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winterallsummer last won the day on November 17 2015

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  1. I work in pt but primary and I am pretty confident specialists have it easier. Rarely primary on team, any pain or social issue they just say "ask your hospitalist", don't have to consult anyone with few exceptions, don't have to deal with disposition etc. that being said still wouldn't trade spots with them as I enjoy dealing with little bit of everything and otherwise love my job. But for those burnt out on primary I would suggest considering a specialty.
  2. Too invested to change now? Wait until you're fifty and think that over. I have said this over and over. Do not become a PA for the money. You will regret it. If you don't enjoy health care this job is not for you plain and simple. Not being rude. I love being a PA and don't regret it at all. Sometimes I think maybe I should've gone to Med school but I'm willing to bet if I did, I'd be thinking just as or more often I wish I had gone to PA school. There are better paying jobs with easier training. I was a tech for years before I became a PA so knew what I was getting myself into. Please, if you are going to become a PA for the money, seriously rethink it.
  3. Nothing you could have done differently. He was dying no matter what, Rectal temp and coags or not. Not getting Rectal temp or getting coags wouldn't have made any difference. In our business death is all part of the job. Very, very few codes have good long term outcomes ever and some evidence exists that only CPR and maybe epi even help. You did fine. Best case scenario this guy should've came in with DNR paperwork and died without chest compressions. But consider running codes on these old morbid pts practice for the few times you will have to code the dying young. As far as cause of death it doesn't sound like aspiration. Probably the stress of the nose bleed taxes his already struggling heart into asystole. Frankly these elderly with so many health issues almost never do well. Such is life.
  4. Really do not want online PA programs. No offense to our colleagues but honestly leave that crap to the NPs.
  5. It would be helpful to get some more info about your job if you really want the best advice. There may be changes we can suggest to make this job more bearable, or if we learned more about it may recommend you change sooner, or can make a change within the system, etc etc. Anyway I am going to go against the grain and say that the appropriate time to leave is whenever you want if you have another job lined up. I am willing to argue that more people do this than the replies on this forum would imply. Besides, if you have another job lined up, you quit your current job then stay at the new place for 2-3 years, I don't think this would be an issue. It's very easy to say "I got the wrong idea in the interview, wass brand new so took my first offer, stuck it out for __ months but then was offered a new position through a friend so decided to make a change" etc etc. Now say the 2nd job you then leave in under a year, then yes you are creating a bad track record. So learn from your mistakes, which it sounds you already are. Both in and outside of medicine I have never really "stuck it out" any longer than needed - that is, if I am unhappy with a job and need a change, I will find a new job while still working my current one, then change. That being said, most my jobs I have kept for a long time, I do not job hop, but sometimes there is need for a change. Life is too short and in the long run, so long as your next job you don't do the same, I would argue it is fine to change now. Again, having more info would be very helpful.
  6. There are very few programs like this left. The few that do have it may have an online option to "complete" the MS. It's good for the profession, IMHO. I don't personally take issue with grandfathering in those with older degrees. Where I practice, most jobs require the MS.
  7. Agreed. Unfortunately it was missed in the ER a week ago and also arguably by the PCP that same day. She had emesis which may have contributed to her lupus nephropathy. A good case for us, but the patient has a potentially difficult life ahead.
  8. Great fast track case the other day. Previously healthy, obese teenage female. Tachy at 112, otherwise VS normal. Complaining of rash on b/l palms of hands (petechia-like), "red rash" on face, emesis, and a couple falls. The RN tells me the rash on the face just looks like acne / acne scars. Was seen in the ED a week ago, sent home with anti-emetics, dx of viral syndrome. Went to PCP before coming to our ER this second time, had blood work done and sent home. Mom not happy with this, so shows up in our ER. Patient threw up some water, basic labs showed transaminitis, Cr around 1.5, thrombocytopenia, neutropenia, no anemia but possibly hemoconcentrated. Blood cx sent along with ANA. Sent out to peds, I did not tap the pt as I did not suspect an infectious etiology and the accepting doc was ok with this being deferred. Few days later (pt transferred out), blood cx return normal, ANA grossly positive. New onset lupus with likely pancytopenia and renal failure. Those were not acne scars, folks!
  9. I would not take it based on the fact that once you calculate the time it takes to get to a house, do everything the visit involves, chart, then drive to another house and repeat, and look at what you are actually getting paid after taxes and everything is accounted for, and subtract for expenses including milage, gas, etc, that the hourly rate would make it too low to be worth taking. Not to mention the hassle of driving around all day. If you really want to do house call medicine I'd probably ask to shadow or talk to a PA and see what their hourly comes down to.
  10. Note - this dx was later confirmed to be true per history from her family and old hospital records. While everyone else poured over her abdominal ct and labs this doc solved her diagnosis simply through inspection.
  11. It is always fun to find a new heart murmur especially if you can determine or guess on what it represents based on its characteristics. Anyway my favorite is finding a sign on the hands inductive of systemic disease. I rotated with a doc who's exam always began by inspecting the patients hands and fingernails, usually without the patient noticing. Everything from the impossible to ignore yellow fingernails of yellow nail syndrome (a lung disease), pitting for psoriasis, meurcke's nails of nephrotic disease, clubbing of end stage lung carcinoma to long standing carpal tunnel (thenar wasting) can be diagnosed or suspected with a glance. I recently saw a patient in the hospital suffering from numerous complications of cirrhosis. She was a non drinker without malignancy, a handful of autoimmune diseases but none responsible for her end stage liver disease, and on very little medication. A slew of doctors had seen her for her cirrhosis and reported that no one knew why she had it but they all chocked it down to some autoimmune process. A heme doc was consulted to address her bleeding vs clotting and not her liver. He took one look at her ulnar deviation and in what had confounded her primary team for days determined she had MTX induced liver failure.
  12. Yes I agree not all back pain is bad. Sometimes you can really improve QOL for these patients and it is very rewarding. And then there are pts you can really make a huge change for. But to deal with it day in, day out, I would imagine most (not all) would get frustrated.
  13. Other procedure heavy fields may be good for the OP as well. For example there are some PA cath lab positions I have heard about. Or if you like the OR (not my thing personally), there are positions with 70-90%+ OR time. If you really don't like dealing with patients (sick or well) then this is the way to go. The other thing is you may have just been exposed to a very crappy patient population. I have heard a lot of horror stories about ortho spine and occ med. Personally I really don't like seeing back pain myself. Often these people think every problem in their life is because of their back pain and have unrealistic expectations of what medicine will do for them. Other times they are outright drug abusers. Even the honest and nice ones who are realistic can be frustrating because you see they are in pain but can do very little for them. Their negativity is often transferrable and dealing with that day after day could suck the life out of anyone. I know you didn't have a favorite rotation but what was your general feel on other rotations? When pts came to you with a more managable or fixable problem, did you enjoy helping them?
  14. Ortho spine and occ med - yeah that may be the reason why. As the above poster said find somewhere that you will find your niche. Don't give up so early, both those fields can be extremely draining (with some exceptions).
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