Sitting around and wondering what it'll be like in PA school if and when you get in?

[Just Steve]

This week's pearl of wisdom...for those of you fortunate enough to be around medicine during this Pre PA phase, start chatting up the various medical reps. Yes...the heydays of pharmacy reps giving away stuff like it's nothing are over. (and for the better I think) but there are still some things out there for those inquisitive enough to be in the right place at the right time.

 

http://www.usp.org/products/pharmacistsPharm/ Pharmacopeia is one suggestion.

http://www.sanfordguide.com/Sanford_Guide/Home.html Sandfords guide is another

http://accessmedicine.com/resourceTOC.aspx?resourceID=40 Tintinalli's is a third

 

hit up your local medical/pharm reps, attend any sort of medical conference that may be rolling through, see if they are giving away SWAG. (Stuff We All Get). Use discretion, manners, tact, and timing please. It is rather unpleasant to watch a feeding frenzy unless it's on the Discovery Channel and those reps are there to persuade the people who actually make (or have influence over the ones making) purchases. They may be a bit hesitant to give away $100+ dollar books to just anyone but at the same time, they really don't feel like lugging a stack of texts with over 2000 pages a piece back to their Toyota Corolla.

 

WAPA conference is going down next weekend (Washington Association of Physician Assistants). May be the perfect spot to cruise around, see what's on the current cutting edge, that sorta thing.

 

Other ideas...I'm an older student. I use my computer for internet access and word processing. The notion of spread sheets and all that is lost on me. However...I wish I knew more organizational skills on the computer. The amount and speed that information is coming now is pretty flipping' impressive. So if you are not super organized, I suggest you re think that. I am not super organized and I am feeling the squeeze...well that, and I get distracted SO FREAKING EASY. I hate my ADD.

 

Anyways...these are the thoughts as I look up from reading all about shock. Emergency Med test 1 tomorrow. Wish me luck

 

ps: have been listening to a podcast called EMCrit on my commute. Love it. Really really really recommend it for those who have some emergency medicine background. It can be great for anyone but it is given at a level that will leave you scratching your head if you don't have at least some experience in that arena.

[Just Steve]

The winter "blahs" have officially settled in. As one of my classmates said, "someone rubbed the shine off my new penny". The school warned us, they see it every year with every class. Shorter daylight hours, increased work load...you feel like you have less time to study and things just snowball. I walked in the classroom the other day and I felt deflated. Not defeated, not stressed out, nothing really negative....just one of those moments where you feel "damn this is gonna be a long day". I'm going from my desk at school where I sit from 9-4, then home and sit at that desk from about 5:30 to midnight or so. Sometimes I am here on this site, or Facebook, or checking ski conditions but for the most part, my brain is engaged in medicine for so many hours a week I've lost count.

 

What am I going to do about it? I think it may be time to buy some reflective clothing, a good headlamp, and get outside and get some exercise. It's tough as things are cold, icy, and dark but those are also words that could describe my mood sometimes if I let myself get in a funk.

 

I do get home every weekend, despite the weather's attempt at messing with my plan to do so. Seeing my wife and kids really help reset my spirit and remind me once again why I am buried in school. Our marriage feels like it's grown stronger since I've started PA school for a wide variety of personal reasons. I can't think of a fluid, easily worded note to quantify "how" it's gotten stronger. Doesn't really matter though, those would be just words on a screen and all I need to do is feel it in my heart. I am sssooo lucky and grateful.

 

This is all totally predictable, completely cyclical, avoidable to a degree, and reversible. I am not "worried" about it per se...writing it down just makes me acknowledge it and is part of my processing of the events.

 

Academically...Our first big test of the quarter was over Emergency Med last Monday. That went well..aka: I understood the questions and guessed the right answer accurately most of the time. We have a large test most Mondays..I appreciate having the weekend to do a final tune up before the exam...but it taints the weekend fun factor for sure. I think I'd rather have a big test on Friday, then off the weekend to just let the hair down and relax. However, this is PA school, not Burger King. You don't get to have it "your way". You get what you get and you like it :-)

 

Back to antibiotics...beta lactamase, macroglides, 4th generation cephlasporins....good stuff :-) Finally learned why BC pills are rendered less effective by antibiotics...any pre PA wanna take a stab at citing the cause AND including your source? No Wiki allowed...

 

ps: Drove down to see my brother yesterday (he's about 180 miles to the south) and check up on his rehab from his car wreck. He's lost a lot of weight (which is a good thing as he is obese), he acknowledges the pitfalls and downsides of things but he he does not focus on them. He is positive goal orientated, keeping a good spirit about him, and starting to make plans for the longer distance future. It's really good to see. I'm not sure I could be as upbeat as him if we were in reversed roles.

[Just Steve]

The winter "blahs" have officially settled in. As one of my classmates said, "someone rubbed the shine off my new penny". The school warned us, they see it every year with every class. Shorter daylight hours, increased work load...you feel like you have less time to study and things just snowball. I walked in the classroom the other day and I felt deflated. Not defeated, not stressed out, nothing really negative....just one of those moments where you feel "damn this is gonna be a long day". I'm going from my desk at school where I sit from 9-4, then home and sit at that desk from about 5:30 to midnight or so. Sometimes I am here on this site, or Facebook, or checking ski conditions but for the most part, my brain is engaged in medicine for so many hours a week I've lost count.

 

What am I going to do about it? I think it may be time to buy some reflective clothing, a good headlamp, and get outside and get some exercise. It's tough as things are cold, icy, and dark but those are also words that could describe my mood sometimes if I let myself get in a funk.

 

I do get home every weekend, despite the weather's attempt at messing with my plan to do so. Seeing my wife and kids really help reset my spirit and remind me once again why I am buried in school. Our marriage feels like it's grown stronger since I've started PA school for a wide variety of personal reasons. I can't think of a fluid, easily worded note to quantify "how" it's gotten stronger. Doesn't really matter though, those would be just words on a screen and all I need to do is feel it in my heart. I am sssooo lucky and grateful.

 

This is all totally predictable, completely cyclical, avoidable to a degree, and reversible. I am not "worried" about it per se...writing it down just makes me acknowledge it and is part of my processing of the events.

 

Academically...Our first big test of the quarter was over Emergency Med last Monday. That went well..aka: I understood the questions and guessed the right answer accurately most of the time. We have a large test most Mondays..I appreciate having the weekend to do a final tune up before the exam...but it taints the weekend fun factor for sure. I think I'd rather have a big test on Friday, then off the weekend to just let the hair down and relax. However, this is PA school, not Burger King. You don't get to have it "your way". You get what you get and you like it :-)

 

Back to antibiotics...beta lactamase, macroglides, 4th generation cephlasporins....good stuff :-) Finally learned why BC pills are rendered less effective by antibiotics...any pre PA wanna take a stab at citing the cause AND including your source? No Wiki allowed...

 

ps: Drove down to see my brother yesterday (he's about 180 miles to the south) and check up on his rehab from his car wreck. He's lost a lot of weight (which is a good thing as he is obese), he acknowledges the pitfalls and downsides of things but he he does not focus on them. He is positive goal orientated, keeping a good spirit about him, and starting to make plans for the longer distance future. It's really good to see. I'm not sure I could be as upbeat as him if we were in reversed roles.

[crystaltide]

Good to hear about your brother! And your marriage for that matter :P

 

I've been interested in the BC effectiveness w/ antibiotics subject for a bit and never quite understood it, so I thought I would do some research. It looks like rifampin and other drugs related to it are really the only antibiotics that have been shown to decrease the effectiveness of hormonal contraceptives. From what I could tell (and I do not know the exact biochemical pathways through which this occurs, just that it has something to do with the liver cytochrome p450 system), rifampin increases the metabolism of the estrogen and progesterone in hormonal birth controls, causing their metabolites to be excreted. Without the hormones at the appropriate level, ovulation can occur, defeating the primary purpose of the contraceptive.

Source is a paper by DeRossi from 2002 "Antibiotics and Oral Contraceptives". Should be the first link if you search that through Google.

[crystaltide]

Good to hear about your brother! And your marriage for that matter :P

 

I've been interested in the BC effectiveness w/ antibiotics subject for a bit and never quite understood it, so I thought I would do some research. It looks like rifampin and other drugs related to it are really the only antibiotics that have been shown to decrease the effectiveness of hormonal contraceptives. From what I could tell (and I do not know the exact biochemical pathways through which this occurs, just that it has something to do with the liver cytochrome p450 system), rifampin increases the metabolism of the estrogen and progesterone in hormonal birth controls, causing their metabolites to be excreted. Without the hormones at the appropriate level, ovulation can occur, defeating the primary purpose of the contraceptive.

Source is a paper by DeRossi from 2002 "Antibiotics and Oral Contraceptives". Should be the first link if you search that through Google.

[Just Steve]

Crystal, yes, there is some discussion of that. Rifampin is a big heavy hitter though and not used as wide spread as other antibiotics. While I have no doubt that the cytochrome system does come into play, I was thinking more of the following: From my reading in Brenner's Pharmacology 3rd edition, (I can't cite page numbers as I am using the Kindle Cloud Reader but it is in chapter 2), estrogens (BC's) are metabolized via then enterohepatic cycle. The hormones are conjugated, excreted from the liver via bile, which are then hydrolyzed back to their parent form by the gut's normal flora, then is reabsorbed back into the liver via normal GI processes. Antibiotics disrupt the normal GI flora that assist in that hydrolyzation process thus disrupting the cycle, thus lowering the efficacy of the bcp. So goes my understanding...

 

 

Pretty cool stuff

[Just Steve]

Crystal, yes, there is some discussion of that. Rifampin is a big heavy hitter though and not used as wide spread as other antibiotics. While I have no doubt that the cytochrome system does come into play, I was thinking more of the following: From my reading in Brenner's Pharmacology 3rd edition, (I can't cite page numbers as I am using the Kindle Cloud Reader but it is in chapter 2), estrogens (BC's) are metabolized via then enterohepatic cycle. The hormones are conjugated, excreted from the liver via bile, which are then hydrolyzed back to their parent form by the gut's normal flora, then is reabsorbed back into the liver via normal GI processes. Antibiotics disrupt the normal GI flora that assist in that hydrolyzation process thus disrupting the cycle, thus lowering the efficacy of the bcp. So goes my understanding...

 

 

Pretty cool stuff

[Just Steve]

Well I finally experienced regret for going home over a weekend. The adult med test we had on Monday and the pediatric test I am about to take in an hour are poised to illustrate that perhaps I should have spent a few more hours in the books instead of driving back and forth. However...what is done is done and all we can do is press forward and roll with it.

 

On the other hand...by Friday of last week I was crispy. Just crawling out of my skin. If I didn't get outside and blow off some good steam I was going to explode. Sitting at a desk for around 12 hours a day FREAKING KILLS MY SOUL!!! and I needed to get out and see that bright orb in the sky the rest of you call "the sun". So while I do regret going home and not hitting the books better, I would also regret having a complete and utter meltdown while I break my foot off in somebody's backside for no good reason. So...it all balances out. :-)

 

One of the side affects of putting me in a pressure cooker is that it turns on my creative juices and I tend to do a bit of writing to help re focus and ground myself. Some of you may be able to tell by the proliferation of posts that I put here on this site. While I can't stand the sound of my own voice, I do like watching my thoughts come into print. As I sat down Sunday morning to start studying, I just couldn't get into it. So I just started writing what I felt...it spans thoughts about my wife, my kids, my brother, my life...it reminded me to forge on and get over whatever was eating at me. It worked. I thought I'd share

 

The Journey is the Destination

 

The rippling pools offer us a shimmering mirror as we peer intently into them. Their surfaces never quiet, their depths unknown as the above moss covered limbs aim perfectly centered drops onto their ever growing surfaces. Our feeble lamps are unable to penetrate the ink as we gaze into them, leaving us wondering what discoveries might lie just under the surface.

 

Rising from moist ground, we brush the leaf litter off of our clothes and gingerly step across the stones that surround the pools. They are rounded, slippery, well worn smooth by unknown forces. Each step is tenuous but our body is sharp and keen, ready to react to any unsure footing. Deeper we venture, further into this place. Where are we going? We don’t know. Why do we continue? There is no reason to turn around.

 

Our trail is not clear nor forged and yet we find it easy to follow. Un deterred that our destination even more foreign, we press on with cautious vigor. Our travels are not for a purpose other than that of discovery. The taste of adventure coats our spirits with a flavor that reminds us of slowly melting ice cream on a warm summer day. Our souls lap at the dripping cream, desperate to consume very last drip and not waste one precious morsel.

 

What will we find? What will mark the end of our journey? For now, it matters not. Only that we press on, continue, experience, enjoy, and remember it for the sensations and feelings it brings us. For what is life but a chance to live? What is living without feeling alive?

[Just Steve]

Well happy Monday! Scores from last week's midterms came in and apparently I'm a decent guesser. Who wudda thunk?

 

I have been pretty adamant on my stance that I believe students need to have some serious health care experience before attending PA school. I know that ruffles the feathers on the back of many hard working students who have the utmost faith in their ability to learn the information being presented without ever seeing a live patient. I have no doubt that you can indeed, learn the info and pass the test. But at what cost? I cannot express the gratitude I have for my previous experience. It has benefited me and my family by allowing me to travel home every weekend and be with them, not buried in the books. I can distinctly recall being on military deployment thinking how much it really stunk then but now, those weeks and months of being in jail with a chance to drown (on a Navy ship floating around) have come back to pay me dividends in comprehension of material which in turn enables me to guess well.

 

Don't torture yourselves Pre PAs...go get some experience. You earn a bit of money, you gain some good experience, you'll be more proficient when seeing patients, giving them a better health care experience, AND it'll gain you some extra ground so you can goof off during PA school and not feel like you'll never see the light of day again.

 

Had an emergency med test today (abdominal trauma, acute abdomen, and upper extremity) Now on to study for Monday's pharm test. Sadly, the 3 hours of "normal pregnancy" lecture today sorta zapped my reserves. 12 bullets per powerpoint slide, then reading directly from them is not a way to teach. It's a way to torture. Thank God for coffee, and the fact we don't have that style of lecture every day.

[winterallsummer]

Just Steve, do you mind taking a few more questions?

 

1. You mentioned the professor who just read off the powerpoints. One big disappointment in my undergrad who teachers who have absolutely no idea how to teach. Is this common in PA school as well? Where all your real learning occurs outside the classroom? Or are the caliber of teachers generally pretty good?

 

2. Do you ever get the feeling "why am I learning this" or is pretty much everything you learn relevant?

 

3. What is the atmosphere like in terms of competitiveness?

 

Thanks!

[DrCats]

Winterall~

I HATED THAT during undergrad! I had a professor with about 12 letters behind her name and taught through powerpoint slides. One time the projection screen was malfunctioning and she was simply stumped. She had no idea what to do. ugh...

 

I really hope that is isn't like that for PA school... at least not the norm.

 

Just Steve~It is really awesome that you take the time to chronicle your days including feelings and such. Its is much appreciated if no one tells you!

[Just Steve]

The program at Medex has a very strong self study component. The presenters vary from day to day, subject to subject. They are typically clinicians in the local community and not professional educators. (at least here at the Yakima campus). They don't necessarily cover material that is relevant to the exam. All four campuses take the same test, at the same time. As a result, they test us off of objectives that are written off of textbooks. They can't expect all presenters at all four campuses to teach the same way we use the presentation as "pearls" of knowledge but study from the book. (we can also ask the presenter specific questions to clarify some of our reading) Yes, this leads to sorta drifting off during lecture occasionally.

 

There are a few students in our class who were caught off guard how "primary care" Medex is focused. They find certain subjects to be rather "non relevant". I'll use behavioral medicine of example. The school counts this as a 1 credit course but we spend WAAAYY more on that topic than just 1 credit's worth. While I haven't had a moment of "why are we doing this", that is not reflective of all the students in the class. Conversely, I have had more moments of "I REALLY wish we would dig deeper into that" as we skip over the top of some rather in-depth material.

 

There is no competition among the students. They school has made it very clear that the program is a collaborative program and that any sort of communication that could be construed as boasting will not be tolerated. They don't post grades at all for public viewing and they rarely mention class averages. The only way another student knows how you do on an exam is if you tell them.

 

All that being said...it's still worth it. Get me to the PANCE...

[Just Steve]

Another week closer. Pharm test tomorrow (GI, antihistamines, analgesics). Two days of the remaining 3.5 are pretty light. Next week will be a clinical rotation for a week doing shadowing in internal medicine for me. Our whole class scatters to the four winds for a week..it'll be a nice break. My site is close to home so I get to see my family every day for 10 days. That's pretty awesome.

 

We come back from that, bang out 7 more class days, roll into finals and SPRING BREAK!!!!!! and the closure of winter term..reportedly the hardest term of didactic year. Spring term will roll through and then summer break. I can almost taste the grilled burgers of summer cookouts. The light at the end of the tunnel is a steady glow..albeit faint still, but dammit I can see it and it's not a train. I realize clinical year will be busy. It'll have its moments of overwhelming my senses and causing doubt in my very ability but I would be disappointed if I wasn't challenged. I just know that I won't be trapped at a bloody desk for 12 hours a day staring at a freaking computer screen or book page. Thank God for that.

 

My 8 year old son had his third ski lesson on Saturday. It was blowing 20 mph, snowing, visibility down to 100 feet some times, temps around 20 F. He had a blast. He and I did a couple of low angle powder runs through the trees and I think I was slowing him down. Those couple of runs were probably some of the best ski runs of my life (been skiing since '98) and one of the best moments of fatherhood to date.

 

Now....back to the books. Probably get up around 4:30 or 5 for a final run through my study materials for the test at 9:30. Lots of folks will say "you don't learn anything at the last minute". They are probably right. However...professional athletes don't step onto the playing field stone cold on the morning of their game. They warm up first...so do I.

 

Sorry there isn't much about school in particular...feel free to fire off questions if you have any.

 

Steve

[Corpsman2PA]

Now....back to the books. Probably get up around 4:30 or 5 for a final run through my study materials for the test at 9:30. Lots of folks will say "you don't learn anything at the last minute". They are probably right. However...professional athletes don't step onto the playing field stone cold on the morning of their game. They warm up first...so do I.

 

So true!!! Couldn't have said it better. Thanks for sharing another day week in the life of a Medex student. Its getting me ready...at least thats what I like to think :)

[Just Steve]

So here we are, day 1 of a week of clinical experience. It's just a week (one, of two during didactic year) where we "shadow" a provider and get a nice little "wake up" to what being in a clinic is really about. To paraphrase the language of the existing contract between the clinic and my school..."student has malpractice insurance through the school, but they are under the preceptor...whatever the preceptor feels comfy letting the student do, have at it.".

 

So by mid morning, I was asking some questions of the patients during the clinic visit. By lunch, I was performing some physical exam steps. After lunch, introductions were made by the preceptor and the visit was handed over to me to handle, beginning to end. When I finished my work up, I presented to the PA, and final decisions for treatment were made.

 

Before today, with my background as a Navy Corpsman and paramedic, I wasn't really expecting to be have my cage rattled at all. I have been seeing patients since 1988..this will be pretty routine..so I thought.

 

1st patient to catch my attention was a pre op physical. A podiatrist planned to nip a few toes off this diabetic but wanted to do it under IV sedation and needed a provider to sign off as the patient being healthy enough. Can any of you give me a written criteria of what is considered as "healthy enough for surgery?" I didn't think so....so this patient was going to go through the rigors of possible intubation (should there be complications of IV sedation) based on my (once I am a full practicing PA) say so. They want the PA to see a patient they have no history with to evaluate a brittle diabetic with hypertension and COPD and say they are "OK" to go under the knife. If for whatever reason the patient has complications from surgery (outside of the operative site), they are going to review the chart to see who green lighted this master plan...the PA. No worries, no pressure :=Z:

 

Second patient that caught my attention was a person past their prime in life looking to renew their Commercial driver's license. Diabetic (but not on insulin), hypertensive (but not too high), COPD (but cleared by pulmonology), PTSD (but cleared by psych). His general affect and overall presentation screams "DON'T LET THIS GUY DRIVE 18 WHEELERS ON THE SAME HIGHWAY THAT YOUR FAMILY DRIVES ON" but he just barely makes the cut off on all the given parameters. You have to tuck away your gut feeling and let this guy renew, despite what your inner voice is telling you because there is nothing concrete to refuse him on. Down the road in a few months when he does goof up and wreck huge, they will review his health records and say "that PA said he was good to go". When they question you in court during the civil trial, you'll have to face the family of the deceased and say "he met all criteria given by DOT" and hope that is enough to help you sleep at night.

 

Third patient to make me go "hhmmm" was a muscular dystrophy patient who has been on steady decline of life, even though he's only 47. 73.5 inches tall, 106 pounds. Yes, the entire patient weighs about as much as my lower half of my body. Cognition, appetite, cardiac function, renal function are all declining. Pt is still ambulatory and can still carry a conversation, but the Grim Reaper has already left a calling card and plans to return in the near future. Pt is in today to refill his pain medication. He refused a feeding tube, refuses IV rehydration for his obvious dehydration, doesn't want any other medical management. Our plan was to refill his pain meds, and offer Hospice. Speaking frankly about death with a 47 year guy who just up to 2 years ago was doing quite well but now is so miserable that he was in agreement that hospice was a good plan. Seeing how I will be turning 40 in a few months, 47 suddenly seemed way to freaking young to be having this conversation. What really struck me though was how natural it came. As much as it rattled my cage, it was the right thing to do in my heart. What a strange dichotomy.

 

4th patient was an 80 year old female in for UTI sx. She has a couple of year, always knows what they feel like, she just wants some antibiotics. Trouble is, she's got 3+ blood in her urine. From my limited understanding, that's cancer until proven otherwise. From my limited education, bladder cancer is one of the deadliest cancers as it's hardly ever found until after it's spread throughout the body. Her brother died of bladder cancer. We referred her to urology to be safe, and highly encouraged her to be sure to make that appointment. She took it in stride like we were telling her there is a sale at Macy's. She left, apparently pleased with her care and rather jovial. Despite our pt education, I am not convinced that she really understood the potential severity of the situation. Hopefully it's just nothing at all.

 

In all my previous experience, there has always been a back up provider. The Navy had docs watching over the corpsman who read every chart. The ER was always the paramedic backstop. I've always had someone downstream to catch my mistakes. I had no real expectation of having my cage rattled in clinic today. Reality snuck up out of nowhere and whispered "boo" in my ear. It didn't freak me out but it sure got my attention, that's for sure. In a weird twisted way, I dig it. Nothing like being challenged in the work place to make you strive to be better every day that you come to work. What will tomorrow bring?

[Just Steve]

Well, it's a bit after midnight, Monday of my week back in the classroom. No real reason to be awake, just can't really sleep. Insomnia is a ***** when you know that the next day will be rough to stay awake in and pay attention to. Oh well...life as a PA student.

 

Clinic last week was fun. Dressing up, looking professional, seeing patients again after almost a year away from it. Except this time instead of wearing BDU style trousers and an issued polyester blue shirt with black steel toed boots it was slacks, dress shoes, and a nice button down shirt. I was informed the tie isn't really common in clinic and best to leave it at home. Although patients were made aware of the fact that I was only a student almost all of them seemed genuinely interested in talking with me. It was quite the shift from my former patients who just saw me as a cab ride to the ER. It felt like clinic staff really went out of their way to support my role as a care provider and not that of a scut monkey. Previously staff RN's and office managers would flex their muscles and impede progress. Now, as an up and coming PA student, they appeared interested in making my visit to their clinic to be encouraging to come back in the future and work there. No one offered a job or anything like that but they definitely made me feel welcome. Such a pleasant change.

 

It was difficult to come back to school after having a taste of the promised land. During my time in clinic we really didn't have that many patients come through that made me take a step back and scratch my head saying "WTF?" but a couple had my attention. One was a 27 year old who has had ulcerative colitis since the age of 9. They have managed their disease with a holistic/naturopathic approach and has been doing well for many years. They have established care with my PA so they were known to the clinic but it was more as an act of health conscious vs acute need. That being said, they were in acute need on this visit as they had been been bleeding rectally for 2.5 weeks and the abdominal pain is becoming unbearable. They had placed an order for their naturopathic meds but the order got delayed a week and now they were seeking a 7 day patch of some sort of care to get them over the proverbial hump. They really did not want steroids and the remaining conventional treatments carry a fairly potent chance of side affects. So we were a bit stumped. The PA and I had a collective knowledge of UC that could fit between this . and this . aka: not much. So armed with an iPad and UpToDate! I sat with the patient and researched. In the end, the patient could see that the list of options were fairly short and she consented to an oral steroid burst x 5 days. I still know nothing about long term treatment of UC, but I do know she was pleased with our efforts and concern to respect her naturopathic approach to living and willingness to explore other options.

 

Behavioral medicine (BM) ... PAY ATTENTION IN CLASS!!! The faculty lied though..they said BM plays a factor in about 80% of your patients. That's BS. BM is a factor in what felt like 98% of our patients. We didn't always address their BM issue during that visit but holy moly, it was there. Had a patient in their late 50's presenting with known hx of HTN who was sent home from her last PCP appointment with instructions to take their BP qd for 2 weeks, then call in results to discuss med changes. She presents in person to the clinic on a day her PCP isn't working. We agreed to work her into the schedule. She is complaining that both her arms and legs are numb..at the same time...while she is talking with her hands and ambulating without difficulty. In the exam room her speech is running about 2 kazillion miles an hour with subject topics ranging from global warming to the affects of fish oil on their memory. I finally get a word in edgewise and simply ask "What would you like us to do for you today?" Their answer was one of the most heartfelt answers I have ever heard "I just want to be told that I am going to be OK today". It was that simple. With a reassuring smile, a 12 lead, quick neuro screen, and a couple of half funny jokes, she left in a good mood with an appointment to come back to see her PCP to discuss anxiety meds. That's really what so many patients want.... just to be told that they are going to be ok. Seems so simple, but yet, can be so complex.

 

The Sandman has finally come to visit so my bed is calling me. In my closing thoughts...if y'all are reading this and gaining something from it, I wouldn't mind a touch of the feedback. I don't know if this is doing any good or just a place to put my thoughts for my own reading years down the road when I dig through the archives. I always encourage questions, no matter how mundane you may think they are. Thanks, and good night.

[SJLamb77]

So I have a big newbie question. Do all programs require living at the school, without your family? I see people saying they're traveling home for the weekend.

[IdahoPA]

So I have a big newbie question. Do all programs require living at the school, without your family? I see people saying they're traveling home for the weekend.

 

Schools don't require any living situation. Some applicants are older with spouses and/or kids. If they choose to attend a program outside of their home city, they might decide that it would be easier to live solo for the 2+ yrs of a PA program, rather than uproot their families who have established jobs and school, esp if they have already purchased a house. My brother is in law school and this arrangement is common with those students, as well.

 

Speaking with other applicants during interviews, I was very surprised when people asked if my husband was going to move with me. Of course! But we don't have a house here and we're both recently out of school so we have no real roots. It just depends on your family situation, obligations, and how you feel about being apart from them.

[Planteater]

Feedback- I do believe this is my favorite thread and I really appreciate that you take time to keep up with it!

[Corpsman2PA]

Feedback- I do believe this is my favorite thread and I really appreciate that you take time to keep up with it!

 

I second that thought. Its nice to have a dose of reality to the insights of PA school and the PA-S mind than just the proverbial "drink from a water-hose and hold on" type advice. The BM reality check is great too, i've been more aware of this in our clinic since you've been talking about it, and its so true.

[crystaltide]

Agreed - this is incredibly appreciated. I particularly enjoy that you point out areas in which your previous experience has been helpful.

[Just Steve]

So I have a big newbie question. Do all programs require living at the school, without your family? I see people saying they're traveling home for the weekend.

 

Our class is about 1/3 living with family, 2/3 without their family/significant other. As L.A. Lewis pointed out, there is no living requirement. They just want you in your seat every day that class is in session.

 

Personally, I feel very fortunate that my wife can wrangle our kids and her job which allows me to concentrate fully on school. This way I get to study hard all week and be homework free for the weekend (for the most part) to maximize my time with my family. Everyone's situation will vary. I will say that several of my "with family" classmates had some serious adjustment discussions with their loved ones. (read: tough times) They have all worked out the issues and are doing well, but it was a difficult stress test.

[eliseis]

Just chiming in with the others to let you know that this thread has been particularily helpful in a number of ways. Keep the posts coming!

[Deadliftyourspirits]

Favorite thread. Keep 'em coming, please.

[bike mike]

.if y'all are reading this and gaining something from it, I wouldn't mind a touch of the feedback.

 

Steve

 

I enjoy reading about your experiences as a PA student. Sheds some light on what PA students face in class and clinic. As someone who hopes to be a PA student sooner rather than later I appreciate it. Thank you for taking the time to post.