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greenmood last won the day on January 17 2018

greenmood had the most liked content!

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About greenmood

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    Physician Assistant


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    Physician Assistant

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  1. Short answer is that yes, you have to read everything in the chart. You do. My first day is usually a mess because I have to learn 5-7 patients who've been here for X number of days, and the hospital course is often extremely complicated. I start by reading what's in the hospital course so far. We keep a running document that each provider updates daily. Ideally, it has the reasons the patient presented and was admitted, along with key points in their hospital stay and remarkable diagnostic testing. I start a stub progress note and organize the patient's problem list. That gives me a really good review of their chronic medical conditions and current issues. Then I comb through their order list and make sure every medication correlates to something in their chart. I compare it to their home med list to make sure I know what they were on prior to admission. I look at their labs and lab trends throughout the hospital stay. I look at any micro results. I look at all of their imaging. I look at their most recent vitals and trends for the last several days. I check I&Os and weights. TBH, it does not take very long for most patients, but I've been doing this for a while. When I first started, I routinely arrived two hours before rounds started so that I could do it effectively.
  2. Well, as hospitalists we deal with the dramatic fall-out from patients who don't listen to their outpatient family medicine providers, so this would likely not be an improvement for you. Tired of arguing about A1C? Now the patient's in with HHS and you still get to argue about that full sugar soda and fries. You still get to argue about insulin. If you're straight hospitalist you probably won't deal with many children, so that might be a step up for you. I also spend much more than 15 minutes with my patients. Sometimes hours. Antibiotic arguments happen everywhere. In the hospital, we often get patients who've been started on something empirically in the ED and we have to take it away. What's worse than refusing to give antibiotics? Trying to take them away once "that other doctor said I had an infection!" I LOVE my job. You should just know that the things you hate about outpatient family medicine are still big problems in hospitalized populations. Have you considered a specialty?
  3. I never use benzodiazepines. Makes the situation worse the next day. I typically use Seroquel in low doses. 25 mg, sometimes 12.5 with a repeat dose if they are not sleeping in an hour. Have a lot of room to go up on that. I also use melatonin. I know many folks believe this doesn't work, but I've seen it effective. Haldol IM is my last resort, if the patient doesn't have LBD and is trying to hurt himself or someone else. We're lucky though, we have a lot of resources including a behavior response team that can spend the time talking the patients down and often helps us avoid medicating them entirely.
  4. Depending on patient acuity, 6-7 admissions in those 10 hours might be a lot. I work 10 hour admitter shifts and my cap is 5 (they are usually very high acuity). I have no other responsibilities beyond those patients I admit - are they expecting you to do other floor work or cover pagers? The no PTO/sick time is rotten. Would the new place offer you PTO?
  5. We do the second option you listed, although we have a very large group (~50) and some of us do 7/7 by choice. PTO is based on years with the hospital, but for most of us is 10.15 hours per 2-week pay period. They call it “33 days” but that’s 8 hour days. So it’s really 22 days of our 12 hour shifts. Were you asking about other bennies or just PTO?
  6. Young mom with aggressive cancer. Came for surgery, found unresectable intraop. No family that we knew about aside from the elementary aged child. She had a panic attack when we told her the news, because there was NO ONE else to take care of the boy. No family, no friends, no neighbors, no church. He was going to end up in the foster care system if she didn’t spend the last precious months of her life desperately searching for someone trustworthy. It was agonizing.
  7. I use it a lot as a hospitalist and I'm currently working towards my certification from SHM. For me, it's been most helpful for a quick glance at the IVC and lungs when I'm on the fence about additional diuresis. I've also saved patients a trip down to radiology for cellulitis to rule out abscess. I'm pretty careful in my documentation to never pin my medical decision making solely on POCUS. I'll probably be less anxious about that once I have the certification so that I can have something to say about my credentials if I'm ever pressed.
  8. I love it. There are parts of the job everyone hates, but that’s true everywhere. I’ve only ever worked for large hospital systems so I can’t help you with the comparison to private practice or smaller clinics. I will say that I practice at the absolute top of my licensure and I don’t think I could go to a place now where that wasn’t the case. I’ve been ruined by all the respect and fantastic culture.
  9. Yes. My niece was diagnosed with influenza B this week (Chicago), after my kids spent all weekend snuggling with her and they all slept together. I'm very excited about the coming days.
  10. 5yo and 2yo kids here. We do experience gifts, books, and one present each. We put puzzles and pencils and one "wow" candy item in their stockings. This year is the second year we're taking our 5-year-old to the Nutcracker and she is getting a pack of passes to the local climbing gym. Our 2 year-old is getting a NatGeo Little Kids magazine subscription and a trip to the zoo without his sister. We purchased a membership to the Kids Moon Club for them which is something we do as a family (highly recommended, membership is open now). They each get two new books. And gifts this year are a small LCD writing tablet for the 5yo and an electric train set for the 2yo. I also love the idea I saw somewhere of asking the kids to donate a toy at Christmas. We made them both select toys for a yard sale benefiting the Ronald McDonald House over the summer and it was hard for them, but so worth doing.
  11. I think this sounds bizarre. If it’s taking you so long to find a job that you’re in danger of having a suspicious gap on the resume, you should consider looking in another specialty or location. Pick up something less than ideal but workable, part time, whatever.
  12. You are misunderstanding the question. The goal of a question like that is to assess your insight into your own strengths and weaknesses, to see if you can identify “big picture” challenges and devise ways of overcoming them. I really think you will be missing the point if you talk about academics the way you’re describing, and honestly I think it will put your application at risk. So, think about your daily life as a PA student. Are you going to be juggling family commitments? Are your study or time management skills rusty? Are you shy or do you have difficulty articulating your strongly held beliefs? Those kind of struggles. Everyone has a hard time memorizing pharmacology. It’s part of life.
  13. That was the first thing I looked at and they were $8K. I want one so badly.
  14. Any fun equipment/devices out there for a hospitalist? I have about $900 of CME funds leftover this year. I have a serviceable stethoscope I bought in April and can’t buy another one til next year (or I would spring for something fancy). I could always find some books, but I’d rather find gadgets. I have pretty wide leeway in using the funds. I can also use the money for iPhone apps, if anyone has favorites.
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