was an MD so no one reviewed her charts, and whatever goofy medicine she was practicing was A-ok because MD.
  4. Yeah, it's called a "z-pack", solves universally everything. Including press-Ganey scores!
  5. I wish that I wouldn't nearly have a stroke when someone states they "don't get flu shots". One lady didn't trust the vaccine makers, but smelled so strongly of cigarettes I had to wear a mask.
  6. Many times when I try to explain to a patient why they need to go to the ED (or see their primary) I used to say "this is what I think might be going on, you might (and I stressed this) need xyz". Many providers would call me up to ask me to stop telling patients that I was sending them over for xyz, when in fact, I was trying to explain what they might need. I realized they were only hearing half of what I said, and telling the next person that they were sent because they HAD whatever, when all I was trying to do was give them an informed reason of why I was sending them. The last straw was with a lady who had chronic otitis externa, and I said that if it continues, the primary may want to consider a swab for a fungal infection. They immediately left me, drove over to the PCP, and demanded the swab. So now I just say, they need further work up.
  7. Physicians appear to have the supply controlled, preventing this exact situation of the market being flooded. PA (and NP) supply exceed demand, the value goes down. Maybe we should slow down the number of PA schools opening each year, and make the training more rigorous- make a PA more valuable than a mass produced NP.
  8. A lot of nsaids aren't well known- diclofenac, relafen, piroxicam, Meloxicam. Just make sure to evaluate their cardiovascular and gi bleed risk. Tylenol and tramadol at the same time can have a synergistic effect. In the end, don't be bullied. Don't give them any, or arrange an appointment with a PCP in a couple of days and give enough to get that appt.
  9. -"I have a fever" despite not owning a thermometer (literally, no one in central NY owns a thermometer, but every.single.one has a fever) -"I'm going on a trip/vacation/meeting and don't want to be sick" -"I don't want my elderly /newborn/whoever to get sick" -"am I contagious?" -"I've tried allergy medicine" -"I've tried EVERYTHING" -"I've tried Mucinex" -"xyz antibiotic doesn't work" -"I need"
  10. Yeah, 99% of the patients are some kind of state sponsored no copay. And they bring their emergencies to the walk-in, I had a fellow with an spo2 of 81 ( a week earlier it was 98%) arguing with me about going to the ED. He's in the icu right now, no doubt cursing me because I wouldn't give him his steroids. His son had the gall to ask me to clarify that I wasn't going to do "anything"- yes, I'm going to call ahead to the er. It's actually frustrating because my previous job at the VA was a similar to an urgent care, I could order labs and actually use my brain, I loved it, I was seeing people who really needed my help...the stories I could tell-like the 25 yo with pericarditis then I saw some lab abnormalities which turned out to be leukemia of some sort. The only problem is that the pay was minimal, and I had what I thought would be a great opportunity making nearly double- and I hate it. Not hate it like I hate creamy peanut butter, but hate it to the point I nearly throw up just thinking about going in the n xt day. I see forty to sixty patients a day, all of whom want antibiotics for their "sinus". I've been screamed at by a "nurse" who wanted a zpack for her granddaughter, who was not sick. Real nurses know how to use a thermometer, so sorry lady. Right now I prescribe a lot of tessalon. Don't get me started on the Robitussin ac, that's what pcp's are for.
  11. After working for the past 9 months in a walk-in clinic, I am convinced that these types of clinics, while making gobs of money, are contributing to the "get better fast" mindset. In the olden days, you called your nurse, she checked with your doc, who said, "eh, sounds like nothing, wait it out", or "come on in next week". So you did, and oh my gosh, it was gone. Now, however, OMGimsickibetterseesomeonerightaway. Its surprising how many people consider a sore throat an emergency but couldn't care less about their blood pressure.
  12. That's exactly what it was. The problem is that the people reading this fake news-and this is it, poorly researched and presented- are the: 1. Lawmakers, who worry about putting such responsibility into "assistants" 2. Insurance companies, who already hate "assistants" are evidently costing them so much money in unwarranted procedures 3. Patients, the most important group, the ones we swore an oath to "do no harm" Look, we all know this article is bullshit. However, the PA profession has just been punched in the kidneys, while I see that ads about "wonderful" nps. The real (and only) question - what is the PA profession going to do about it? And it better not be a rebuttal in the comments.
  13. Toe bone connected to the foot bone Foot bone connected to the heel bone Heel bone connected to the ankle bone Ankle bone connected to the shin bone Shin bone connected to the knee bone Knee bone connected to the thigh bone Thigh bone connected to the hip bone Hip bone connected to the back bone Back bone connected to the shoulder bone Shoulder bone connected to the neck bone Neck bone connected to the head bone... That pretty much covers it.
  14. I usually just go with whatever drug company pen I'm using at that moment. If I have two in my pocket, I go with the one that doesn't smear.
  15. 1. Yes, health system sucks. We all agree. 2. I'm not sure how much your ex knows, but from an outsiders point of view, all we do is ask a few questions, but the patients don't pay much attention while someone else is footing the bill (eg insurance). However, as pointed out above, we bill for medical decision making, which is often not apparent to people watching- and to people who "know" what they have it can be frustrating, such as a 70 year old with 15 pound weight gain, dyspnea, orthopnea, rales, who comes to a walk in for a "cold". 3. Since we are being paid for the "medical decision making", each decision needs to be justified. No reason for it? Shouldn't order it. 4. Billing is based on contracts between the insurance companies and the hospital. Uninsured can still disagree over a bill, but would need to involve a discussion with the billing department and perhaps a lawyer. I don't know, I'm guessing on all of this.