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skyblu

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skyblu last won the day on January 6 2014

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About skyblu

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    Physician Assistant

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  1. Thank you so much, everyone. I got the job! Fought tooth and nail for it, and finally got it. I actually read your replies here to my boss. The more of us who get these titles, the better! Thanks again for your help. Sent from my iPhone using Tapatalk
  2. Thanks! I was offered the same as you but since I don’t assist the Medical Director, I declined on the grounds that as a PA I already have an inaccurate “assistant” in my title. ;-) I’m still fighting. This is exhausting! Sent from my iPhone using Tapatalk
  3. That guy forgot he was an MD. ;-) Sent from my iPhone using Tapatalk
  4. Hi everyone, When our medical director left the practice, the job’s responsibilities were divvied up among several individuals. Long story short, I am doing all the duties that do not require an MD (so about 70% of them) and I’m in the process of negotiating a promotion that recognizes all my extra work. I’m asking for the title of Associate Medical Director but the practice owner (not an MD) thinks a PA can’t have that title. I know of two other PAs who carry that title and sent the owner their LinkedIn profiles, but he is asking for more examples. So if you have that or another
  5. I just sent an email to our nurses and MAs that their triage note cannot simply say “flu like sxs.” Yesterday I had a patient whose “flu like sxs” were abdominal pain, fever, diarrhea, and vomiting. It was appendicitis. “But that’s what the patient said!” the nurses cry. I don’t care. Ask them, “What kind of symptoms are you having, specifically?” Flu is a diagnosis, not a chief complaint! Sorry for the rant. This is a big pet peeve of mine. Sent from my iPhone using Tapatalk
  6. When I worked in EM (the first 10 years of my career, started as a new grad), I’d come home after a shift and my husband would ask, “So, who did you have to fight with today?” Your main concern is the patient’s best interest. You have to brush up on your skills and develop confidence. Look stuff up, practice according to evidence based guidelines, then you can support your workup if challenged. And when you encounter some asshat consultant or hospitality who only cares about not adding to their workload, stand up for your patient. Someone won’t speak to a PA? “I am the provider in c
  7. I’m the chief PA of an UC similar to what you describe as far as acuity, and there is NO WAY a single provider in my practice would be expected to see 70-100 patients a day (12 hr shifts.) Once we hit 50 due to flu season, I went to management and demanded double coverage for my staff. The owner wanted to pay us more, but the providers all agreed: no amount of money can compensate us for practicing unsafely. We are also in the process of training scribes, because let me tell you, nothing is more soul crushing than sitting down to do 40 notes at the end of the day! Especially when so many w
  8. Have you ever shadowed a PA? I have worked in EM and now in UC and have never had to “take orders” from anyone. I see my own patients now in UC, often as solo coverage or working with another PA. An MD signs my license but has no bearing on my daily practice. In the ED, I presented major cases when they were ready for disposition. Meaning, I evaluated, tested, diagnosed, and treated the patient and just ran it by the doc when I was ready to discharge, admit, or transfer. Or, of course, if I had questions or needed help with a case, but mostly each provider carried their own patient load.
  9. We do a lot of work comp in my UC and I’ve found people are mostly reasonable. Some pearls: Nobody gets put out of work unless they are truly incapacitated (bed bound, hospitalized, emergency surgery, etc.) If patient tells you there is no light duty at their job, put them on light duty anyway. That way it is the employer’s responsibility to find them something to do or send them home. Bring everyone back for re-eval in a few days to re assess. If symptoms are the same, refer to PT. If sxs are improving, dial back their work restrictions and see them again in a few days. If sxs are res
  10. We switched labs recently (I’m in UC) and we suddenly have an enormous number of “no growth” on positive UAs w/ 500 leuks, nitrites, etc. Our new lab is a “budget lab” and sucks on so many levels, I am partially convinced they are somehow improperly incubating the urine cultures. Sent from my iPhone using Tapatalk
  11. “Last seen well” concept is bullshit? Oh, good to know, given that it is literally the guiding principle of the stroke center ED where I spent my whole career. Granted, different providers have different comfort levels with windows for procedures, but the concept itself is at the core of stroke management! I’d say that whomever “owns” the patient, writes the orders. Whose name/service is the admission under? If under the intensivist, then they write the orders. If under neurosurg, then you write the orders. And nobody should ever speak in a disrespectful or unprofessional manner. Address it
  12. “But we’re not NOT saying it”? Sent from my iPhone using Tapatalk
  13. Wholeheartedly second Minor Emergencies. Other books I recommend to my new hires in UC: Also re-familiarize yourself with EKG interpretation. Sent from my iPhone using Tapatalk
  14. What’s the mechanism through which THC would cause myocarditis? I’ve never heard of that correlation before, and god knows I’ve seen more than my fair share of THC enthusiasts during my ED career! (And my husband’s Grateful Dead “career”, more to the point.) Sent from my iPhone using Tapatalk
  15. It’s a fracture, patient is symptomatic, and nobody knows what “gentle walking” means in a measurable way. So immobilize, non Weight bear, f/u w/ ortho. (I’m EM/UC, obviously an ortho PA might have a different POV) Sent from my iPhone using Tapatalk
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