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rev ronin

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Everything posted by rev ronin

  1. Meh, DOT physicals are fine if you set expectations right up front, don't be a jerk about it, and don't mind unhappy patients. I would MUCH rather do DOT physicals in a practice with a management team that backs me up than in corporate drone medicine ("Your DOT patient satisfaction scores are too low. We've scheduled you for reeducation")
  2. I get paid $32/hour to do EMT initial and ongoing training, as a W-2 working for my county EMS agency.
  3. Your degree doesn't matter in any case that I'm aware. Your current term grades, however, do. I would advise submitting now.
  4. The point of mock interviews isn't to drum out all the individuality, but to get past the "deer in headlights" reaction of an unfamiliar question or a question asked in an odd way. I would still recommend some mock interviewing, just as a way to get used to hearing the questions and saying something intelligent back.
  5. It does now. Did it then? I think it would be far more unethical to conceal the relationship, than to solicit such a LOR in the first place. It's clearly got some drawbacks, but does the OP have a better option? 50 hours of shadowing is certainly non-trivial, so looking forward to the eventual LOR needs, I would have counseled the OP to not follow a family member so extensively, because this problem is neither novel nor unpredictable.
  6. I'd rather just do people favors, with the expectation that one day I may ask them a favor in return...
  7. It actually doesn't. The instant the patient is a credible threat of death or serious bodily injury, they're no longer a patient. The instant the ex-patient is subdued enough to not be a threat any longer, they're a patient again. If you've ever watched any of the full-length officer involved shooting videos, it's very common to see police shoot an aggressor, handcuff them, and then summon EMS and render first aid. Talk about emotional whiplash! But yet, it's what we need to be able to do...
  8. Last time I interviewed for a PA job across the state, I flew out for a day trip interview, and they paid my plane fare. This was late 2014 and with a faith-based nonprofit.
  9. That's comparable to what I get for teaching EMT class.
  10. What do you mean by 'skilled'? FP Docs have more clerkships and residency, but PA procedural skills can certainly catch up. The additional topics not covered or not covered as deep in PA school vs. med school--I don't know that there's any structured way to measure that without letting PAs take FP doc boards. The one area where MDs have been shown to be superior to PAs is in diagnosing undifferentiated new illnesses correctly and rapidly, and I suspect that's tied to our shortcuts... but I would be interested to see how that played out over time. I don't doubt experienced PAs could outperform brand new FP docs, but it would be interesting to see how common an occurrence that would be.
  11. Just because something is incindiary doesn't mean it's trolling. We allow difficult conversations here, unlike Huddle. Huddle knows who you are, so they censor you based on what you say. We allow pseudonymity here, so we remove people for trolling behavior, not primarily on the contents of their posts.
  12. This one, at least, is legislatively fixed, right? We may wait years for the actual implementation, of course, but hasn't it been remedied at the Medicare level? Now as far as diabetic shoes go...
  13. That seems like a pretty sensible policy to me, but I'm in outpatient medicine. What would be the downsides of this sort of formality requirement?
  14. Orgo is hard for everyone. I think you'd be better off to take and do well in (4.0) an upper division biological science class.
  15. Interestingly enough, Bob, I will be at that class in August.
  16. How are we ever going to teach each other on our respective journeys if we all think alike? Like I said, my own views have changed over the years, so who am I to fault you for seeing things the way I used to? Or any other reasonable way, for that matter?
  17. Yeah, that ship has sailed. There are enough people who are getting these degrees that the programs are not going bankrupt, and will in fact expand. Then, a clinical doctorate will be expected eventually. The quoted poster may or may not have retired by then. The one thing they don't get: We're not doing it ("we" as in PA's; I have an unrelated masters' to finish before I can consider a clinical doctorate) to irritate the physicians, but rather to hold our own with NPs and gain credibility with admin.
  18. Sigh. Shame on us all for taking something on the Internet at face value...
  19. Balance of harms, my friend. They will eventually understand that I had the right to do more harm, possibly even killing them to protect other people, and instead chose to lie, and at that point they can either forgive me or not. If they end up getting shot and dying... well, they're never going to forgive me for that. For those of you not familiar with it, "... an actual, imminent danger of death or serious bodily injury to self or others" is just a rephrasing of when homicide is justifiable in defense of self or others. It's not a light consideration, even if it can be a split-second evaluation.
  20. Absolutely not! Provider acts are either unethical--it is always wrong to do something you think is wrong, even if you are wrong that it is wrong--or constrained by religious beliefs. Only once there is no malevolent action on the part of the provider can we assess the external goodness of an action. Now, one can do plenty of things in the course of healing that allow a patient to use his or her free will to go do things that are against a provider's religious beliefs, but that's on them, not the provider. In my personal case, I ONLY serve my own religious beliefs. I've never helped a patient, not once since becoming an EMT, where that action wasn't driven by my own personal faith. Your own care is almost certainly driven by your worldview, too, even if you don't call it a religion. I do absolutely agree that "playing God" is a poor choice of phrase. Any provider who has any belief at all in one or more supernatural beings with healing powers WANTS to play God to the extent of healing our patients! The other half of Divine power--killing, rather than healing--is usually what's meant by "playing God", and I think that's a reasonable distinction. I am happy to be a healer; it's what makes my day. Offer me the chance to execute a criminal, and I'm going to defer. For what it's worth, I doubt I would have said that last bit 10 years ago, but I find that the act of healing people for a living has changed my perspective on a lot of things and caused me to reevaluate my own personal ethical stances.
  21. The problem isn't that I have a background in religion, it's that so few other medical providers do. It needn't actually be any particular sort of religion, any philosophy or ethics background will do, but when we play with life or death, we need to be thinking much more broadly than our case, our patient, our country. The People's Republic of China is killing prisoners, most likely prisoners of conscience from Muslim and Tibetan minorities, and harvesting their organs for profit. https://nypost.com/2019/06/01/chinese-dissidents-are-being-executed-for-their-organs-former-hospital-worker-says/ https://www.theguardian.com/science/2019/feb/06/call-for-retraction-of-400-scientific-papers-amid-fears-organs-came-from-chinese-prisoners Honestly, my consideration of consequences comes more from my studies in game theory and complex adaptive systems than it does from my theology studies. Not to put too fine a point on it, but philosophy or theology will tell you THAT killing people is bad, but game theory and complexity theory will lead you to think up HOW it's actually going to end badly. I don't disagree with you at all about third party payment being a fundamental conflict of interest. I would very much love to find a way--widespread and sustainable--to keep the benefits of modern medicine without the downsides that corporatization has given us! I don't know that zDogg has all the right answers, but he certainly seems to be asking the right questions.
  22. At the point where a patient poses an actual, imminent danger of death or serious bodily injury to self or others, then using the least amount of force necessary to neutralize the threat. If that force can be a falsehood instead of a taser, baton, or firearm, I am ethically OK with that.
  23. Sure, but when your medical provider is beholden to the insurance company and gets indirect benefits from helping as many terminal patients die vs. fight as possible, that's a fundamental conflict of interest. If society must have arbiters of elective homicide, let it be a separate profession unconnected to medicine; they can do capital punishment cases, too. The Hippocratic oath exists for a reason, and everything available in modern medicine makes that oath that much more important that it ever has been before.
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