GatorRRT Posted March 25, 2012 Share Posted March 25, 2012 ....how is it that every thread on here turns into a HCE discussion?:;;D: Link to comment Share on other sites More sharing options...
GatorRRT Posted March 25, 2012 Share Posted March 25, 2012 ....how is it that every thread on here turns into a HCE discussion?:;;D: Link to comment Share on other sites More sharing options...
Joelseff Posted March 25, 2012 Share Posted March 25, 2012 ....how is it that every thread on here turns into a HCE discussion?:;;D: And I didn't even start it this time lol.... Sent from my HTC MT4GS using Tapatalk Link to comment Share on other sites More sharing options...
Joelseff Posted March 25, 2012 Share Posted March 25, 2012 ....how is it that every thread on here turns into a HCE discussion?:;;D: And I didn't even start it this time lol.... Sent from my HTC MT4GS using Tapatalk Link to comment Share on other sites More sharing options...
whimsygirl Posted March 25, 2012 Share Posted March 25, 2012 That's not what I mean. If I'm working in a critical care/pulmonary setting as a PA, the vent is my responsibility if I'm caring for the patient. RT's can't legally make vent changes unless they're operating within a specific protocol. If I'm in a patients room and the vent needs adjusting, why would I call the RT when I'm already in the room? I'm not saying I wouldnt let the RT know I made a change, or if I have a question in regards to how the patient is doing I won't consult the RT. I guess my point is, changing vent settings would/should be within a PAs scope of practice if they are in a pulmonary/critical care setting. It would get you written up at my hospital. You could write the order, but you can't make the change. Its a checks and balances system. Link to comment Share on other sites More sharing options...
whimsygirl Posted March 25, 2012 Share Posted March 25, 2012 That's not what I mean. If I'm working in a critical care/pulmonary setting as a PA, the vent is my responsibility if I'm caring for the patient. RT's can't legally make vent changes unless they're operating within a specific protocol. If I'm in a patients room and the vent needs adjusting, why would I call the RT when I'm already in the room? I'm not saying I wouldnt let the RT know I made a change, or if I have a question in regards to how the patient is doing I won't consult the RT. I guess my point is, changing vent settings would/should be within a PAs scope of practice if they are in a pulmonary/critical care setting. It would get you written up at my hospital. You could write the order, but you can't make the change. Its a checks and balances system. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 25, 2012 Moderator Share Posted March 25, 2012 most critical care pa's/docs I know make vent changes themselves and note their changes in the chart. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 25, 2012 Moderator Share Posted March 25, 2012 most critical care pa's/docs I know make vent changes themselves and note their changes in the chart. Link to comment Share on other sites More sharing options...
acozadd Posted March 25, 2012 Share Posted March 25, 2012 NO you won't. trust me. because that kid will be puking on their shoes at the smell of the pus they know how to quantify while you will be doing the procedure to alleviate the condition....I.D. really isn't all that difficult. you learn what is normal and what isn't and who gets the abnl infections...and you carry a pocket copy of sanfords.... Strong assumptions... I would argue it would take much longer to learn ID than to learn how to do and I&D, which any monkey could do. Having done an ID rotation, it is actually quite complicated and the patients they work with are often the sickest of the sick. Treating a patient with antibiotics empirically in the ED isn't really ID. Link to comment Share on other sites More sharing options...
acozadd Posted March 25, 2012 Share Posted March 25, 2012 NO you won't. trust me. because that kid will be puking on their shoes at the smell of the pus they know how to quantify while you will be doing the procedure to alleviate the condition....I.D. really isn't all that difficult. you learn what is normal and what isn't and who gets the abnl infections...and you carry a pocket copy of sanfords.... Strong assumptions... I would argue it would take much longer to learn ID than to learn how to do and I&D, which any monkey could do. Having done an ID rotation, it is actually quite complicated and the patients they work with are often the sickest of the sick. Treating a patient with antibiotics empirically in the ED isn't really ID. Link to comment Share on other sites More sharing options...
GatorRRT Posted March 25, 2012 Share Posted March 25, 2012 It would get you written up at my hospital. You could write the order, but you can't make the change. Its a checks and balances system. ...and I'll be sure to cross off that from possible places of employment once I graduate Link to comment Share on other sites More sharing options...
GatorRRT Posted March 25, 2012 Share Posted March 25, 2012 It would get you written up at my hospital. You could write the order, but you can't make the change. Its a checks and balances system. ...and I'll be sure to cross off that from possible places of employment once I graduate Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 25, 2012 Moderator Share Posted March 25, 2012 Strong assumptions... I would argue it would take much longer to learn ID than to learn how to do and I&D, which any monkey could do. Having done an ID rotation, it is actually quite complicated and the patients they work with are often the sickest of the sick. Treating a patient with antibiotics empirically in the ED isn't really ID. waiting 3 days for the results of cultures isn't really practical either. you learn what types of infections are most common in which clinical scenarios and cover with the antibiotic(s) most likley to cover the pathogens in question. ID gets involved during business hours the next day after we have done all the heavy lifting for them. sure, they might tweak the regimen a bit but most just continue what we have already started. it's not the I+D that's tough, it's learning how to deal with the smell of the perirectal abscess that climbs into your nose and stays there for the whole shift and the pt howling in pain and calling you a bastard while you are injecting the anesthetic. I have literally had students faint while doing this procedure. bet you can guess what kind of students they were.... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 25, 2012 Moderator Share Posted March 25, 2012 Strong assumptions... I would argue it would take much longer to learn ID than to learn how to do and I&D, which any monkey could do. Having done an ID rotation, it is actually quite complicated and the patients they work with are often the sickest of the sick. Treating a patient with antibiotics empirically in the ED isn't really ID. waiting 3 days for the results of cultures isn't really practical either. you learn what types of infections are most common in which clinical scenarios and cover with the antibiotic(s) most likley to cover the pathogens in question. ID gets involved during business hours the next day after we have done all the heavy lifting for them. sure, they might tweak the regimen a bit but most just continue what we have already started. it's not the I+D that's tough, it's learning how to deal with the smell of the perirectal abscess that climbs into your nose and stays there for the whole shift and the pt howling in pain and calling you a bastard while you are injecting the anesthetic. I have literally had students faint while doing this procedure. bet you can guess what kind of students they were.... Link to comment Share on other sites More sharing options...
acozadd Posted March 25, 2012 Share Posted March 25, 2012 Agree 100%. My experience placing central and arterial lines, swans, working vents, intubating, preop patients, runnings codes, doing pain management, spinal taps, all that jazz will be helpful to me, but I know infectious disease (for example) will be a hurdle for me and I'm going to wish I was that new grad kid with a 4.0 in microbiology. While I have done many procedures on my rotations, almost none of what you listed will benefit me in my career in Ortho. I dont see myself placing swans, art lines, intubating, working vents, spinal taps, MAYBE running a code but that would be a very rare occurance. In your post a few lines down you say that placing IVs, etc. are essential in getting to the next level but again I have never been asked to do this thus far and will not be asked to in my future career. So why is it that all of these things that people deem essential aren't going to help me one bit? It seems like there is a great disconnect between what some deem essential, and what actually is essential in practice, which weakens the prior HCE imo. (With that said Im all for prior HCE and feel it should be a pre-req for PA programs.. just not to the level that some of the old school members on this forum tout.) Link to comment Share on other sites More sharing options...
acozadd Posted March 25, 2012 Share Posted March 25, 2012 Agree 100%. My experience placing central and arterial lines, swans, working vents, intubating, preop patients, runnings codes, doing pain management, spinal taps, all that jazz will be helpful to me, but I know infectious disease (for example) will be a hurdle for me and I'm going to wish I was that new grad kid with a 4.0 in microbiology. While I have done many procedures on my rotations, almost none of what you listed will benefit me in my career in Ortho. I dont see myself placing swans, art lines, intubating, working vents, spinal taps, MAYBE running a code but that would be a very rare occurance. In your post a few lines down you say that placing IVs, etc. are essential in getting to the next level but again I have never been asked to do this thus far and will not be asked to in my future career. So why is it that all of these things that people deem essential aren't going to help me one bit? It seems like there is a great disconnect between what some deem essential, and what actually is essential in practice, which weakens the prior HCE imo. (With that said Im all for prior HCE and feel it should be a pre-req for PA programs.. just not to the level that some of the old school members on this forum tout.) Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 25, 2012 Moderator Share Posted March 25, 2012 don't you think if you had been an ortho tech for 10 yrs first assisting in the o.r. and in clinic you would have a step up at your current job? are you really learning nothing from the non-physician folks you work with? they know things you don't know yet. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 25, 2012 Moderator Share Posted March 25, 2012 don't you think if you had been an ortho tech for 10 yrs first assisting in the o.r. and in clinic you would have a step up at your current job? are you really learning nothing from the non-physician folks you work with? they know things you don't know yet. Link to comment Share on other sites More sharing options...
acozadd Posted March 25, 2012 Share Posted March 25, 2012 waiting 3 days for the results of cultures isn't really practical either. you learn what types of infections are most common in which clinical scenarios and cover with the antibiotic(s) most likley to cover the pathogens in question. ID gets invoilved during business hours the next day after we have done all the heavy lifting for them. sure, they might tweak the regimen a bit but most just continue what we have already started.it's not the I+D that's tough, it's learning how to deal with the smell of the perirectal abscess that climbs into your nose and stays there for the whole shift and the pt howling in pain and calling you a bastard while you are injecting the anesthetic. I have literally had students faint while doing this procedure. bet you can guess what kind of students they were.... I forgot that every RT, RN, medic, etc. had already performed this procedure and were used to the stench in their careers prior to PA school... Maybe it was just the hospital I was at, but many of the ID cases were patients with allergies to every antibiotic known to man tha are now growing pan-resistant bugs, or bizarre infections that took a lot of detective work to figure out their origin-- not just "continue current therapy for 2 weeks and follow up in the office" type stuff. Maybe my perception is a bit skewed. Link to comment Share on other sites More sharing options...
acozadd Posted March 25, 2012 Share Posted March 25, 2012 waiting 3 days for the results of cultures isn't really practical either. you learn what types of infections are most common in which clinical scenarios and cover with the antibiotic(s) most likley to cover the pathogens in question. ID gets invoilved during business hours the next day after we have done all the heavy lifting for them. sure, they might tweak the regimen a bit but most just continue what we have already started.it's not the I+D that's tough, it's learning how to deal with the smell of the perirectal abscess that climbs into your nose and stays there for the whole shift and the pt howling in pain and calling you a bastard while you are injecting the anesthetic. I have literally had students faint while doing this procedure. bet you can guess what kind of students they were.... I forgot that every RT, RN, medic, etc. had already performed this procedure and were used to the stench in their careers prior to PA school... Maybe it was just the hospital I was at, but many of the ID cases were patients with allergies to every antibiotic known to man tha are now growing pan-resistant bugs, or bizarre infections that took a lot of detective work to figure out their origin-- not just "continue current therapy for 2 weeks and follow up in the office" type stuff. Maybe my perception is a bit skewed. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 25, 2012 Moderator Share Posted March 25, 2012 most folks with any kind of prior experience have dealt with bad smells and pts in pain/difficult patients before. that pretty much translates to any field you might later work in. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 25, 2012 Moderator Share Posted March 25, 2012 most folks with any kind of prior experience have dealt with bad smells and pts in pain/difficult patients before. that pretty much translates to any field you might later work in. Link to comment Share on other sites More sharing options...
acozadd Posted March 25, 2012 Share Posted March 25, 2012 don't you think if you had been an ortho tech for 10 yrs first assisting in the o.r. and in clinic you would have a step up at your current job?are you really learning nothing from the non-physician folks you work with? they know things you don't know yet. Yes, If I had been an ortho tech it would have helped. However if I went into gyn it wouldn't. Hence why the assumption that prior healthcare experience translates into a better provider in ALL specialties is ridiculous. Certain experience lends itself nicely to certain specialties, but that is the exception moreso than the rule. To bring back the original purpose of this thread, PERHAPS someone that worked as an ortho tech for 10 years would need less supervision in ortho, but they would need equal supervision in just about every other specialty. Medicine is highly specialized today... Link to comment Share on other sites More sharing options...
acozadd Posted March 25, 2012 Share Posted March 25, 2012 don't you think if you had been an ortho tech for 10 yrs first assisting in the o.r. and in clinic you would have a step up at your current job?are you really learning nothing from the non-physician folks you work with? they know things you don't know yet. Yes, If I had been an ortho tech it would have helped. However if I went into gyn it wouldn't. Hence why the assumption that prior healthcare experience translates into a better provider in ALL specialties is ridiculous. Certain experience lends itself nicely to certain specialties, but that is the exception moreso than the rule. To bring back the original purpose of this thread, PERHAPS someone that worked as an ortho tech for 10 years would need less supervision in ortho, but they would need equal supervision in just about every other specialty. Medicine is highly specialized today... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 25, 2012 Moderator Share Posted March 25, 2012 how likely is an ortho tech to go into gyn? people do what they know.... know who mostly goes into gyn? medical assts, doulas, and nurses who previously worked in gyn. after all these years I still find it hard to believe that you don't accept that some basic skills in medicine translate to any field. those basic skills are important and lacking in many without prior experience.and to the original intent of the thread, I think any new grad needs a reasonable level of supervision until folks are comfortable with what they know. some folks may get "let off the leash" sooner than others based on a combination of factors.... Link to comment Share on other sites More sharing options...
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