Acebecker Posted July 14, 2012 Share Posted July 14, 2012 To say that I'm seething with anger would be an understatement. Had a senior physician at my practice tell me just now, "This is a tough clinical decision. Better if I make this call. You handle the easy ones, I'll handle the tough ones." This was with regard to a multi-drug resistant bacteria in an elderly woman's urine... A complicated UTI. The fact that he thinks I'm incapable of handling a complicated UTI makes me see red. I know that approaching him is theoretically the best method, however he's been approached multiple times about this kind of crap and nothing has changed. So, I'm just writing to vent. Just need to vent. Ridiculous. Link to comment Share on other sites More sharing options...
jdenning Posted July 15, 2012 Share Posted July 15, 2012 This may not help much because there's absolutely no reason why, as a PA, you shouldn't be equipped to handle a complicated UTI....but I like to think of it this way and that is that when this patient has a complicated or lengthy recovery with multiple complications and multiple phone calls from her care facility and her family that you have absolutely no responsibility or liability. It makes it easier for me when I think of things this way because in my practice I have more than enough patients to worry about. Link to comment Share on other sites More sharing options...
JCrownover Posted July 15, 2012 Share Posted July 15, 2012 I understand, Ace. Totally lame. Link to comment Share on other sites More sharing options...
Just Steve Posted July 15, 2012 Share Posted July 15, 2012 be a shame if a potato got stuck in his tail pipe... weird things happen out there in Idaho...so I've heard Link to comment Share on other sites More sharing options...
physasst Posted July 15, 2012 Share Posted July 15, 2012 Understand completely Ace......a daily frustration of mine....one of my dissatisfactions with being a PA....a BIG one. In fact, our ED has this ridiculous policy that all admitted patients need to be staffed with a physician. I've fought for 4 years and recently got the rules changed to allow us to see ESI level 3 patients independently. Previously, we were restricted to ESI level 4 or 5 patients. We have about a 35% admission rate because of the patient complexity at our hospital. For example, the national mix of level 4 or 5 patients is about 33-40% depending on facility..... Our facility only sees about 8% level 4 or 5 patients. We just don't see many of them. So we have a higher than average admission rate. I recently discussed this with our Chair, and I said that while I appreciated all of their support, this was really a limiting rule....When she said she understood, I said, well think about it this way. You are precepting an intern and they see a patient with chest pain. They come up to you and say blah, blah, blah, 56 year old, chest pain, blah, blah, blah....I want to admit them to cards......My response..."sure, sounds great" NOW, you have the same intern, same patient scenario, but the intern says, "I'm going to send him home"......NOW, at least for me, my antenna goes up, and I want to know more.....A LOT MORE...... Truthfully, I worry a helluva lot more about patients I dismiss than patients I admit. The ones who are admitted are going to be cared for and watched..... So, it's a ridiculous rule, but it is what it is for now.... Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 15, 2012 Moderator Share Posted July 15, 2012 happens a lot with me - I used to care - now I just figure it is the way the world works at my current job - I do take joy in "teaching moments" with the old time doc's though..... makes me smile when I am telling them the newest stuff Honestly I am just let them do it - they are the top of the food chain and if they want to manage it so be it - but I don't volunteer them to manage my complex one's.... only if they find out (or I ahve a question - which is rare) bummer need to be physician associates and be freed from the underling role after 10 years of practice and passing USMLE 3 Link to comment Share on other sites More sharing options...
Guest Paula Posted July 16, 2012 Share Posted July 16, 2012 There are times when I wish my SP would take the hard ones. He, instead has told the receptionist to put some patients in my schedule when he thinks he is too busy. So, I get the patient, they say, "I'm here to re-establish care with Dr. X. I haven't seen him for a long time. I come here weekly for my PT-INR. You guys always renew my meds for me. So...I am falling all the time, my house was broken into and trashed and everything taken except the clothes on my back, including my insulin. I moved back to the shack I still have here in town. My son is sick and can't help me much and I'm 82. My legs are swollen and I just got out of the hospital for the reason that other Dr. did something to my bowels in surgery. I bled all over and got transferred to the BIG hospital. They said I had heart failure. I have colon cancer, too, and a pace maker. I'm out now and feel weak. What are you going to do for me?" I ran screaming out of the room......not really...but I felt like it, as I saw my SP load his clubs into his truck. Next day, "hey Dr. X, I saw your patient yesterday. You know, Mrs. So and So. She is re-establishing care with you and I just renewed the meds that had been stolen from her and her son. I recommended she consider assisted living facility and this is what's going on with her..etc. She will be in for a full physical with you. Dr. X says, "oh, dang, I don't want her back in my practice." Link to comment Share on other sites More sharing options...
Guest Paula Posted July 16, 2012 Share Posted July 16, 2012 P.S. Yup, we need to be physician associates and out from under. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 16, 2012 Moderator Share Posted July 16, 2012 P.S. Yup, we need to be physician associates and out from under. it's a work in progress.... Link to comment Share on other sites More sharing options...
Hemegroup Posted July 16, 2012 Share Posted July 16, 2012 There are times when I wish my SP would take the hard ones. He, instead has told the receptionist to put some patients in my schedule when he thinks he is too busy. So, I get the patient, they say, "I'm here to re-establish care with Dr. X. I haven't seen him for a long time. I come here weekly for my PT-INR. You guys always renew my meds for me. So...I am falling all the time, my house was broken into and trashed and everything taken except the clothes on my back, including my insulin. I moved back to the shack I still have here in town. My son is sick and can't help me much and I'm 82. My legs are swollen and I just got out of the hospital for the reason that other Dr. did something to my bowels in surgery. I bled all over and got transferred to the BIG hospital. They said I had heart failure. I have colon cancer, too, and a pace maker. I'm out now and feel weak. What are you going to do for me?" I ran screaming out of the room......not really...but I felt like it, as I saw my SP load his clubs into his truck. Next day, "hey Dr. X, I saw your patient yesterday. You know, Mrs. So and So. She is re-establishing care with you and I just renewed the meds that had been stolen from her and her son. I recommended she consider assisted living facility and this is what's going on with her..etc. She will be in for a full physical with you. Dr. X says, "oh, dang, I don't want her back in my practice." I'm so going through the same thing. I'm working solo at a FM/IM/UC practice with a longtime patient base where these peeps have come to this Doc for years and years ... some very complicated cases, with a list of 16 ailments, many cardiac or other ... challenging but so rewarding. I'm thankful the patients appreciate it when I run out to get my Currents so that we can learn together ;) The Doc left 2 hours after I started a month ago and hasn't been back since lol, other than to drop off the paychecks. But that works well for me and it's a tremendous opportunity ... better that than the other extreme ('what are you doing, are you sure you can handle anything more than pharyngitis, how do you know about erythropoietin' lol) ... there was a great blurb in the last CAPA newsletter about Docs who don't know about PAs, they suggest precepting and state how that helps a lot of Docs learn about our training ... Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 16, 2012 Moderator Share Posted July 16, 2012 don't ever forget 1)that doc's don' t know it all either 2) a great H&P is always essential when there are question (and usually will answer the questions for you) 3) you can't know everything on the first visit 4) triage of active problems and close follow up gives you time to research issues don't ever just throw up your hands and give up - take on the complex, learn, assess, plan - maybe get some input from your attending if you are realy struggling, but fear of the unknown is true for "hard" medicine and the doc's have the same fear.... Link to comment Share on other sites More sharing options...
Hemegroup Posted July 16, 2012 Share Posted July 16, 2012 I would ask him, "so are you going to prescribe such and such and do this or that? because I would etc etc" Put him on the spot to show you what he would be doing differently. If at the end of that, your treatment would be different in some way then great, it's a learning experience. If not and he still continues with his treatment of you, then you know it's just the way he is and there will be nothing you can do about it other than trying to find a different physician to work with. Link to comment Share on other sites More sharing options...
chatcat Posted July 16, 2012 Share Posted July 16, 2012 Had a senior physician at my practice tell me just now, "This is a tough clinical decision. Better if I make this call. You handle the easy ones, I'll handle the tough ones." I think we have all worked with these condescending types at some point in our careers...they are infuriating to deal simply and add lots of shock value to the day due to their lack of good interpersonal skills with staff. I had an especially nasty dinosaur I had to interact with in the past. Once I knew what I was dealing with I : 1. Lowered my expectation regarding having any sort of satisfying interactions with the Doc.....he rarely exceeded this expectation and I could proceed without emotional duress. 2. Always made sure I was extra astute about current treatment plans when discussing cases with him....and if his ego simply had to take over I tried to drop mine and be open to learning for future reference. It remained a dysfunctional relationship however he never had any reason to question my competency of care. Optimally, I have usually enjoyed my SP relationships but if they are problematic I just focus on patient care and choose to not engage in their "issues". Link to comment Share on other sites More sharing options...
Guest Paula Posted July 16, 2012 Share Posted July 16, 2012 I'm so going through the same thing. I'm working solo at a FM/IM/UC practice with a longtime patient base where these peeps have come to this Doc for years and years ... some very complicated cases, with a list of 16 ailments, many cardiac or other ... challenging but so rewarding. I'm thankful the patients appreciate it when I run out to get my Currents so that we can learn together ;) The Doc left 2 hours after I started a month ago and hasn't been back since lol, other than to drop off the paychecks. But that works well for me and it's a tremendous opportunity ... better that than the other extreme ('what are you doing, are you sure you can handle anything more than pharyngitis, how do you know about erythropoietin' lol) ... there was a great blurb in the last CAPA newsletter about Docs who don't know about PAs, they suggest precepting and state how that helps a lot of Docs learn about our training ... That patient came back today. Again,she was scheduled with the Dr., but put back into my schedule. I saw her, found out in more detail that she does not have running water, no furnace, no usable bathroom, no land line phone, a Trac phone without minutes, and a son with a broken cell phone. It is not a healthy living situation and she really wants to (and needs to be) in a nursing home. That was our discussion after i did a pretty thorough assessment for Activities of Daily Living, etc. and talked to her son, who looks like he needs to move to a nursing home,too. I reviewed this patient with the Dr. BEFORE I even went to see her and asked him if I should just refer her back to whoever she was seeing before she turned back up at our clinic. He says, " I really don't want her back, but, darn, we can't abandon our patients, and I'm a softie, so see what you can do". Lightbulb went on in my brain, realized that he cannot say NO to anyone, and I'm the heavy. So, it all ended ok, and I think I handled it all right. Hopefully, the patient will be in a home before the snow flies. Link to comment Share on other sites More sharing options...
physasst Posted July 17, 2012 Share Posted July 17, 2012 I think we have all worked with these condescending types at some point in our careers...they are infuriating to deal simply and add lots of shock value to the day due to their lack of good interpersonal skills with staff. I had an especially nasty dinosaur I had to interact with in the past. Once I knew what I was dealing with I : 1. Lowered my expectation regarding having any sort of satisfying interactions with the Doc.....he rarely exceeded this expectation and I could proceed without emotional duress. 2. Always made sure I was extra astute about current treatment plans when discussing cases with him....and if his ego simply had to take over I tried to drop mine and be open to learning for future reference. It remained a dysfunctional relationship however he never had any reason to question my competency of care. Optimally, I have usually enjoyed my SP relationships but if they are problematic I just focus on patient care and choose to not engage in their "issues". See, and I go the other direction... I have one annoying physician that I work with....that when I work with him....I simply don't tell him about any of my patients and I don't interact with him. I've told him in the past that I don't need his particular kind of help. He also gets annoyed by being called by his first name instead of "Dr.", and so I deliberately call him by his first name any time I see him. I just see my people and don't staff anyone on those rare days..... I think he schedules around me now as I haven't worked with him in months except seeing him in meetings. F him.....he's an a*s, and I simply cannot and will not put up with it. I've learned to just ignore him for the most part... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 17, 2012 Moderator Share Posted July 17, 2012 I do the same thing. I will call someone across town for a phone consult RATHER THAN TALK TO THEM IN THE NEXT ROOM. Link to comment Share on other sites More sharing options...
rxtechhk Posted July 19, 2012 Share Posted July 19, 2012 I think we will encounter these sort of situations throughout our careers unless we become physicians..its just such a a difficult move to make once you have settled down, purchased a home , and have a comfortable life outside of work..if there were only an easier way at obtaining autonomy/respect.... Link to comment Share on other sites More sharing options...
rxtechhk Posted July 19, 2012 Share Posted July 19, 2012 The question remains would we gain more respect with PhD Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 19, 2012 Moderator Share Posted July 19, 2012 The question remains would we gain more respect with PhD I really hope so....:) Emedpa, Doctoral student Link to comment Share on other sites More sharing options...
primadonna22274 Posted July 19, 2012 Share Posted July 19, 2012 Sadly, I doubt an advanced degree would make a difference. I am having the weirdest twilight zone rotation experience now...inpatient IM rotation (DO student) where it seems to be the attending's MO to drum The Hierarchy into everyone. Cruelly so. Damn good thing I'm no shrinking violet, but seriously, there are a lot of unhappy and frustrated students. I don't find it conducive to learning and it is so completely different from any experience I had in PA school or in 12+ yr of seeing patients. For some docs, I think they just think this is "normal" medical education and that likely follows them into medical practice. I wonder if my very different experience is/was due to regional, even cultural differences...I had CT surgery preceptors who were downright gentle next to these guys. ....?????? Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted July 19, 2012 Moderator Share Posted July 19, 2012 Sadly, I doubt an advanced degree would make a difference. I am having the weirdest twilight zone rotation experience now...inpatient IM rotation (DO student) where it seems to be the attending's MO to drum The Hierarchy into everyone. Cruelly so. Damn good thing I'm no shrinking violet, but seriously, there are a lot of unhappy and frustrated students. I don't find it conducive to learning and it is so completely different from any experience I had in PA school or in 12+ yr of seeing patients. For some docs, I think they just think this is "normal" medical education and that likely follows them into medical practice.I wonder if my very different experience is/was due to regional, even cultural differences...I had CT surgery preceptors who were downright gentle next to these guys. ....?????? Totally agree on it not making any difference as far as how one is viewed, if you're looking at a doctoral degree in and of itself. However, like everything in the professional world, depending on what you achieve with your degree, then you build your respect. And quite honestly, I'd rather have it that way, instead of instant respect just because I added a doctoral degree to my credits. I think, prima, in regards to your situation, it's more dependent on the individual attending than the physician world as a whole. My rotations during my ER residency varied in regards to what hierarchy was instituted, which I also did not experience during PA school, but no one made it a point to drill it home to myself/physician residents/medical students who were also rotating on the service. And if there was anywhere I would've expected the hierarchy to be completely rigid it would be in a purely resident setting where they don't ever see PA's. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted July 20, 2012 Share Posted July 20, 2012 See, and I go the other direction... I have one annoying physician that I work with....that when I work with him....I simply don't tell him about any of my patients and I don't interact with him. I've told him in the past that I don't need his particular kind of help. He also gets annoyed by being called by his first name instead of "Dr.", and so I deliberately call him by his first name any time I see him. I just see my people and don't staff anyone on those rare days..... I think he schedules around me now as I haven't worked with him in months except seeing him in meetings. F him.....he's an a*s, and I simply cannot and will not put up with it. I've learned to just ignore him for the most part... Panda Bear is in your group? Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted July 20, 2012 Moderator Share Posted July 20, 2012 Panda Bear is in your group? Heh....is his blog still up? Link to comment Share on other sites More sharing options...
CAdamsPAC Posted July 20, 2012 Share Posted July 20, 2012 Heh....is his blog still up? I don't know about his blog's status. I'm just happy that he hasn't polluted this site with his egocentric tripe for a good while!!I'm just restating, that this would be the conduct I would expect from him or his eviler twin brother!;-) Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 20, 2012 Moderator Share Posted July 20, 2012 if he pulled the stuff here he pulls at sdn I would ban him in a heartbeat. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.