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 in a very unique situation, and would love everyone's input!
I have been wanting to be a doctor my whole life, but after meeting my stepmother 10 years ago (who has been a Physician Assistant for over 20 years) I have grown to have a great admiration for the profession and countless hours of shadowing has given me a deeper understanding of the PA role. When I applied last cycle to PA schools I did not get a single interview invite. I began to internalize the idea that perhaps the Physician Assistant profession was not in the books for me. I decided to apply again this cycle and retake a couple classes to help my science GPA. One of my professors this summer recommended I apply to Podiatry School which will allow me to become a doctor/surgeon with 2 years of didactic, 2 years of rotations and 3 years of residency. I was very desperate to be in medicine and felt like this was my golden ticket, I applied (literally on the last week of the cycle being open for Podiatry) and to my surprise I was accepted! I started podiatry school a few weeks after being notified this August 2020. I had applied again to PA school but given that I did not get a single interview invite, I felt that my odds were low and didn't want to miss out on what might be my only opportunity to be in healthcare. Then to an even bigger surprise I got accepted Into PA School just last month. My dilemma is that, if one year ago I had gotten into PA school that is where I would be, but I am now in medical school and have been struggling internally ever since I received notice of my acceptance into PA school.
Now this is me being very very honest. Due to life circumstances, I am almost 30 and just now starting medical school. Although this has been a dream of mine, I can't help but feel that in 7 years when I am done with my residency, I will have career fulfillment but at the expense of personal sacrifice. I am currently engaged and we would like to have kids in the future, but with the way school is going I can't image doing either of those while I'm still in school (although I know it is possible). PA has always been high on my list because of the flexibility it provides. I witnessed my stepmother have the opportunity to easily adjust her work schedule as my brothers were growing up so that she could prioritize her personal life and even switch specialists based on her new interest and schedule desires.
I guess I am hoping to get feedback on weather or not I should quite medical school to start PA school next Fall. I know that this is a decision that I alone can make, so I'm hoping that someone can give me the pros and cons to being a Doctor over a PA and a PA over a Doctor.
Thanks in advance! 🙂