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Boatswain2PA

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  1. Yes we can Migrainer: no focal deficit = doubt a space occupying lesion. No sudden onset = doubt SAH. Feels better with toradol = go home. Pseudoseizure: I call it seizure-like activity and once back to baseline they go home, frequently without any testing. It's our job to hold the line.
  2. I go to both the VA and a local military base as I have a PCM at each. My VA experience has generally been terrible. New PCM every year, most of them never touched me, and most have been FMGs with extremely poor communication ability in English. I just went to them because it is convenient to have the VA mail me my mobic and lidoderm patches. However for past two years I have had an NP who has listened well and performed a decent PE. My military PCM also changes every year, and I've had docs, PAs, and NPs, and never been really impressed with any of them. I go to them for referrals for any specialty care I need (usually ortho). Seems mostly to be a bureaucratic position....
  3. Anyone who wants to stretch their student loans out for 10 years in exchange for working at one specific place should take note of this. You can make the minimum payments for 9 years, and just be one year away from that big pay-back of your student loans disappearing, when some asshat CEO like this takes over and you are put in this situation. Say no and you're fired in 6 months. Suddenly, 9.5 years after graduation you have paid off zero in student loans. I wish the medmal attorneys would do us all a favor and delve into this. There's GOTTA be a lot of money there for them. I'm going to be a little devil's advocate here. What's wrong with accepting these patients and starting weaning them off. Do your research and become the expert on pain management. Document well that you discussed with each patient the new data that chronic opioids result in decreased in quality of life so you are going to decrease their MME while working with them to find the best possible methods to manage their pain. Consider the money in this. Have your chronic migrainers scheduled weekly for a trigger point injection. Your tech can have the room set up, the 10cc of lidocaine prepped, and patient gowned before you walk in. You walk in, glove up, ask the patient a few questions as you wipe down the site, make the injections, and walk out within 4 minutes. Might keep them out of the ED (thank you!!!!!), makes you money, extremely low risk for the patient, and no more opioids for the chronic migrainer! Everyone is happy! And if that doesn't work, refer them. Diclofenac, lidoderm patches, yoga, trigger point injections, referrals for nerve ablations, ketamine....all things you can be a relative expert on in just a few days reading. I doubt you would look bad to anyone if you "suddenly started writing for a bunch of controlled substances 2 months into practice" if you showed a gradual decrease in MMEs. Go for it, you can do it!
  4. I agree, of course. However if your ideology forces you to demonize (like calling them a hypocrite/racist/homophobe/bigot) those who believe differently than you (like the AAPA leadership did with Dr. Ben Carson), then it becomes easy to dismiss anything they have to say as a lie. In other words...just because it FEELS like a lie, doesn't mean it's a lie. I'll use an inverse scenario for you: I am not really worried about anthropomorphic climate change. We have had relatively small meteor strikes that have sent us into ice-ages for centuries/millennia. Within recorded history we have had several volcano eruptions (like Krakatoa) that have put more crap into our atmosphere than all human produced coal/wood/oil/gas burning combined. The climate WILL change, and humans will adapt like we always have (maybe the Vikings will go back to Greenland if it's green again!). It feels to me like the climate change movement is just another in a long series of doomsday prophecies. But does that mean I think those who believe in catastrophic anthropomorphic climate change are liars? No, I think they (mostly) believe in it (Al Gore and others who make lots of money off it are the exception.) Does it make me a LIAR because I look at other data? No. Regarding Dr. Carson and the AAPA - To many leftists (and possibly to you) I am a LIAR because I didn't hear Dr. Carson equate homosexuality with bestiality (or was it pedophilia?). But I'm not a liar, I just look at his comments through a different lens. If I were an extremist I could start screaming and calling you a LIAR for posting such things as there are several polls who show President Trump is at 47-49%. Then we could start yelling at each other about the bias of your polls versus the bias of my polls, and then yell at each other about what the definition of "major poll" is, then yell at each other about the questioning in the polls, etc etc ad nauseum. But I don't think you're a liar. I think you're wrong about a lot of stuff my friend...but I don't think you're a liar! Sure it is. But it is also a political issue. Shall we give up our guns to be safe, but give up our liberties? Cars kill vastly more people every year in America than guns. Should we give up our cars? When automated cars become as safe as manually driven cars, shall we criminalize ownership of manually driven cars? We are supposed to be a free people. How much of our freedoms should we give up for safety? You trust them to do what? Exactly. I don't delve into politics with my patients. AAPA damn well shouldn't have delved into politics when they removed Dr. Carson's invitation to receive the Paragon awards. But unfortunately they caved to militants who lack the ability to separate politics from other aspects of life. Because, to them, to have conservative views are equatable to being homophobic/mysogenistic/racist/etc, and those people are evil, and they LIE!
  5. Not sure what Stormfront is. But no, none of my published papers, even the one I was paid for, made a strong impact. Are you capable of rising above personal insults?? Thank you for proving my point that leftists will call anyone who disagrees with them racist (or homophobic/mysogenist/etc ad nauseum). And when this leftist ideology invades organizations like the AAPA, like it has in the past, it will turn off many people. I never said public health = politics = leftism/activism. Simply said that public health and politics are intimately married. I don't think of it as a "fault" at all, just the way it is. From the Italian "quarantinos" to John Snow's discovery of turbid water causing cholera to today's failure to provide clean water to Flint, everything in PUBLIC health is involved with politics. And evidence can absolutely be argued with personal biases. All one would have to do is select the evidence that supports your cause, something that is done all the time by both sides. Correct. Just using an example of how the most basic public health program, that we all agree with, is connected to political situation (like you point out). Agree completely. However, since health, and especially public health, can now be regarded as something that is affected by EVERYTHING, some people would use this door as a means to advocate for ANYTHING - from gun control to climate change to LGBTQ rights to poverty reduction to anti-vaccination.
  6. There isn't much between public health and politics. Politics is the art/science of governing people, who make up the public. The two things are intimately married. We all agree that it is good public health policy to require car seats for infants. But what about the new mom who can't afford one? What if she is caught taking kid to daycare so she can go to her job and gets a ticket, that she can't afford? And then goes to jail for not paying ticket....how is that a public good? Unfortunately most public health "experts" are ONLY experts in public health, and they ignore the political aspect of public health policies. See my comments above about illegal immigration, drug decriminilization, etc.
  7. It was not my intention to trigger you so much, or to cause anyone to "hate and blame". I think (hope!) we can all agree that today's progressives generally push for larger government involvement, and conservatives want less. And my term liberal/leftist was intended to differentiate between today's "progressives" who identify as liberal but generally have much more leftist ideologies and those who have more classical/jeffersonian liberal beliefs. If I can wade through the contempt you appear to have for half of America, I think I can agree with your point that President Trump has continued to blow the budget. But since that has nothing to do with this thread, let's not discuss that here. I think much of this thread highlights this point clearly. Look at the language of the left-leaning posters who utterly refuse to entertain the thought that anyone on the right could possibly be justified in any beliefs. Instead of discussing the topics, they rail that those who disagree with them are flat-earthers, anti-vaxxers, "impregnating the minds of those not educate", and...of course..."hypocrites in the extreme." This is the problem with AAPA, the AMA, and many other organizations. If you are someone like Ben Carson, then you MUST be an evil/racist/mysogenist/bigot. That leads people who would like to be members to avoid membership because their beliefs are denigrated by the organization.
  8. I have a MPH, and I am published in a peer reviewed journal. You're free to believe that, but I see plenty of evidence of selection bias in publication, not to mention the political bias I mentioned. Speaking of "conclusions that play out as anticipated", why do the medical societies ignore public health problems (such as the spread of typhus in Los Angeles, the increase in TB, drug-induced mental health problems, etc ad nauseum) that are directly linked to progressive policies (such as open borders, drug decriminilization, etc)?
  9. But the vast preponderance of established public health "science" is incredibly biased toward the liberal/big government/leftist ideology. Selection bias in such "science" skews it toward things we can DO to save lives, but ignores the socio-political-historical aspects of what they propose. Best example is, again, gun control. Those who advocate for increased gun control measures use data points that highlight the very real damages of guns in society. But they completely ignore the historical socio-political risks of an unarmed society. It would take centuries for our gun-homicide numbers to equal the numbers killed by totalitarian governments after disarming their populace....but that is never considered by the "established public health science". Same thing with abortion. Public health "experts" focus on the benefits of abortion on maternal health, while ignoring the socio-political implications such as the reduction of minority populations, let alone the moral damage to society (which is much harder to measure).
  10. Imagine the dismay if the AAPA would pull a conservative move and call for an end to abortion? I'm sure McClane would disagree, but what better "public health" issue than the ending of the life of hundreds of thousands of minorities? While I am anti-abortion, I wouldn't want the AAPA to wade into that. Just like I don't want them involved in the gun control argument. But that's one of the big differences between today's conservatives (Jeffersonian liberals) and the progressive leftists who identify as liberal. The leftists will use any tool they can find, from castigating those who believe otherwise as evil to taking over organizations like the AAPA, to force their agenda on others.
  11. Of course we should. And we should expect people to use the FRONT DOOR when entering our house.
  12. My wife and I both max out our 401Ks which is about 12% of our income. Of the remainder, we pay about 30% tax. Of the remainder of that we are saving about 65% of our income toward building our dream house, with the rest going toward living expenses and giving. It's not a "PA epidemic", it's an American Consumerism epidemic. People have been indoctrinated into believing if they can afford the monthly payment on something (house, truck, car, boat, phone, watch, etc) then they can "afford" it. And the mental midgets who are running academia tell kids to take out student loans for useless degrees just make things worse. Not saying your plan is "wrong" in any way, but if I were in your shoes I would put 6% toward retirement (enough to get the full match) and then push to get completely debt free in 3-4 years instead of 7. Anything beyond the 6% match I would put into a ROTH. Once you pay everything off and are debt free (and putting money into retirement) you will be golden. I read an article recently that one reason young people aren't getting married is because the lack of financially stable men able to support families. Very soon you will be one of the men who can!
  13. You've been a PA for 15 years, and couldn't cut back (or take your dream job) for $30-$40K less. Recommend you take some steps so you are not in the same situation in 10 years from now. For new(er) PAs, I recommend you take note of this and take steps so YOU are not in this situation 10 years from now. Tristate - I think burnout can often come from the feeling of just spinning your wheels. You get a great paycheck, only to see it get eaten up by taxes, mortgage, car payments, CC payments, etc. Then you pay for the braces, sports, music lessons. You put vacations on CC because you know you can pay them off, but then you're burned out because you're working like mad for the next 4 months paying it off. Burnout can come from being trapped, you GOTTA go to work, and you're gonna have to work FOREVER. That just wears you out. Perhaps reconsider your financial plan. Become debt free in a few years and good chance your burnout will resolve as you won't be trapped in any job.
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