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I work in cardiology with 11 cardiologists. When I came on board not all of them were so sure about PAs. I've been able to prove my abilities to the group and physicians who previously wouldn't send their patients to a PA now regularly send them my way. I shudder when I see some of our consults sent by some of the local PAs which just reenforces their beliefs that most PAs don't know what they are doing. Today we received a consult for a patient with complaints of dizziness. It appears they didn't pay any attention to the TSH of 64 and the Hgb of 8.2. Good Lord. 

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I work in cardiology with 11 cardiologists. When I came on board not all of them were so sure about PAs. I've been able to prove my abilities to the group and physicians who previously wouldn't send their patients to a PA now regularly send them my way. I shudder when I see some of our consults sent by some of the local PAs which just reenforces their beliefs that most PAs don't know what they are doing. Today we received a consult for a patient with complaints of dizziness. It appears they didn't pay any attention to the TSH of 64 and the Hgb of 8.2. Good Lord. 


I think “most PAs” is an unfair characterization.

(From a fellow cardiology PA)


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Do we need a way--not tied to any formal body--where we can report other PAs who do stuff like that?  I mean, a friendly, "Hi, I'm not anyone official, just a fellow PA, but this made PAs look bad.  What were you thinking and how can I help you?"

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Do we need a way--not tied to any formal body--where we can report other PAs who do stuff like that?  I mean, a friendly, "Hi, I'm not anyone official, just a fellow PA, but this made PAs look bad.  What were you thinking and how can I help you?"

 

Could just pick up the phone?

 

 

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Just to play devil’s advocate, did the a&p detail why they thought a cardio consult was necessary?  Were they concerned about heart failure?  Of course, making you guess is just as bad...

A little lesson that has saved my bacon many times is to put my assessment in the assessment section...this is probably the only part of the job that I like any more, getting to tie it all together with my plan.  All too often, I see a selection from a quick pick thing without any indication to me why the plan was chosen.

Also, I read all my consults I get back- I learn more that way.  If the pa is a newbie or unsure, turn the consult note into a learning experience...of course, they may not read it.

ive has a pa actually call me, and he was confrontational and an ass, and I hung up on himinvolved my sp, big issue.

probably the best way to deal with this is to call him up, and say “great job on so and so...I’m just wondering if you noticed Cyrus or z?”  In general, constructive criticism is hard to give.

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I would just pick up the phone and say "By the way did you see this?"  I have done that in multiple specialties and it usually ends up with a pause on the phone.  It doesn't matter to me if they think I am an arse.  There have been times when I have called them and they put the blame on someone else and it was probable.  I would want to know if I missed something but probably an issue of just trying to move on to the next patient and refer out.  

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2 minutes ago, NeoTrion said:

I would just pick up the phone and say "By the way did you see this?"  I have done that in multiple specialties and it usually ends up with a pause on the phone.  It doesn't matter to me if they think I am an arse.  There have been times when I have called them and they put the blame on someone else and it was probable.  I would want to know if I missed something but probably an issue of just trying to move on to the next patient and refer out.  

Sure, asking if they saw something is one thing.  I love getting those- "please consider endo instead of consulting cardio about their thyroid".  Coming at them about their general approach- "hey, you are making all of us look bad, wtf are you doing?" is another.

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Is there any way to communicate with the PA directly? I'm relatively new, and in a new specialty... I'm sure I've already made some ridiculous errors. If it were me, I'd appreciate a more senior PA giving me a heads up "behind the scenes" kinda. In some hospital systems you can send a staff message.  

I don't want us to be perceived as incompetent providers... but I also don't want us to have a reputation where we throw each other under the bus in a "eat the young" mentality that the nursing field has. 

Edited by GMM2019
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We have missed something somewhere if a PA comes out training NOT knowing how to write a decent Assessment and Plan that includes a differential diagnosis and some sort of explanation for chosen next steps.

In the age of click and crap EMRs - the Assessment and Plan might be the only place allowed to express a decent thought.

I still try to teach charting as "painting a picture" for another provider to understand the story to date.

Calling the PA would be my first thought - I am an educator and preceptor - I can try to approach in a collegial manner without being condescending. My fear would be getting a response of pound sand or mind your own business - that would be saddening for the profession and make me want to rip heads off.

We need to police ourselves - we need to give each other feedback - you can learn from every person you work with.

 

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5 hours ago, Reality Check 2 said:

We have missed something somewhere if a PA comes out training NOT knowing how to write a decent Assessment and Plan that includes a differential diagnosis and some sort of explanation for chosen next steps.

In the age of click and crap EMRs - the Assessment and Plan might be the only place allowed to express a decent thought.

I still try to teach charting as "painting a picture" for another provider to understand the story to date.

Calling the PA would be my first thought - I am an educator and preceptor - I can try to approach in a collegial manner without being condescending. My fear would be getting a response of pound sand or mind your own business - that would be saddening for the profession and make me want to rip heads off.

We need to police ourselves - we need to give each other feedback - you can learn from every person you work with.

 

I also think that the minimum passing score on the PANCE and PANRE are too damn low.   Every time I got my results back and looked at how low the passing score was, I shuddered and felt NCCPA needed to raise their standards.  I think some of the PA programs out there need to as well.  There's no reason for any program to have less than a 90% PANCE first-time pass rate for their students.  

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4 hours ago, dfw6er said:

I also think that the minimum passing score on the PANCE and PANRE are too damn low.   Every time I got my results back and looked at how low the passing score was, I shuddered and felt NCCPA needed to raise their standards.  I think some of the PA programs out there need to as well.  There's no reason for any program to have less than a 90% PANCE first-time pass rate for their students.  

agree. I think passing on pance is usually something like 54% and panre is around 64% or so. what's wrong with 70% at least?

The year I took pance I think passing was something like 350 out of 800...

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