Excuse to go look something up

[Yasuo]

Hey guys! I have a random question as a new grad PA 

What if you know what the diagnosis is when seeing a patient, but forgot the appropriate diagnostic workup/treatment? What's a professional way to say "I'll be right back" and quickly go look it up on UpToDate or something without sounding dumb? 

[Febrifuge]

I am constantly looking stuff up, right there in front of the patient. Have been doing so for 11 years of practice. We even have a big flatscreen LCD on the wall that shows my screen to the patient. It doesn’t make you look dumb. Excusing yourself every few minutes like Clark Kent on a college football Saturday looks weird, though. 

I just click the UpToDate link right there in Epic and say, “hey, so what you have is ____, and the last time I dealt with a case of this, it all turned out great. I just want to check real quick and make sure nobody changed a guideline, or did a study that changes the recommendations.” Then I scan for what I need, and say something like, “okay, it’s still Cipro plus Flagyl,” or “aha, see, when I went to school they were still saying you needed to finish 14 days of treatment, but 7 should be plenty,” or depending on the patient I could crack a joke, like “yeah, okay, former head of the American College of Endocrinology, if that’s your *opinion* then I guess we can go with that.” 
 

Mostly though, as a new grad you just need to read. Set aside half an hour after dinner 4 days a week, and read up on what you didn’t know that day. Don’t obsess, and don’t berate yourself, but build up your knowledge base because that builds your confidence. And you need both.

Edited November 17, 2020 by Febrifuge

[bike mike]

Did this today as pulmonologist sent patient back to me for continued SOB/hypoxia. LHC with no CAD, echo with normal EF and no VHD. Pulmonary med hasn't figured out what's causing her issues but no one has worked up coccidiomycosis. Now this is not my area of medicine but knew enough that this should be ruled out as it's prevalent in our area. Quick search to see exactly what should be ordered. Patient was happy that I was thinking of things other than cardiac and I was open that this is not my area of expertise. 

[ANESMCR]

Just say you’re going to go put some orders in and you’ll be right back to discuss them.

[UGoLong]

I look things up in front of the patient as well and have ever since becoming a PA 14 years ago.

When I was young, my doctor used to leave the exam room every now and then. I always assumed it was to see another patient since the office was very busy. One day I had to find a bathroom and saw him in his office, crammed with books, reading something from one of them.

We're fortunate to live in a world where a lot of the world's knowledge is accessible from your phone.  Having an advocate who is willing to make sure he or she is correct before doing something probably looks better than one who thinks they know (and remember) it all.

[ventana]

on line up to date, quick things get looked up live right in the exam room, patient never knows

I am the first to admit I don't know something and that I will look it up.... never once, not even a little bit, had any pushback from patients.   No one expects us to know it all except ourselves 

[greenmood]

Look it up in front of the patient. If you’re scared about it, you can do it under the guise of teaching them, and print them the patient-centered materials from UTD.

[Cideous]

2 hours ago, greenmood said:

Look it up in front of the patient. If you’re scared about it, you can do it under the guise of teaching them, and print them the patient-centered materials from UTD.

LOL no offense but I would NEVER do that.  That's a good way to get a 1 star google review that starts out, "Your never going to guess what this "Assistant" did in front of me!???"

[thinkertdm]

Just say you’re going to get a sandwich.  Or talk to the manager like they do at the car dealership.

in reality, I just alt tab to uptodate while making small talk.  

[LT_Oneal_PAC]

I’ve looked up plenty of things in front of a patient, sometimes I leave if I think it will take a minute. Sometimes I tell them I’m doing a risk calculation or I have to double check as I recall there may be some new research on the topic that just came out. Plenty of reasons for it. 

[CAAdmission]

Tell them you need to see a man about a dog. 

[thinkertdm]

Don’t say these to patients (number four will shock you!)

1.  Uh oh

2. whoops!

3.  Can you return my watch with your FIT test 

4. Your prostate feels good 

5.  CRAP!

6.  I’ve got good news and bad news.  The good news is I saved 5% on my ...

As long as you don’t use any of those, you are ok.

[Cideous]

20 hours ago, thinkertdm said:

Don’t say these to patients (number four will shock you!)

1.  Uh oh

2. whoops!

3.  Can you return my watch with your FIT test 

4. Your prostate feels good 

5.  CRAP!

6.  I’ve got good news and bad news.  The good news is I saved 5% on my ...

As long as you don’t use any of those, you are ok.

I walked into the procedure room one time in Urgent Care to see a bloody arm wrapped in a shirt.  My MA walked in there with me and when I took off the bandage/shirt there was a large FA lac, which looked impressive but was nothing I couldn't fix.  However, as soon as it was exposed my MA gasp and said in a very loud voice, "Oh my gosh, can you fix that!!??"

After I had "the talk" with her, we laughed about it for years.  

Edited November 18, 2020 by Cideous

[greenmood]

On 11/17/2020 at 10:50 AM, Cideous said:

LOL no offense but I would NEVER do that.  That's a good way to get a 1 star google review that starts out, "Your never going to guess what this "Assistant" did in front of me!???"

I’m not afraid of lack of subspecialty knowledge, or ashamed of learning with my patients. 

My job as a Hospitalist isn’t to know the fourth line treatment for XXX which is already so rare we’ve only had three cases in the last year. There’s no way for me to be more of an expert in a weird disease than the person who’s living with it. I don’t recommend hemming and hawing over UTD in front of the patient, but saying “let’s double check the MRI guidelines on this one and I’ll send you with some reading before your outpatient follow up” is an acceptable way of dealing with the OP’s scenario. If you’re good at it, it builds trust with the patient. And you learn something. I’m not aware of any negative google reviews (7 years).

Edited November 20, 2020 by greenmood

[Cideous]

2 minutes ago, greenmood said:

I’m not afraid of lack of subspecialty knowledge, or ashamed of learning with my patients. 

My job as a Hospitalist isn’t to know the fourth line treatment for XXX which is already so rare we’ve only had three cases in the last year. There’s no way for me to be more of an expert in a weird disease than the person who’s living with it. I don’t recommend hemming and hawing over UTD in front of the patient, but saying “let’s double check the MRI guidelines on this one and I’ll send you with some reading before your outpatient follow up” is an acceptable way of dealing with the OP’s scenario. If you’re good at it, it builds trust with the patient. And you learn something. I’m not aware of any negative google review (7 years).

You're a  hospitalist.  I'm coming from the point of a corporate Urgent Care.  180 degree difference here.

[Joelseff]

17 hours ago, greenmood said:

I’m not afraid of lack of subspecialty knowledge, or ashamed of learning with my patients. 

My job as a Hospitalist isn’t to know the fourth line treatment for XXX which is already so rare we’ve only had three cases in the last year. There’s no way for me to be more of an expert in a weird disease than the person who’s living with it. I don’t recommend hemming and hawing over UTD in front of the patient, but saying “let’s double check the MRI guidelines on this one and I’ll send you with some reading before your outpatient follow up” is an acceptable way of dealing with the OP’s scenario. If you’re good at it, it builds trust with the patient. And you learn something. I’m not aware of any negative google reviews (7 years).

I got no shame either in saying "I don't know but let me find out." been practicing only 10 years (mostly Primary care and HIV, did 2 years in GI, moonlit in UC for a year and 6 mos in PM&R) but in that ten years my yelp and Google scores are near 5 stars (some have complained about our billing dept and knocked me down to 4.8 ) press ganeys are high 90s and at my last primary care job at a hospital based IPA setting I was ranked 5 out of 66 ambulatory care providers (Docs and APPs... only APP in the top 20) so if it's detrimental to say "I don't know" or "let me check on that" it hasn't affected me or how my Patients perceive my care... Yet  

Edited November 21, 2020 by Joelseff