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Everything posted by Sed

  1. Sed

    Difficult Nurses

    Unfortunately, this is not how it works with nursing. It's always about going up in the chain of command. ^This. OP, you don't know what's going to come into that ED: necrotizing fasciitis, MRSA, projectile vomiting, scabies, IVDU needle, etc. The last thing you want is some easy avenue to get yourself infected or covered with nasty bodily fluids. Keep em covered, bro.
  2. Sed

    Family life as a PA?

    Are you hiring? ?
  3. If your original negotiation was for $105k, don't ask for it again. Come in at $108k+. If they decline, ask for COL raise and more CME ($2000). If they decline, ask for another day or two of PTO.
  4. Here are some interesting articles I found during a quick search on chronic pain statistics, disability, and possible malingering: https://www.sciencedirect.com/science/article/pii/0304395993900762 "...16.4% of the subjects with chronic pain were depressed compared with 5.7% among those with no chronic pain." http://www.painmed.org/patientcenter/facts_on_pain.aspx#hhs Among the major adjustments that chronic pain sufferers have made are such serious steps as taking disability leave from work (20%), changing jobs altogether (17%), getting help with activities of daily living (13%) and moving to a home that is easier to manage (13%). Women were more likely to experience pain (in the form of migraines, neck pain, lower back pain, or face or jaw pain) than men. Women were twice as likely to experience migraines or severe headaches, or pain in the face or jaw, than men. The percentage of person experiencing migraines or severe headaches was inversely related to age. Twenty percent adults aged 18-44 years experienced a migraine or severe headache in the 3 months prior to the interview compared with 15% of adults aged 45-64, 7% of adults aged 65-74, and 6% of adults aged 75 and over. Adults aged 18-44 years were less likely to have experienced pain in the lower back during the 3 months prior to the interview compared with older adults. When results are considered by singe race without regard to ethnicity, Asian adults were less likely to have pain in the lower back compared to white adults, black adults, and American Indian or Alaska Native (AIAN) adults. Adults with a bachelor’s degree or higher were less likely to have migraine headaches, neck pain, lower back pain, or pain in the face or jaw, compared to adults who did not graduate from high school. Adults in poor and near poor families were more likely to experience migraine headaches, neck pain, lower back pain, or pain in the face or jaw in the 3 months prior to the interview than were adults in families that were not poor. Among adults under age 65, those covered by Medicaid were more likely to have migraine headaches, neck pain, lower back pain, or pain the face or jaw than those with private insurance or those who were uninsured. Among adults aged 65 and over, those covered by Medicaid and Medicare were more likely to have migraine headaches, neck pain, lower back pain, or pain in the face or jaw than those with private insurance or only Medicare health care coverage. https://www.ncbi.nlm.nih.gov/m/pubmed/12650234/ Base rates of malingering and symptom exaggeration Twenty-nine percent of personal injury, 30% of disability, 19% of criminal, and 8% of medical cases involved probable malingering and symptom exaggeration. Thirty-nine percent of mild head injury, 35% of fibromyalgia/chronic fatigue, 31% of chronic pain, 27% of neurotoxic, and 22% of electrical injury claims resulted in diagnostic impressions of probable malingering. Diagnosis was supported by multiple sources of evidence, including severity (65% of cases) or pattern (64% of cases) of cognitive impairment that was inconsistent with the condition, scores below empirical cutoffs on forced choice tests (57% of cases), discrepancies among records, self-report, and observed behavior (56%), implausible self-reported symptoms in interview (46%), implausible changes in test scores across repeated examinations (45%), and validity scales on objective personality tests (38% of cases).
  5. https://nccih.nih.gov/news/press/08112015 "...An estimated 25.3 million adults (11.2 percent) experience chronic pain—that is, they had pain every day for the preceding 3 months. "Pain is one of the leading reasons Americans turn to complementary health approaches such as yoga, massage, and meditation—which may help manage pain and other symptoms that are not consistently addressed by prescription drugs and other conventional treatments." Consider referral to PM&R, spine, counseling/psych, and/or pain management. As above, there are alternatives out there for pain, such as dry needling, aqua therapy, marijuana, massage, etc. Good luck. Disability is a frustrating concept for both the provider and patient. Try to be objective and not let your past experiences cut your treatment short.
  6. Good to know. Thanks for sharing.
  7. Can I ask why you ended up leaving locums work to go back to private?
  8. Get the paid tail coverage policy in writing. I'm sorry to hear you're having to go through this. Chin up and good luck.
  9. Some more things to include: is there anything about if you choose to leave the practice? 60 days notice? Do they cover tail?
  10. Consult a lawyer. Are you listed in the suit? Contact the old workplace for a copy of your contract, which should list your malpractice insurance company or coverage type. Contact the insurance company for details of your coverage, e.g., coverage dates, claims made, occurrence, and tail.
  11. Device or implant rep (ortho, spine, CMF, hand, plastics). These are usually sales positions and competitive.
  12. Sed

    Job Outlook

    To kind of piggyback on MT2PA's post, I think the PA field will continue to be around. In my experience, there's a bias toward surgery and ER but who knows what the future will hold. The dependent status will make admin/employers shy away from PAs, especially as NPs gain independence, but I think there will always be a need for PAs, especially in surgery. Hospitals still require physician supervision of midlevels, even with independence, so you may still see a PA presence in the hospital. Regarding how easy or hard to find a job, that depends on the specialty, location and pay. The big three.
  13. I always make sure to sign out each time I leave the computer. It's a legal document. Offer to copy and paste the note appropriately under his account to correct the issue. Although you shouldn't have to since it was he who used your account, at least this insures you that it has been corrected. Then, mark your note in error and why.
  14. Sed

    GI Offer (2nd Job)

    Agree with Han's post. Also, verify 401k. Two weekends a month of call plus working 6-day weeks on some weeks (assuming based on the rotating schedule) will get old, so ask for some more. Ask your friend what the typical schedule is like to see if it will be something you want to do month after month.
  15. On rounds today, a patient's family member took a video recording. They pointed the camera at my badge and then my face. I haven't had any issues whatsoever with this patient or family member and to my knowledge, they don't have any issues with me or our service, but the patient has fired several nurses and has issues with some of their other providers. Could they collecting recordings for possible use in the future? In the past, I've had patients ask if they can record me (typically on how to do a certain dressing change) or the visit to share with family later when they're available, and I almost always allow it. But on this particular instance, they didn't ask for my permission to record the visit let alone my face. I don't have anything to hide, especially in regard to my patient care, but I honestly felt violated. I'm a very private person, so I'm probably just being paranoid, but are there any personal or professional protections in place for us as providers in this kind of situation? Do I have the right to ask them to stop recording me? I left a message for the hospital's risk management to get their input. Thoughts?
  16. Naahh, too stiff and too much paperwork...
  17. Good points. Thank you for your in-depth response. I think I am now much better prepared to handle any future issues with media and patients. It's silly that we have to worry about things like this instead of just doing our job as medical providers...
  18. Update: saw the patient for a follow-up visit and asked the family member why. Their reasoning was that they wanted to keep track of everyone to keep them straight throughout the two-week admission. She showed me several dozen videos and pictures of staff. I relayed my concern about not asking my permission before videoing me and they offered to delete. Still sounded fishy... No call back from risk management yet, so I'm taking Sas' approach for right now. On the note about Hawaii, I just came back myself. Great place to vacation.
  19. I wish that I could escort certain patients out of the hospital...
  20. In my experience, once we get to know each other, they usually back off the attitude. Maybe it's a respect thing. Until we get to that mutual level of respect, I will oftentimes assist with dressing changes, patient turns, etc, and I think that helps a lot. The nurses are often running around, taking care of a ton of things, so I've found that setting some time aside to help goes a long way. Sometimes I even go so far as to ask, "Hey Jane, would you mind X task please? I know you're super busy, so if you can't, no worries, I can do it. Just let me know and I'll come by and do it later." More bees with honey vs vinegar thing. I always be sure to thank them for doing said tasks. Yes, it's their job, but a recurrent theme with job dissatisfaction is not being appreciated, so I try to tell them thank you and that I appreciate them taking the time to do it. Also, for the ones who question your decisions, I've found that if you briefly explain why you want something done a certain, they really appreciate it and respect you as a provider because they usually just don't know. I usually get a better response to that than just telling them what to do and to just do it and not ask me questions.
  21. Thank you both for sharing your experiences. I appreciate it.
  22. Wiretapping is legal in my state if at least one party is aware. But to my understanding, that's just audio and not video. The link I posted above suggests that there may be some protections in place for providers in the healthcare setting. I will follow up with risk management.
  23. Thank you for your input, everyone. I will be sure to decline next time since I agree that nothing good can come from that. In that moment, I felt like declining would be inflammatory to an already inflammatory patient/family (although fine to me). After discussing with a physician colleague who was also unsure on the hospital policy, what if they say no? Do I stop the encounter or just keep going? I found this resource regarding recording policies in healthcare, which are protective of physicians, staff, and other patients: https://www.healthdatamanagement.com/opinion/why-video-recording-in-healthcare-facilities-could-pose-a-hipaa-risk I'll follow up with risk management.
  24. Sed

    Paying preceptors

    It may be rotation-specific or where schools find it hard to retain quality sites. For the school I precept for, they don't pay for elective rotations, but they do pay for core rotations. I make sure that students know that I don't get paid. It's interesting to see the shift in attitude when they find out I'm doing this free and not the few thousand dollars they're paying the school.
  25. Sed

    Goodbye student loans

    Congrats! I am set to pay off mine (also a high amount like yours) at 4 years. I might've had it paid off by now had I not gotten married, bought two houses (bought a modest home after settling into my job and then recently sold it at a good time), redid the backyard of the first home in order to sell, bought two cars (low-end and used but newer), and took some decent vacations. However, the sale from the first house yielded profit and a good portion was put toward loans instead of the down payment on the next house. Like you, NO KIDS, which I think is a high factor in loan payoff. Refi'ed my loans after a year or two: left half in govt loans (the lowest, youngest loans, however rate and amount were still high but I was at least still able to defer if needed) and refi'ed the highest govt loans to private at a lower rate. Hit the govt loans hard by making double payments when possible or even more during bonus time. Now doing the same with private loans. I made sure to spread out purchases so that they weren't on the same credit card statement, which allowed me to pay off each bill and therefore carry no balance. I still have a car payment but modest and I'm also paying extra on that. I plan to focus on that next after loans are done. It helps that I also have a spouse who makes the money I do and so everything is split, mainly the mortgage and house down payments.

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