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  1. School’s Open Robert M. Blumm, MA, PA, DFAAPA, PA-C Emeritus September is a month of new beginnings. For our Jewish colleagues and patients is the celebration of the new year; and for many of our students in the USA, a new year of development and opportunity in school. I was driving to my office on a Wednesday, the first week in September. When I arrived at my main street, I noticed students with bookbags, filled to the brim and ready for a new challenge. Schools’ opening equates to increased traffic during our commutes, more vigilance when driving and an increase in patients in our offices and clinics due to contagious diseases. What are the ramifications for PAs and NPs? We will once again need to become more aware of our patients’ presentations, we need to stock up on diagnostic supplies and become familiar with a greater set of differential diagnosis as infections due to confined spaces and travel will be on the increase. The goal for the students will be to start afresh and to try to excel in their scholastic endeavors. This represents a new opportunity to write a new page in their journey of life. For the healthcare professional, it creates the opportunity for increased conferences and learning new information and skills. What problems will we encounter and what diseases and situations will we need study in order to enhance our knowledge? We will need to recognize the many signs of influenzas and use our diagnostic tests, prescription pads and influence, so that our patients are immunized early. We should be aware of the red flag signs of meningitis, a potential deadly disease. We will be treating hundreds of sore throats, viral illnesses, strep throats, sinusitis and the common cold. It is also a time to expand our examination and to discover those who have psychiatric illnesses such as severe stress as well as those that may have drug or alcohol addiction or who may suffer from sexual abuse. We can also be on the lookout for PTSD in this age group. Yes, these students may have been the victim of a fire, flood, the results of a hurricane, mudslide, rape, and loss of a loved one through violent circumstances. What does the astute PA or NP do in order to perform as expected in this ever-evolving landscape? Here are a few suggestions from a clinician with a long track record of patient care. Stay informed on the current problems and their treatment, as well as the need to refer when indicated. A missed referral can change a prognosis for a patient and create a catastrophe for the provider. Improve your technique of asking questions for your patient history. Perform the proper diagnostic exams and labs and radiological procedures and follow-up on them personally. Start obtaining a pharmaceutical profile on your patients if you have not done this previously. Lastly, consider your exposure to litigation and your options of insurance coverage for a potential medical disaster. This can befall anyone at anytime in their career, when they least expect it. Learn to distrust employer malpractice coverage, which is made to protect them more than you as a provider. Purchase a personal liability insurance policy from your professional organization’s endorsed option as this policy will have the highest rating and exists to protect your interest today and tomorrow.
  2. Looking for some HCE feedback. Been working @ VA for 3+ years, all PTSD research - first two years were as EMG startle tech (running emg testing 1on1, 12 patients a day) working on base with AD marines. Now last 8 months is PTSD screening (CAPS) appointments with veterans I screen for eligibilty and schedule myself. Appointments include 2x 1on1 sessions; I assess for validity and we discuss trauma, symptoms and other life stressors in depth, before they are randomized (if I deem eligible) to a treatment program. Usually 5+ hours 1on1 per patient. Also includes lab work, I don't draw blood (no phlebotomy training) but take patients to clinic and process samples after. Occasionally consult with supervising MD but mostly working solo. MD has no interactions with patients other than if I deem SI to be extreme. Patients vary, but majority have comorbid diagnoses - bipolar, major depression, BPD, schizophrenia, substance abuse etc. Planning to take EMT cert in Spring and hopefully work in the field part-time alongside school & VA position (study ends when I start my BS) for next 3 years. (Already have British college time which accounted for VA position but credits not accepted by CA schools due to how long ago it was/some not transferable) Question is, will any of my psych work count at all towards HCE? I'm aware research is one of those touchy areas. Thanks in advance for any info.
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