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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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  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 similar title as a PA, and you feel comfortable doing so, could you PM me your LinkedIn profile? I promise not to use it for anything other than a screenshot proving my point. Trying to shatter some glass ceilings around here. Thanks in advance for your help! Sent from my iPhone using Tapatalk
  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 charge of this patient, so I am the person calling for this consult/admission.” They refuse to take your call, won’t see the patient, try to dodge the admission? “Just to be clear, are you refusing the consult/admission? I want to clarify so I can document in my chart that your refusal is why the patient required transfer to an outside facility.” Chart then says: “Attempted to consult/admit, spoke with Dr. Dickhead who refused the consult/admission. Patient was transferred to OSH to receive services required by his/her condition.” Hospitals don’t like gratuitous transfers. They lose business. It will be addressed, and you will have advocated for your patient. The first time I stood up to a hospitalist I was shaking inside. But ultimately, it served my patient, my department, and our profession well. Be brave, be strong, be confident, and READ all the time about conditions you encounter so you can develop unshakable skills. YOU HAVE TO KNOW YOUR SHIT. Nobody will take you seriously if you don’t, and most people won’t brush you off if you do. It gets much easier, I promise. And to clarify, I highly recommend using the “more bees with honey than with vinegar” first, whenever possible. You’ll have many fights to fight, no sense looking for one when you don’t need one. If a slightly cranky consultant asks why you didn’t do XYZ, you can calmly say, “It was not part of the workup we deemed appropriate for the ED/we felt a specialist should spearhead that/I didn’t think of it/whatever. If you’d like for me to get that started (as long as it’s within your scope of practice), I’d be happy to.” Sent from my iPhone using Tapatalk
  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 were for similar complaints. This is not safe, you will not be practicing good medicine, and you will not be doing quality charting. You’ll be a machine stamping scripts and churning out half-assed diagnoses, because that’s literally all you will have time for. If you were on of my students or my mentees, I would advice you to run far far away from any place that treats patients as numbers and medicine as a production line in a factory. PS: I have 10 years of ER experience before moving to UC, and have seen first hand how catastrophically wrong a “simple” visit can go. Don’t do it!
  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. Things are different in different institutions, but maybe try to shadow different settings to make sure you have a realistic view of what PA practice is really like. Sent from my iPhone using Tapatalk
  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 resolved, release them to full duty. In our UC, policy is to not write for anything controlled. We can if we want you, but as a group we are on the same page and we just don’t. In 2.5 years there, I’ve written for opioids maybe half a dozen times, all for acutely broken bones. If the patient needs ortho or other specialist referral, write it in their paperwork and tell them to have their case manager give them a list of specialists covered by their WC insurance. Then ask that they come back to see you with ALL paperwork from their specialist visit and proceed from there. Sent from my iPhone using Tapatalk
  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 with someone. This is not okay, and it’s not okay for that person to call into question your ability to make medical decisions. I would have said something like, “I am a medical professional and am trained to make clinical decisions. You are allowed to disagree with them, but you are not allowed to belittle my profession.” Sent from my iPhone using Tapatalk
  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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