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WeBuyAndSellJunk

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About WeBuyAndSellJunk

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  1. It doesn't read as a highly politicized article, but it is a bit sensationalist in nature. Regeneron hasn't even really completed clinical trials yet, but this article presumes it to potentially be some sort of end to the nightmare. I guess I am just uber skeptical. We've had how many "super promising" treatments get through 1 or 2 RCTs and basically look stale or actually cause harm? The cost of therapy is in the tens of thousands also, and I'm under the impression that getting sufficient amounts of the medicine available isn't actually much of a reality. I'll hope for the best, but expect another RCT that data dredges up a questionable benefit. We simply need a vaccine. It is starting to seem clear that this virus is just an enormous insult on the entire body, and 1 miracle cure isn't likely to cut it. Convalescent plasma or neutralizing antibodies can't stop the immune systems own destruction once the ball gets rolling... In a hope to remain apolitical, Operation Warp Speed really does seem promising. EMRAP had a couple of great interviews with a couple of the researchers, and I do think their approaches to doing and accepting clinical trial results falls well within the standard practice.
  2. I have been working once weekly regularly for almost 2 years at a position. I just saw my schedule for next month and I am no longer on the schedule at all. I get that I am no longer "needed", and that is fine as the position implies the risk, but how have you all been let go from this type of position? I guess I would have appreciated more than a week and a half notice before I knew about the upcoming pay cut/job loss.
  3. Interesting for those of us with jobs already. Last year was terrible for a big chunk of (at least our) new graduates. This year is looking dismal with C19. Physicians like to complain about our desire for “independence”, but I’ve seen them do next to nothing to help us compete for jobs against NPs. I really hate all of the doomsayer conversations, but it is starting to feel like we are getting behind an eight ball of some sort. It might not be our profession dying, but something is going to give...
  4. Exactly my point. As a medical professional, this should not be viewed as a political issue. Be it what it is outside of the medical sphere, within it, it is a known and enormous factor regarding people’s health. It is the height of arrogance and almost malfeasance to let one’s political beliefs shape their views on topics that are not controversial within the world of medicine as a means to further your own agenda (i.e., abortion rights). It is easy to create thought experiments and draw parallels to highlight how mind numbingly ignorant one sounds to question such statements. E.g., AAPA endorses buprenorphine use. AAPA endorses treatment of hepatitis C. AAPA endorses treatment of lung cancers associated with smoking. AAPA endorses more investment in childhood education. Each of these is controversial in society. The PA or medical community wouldn’t blink an eye at these statements now though. If addressing race-related health disparities or poverty-related health disparities is political for you, you are the problem. I will buck the trend and tell you that I aim to continue supporting the AAPA because they aren’t afraid to make evidence-based statements to support patient care in the face of political pressure. That is the kind of leadership and courage we need going forward. Maybe it translates in to finally being courageous enough to push a title change or to stand up for our own profession too.
  5. You are assuming that this doesn’t generate interest or respect from people who aren’t currently members or stakeholders. I’d love to know the AAPAs percentage of membership capture amongst all PAs. You are also assuming that one must remain neutral on all topics as an organization representing a larger body for fear of extinction. Imagine if we did that right now in the face of huge physician groups not supporting our advancement (yes, a really controversial topic). You pick and choose your battles. Staying neutral on abortion probably makes sense since the crux of the medical argument is still philosophical or religious in nature. Staying neutral on what are absolutely known to be some the most health-altering patient factors in the middle of a crisis is at best a waste of energy and at worst the equivalent a medical body being neutral about something like HIV and homosexuality (we’ve seen that before, huh?).
  6. The main problem is that many people have politicized a topic in medicine that shouldn’t be politicized. People these days try to make everything a political issue. It divides us on topics that we shouldn’t be divided on. No where in either of the AAPA statements did they favor 1 political faction over another. We are PAs at the hospital, not republicans or democrats. Racially-based health disparities exist. They are at the forefront of our thoughts right now, for good reason. They need recognized and addressed better in medicine. The AAPA made a statement somewhere along those lines and people are taking them to task for it. What? Imagine how selfish you need to be to try and call this in to question and then wagon-hitch anything, and especially something as controversial abortion, to the topic as some sort of virtue signaling and counterfactual to their point. You can argue all you want about why it happens, or who else it also happens to, but right now we are using our energies to try and fix at least this problem. If you can’t help, then at least don’t get in the way.
  7. I am not here to say these tests are perfect or ready, but coronaviruses don’t lie dormant or sequestered from the immune system like hepatitis or HSV. When the evidence isn’t available, we should at least rely on the basic sciences to bolster claims. Other coronaviruses generate immunity for 2-4 years after infection. Even in the setting of asymptomatic exposure and a weaker immune response, the general theory is that memory T/B cells are stored and would provide a quicker and more robust response to reinfection (provided there isn’t some crazy mutation). The differential rates of antibody positivity geographically also lend some credence to their specificity for COVID-19. Rates in the California FB study for seroprevalence were ~3%, while rates for the NY study were ~20%. That superimposes well on to the backdrop of known infection prevalence, respectively. Like I said before, this needs rolled out in an already high risk group and not to the general public. High risk group X can’t really avoid exposures, but we can certainly then study them for PCR confirmed infection rates versus their already known antibody status. The research wouldn’t even take very long in a hot zone, given that we have some data on average rates of healthcare worker COVID contraction. I really can’t wait for some data on convalescent serum treatment also. Some of these antibody tests measure the exact same antibodies that we are using as neutralizing antibodies in therapy.
  8. There are more reasonable tests on the market. Tests with sensitivities and specificities in the high 90s. That still results in a lot of false positives with such low seroprevalence, but you simply need to just repeat the test twice (not unlike HIV testing). We also effectively have no specific treatment and thus some immune response is obviously occurring to allow people to have disease resolution. The most likely situation is that immunity last 2-4 years, like other corona viruses. Sure, that isn’t to say that these specific antibodies are the ones that indicate immunity, but a test where antibody generation is corresponding temporally with prior PCR positive testing is likely to be accurate. The real issue is the roll out to the public. This should go to front line workers first, with the knowledge that they may be a false positive or still have some amount of risk. Even that amount of possible risk mitigation (I.e., I am potentially immune) could go a long way for me feeling safe taking care of regular old non-COVID people.
  9. What a tangent we are on... haha. But an interesting conversation! Thanks for partaking. I think we established earlier the hypocrisy of practicing medicine under the guise of preserving some historical life. There is a nasty underbelly to it all. I feel now that you are building a straw man argument around population-based abortion ideals (which are riddled by sampling bias to begin with). Our patients can have whatever view they like. They can tell us not to vaccinate them. The medical provider, an expert in their field, shouldn’t employ such views to their end (I.e., to not vaccinate). Pay attention here in that I am not saying that they can’t hold them. I also made a case in my first post about others placing these orders for providers with objections to a particular sort of care. In an effort to legitimize the OP to employ their views, you are also straw manning well-known medical dilemmas (e.g., CTE risk from youth/high school sports head trauma) with anti-vaccination (I.e., something the medical community has almost no controversy about). In these situations, I think we are all granted the right for our morals to inform our care. That is the nuance. I disagree wholeheartedly that “religious thought” is our only medium to inform our moral compass also. You can study morality just as you can study mortality. You can look at how evolution and genes have influenced our behaviors as a species. We have continually advanced science, and with that you’ve seen us constantly shedding religious dogma from our lives. The goalposts simply move from year to year for religion. The better we understand fetal development, consciousness, and pain/suffering, the more likely we are to send this argument about the sanctity of fetal stem cells to the toilet. Yes, you will always need to define “sanctity”, but our definition of that will certainly shift for any given topic when we have a better understanding of that topic. I do think we are talking some circles now and I am seeing some emotions flair up. I’m going to bow out going forward. Best of luck in figuring out your internal dialogue Aunt Val!
  10. That people may have differing views regarding the sanctity of life. That patients are likely to not share your ethics and you are still willing to impose them on the patient. The equating of science and religion with respect to moral authority. I understand that there is a ton of nuance in how science and morality shape each other, but we are not talking about nuance here. My concern is when any doctrine clashes so diametrically with what are considered core measures of medical care. Vaccinating appropriately will save more lives than all of your years put together assisting in cardiac bypass, treating diabetes, managing hypertension, etc... I worry that there is also a large appeal to authority factor at play in a situation like this. A couple big name celebrities, some physicians and APPs that are anti-vax, and we have a whole population of people that are provided credence for their fringe beliefs.
  11. I am allowed to be intolerant of those who are intolerant themselves. You don’t get to hold extreme views without repercussions. Thinking you are doing the right thing ethically and actually doing the right thing ethically are two different things. Religion doesn’t give you a pass to make bad decisions, especially about other people’s lives. Religion also doesn’t allow you to hold some moral high ground regarding the sanctity of life. People want to be able to hold and act out their own views, but don’t find it fair that other people can hold and act out theirs also. Freedom from religion is just as important as important as freedom of religion. The Hippocratic oath has me placing higher value on those students/providers who will do less harm, especially over a career. In fact, I think the Hippocratic philosophy is driving me here more than anything. What irony!
  12. I worked in a clinic with a physician who would not prescribe contraceptives due to religious objection. All the other clinicians simply worked around it and sent her OCP prescriptions for her. It was a pain in the butt, but patient-centered care still occurred. I do think it only fair for any clinic to be clear to patients that they will be seeing a provider that holds fringe views with respect to standard of medical care. I would absolutely not have visited the physician in our clinic given her views. I share so few values with that type of physician/provider, that I would be worried that an individual’s capacity to make other logical and evidence-based decisions would be compromised by their belief system. It is important to recognize that this is not the same as skepticism of medical literature, it is a moral position based on an unfounded religious doctrine. Were I a medical director/clinic, I would probably even take it a step further and would never assume that any 1 patient would have enough medical literacy to recognize any treatment plan that is far removed from standard of care. While maybe extreme, given the case, I would argue pretty heavily to never hire a provider with such views. Especially not a new graduate. At least not in a clinic that isn’t already fringe in its care. To go 1 step further, I think I would even favor this individual to not be accepted in to a PA program. I don’t think you ever get that granular of detail about applicants, but I do think it important to recognize bias at the door. Kiddos can change and grow, but there are another 100 solid applicants waiting to take that individual’s seat. A PhD in philosophy, theology, research, or possibly public health administration may be a good avenue to take your views to try and change policy or create better products, but it is not moral to take those thoughts to the front line (IMO).
  13. I think my grievance is twofold. Past medical experience really only represents a small advantage when it comes to being a provider. The duties of a nurse, paramedic, or scribe don’t fully encompass the breadth and depth of being a primary care provider or to work in a subspecialty. It is why you see such variance in quality on the other side that seems pretty independent of past medical experiences. Smart people and hard workers will always lead the pack. The threshold for entry in to PA school is also so much higher than for NP school. I will every single time choose the person who was top 5% of their class versus the person who happens to have nursing experience but wouldn’t be accepted to any PA program. Note that I am not equating the nurse in PA school to a top 5% student. That isn’t generally who we are comparing though.
  14. As much as programs and students seem to chalk up PANCE pass rates to how well a particular program may educate you, a whole lot more of passing the PANCE is self directed. You will pass if you can keep up with the studying and grind. The people who coast are the ones I see failing. I agree with the poster above too. Are both programs getting people in to good clinical rotations and in the areas where they would generally like to be? I would worry a lot about a new program in that regard. Rotations are really tight and hard to secure right now. You learn a lot of stuff during a good clinical rotation too that you will never see on the PANCE. You also get job offers and make connections that way. Financially, you may save money being at home, but not if it cost you 30-50k in lost revenue because you have to spend 5 months finding a job and pay to move across the country to start.
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