SomeDayPA09 Posted March 1, 2011 Share Posted March 1, 2011 just a rant work at level 1 trauma ER. Been crazy busy lately. 31 beds and 75 people in ED most days. We have a small triage room with bed otoscope etc that has essentially been serving as a room to fast track pts. Most pts love it when you get them in and out from the waiting room. Yesterday this lady came in with knee pain. Had xray was evaluated and discharged in about an hour. Dont usually write narcs for knee sprain but had a moment of weakness and gave her a couple. at this point wait time was about 3 hrs. nurse went to d/c her but she claimed she wasnt tx appropriately and wanted to see MD. Pt explained to MD that she needed stat MRI, IV pain meds. MD told her that she didnt go to medical school so she doesnt get to decide what care she receives at which point she looks at me and says "well neither did he so I guess that means he shouldnt get to decide what care i get either" so tired of these scumbags who come to the ED for pain meds and turkey sandwiches dont know how you long time ED PAs have done this for such a long time rant over thanks Link to comment Share on other sites More sharing options...
tlahut Posted March 1, 2011 Share Posted March 1, 2011 Jobs in medicine have two faces: 1] Work that gives meaning to your life 2] Work that comes with the role Category one involves the complex thinking, progressive action and timely interventions which describe emergency medicine at its best. For me, my ED Sunday included the patient with hemoptysis after recent hospital discharge, in a 64-year-old gal who survived five field defibrillations, ICU care and was discharged home. Two days after discharge, she had her new GI problems, and I evaluated her. My differential included an esophageal perforation. To re-admit her was a struggle, as the hospitalist considered the hemoptysis “speculative” and “viral syndrome.” This morning I found I was right. Category two is typified by your case. Often for a healthier patient, more time, more education andb more resources seem to be required, often to change nothing. The ED takes all these patients. The majority of ED work involves treating the patients in category two, for the privilege of treating patients in category one. PAs have more than a license to touch, you have a license to treat, prescribe and make life & death decisions. Beyond category one is category two, which is the responsibility to deal with obnoxious people, who may or may not be sick, and who may or may not be in pain, and may or may not be scumbags. The ED rarely sees “normal” people. PAs are challenged in different ways. Physicians in Haiti and the Dominican Republic have less education than PAs here. If you want to see appreciative patients, take a week on a medical mission. Multiple patients with knee problems similar to your ungrateful patient in the slums of Carrefour or Port-au-Prince will be literally kissing your skilled hands for making clinical decisions and providing tylenol. -Tom . Link to comment Share on other sites More sharing options...
DizzyJ Posted March 3, 2011 Share Posted March 3, 2011 I feel your pain. Yesterday I had a patient diagnosed with bacterial vaginosis and she went off on me for not prescribing narcs. She screamed across the ED "You suck at your job and need to go back to school and do something else!". Sorry, but narcs for BV? I think not. Link to comment Share on other sites More sharing options...
eze8923 Posted March 3, 2011 Share Posted March 3, 2011 Jobs in medicine have two faces: 1] Work that gives meaning to your life 2] Work that comes with the role Category one involves the complex thinking, progressive action and timely interventions which describe emergency medicine at its best. For me, my ED Sunday included the patient with hemoptysis after recent hospital discharge, in a 64-year-old gal who survived five field defibrillations, ICU care and was discharged home. Two days after discharge, she had her new GI problems, and I evaluated her. My differential included an esophageal perforation. To re-admit her was a struggle, as the hospitalist considered the hemoptysis “speculative” and “viral syndrome.” This morning I found I was right. Category two is typified by your case. Often for a healthier patient, more time, more education andb more resources seem to be required, often to change nothing. The ED takes all these patients. The majority of ED work involves treating the patients in category two, for the privilege of treating patients in category one. PAs have more than a license to touch, you have a license to treat, prescribe and make life & death decisions. Beyond category one is category two, which is the responsibility to deal with obnoxious people, who may or may not be sick, and who may or may not be in pain, and may or may not be scumbags. The ED rarely sees “normal” people. PAs are challenged in different ways. Physicians in Haiti and the Dominican Republic have less education than PAs here. If you want to see appreciative patients, take a week on a medical mission. Multiple patients with knee problems similar to your ungrateful patient in the slums of Carrefour or Port-au-Prince will be literally kissing your skilled hands for making clinical decisions and providing tylenol. -Tom well said. thanks for sharing your insight. Link to comment Share on other sites More sharing options...
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