• Content count

  • Joined

  • Last visited

  • Days Won


LT_Oneal_PAC last won the day on December 10 2016

LT_Oneal_PAC had the most liked content!

Community Reputation

750 Excellent

About LT_Oneal_PAC

  • Rank


  • Profession
    Physician Associate

Recent Profile Visitors

704 profile views
  1. The only problem with our current hound applicants is they have no commitment to the profession and advancing it (apathy), which combined with old guard that commits to much to tradition leaves us in a pickle. In my opinion we need young people, but they need passion. We need ones who want to do a residency, finish a doctorate, be involved in politics, not just a sweet paycheck and limited responsibility. I’ve seen the spectrum as a RN and a PA where people have a decade of experience and just plain suck. Dumb or just want a better gig because they can’t see themselves tolerate one more night of bathing a dude on a vent. I’ve also seen young with no HCE blow everyone out of the water. In the end what matters is passion. Unfortunately we have no reliable way to select that in an interview process.
  2. Like how good marines don’t have to worry about cutting scores! Lol
  3. I’ve mentioned before how awesome I think my new balance shoes are, but I’ve found something even better recently. Keen brixen has a wide toe box, water proof, and slip on. First time I put them on thought they weren’t going to be good. Kept waiting for them to hurt but they just kept on feeling awesome. The grip on them is amazing. Got them because I’m moving to a snowy area, and my feet stay really warm in the shoe too (though not tested in truly cold weather yet) so probably not so good for those in hot climate and sweaty feet.
  4. If they refused any evaluation, testing, treatment, then AMA. If they, for instance, just wanted me to do a neuro exam and avoid radiation from a CT if exam normal though I think they need one anyway, then we have a risk benefit discussion and they make their choice through shared decision making and patient autonomy.
  5. Suspect it’s going to be worse after this year. Flu vaccine only 10% effective in Australia this year, which means we can see more of the same here.
  6. I still give abx for ear infections if not improved in 48 hours or clearly suppurative. I’m pretty sure you remember my opinion on abx for pharyngitis.
  7. Exactly.
  8. For me it’s the below. While small, still more likely than making the patient feel any better. Adverse Reactions >10%: Central nervous system: Headache (adolescents and adults: 2% to 17%) Gastrointestinal: Vomiting (2% to 16%) 1% to 10%: Central nervous system: Pain (adolescents and adults: 4%) Gastrointestinal: Nausea (adolescents and adults: 8% to 10%) <1%, postmarketing, and/or case reports: Abnormal behavior, abnormal hepatic function tests, accidental injury, agitation, anaphylactoid reaction, anaphylaxis, anxiety, cardiac arrhythmia, confusion, delirium, delusions, dermatitis, eczema, erythema multiforme, exacerbation of diabetes mellitus, facial edema, gastrointestinal hemorrhage, hallucination, hemorrhagic colitis, hepatitis, hypersensitivity reaction, hypothermia, impaired consciousness, nightmares, seizure, skin rash, Stevens-Johnson syndrome, swollen tongue, toxic epidermal necrolysis, urticaria
  9. Only given tamilfu once in 3 years. Granted I missed most of last flu season while on deployment. If they look good, do not care about high risk. I don’t even test unless they look like I would give tamiflu. Always give good return precautions and document them
  10. This has happened. I’ve read the notes where they’ve stated “follow up with PCM for ortho referral.” i have no expectation that EM should put in referrals. Though it’s a bit different in the military system. They do have access to all the PCM notes, but I don’t expect them to do such.
  11. I just wish they would stop telling patients “you need a referral to X. Go see your PCM,” and then they come to me and say “The ED told me I need a referral blah blah.” Then I’m the a-hole when I say we can handle it or it’s inappropriate. A lot of times they are right, but the times they are wrong are a pain. If they are going to tell a patient they need a referral, they should just give the dern referral
  12. Narcs are inappropriate management for migraine headache. Pretty sure that's in the neurology guidelines, but I'm not a neurologist. I personally have no chronic migraine patients on narcs and none of the neuro guys I refer use them except one who is obviously taking advantage of people's addiction.
  13. Agree 100%. I had so many opioid seekers my first 6 months of practice. Almost never prescribed and when I did said it wouldn’t happen again if they didn’t do [see pain management, PCM, attempt alternatives treatments] and what happened, no one asked for the next year. Then went on deployment and had to start again when I got back, but I was established much quicker on my return. Same thing for benzos, which I provide more often but small supply and even more stipulations.