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Hi all,

 

I'm a PA student in the first year of my program and I'm having some concerns about my performance as it pertains to careless mistakes. I'm not having trouble grasping the material and I am doing very well on tests (I'm in the top 1/4th of my class grade wise, not that that is a predictor of how I'm going to be as a clinician). Anyway, I find myself making too many careless mistakes and being forgetful on certain assignments. I've been very hard on myself for as long as I can remember so maybe I am exaggerating all of this in my head, but my fear is that I am going to continue to be forgetful once I am out practicing and accidentally cause harm to my patients. Has anyone struggled with this sort of thing? I think part of it is that I always feel rushed even when I am not. 

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There is a difference between healthy doubt (eg you forgot to prescribe a statin or write down adenopathy or order chest x Ray) and being to hard on yourself, vs truly being careless (poor wound closure, not going to your preceptor for help when a patient is in trouble). Maybe you should start by talking with your counselor at your PA school.

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I wouldn't sweat it. I felt the same way. It's kind of overwhelming when you think about the number of things you can royally screw up in practice. But, you get used to the responsibilities slowly, and there are usually safeguards in place for many of these things. After some time working your doubt should be mostly healthy. Always do a mental checklist when you start seeing patients. You'll have to come up with your own, but go though the things that should not be missed for a given encounter. Forgetting to refill someone's carvedilol---not a huge deal. Forgetting to CT a traumatic head or neck injury, or prod a little more about that errant complaint of chest pain, SOB, or abdominal pain---bad.

 

I've had patients come in to our office with BROKEN NECKS that were missed by some urgent care clown who didn't image them. We all make mistakes but always be thinking what could potentially (and most likely) kill or paralyze someone.

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I wouldn't sweat it. I felt the same way. It's kind of overwhelming when you think about the number of things you can royally screw up in practice. But, you get used to the responsibilities slowly, and there are usually safeguards in place for many of these things. After some time working your doubt should be mostly healthy. Always do a mental checklist when you start seeing patients. You'll have to come up with your own, but go though the things that should not be missed for a given encounter. Forgetting to refill someone's carvedilol---not a huge deal. Forgetting to CT a traumatic head or neck injury, or prod a little more about that errant complaint of chest pain, SOB, or abdominal pain---bad.

 

I've had patients come in to our office with BROKEN NECKS that were missed by some urgent care clown who didn't image them. We all make mistakes but always be thinking what could potentially (and most likely) kill or paralyze someone.

Obviously missing a fractured cervical spine is unacceptable, however I think that radiographic studies are extremely over-ordered.  It is an expense to the patient, to the system, and long term detriment to a patient.  I see thousands of emergency department follow-ups where I read the mechanism of injury, and see the extreme amount of studies ordered (x-rays, CT Scans, Etc) that really in my opinion had no business being ordered.

 

I would argue that someone without "major trauma", and a normal neurological evaluation does not require any imaging.  It seems to me like nowadays anyone in a fender bender gets CT-Scans.  

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