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rev ronin

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rev ronin last won the day on January 22

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About rev ronin

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    Physician Assistant

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  1. rev ronin

    What Was Your Major?

    Mine was Computer Information Systems. Honestly, the fact that I worked in computers for 20ish years before PA school has been a big door opener for me: everyone knows I can make the EMR work.
  2. rev ronin

    Toxic Work Environment

    Remember, the lessons you learn standing up for yourself now will translate into your ability to avoid getting walked on later in your career. I used to hate conflict, and would avoid it. But sometimes, you just can't, so I stopped, and I got a lot better at it. You'd think, with people management experience, tactical deescalation training, and a black belt, conflict would be second nature, right? Nope. Being a medical provider has forced me to actually get good at it. Now, it's not a big deal to confront or fire a patient for their drug misuse, or being inappropriate towards staff. Just take a deep breath, stay problem focused, and state plainly what action you're taking and why. Oh, and also have a plan to respond to violence, should it be directed against you. I've been OK with that last bit far longer than I have the actual constructive confrontation part.
  3. Loans. Paying off loans gives you freedom in the here and now. investments? Not so much.
  4. Medscape CME is free, but the CME part doesn't kick in until you're licensed. Most professional societies have a student rate, that includes their journal. If you're wanting to go into a particular specialty after graduation, it's a no-brainer to sign up for that.
  5. rev ronin


    The number of programs you're going to apply to should really vary based on how competitive you are. I've written on this before, but there are essentially three tiers of applicants: Top tier: 3.9+ GPA, 2000+ hours as an EMT+, LPN+, or Corpsman, LORs from the Pope and Dalai Lama, Eagle Scout/Gold Award at age 13, seen more foreign countries than you can count on two hands doing medical missions. Apply only to the few schools you really want to go to, save your money. Middle tier: GPA 3.3-3.6, 1000 hours as an MA or scribe, LORs from local supervisors who really like you and believe in you, decent extracurriculars. Apply broadly, with special attention to schools where you are a particularly good match. THIS is where applying to a lot of places can make a difference between acceptance or not. Lower tier: GPA 3.0-3.2, maybe with some blemishes like trying to take the MCAT or getting put on academic probation, LORs from local supervisors who really like you and believe in you, worked 500 hours in a nursing home, didn't have time for extracurriculars due to life situation. Apply NARROWLY, only to schools where you are what they're looking for. Applying to Duke is just a waste of money for you. Best wishes!
  6. rev ronin

    Violent Patients

    Call 9-1-1, discharge them regardless of outcome. Heck, I'll do it in front of them, all the while watching carefully.
  7. rev ronin

    doing VA disability exams?

    I looked into it a couple of years ago, based on how lucrative it looked, but after estimating the time it would take, I decided to just stick with Labor and Industries, which is actually more profitable per hour of legitimate/ethical effort in my estimation. Plus, I like developing the relationships with long term injuries.
  8. Anyone dealt with PMR recently? I've got a case I want to run by someone else, but not in public. PM me if you can help...
  9. rev ronin

    Confronting patients

    I confronted one of my worker's comp patients last week. I felt really good about how I did it: 1) I prepared what I was going to say in advance. That is, I reviewed the surveillance footage the state investigator had assembled and knew exactly what I was going to say about it. 2) I sat down, faced my patient, and calmly but directly informed him that he had been under investigation, and that I was going to agree with the investigator's recommendation that he appears to be fit to work. I then explained what I'd seen, what I interpreted it to mean, and that I was going to be releasing him to work immediately. I let the translator do her work, knowing full well the investigator's footage had shown a far better command of English than the patient had displayed in my exam room. 3) I then talked through the implications: time loss and vocational services would stop, and he would be expected to go back to work. I also talked about his right to appeal my decision, get a copy of the investigator's video footage, and have his lawyer appeal any of the orders. I made it abundantly clear that I though being placed in this position was damaging to a provider/patient relationship, and I would entirely understand if he transferred to a different provider. 4) He did have some objections to what I told him about the video, but I politely declined to quibble over details, stating that was something his lawyer could dispute if she felt it was appropriate. I gave him an opportunity for questions, wished him the best, and on the way out he stated he'd prefer to stay with me as attending provider on his claim. I'd consider it a successful visit. I knew I was doing the right thing, but now I'm also convinced I did it in the right way. Patients, even ones we believe to be taking advantage of the system, deserve to be treated with respect and do seem to respond appropriately.
  10. rev ronin

    Alcoholism and DOT Physical

    I got an email yesterday saying the FMCSA website was going to be integrated to login.gov or something. Great. Now my password will have to consist of uppercase, lowercase, special characters, numbers, small furry animals, and at least one tropical fruit, be changed every 60 days, and no part of any previous password can ever appear in any future password for the natural life of the account holder.
  11. rev ronin

    Healthcare reform

    If you're going to advocate responses to a post be non-political, using the term "President Trump" and "Obamacare" 4 and 2 times, respectively, in the next paragraph is not a great way to stimulate nonpolitical dialogue. Just speculating why in ~10 days no one has responded to you...
  12. For blood glucose, I never check that in isolation--ever since I started in practice in 2012, I went with A1c: no muss, no fuss, no recheck for 90 days.
  13. In addition to what Reality Check 2 said, I think there are a couple of other points or slight variations I want to make: 1) While the rest of the Washington State MQAC may not realize it, James Anderson is a political activist within the AAPA, unsuccessfully campaigning against the election of the current president. He is clearly an advocate against PA practice modernization, as its proponents would term it, and his words are best understood within this context. 2) It's unprofessional not to respond to a written complaint. I received no acknowledgement that the MQAC had received my email until I actually called and talked to a staffer. 3) The fact that MDs serving on the editorial board did not realize that Mr. Anderson's piece was a political advocacy piece demonstrates that two PAs is insufficient representation on the MQAC: he has their ear, and so they are out of touch with what the rank and file actually think. A PA board with broad representation would clearly be superior. ... Still thinking more on this.
  14. Eh, while I've said before there are only three interview questions (can you do the job, can we get along with you, and are you going to stick around?), getting useful responses is not as easy as just asking directly. I'd second the recommendation for a good book, or better yet, a course on behavioral interviewing.
  15. The Washington State Medical Commission has responded to the feedback they got last issue: https://www.doh.wa.gov/Portals/1/Documents/3000/MedicalCommissionUpdate!Summer2018.pdf I'll refrain from comment at the moment, as I'm still digesting how to most appropriately address their response.

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