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sk732 last won the day on February 3 2018

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About sk732

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    Physician Assistant

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  1. I'd love to have IV Tylenol...but, meh, it ain't gong to happen in my system any time soon. I still use morphine, since I too am old and don't feel like doing the math regarding dosing...it's reasonably predictable, it's cheap (important where I work - hence no IV APAP or Ibuprofen) and has a decent hang time for those that need something with that. I do use fentanyl and hydromorph for certain things, sometimes ketamine. My go to for IV/IM initially is still usually Toradol (as long as they're not a moldy person, someone with a bleed or barely have a functioning kidney of course) or a Silver Bullet (diclofenac supp...used to be indomethacin but they're hard to come by now).
  2. sk732

    Clinical Assistant

    Where I work, a clinical assistant is an IMG who can't get a residency and has taken and passed a certification exam similar to our PACCC (Physician Assistant Certification Council of Canada) and essentially works as a PA on a given service. Now that you're totally confused...
  3. The thing I 've noticed about most any EMR I've used is the things are designed by and for admin geeks, not by/for end users. Our ER system just got updated - our shortcut note most of us use was eliminated in favor of a note designed for people that like writing small novels (and it seems, there is a direct correlation between those types and their typing speeds) which I suspect is a data mine for some Sheldon Cooper type in the Ministry of Health...I shouldn't be prodded to fall into a time trap of going through a full internal medicine history type note for someone with a cold for 2 days. At least the emergency diagnostic and the ICD10 databases talk to each other now - we had to manually enter diagnoses because when we did a search on say "viral URTI" you'd get in return...if you got anything.
  4. Two of Canada's greatest exports...syphilis (one of the highest prevalence rates in NA just down the road from me) and Bill Osler.
  5. They did order these tests...just the patients didn't feel they should have to pay for them, though they don't seem to understand that they have to pay for the chelation therapy they don't need, thyroid meds they don't need, then the AFib meds they WILL need from taking all the extra thyroxine they're now taking for no reason, etc, since their Blue Cross or Green Shield won't.
  6. I suppose I should change the "ND" to "VD"...but people might get the wrong idea.
  7. We've been getting a number of Flu A's and also a pile of sick adults with RSV as well. My flu shot worked quite well this year, as most others seemed to.
  8. Interesting...LP for atypical GBS?
  9. Had the person said to me what they said to the OP, I'd likely respond "Well, then I take it that I won't be seeing you again anytime soon?" I didn't worry too much about patient satisfaction surveys - my waiting room was almost always full. I did used to get a lot of requests/demands for tests ordered by voodoopaths from folks - here the voodoopath can order the test, but it comes out of the patient's pocket, as it needs an actual licensed MD/PA/NP to order tests on the public's dime - in other words, there needs to be an actual reason to order them. If I had a nickel for every wannabe heavy metal victim, sub-sub-sub-sub-acute hypothyroid or adrenal fatigueite that would show up, I would have retired my first six months out in civvy practice. Typically, the appointment would start something like this - "My (voodoopath of choice) thinks I have "imaginary condition X" and says that I need this test done and that you HAVE to order it for me". "Well, Dr I Lost My Real Medical License can't actually tell me to order any test, much less one that I don't think is needed or indicated - for me to do this is actually FRAUD against the Provincial Health Ministry. If he/she/it feels you need this test and so do you, you go to the lab and pay for it out of pocket...however, since we still have a few minutes, I can take your history, examine you and I'll order what I feel is actually indicated if you so wish..." I always liked that sallow colour they turned when I told they wanted me to help them commit a crime and I wasn't interested...and then would get really put out that I wouldn't order the nuclear heavy metal screen the ND felt was needed to justify charging the patient through their arse for chelation therapy they didn't need.
  10. Duty??!! The words "Chuck You Farley" come to mind...followed by "Good luck getting my to fly your friendly skies again".
  11. sk732

    Crazy FB removals

    I have a pic somewhere of a huge hunk of cinnamon bun I McGilled out of someone's larynx under direct laryngoscopy...surprisingly hasn't turned me off one of my favorite comfort foods. A not me one, but a kid from my home town got a javelin through his chest at a track meet when I was in high school - went in behind his (R) clavicle, out (L) rib cage - paramedics had to hacksaw a couple feet off each end just to get him into the ambulance. MM
  12. It's difficult to meet "Standard of Care" for a fully equipped ER in the street when you're out for a run (true story - out jogging, ran by two dudes with no first aid training trying to deal with another dude via 911 operator - I actually ran about 200m past, then had an attack of conscience and jogged back) or out for a drive (2 other occasions for me) or minding my own business in Costco when my wife texts me that a guy had hammered in and could I please come help...Luckily courts here recognize that little bit of common sense and drop the hammer on frivolous lawsuits. Most Good Samaritan Laws in Canada go by the "Reasonable Person" principle (some are actually called "Reasonable Persons Acts") - what would a reasonable person in an unreasonable situation do? If a person not trained in brain surgery tries putting a burr hole in someone's noggin just because that person was unconscious and they had seen something like that on Rescue911, that would be unreasonable...if a person plugged bleeding holes and tied a tourniquet off because that was at hand and necessary, that's a reasonable thing for that person to do...even more so if trained to do so. If the dude needed a burr hole, you were trained but not able to (no drill, hammer/chisel, CT scanner, etc), it would also be considered reasonable - you can't be held responsible for silliness like that...as long as you act in good faith. As Rev noted, some people tend to lean towards the "Hypocritical' oath vs the "Hippocratic" one...sounds like a number of your medical boards and a lot of judges do as well. And BTW Bohuntr, BZ .
  13. Guy dressed in drag? Androgynous Pat from SNL? Has more muscles than Arnold and was on the East German women's track team?
  14. You are now duty scapegoat for next 6 months...
  15. I get that a lot too...."Is it broken or only fractured?". I answer "Yes".

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