What’s In A Spoonful?
Robert M. Blumm, MA, PA-C Emeritus, DFAAPA
Being a grandfather or grandmother is one of life’s most rewarding experiences. While reliving the early stages of life with our grandchildren we can enjoy their movies and get a second chance at some which we may have missed. I was recently watching Mary Poppins with my grandkids and found it delightful and uplifting. For days, I was rehashing that famous song in my head, “just a spoonful of sugar helps the medicine go down.” As a clinician, I paused with some concern as I had to ask myself: What, actually, is a spoonful?
It is in the purview of physicians, NPs and PAs in pediatrics, family practice, internal medicine, urgent care, emergency medicine, retail health care and geriatrics to examine their patients who present with symptoms of a cold, allergy symptoms or a cough, resulting with a note recommending some form of OTC medicine. We commonly use the phrase “one or two teaspoons” and either document (or fail) to document this dosage. Either way, the potential for creating an iatrogenic poisoning or a drug reaction is quite high. It is always important to know what medications your patient may be taking - a critical practice which should accompany every patient encounter, whether new or not. Most PAs and NPs enter healthcare with the idea of working for 30-40 years but prudent attention to malpractice prevention can never start too early. Thorough, thoughtful practice can illuminate cross-sensitivity to prescribed OTC drugs. We need to look at OTCs as carefully as we would any prescribed medication, and it is equally important to know the age and weight of your patient, as a spoonful may be too little or too much. If the patient is a pediatric patient, the parent may be confused by the description of a spoonful and give a tablespoon, a teaspoon or a pediatric feeding spoonful. Children who are taking a drug, particularly an OTC drug, have a much greater possibility of a reaction.
For many of our senior citizens on polypharmacy, there are many potential drug-drug-interactions that will increase or decrease the effectiveness of their other medications making way for hypertension, severe hypotension or rhythm changes related to their cardiac drugs. For a moment, consider the patient on Coumadin. This drug has restrictions on other medications, as well as foods and alcohol which can greatly affect the INR and create a life- threatening bleed in the brain or in the GI system. I was scolded by my cardiologist a few years ago for taking a class lll antiarhythmic with herbal drugs or vitamins and minerals. He made me wait an additional hour in his office, then had me step into his private room and asked me, “What is it that you don’t understand about taking NO additional supplements or herbs?” As a healthcare professional, he was shocked at my actions. These substances can interact with my prescribed drug regimen to the degree that I could have developed Torsade’s De Pontes. He asked me if my need to take supplements - including fish oil, glucosamine and chondroitin - surpassed my need to live. His direct approach about my nonchalant attitude regarding supplements certainly got my attention!
Being careless can lead to a poor outcome for the patient, as well as a possible lawsuit. What can the collective “we” do to prevent a patient incident that is negative or life threatening? Check for other medications, review current drugs, look at age and weight and be cautious to write an OTC medication unless aware of all of the possible reactions. Is there anything else to glean from this? Another related concern is failure to document the other medications and to cross reference all contraindications, which are frequent causes for litigation involving PAs as well as NPs and particularly in the setting of the Retail Healthcare Clinic or Urgent Care Center. The same focus should apply to Telemedicine since it has become particularly popular during the pandemic. These concerns should encourage clinicians to consider how to best protect themselves, their professional futures and their families from litigation due to negligence.
Accuracy is the name of the game and is the mandate for all healthcare professionals but owning proper professional liability is the safest solution for potential error. It is not a coincidence that you are reading this today, but a heartfelt concern of a colleague who wishes all PAs and NPs a long and successful career. You do not want to create a life-threatening situation or worse. Our ultimate goal is to retire with professional pride and satisfaction – with NO history of careless nonchalance or, pardon the expression, “sloppiness”. Perhaps this “spoonful” of advice might help…
Good afternoon everyone. My name is Daniel. I am an EKG Technician. I've been in college earning credits towards a Registered Nursing program which I'm planning on attending this August. This program has a lot to offer especially in the fact that it is taking place at a teaching hospital. My true ambition, however, is becoming a Physician's Assistant. I have been very conflicted regarding this decision because I've read in certain articles that there are some PA programs out there which prefer applicants have an RN lisence. While others say they do not require it. Apart from that aspect, I understand that as an RN I'll be learning valuable bedside clinical experience. But yet I think to myself, why wouldn't I spend my time doing online courses necessary to enrolling into a PA program until I earn a Bachelor's Degree in Applied Science? While working part time getting my clinical hours as an EKG Technician or a Medical Assistant which I am also certified in. I would like to know some of your expeirences as new PA students. How many of you were nursing students before you made the decision to transition into a PA program as a career? Would you recommend a prospective student become a nurse before even considering becoming a PA? Or would it be better to comfortably go to school while working part time? I am thinking about this logically.
I am a second semester PA student who was accepted with a low GPA directly out of undergrad. I am holding Zoom Advising sessions where I can help you figure out how you can improve your application and answer any questions you may have about the application process including personal statement review. The cost of each session is $10. Please send me a PM if you are interested! Thank you, and Good luck!
I am a high school senior with two questions about NYIT's BSPA program.
1. Does anyone know the amount of pre-undergrad students that are accepted into the program each year? The FAQ page isn't very clear on whether it's talking about the last three years or who's initially accepted into the school under that program.
2. Is it possible to be accepted without an interview? I was accepted into the program, but there was no invitation for an interview or anything.
Congratulations to everyone who got accepted by the way! 😄
I am done with didactic and is about start rotation soon. I think should feel excited to be done "the hard part" yet I'm filled with doubts and anxiety about moving forward. I originally came into this profession with the idea that I want to help patients understand diseases and empower them with knowledge to help themselves. Looking back now, I somehow feel like I've been passively heading toward this direction all my life because when people asked me what I wanted to do, I just said I want to do something medical related. Be it after school programs in high school or medical related jobs after college. There were times before PA school where I had doubts that this may not be right for me but then quickly brushed it off. When I do bring this up with family and others, I always get asked "what else do you want to do if not this" and I never had an answer because I wasn't actively looking at alternatives. Then I would get told that just do this if you don't know. I felt like I set this expectation for myself to set out to be a medical provider when I was way younger and now im feeling kinda stuck with having to follow through. Else i'd be a disappointment. I'd be lying if I didn't feel any familial pressure to stay the course.
Then I got into PA school and it gave me a sort of adrenaline rush like "yeah! i got in, i can do it!". I thought it was gonna be simple and all I had to do was keep my head down and get through it. Yet throughout didactic there was always this tiny inner voice whispering to me "this feels wrong". I chalked it up to just being stressed out by the heavy workload and imposter syndrome and buried it. Sometimes when I do talk about it with my family I just get told to keep going because I've invested so much into this so at the very least just stick out the first year and see how it goes. Now that i've clawed my way through didactic, I feel completely burnt out. I took a month long break without doing anything PA school related. I spoke with friends who graduated already who tell me that clinicals would be completely different, similar to the countless other posts i read online.
Looking ahead to clinicals I just don't even care much less feel excited and I know that won't help me make it through. Thinking back to when I decided to enroll in the first place vs now make me feel like I'm in a totally different person. I feel like the spark of interest for medicine that could have ignited a flame of passion just kinda fizzled out as time went on for me. I don't get interested in medical topics anymore. I don't feel motivated anymore and have trouble feeling empathy for anyone. I sure this is part of the burn out but can't shake the feeling that it's more than just that. I lay awake at night contemplating whether I've had enough and seen enough to say "I've gave it an honest attempt and now it's time to move on" or if actually being in clinicals will make a difference. When imagine winding up to grind through a 2nd year for clinicals, i get a sinking feeling in my stomach. When I imagine not being a PA, i think, "im ok with that". If I quit now, it would feel like be a huge financial and time wasted on this path and a lot of resistance from those around me. If I continue, it could possibly be an even bigger wager of time, money, and effort on a "maybe" I'll change my mind during clinicals. I think about this on a daily basis now. Anyone who have experience care to give some advice?