Am I getting steammed over something small?

[Devildog]

so I try to be as easy going as I can but recently I read a column from an admittedly new EM attending in one of the EM magz where this doc is imparting his "wisdom" on the yet to be annointed EM residents.

 

here is the piece:

 

http://www.epmonthly.com/features/current-features/rules-of-the-road-tips-for-the-new-class/

 

so what I am bothered is his couple of points about how to "handle" the ML's...I think this guy has a very myopic image of how to effectively work in the MD-PA model..

 

thoughts?

 

Peace

Dog

[LT_Oneal_PAC]

If he's got all those rules, then he's not confident in his own skills and is projecting.

 

 

Sent from my iPhone using Tapatalk 2

[myerardi]

I've been doing this for many years and I am never surprised by how we are treated by some docs. Just the other day I had an attending remove a dressing from an ear lac that I had skin glued. It was one cm long but he just had to see it! This is the way it is and will likely never change.

[True Anomaly]

3. Don’t let your mid-levels run you

At the start of your shift, have either an individual chat or team huddle to set your general rules for the shift. For example, “Don’t wait more than 30 minutes to present a patient, tell me before you order a d-dimer or CT, I want to be present for all procedures (bedside ultrasound), see all wounds before you suture them up, and for all patients with abdominal pain, please document a re-examination note and PO trial before discharge.”

 

I will acknowledge that being a new attending creates a lot of "pucker factor". And not all PA's have the same EM experience in school, so we have varying degrees of training and experience.

 

That being said...

 

If my department had myself and my fellow PA's in our group follow these rules, our department would grind to a halt. I would be completely useless.

 

My attendings have a lot of trust in me. The tradeoff is that I do not violate that trust and involve them as much as either I or they need to be.

[DBK2000]

I would drop that doctor like a hot potato. Im not an intern and dont need to ask permission for every single thing. He can sew his own lacs and order his own ct scans if he wants to be so micro managing. The good news is that he seems to be an outlier, since most ED docs dont act like this, and the ones that do will be less productive without a midlevel, and nobody likes a doc that produces less :)

[EMEDPA]

I have left jobs where attendings treated PAs like that.

if you want me to present every case get someone else.

[GreatChecko]

What I see here is a poorly written essay. The good doctor goes from advising to do a team huddle at the beginning of every shift so that your PA's don't "run you" and in almost the same breath he talks about consulting with his senior PA's for help. He implies a difference between junior and senior PA's, but doesn't do a good job of explaining it and ends up lumping all midlevels together.

 

I'm sure some unsuspecting newbie will take his advice and a PA will suffer for it. However, even the author identifies the value of an experienced PA, which I don't think anyone here would disagree with.

[ventana]

5. Ask for help

A favorite quote at my ED is “Upstairs care downstairs with a friend”. Don’t expect to know everything. You don’t. So ask your co-attendings or senior PAs for help if you need it. The sick and not sick are often the easiest to deal with while the grey middle will always be a challenge.

 

 

 

the only paragraph that made sense......

 

 

i see a lot of what he is talking about

remember this is directed at the new attending, trying to offer some guidelines.....

 

also, please remember that there are some places that are overusing (giving to much to PAs that are to new with out supervision) PAs and if an attending is not comfortable with a newer PA they should ask up..... course if they do that with a "senior PA" (what ever that means) they might get an ear full

 

sort of like the military - the E-9 still has to salute the O-2 BUT if the O-2 ever tries to dress down the E-9 he had better have his/her ducks in a row as the squadron commander is very likely going to side with the E-9.....

 

As for all the other parts of the article........ minus well put pom poms in his hands..... rah rah you can do it....

[Joekalish]

I'm not a PA, I'm not even a PA Student, and I am a heavy believer in the MD-PA model, but it seems to me that the MDs are responsible for the decisions made by the providers they oversee, so although there seems to be a flavor of pomp with this particular MD, I can't completely wrong him for approaching his staff with rules and regs. Then again, there is obviously no experience behind my opinion. I am confident however in saying that MDs should get on track with the fact that PAs are largely competent providers with great education in most cases.

[Simplify]

I'm not a PA, I'm not even a PA Student, and I am a heavy believer in the MD-PA model, but it seems to me that the MDs are responsible for the decisions made by the providers they oversee, so although there seems to be a flavor of pomp with this particular MD, I can't completely wrong him for approaching his staff with rules and regs. Then again, there is obviously no experience behind my opinion. I am confident however in saying that MDs should get on track with the fact that PAs are largely competent providers with great education in most cases.

 

The responsibility is shared- a PA has can also be hit w/ malpractice and lose his/her license, he/she is every bit as invested in practicing gold standard medicine.

[True Anomaly]

The responsibility is shared- a PA has can also be hit w/ malpractice and lose his/her license, he/she is every bit as invested in practicing gold standard medicine.

 

Not only can we be hit with a malpractice suit, but be found completely at fault with it, while the physician is dropped from the suit.

[Joekalish]

Fair enough!

[doubledown10]

I would'n't get all bent about this. I've worked with a few docs like this one that after a while, never got out of their chairs to see my patients. Win them over with competence. However, if it persisted, I would be a ghost. Don't let it get to you, most good ER docs aren't like that.

[PAtoB]

have the grizzled PAs here noticed in general whether or not teaching/research hospitals treat PAs differently than community hospitals? Time and again, I see and hear stories about their treatment at the hospital where I work, and it gives me pause for the future there.

[EMEDPA]

have the grizzled PAs here noticed in general whether or not teaching/research hospitals treat PAs differently than community hospitals? Time and again, I see and hear stories about their treatment at the hospital where I work, and it gives me pause for the future there.

never worked at a major teaching center. I have worked at 2 places with fp residencies. one treated pas well, one does not.

I have worked at community hospitals that both treat us well and don't.

both rural facilities that I currently work at treat me well, in fact pas are in short supply in the rural environment so on many days I am not at one site they have no double coverage at all so the doc works alone and frequently gets overworked.

[PAtoB]

What are the main reasons why some docs fail to respect or treat PAs better? Is it as simple an answer as ignorance, or perceived competitive threat?

[RetNavyPAC]

Not only can we be hit with a malpractice suit, but be found completely at fault with it, while the physician is dropped from the suit.

 

True, true. I'm doing a deposition as an expert witness for a PA that missed a patella fracture. Doc nowhere to be seen in the suit despite the co-signature.